UK drug rehabilitation service is 'collapsing'

Private clinics struggle to get funding as government policy favours less effective – but cheaper – methadone clinics. Nina Lakhani reports
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Britain's rehab services are facing collapse. No fewer than 15 of the UK's 100 rehab centres have closed in the past 15 months, despite an increase in the number of people seeking help for addictions.

Because of changes in government health policy, private rehab centres are finding fewer and fewer health authorities are willing to foot the bill for addicts to have residential treatment, despite that fact that it is much more effective in getting them off drugs, according to the Addiction Recovery Foundation.

The Independent on Sunday learnt this weekend that a flagship rehab centre – £26m Winthrop Hall in Kent – is preparing to shut after only one year of operation.

According to the latest Department of Health figures, 202,660 drug users were seen by addiction services in England in 2007-08.

The National Treatment Agency (NTA) has spent millions of pounds getting thousands more drug users into contact with addiction services since it was set up in 2001. Yet last year only 3 per cent of cases were referred to a residential rehab service, while two-thirds were prescribed heroin-substitute medication by GPs and NHS doctors working in addiction services.

Critics claim there are few long-term benefits of this medication-centred approach. The majority of rehab services use a version of the 12-step programme, and abstinence – becoming drug free – is the goal after four to six weeks of intense therapy. Clinics are run by large companies such as The Priory or small charitable organisations such as the Providence Projects in Bournemouth.

Up to now, rehab has been paid for by the drug abusers themselves or their local health service. But, increasingly, government policy supports putting as many addicts as possible into methadone-substitute programmes because they are cheaper.

As a result, rehab clinics such as Winthrop Hall have become reliant on private clients. The hotel-style addiction clinic was opened in October 2007 by Jon Moulton, a venture capitalist and millionaire, to provide specialist treatment in luxury surroundings for high-flying City executives. But yesterday, staff confirmed that the £32,000-a-year clinic is no longer accepting new patients.

Advocates of rehab say that the closure encapsulates the problem with government thinking on rehab. They point to research by the University of Glasgow, which found drug users who go through residential rehab are seven times more likely to be drug-free after three years than those who go to methadone clinics.

The Health Care Commission last week identified the low use of residential rehab services as a weakness.

Dr David Best, from the Department of Psychiatry at the University of Birmingham, said: "Commissioners have spent bigger and bigger slices of the pie on harm reduction services at the expense of rehab, despite the evidence that rehab works. Users now have to jump through so many hoops to get there, it has become much harder, and rehab centres have closed as a result. It's not because we don't need these services but the system has become saturated in methadone clinics, which are a much cheaper and easier way to 'treat' people."

Professor Neil McKeganey, director of the Centre for Drug Misuse in Glasgow, said: "When we stop patting ourselves on the back and look back on this period, we will see that this was a shameful dereliction of our responsibility and we failed the majority of drug users by keeping them locked into addiction. Drug services fail addicts, contrary to official figures which report overwhelming success. Our research shows that those lucky enough to get residential rehab are seven times more likely to be drug free after three years. This is an inconvenient finding for politicians and civil servants who have preferred to support cheaper services that deal with large numbers of people."

Anecdotal evidence suggests addicts who want to come off drugs are often met with reluctance from drug workers. In some areas, primary care trusts will only pay for rehab if the individual's health or public safety is deemed to be in imminent danger because of their chaotic drug use. And there are growing reports of desperate addicts committing crimes as they try to convince the authorities to pay for rehab.

The not-for-profit Providence Projects in Bournemouth was forced to open its doors to private clients in 2005 after a drop in NHS referrals pushed it close to ruin. Paul Spanjar, the treatment director, said: "We get calls on a regular basis from friends and relatives who are desperate because the user's primary care trust will not pay for rehab. Don't get me wrong, there are great NHS trusts, but in some areas it is impossible for an addict to get funding."

The NTA points to research that shows substitute prescribing reduces dangerous injecting and crime rates among addicts. It also claims that overcoming dependence is the ultimate goal of all treatment it supports. Paul Hayes, the NTA's chief executive, disputes the number of rehab closures and believes the proportion referred to rehab is closer to 8 per cent.

Road to rehab: 'You must learn why you're an addict'

Andy Hayden, 40, a former addict, lives and works with ex-offenders in in Weymouth, Dorset. He has been clean for five years.

"I started on alcohol, glue and gas when I was 12, but within a few years I'd progressed on to anything I could get my hands on. At my worst, my girlfriend and I spent £600 a day on crack and heroin. Eventually I ended up living on the streets, picking food up off the floor, and was in and out of hospital with abscesses and cellulitis.

"About six years ago I suddenly realised that if I didn't do something I was going to die. I went to the local methadone clinic and was immediately prescribed 50ml 'maintenance' a day. This was enough, but I told them I needed more so they doubled my dose. I still had no idea what was wrong with me; we never talked about that. So I kept stealing to buy drugs because while methadone stops you feeling ill, it doesn't give you a high. When the clinic threw me out for using extras, my addiction was even worse. Methadone is a horrible drug to come off, much harder than heroin.

"In 2003 I heard about a project that sent prolific offenders into rehab. I was so desperate by this point that I made up loads of offences, just so that I'd get in. I was eventually referred to the Providence Projects in Bournemouth and have never looked back since. I know rehab is more expensive, but you have to learn why you're an addict before you can stop."

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