Today Public Health England published national drug treatment statistics for adults in 2012-13. They show that treatment continues to perform well overall and that, within the context of declining prevalence, the numbers in treatment are falling. Access remains quick and easy for anyone who needs help with a drug problem.
However, after an increasing trend over recent years in the proportion of people successfully completing drug treatment, we are now seeing that proportion begin to level off. Treatment is now dominated by older heroin users; this group, with entrenched addiction and multiple problems, is particularly hard to treat and this makes further progress on recovery rates more difficult.
So what do we know about how best to support people into lasting recovery? Where are we in terms of achieving our recovery ambition for people in drug treatment? And, in the context of the statistics released today, what can local authorities do to continue the momentum and support recovery in their areas?
Drug dependence is a complex issue. A range of factors is involved, including the individual, the drug, patterns of use and social determinants. Severe dependence is often complex and long term, and often characterised by cycles of relapse. The majority of those in treatment in England are heroin and crack cocaine users; many have been using for a long time and as they get older are experiencing chronic health problems. Recovery for these people can be incredibly hard, however many have made remarkable recovery journeys and now lead full and accomplished lives. It is also significant and positive that recovery is becoming much more visible in our society, demonstrated in part by recent well attended recovery walks.
A great deal was achieved over the last 10 years by drug treatment in England in reducing harms for individuals and communities. Perhaps because of the size of the task and the considerable benefits achieved in these domains, it took some time for a focus on achieving social integration as the goal of drug treatment to emerge. But emerge it did, with the rise of the recovery movement in the field from around 2005 and culminating in the Government’s 2010 Drug Strategy.
Like drug dependence, recovery is a complex concept. While what constitutes recovery may be a subjective judgement, clearly it needs to be an individual and an individually-owned journey. We need to acknowledge, respect and support the full spectrum of beliefs and methods that people may choose to adopt to achieve recovery.
The challenge in essence has been to increase the focus on the ‘psychosocial’, and particularly the ‘social’, components of the bio-psycho-social approach to dependency. Involving families and broader social networks of support, including mutual aid groups such as the twelve-step fellowships and SMART Recovery, has been and remains a priority. There is much practitioners can do in terms of facilitating access to these groups, and much local authorities can do to foster communities of recovery, through an asset-based approach. Many areas of the country are beginning to achieve success with this.
Pharmacotherapy also has a strong evidence base and an important role in recovery. The work of the expert group chaired by Professor John Strang, culminating in its 2012 report ‘Medications in Recovery’, made an internationally recognised contribution to realising the appropriate balance between the different components of treatment.
Looking ahead, while protecting the health and community safety achievements to date, we need to focus on social integration and wellbeing. It is encouraging that many drug treatment services are using the five ways to wellbeing and incorporating them into thinking about care planning. The stigma associated with dependency is also an important issue, and PHE must have a clear voice in combating it.
Recovery, as with wellbeing, is mediated by someone’s access to social or ‘recovery’ capital. Alongside treatment, access to stable housing and developing the wherewithal to be work-ready are vital components. This is where the transfer to local authorities of responsibility for drug treatment presents the greatest opportunity in my view. They have a genuine opportunity to link services to provide properly integrated responses to drug dependency and we will be supporting them to realise this ambition.
Drug recovery is one of PHE’s top priorities. To support our efforts and thinking in this area we have appointed the addictions expert Professor Tom McLellan to provide us with clinical and academic advice, from an independent international perspective, on how we can most effectively lead in this area.
Evidence tells that not everyone will recover, particularly those who experience the greatest health and social inequality. As we see the numbers successfully completing treatment level off, are we actually beginning to reach pinnacle of what can be achieved? At PHE we believe there is still further to go if we hold onto our ambition and if everyone is given the best possible chance of recovery.
We have a robust evidence base for the fact that the way in which pharmacotherapy, psychosocial interventions and integration pathways are delivered has a significant impact on outcomes. Until everything local areas do to drive recovery is aligned with that evidence, there is still some more road to travel.