We need to talk about…The purpose of drug treatment

Who exactly is drug treatment designed to benefit, asks Nick Goldstein.

Police officerThe genesis of this article was Priti Vacant’s (Patel’s) recent bung of £148m to cut drug crime and introduce project ADDER (DDN, February, page 4). ADDER is yet another treatment service acronym standing for ‘addiction, diversion, disruption, enforcement and recovery’, although if history is anything to go by shouldn’t it really translate to just another dumb drug exercise? It doesn’t really matter what it stands for, because the odds are it will end up in the government policy wastebasket with all the other failed new agendas.

ADDER doesn’t inspire confidence. Little of the money is ‘new money’ and on a close reading it can only really be described as grossly depressing. In fact its only saving grace is we’ve heard it all before, which makes the depression seem like an old acquaintance – like meeting a cop who’s arrested in you in the past.

Although the actual document is meaningless pap there were several interesting comments from the rogue’s gallery of ministers who were rounded up for its release. Our esteemed minister for health and social care, Matt Hancock, got the ball rolling with ‘addiction and crime are inextricably linked’ and followed up by pointing out that Priti’s bung was ‘the largest increase in drug treatment funding in 15 years’. While being true, it said more about the savage cuts of the last 15 years than anything else.

The esteemed minister was rapidly followed by Priti herself, who reminded everyone that she was determined to cut crime. She was especially keen to announce her personal war with county lines gangs, who are rapidly becoming the folk demon du jour. Priti suggested she was ‘restoring confidence in the criminal justice system’ so that people could live their lives knowing their family, community and country is safe – from drug users. Thankfully she remembered not to say the last part out loud!

Next up at the podium was the headlining act, the grand fromage himself, the prime minister. Boris, as ever, blustered on about making the streets safe and tackling criminal gangs by ‘cutting the heads off snakes’ amongst many other favourite platitudes from drug policy and/or treatment speeches over the years. Boris finished up with ‘I am determined to fight crime’. The whole event, the policy release and speeches engendered nothing more than mild depression, just like the last policy release, the one before that and all the others – just more of the same thoughtlessness that has been failing for years. It’s just more criminal justice solutions with some ill-defined recovery thrown in to make the policy palatable. I swear, if politicians were banned from mentioning crime in a discussion on drug use they’d be forced into silence.

Depressing though all of this may be, it is of value because it perfectly illustrates a fundamental flaw in drug treatment and policy that really does need commenting on, because it’s the root cause in much misunderstanding. It’s this – drug treatment is not for drug users, rather it is an attempt to protect society from drug users. I appreciate some readers might be wincing or exhibiting anger at this point, but hear me out.

Let’s look back over the last few decades to the ’80s when I first stumbled into treatment with a grade A heroin habit and a whole host of illusions just waiting to be shattered. The treatment system back in the ’80s featured injecting or rather the desire to stop injecting – the reason for this was nothing to do with healthcare for drug users and everything to do with stopping drug users spreading HIV to polite society.

In the ’90s the arrival of New Labour – tough on crime, tough on the causes of crime – moved the aim of treatment onwards, and now maintenance prescribing became vogue. Scripts and script sizes multiplied and grew to ensure drug users were nodding at home rather than out robbing your car. Again, the change in policy was more to do with cutting crime statistics than improving the lives of drug users. As an aside, if you described a society in which dissidents were made to take a heavy psychoactive drug, like methadone, you’d presume the country was some Eastern European cold war dive, not England. Yet it happened here.

Then came the coalition government and their recovery agenda which – call me cynical – I believe was mainly about reducing the cost of treatment by producing economically productive members of society out of drug users, no matter how hard it was to force drug users into sobriety, and productivity, as the graveyards attest.

Project ADDER and the above pronouncements suggest current changes will be a case of it being, in the words of the late, great Yogi Berra, ‘deja vu all over again’. It’s yet more policy from politicians who don’t really care about something they don’t understand or really care to understand, and its aim is most definitely not about helping drug users. It’s not really surprising drug use and users are always an afterthought for politicians – there aren’t enough of us (about 300,000 in treatment) when compared against other vulnerable groups.

As well as being short of numbers, drug treatment also falls victim to being short of time too. Policy runs on a four-year electoral cycle and many changes to drug treatment won’t bear fruit quickly enough – if you’re the minister for health or the home secretary what’s the point of enacting policy, often at great expense, if it doesn’t show positive results before the next election?

Nick Goldstein is a service user
Nick Goldstein is a service user

Whatever the reasons, it’s clear that drug treatment is primarily about protecting wider society. If ADDER is good for anything it’s as an illustration of policy aims which are yet more of the long-failed criminal justice-based policies. ADDER might be new, but it’s philosophy and aims are old as the hills.

Any considerations of the needs of drug users are secondary – an afterthought. Here’s a parlour game to prove the point. Get a pen and piece of paper and design a basic treatment system that promotes drug users’ health and wellbeing. I bet it looks fuck all like the system we have. A system that hopelessly fails drug users on any reasonable terms, and ironically doesn’t do much for wider society either. It might be time for an honest conversation about the true purpose of drug treatment, for everyone’s sake.


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