IoS letters, emails & online postings (8 February 2009)

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DrugScope supports calls for an expansion in residential rehabilitation provision, but it should not be seen as a "silver bullet" for overcoming drug dependence ("UK drug rehabilitation service is 'collapsing'", 1 February).

There are many routes into addiction and many routes out of it. Not all drug users are ready for the mental and physical challenges of rehabilitation and the significant benefits of substitute prescribing should be recognised. Methadone prescribing improves lives and for many is a step on the way towards ultimately becoming drug free.

Factors that can contribute to drug dependency also need to be addressed: people need support to access housing, social services, and training and employment opportunities. Without this, the chances of sustained recovery are slim.

Martin Barnes

Chief Executive, DrugScope

London EC1

It simply won't do to describe the effectiveness of residential rehabilitation units on the basis of either the numbers of people who are drug free at follow-up, or the personal accounts of successful residents. This evidence has to be balanced by an acknowledgement of the risk of relapse and death following detoxification, and by personal accounts from those for whom it didn't work or for whom it could never be an option.

We should still regard the number of people who have been treated with long-term prescriptions for methadone or buprenorphine as a success, while acknowledging that the next stage in improving treatment is to widen the options available.

The UK has one of the most humane and holistic treatment systems in the world; not perfect, but not collapsing. Special pleading for any one sector, which becomes divisive and critical of other sectors, is not useful.

Louise Sell

Consultant Addictions Psychiatrist

Greater Manchester West NHS

It is a scandal that the number of places in rehabilitation clinics is being reduced. We need an expansion in these facilities. Many people who are incarcerated in prisons and psychiatric hospitals are addicted to drugs or alcohol. Most would surely be better suited to rehabilitation clinics. The money spent on keeping these people in prison or hospital would be better spent on supporting people in rehabilitation centres.

Robert Heale

Brighton, East Sussex

It seems the transformation of New Labour into Old Tory is complete, now that Lord Mandelson has urged British workers to get on their bikes and look for work in Europe ("You can go and work in Europe, Mandelson tells strikers", 1 February). Sadly, many British workers and their families are not blessed with the flexible mortgage arrangements, government job creation schemes and gold-plated EU bikes so extravagantly showered upon Lord Mandelson over the years.

Chris Webster

Abergavenny, Gwent

Sir John Thomson talks about Iran acquiring a nuclear weapons capability without referring to the Middle East's sole nuclear power or the UN General Assembly's call for a nuclear-free Middle East ("Time is short, but a deal can be done", 1 February).

Barack Obama needs to act on the basis of two key geopolitical facts. Israel possesses, for the foreseeable future, overwhelming conventional military superiority in the region, and Iran understandably objects to being treated as a special case with regards to nuclear non-proliferation. It follows that it is in the United States's national interest, as well as that of the West, to pressure Israel into giving up its nuclear weapons. Iran's co-operation on nuclear non-proliferation can then be taken for granted, provided Washington also formally commits itself to a policy of no first use of its nuclear weapons in the Middle East. The opportunity is there, but it requires change in Washington.

Yugo Kovach

Twickenham, Middlesex

I share the widely expressed dismay at the Bank of England's clumsy attempts to tell female staff what clothes and make-up they should wear. ("Bank tells staff: Don't forget the lipstick, girls", 1 February). But it really shouldn't be so surprising when even the "quality" press publishes long and judgemental articles about women's wardrobes (politicians' wives and film stars seeming particularly popular). If Michelle Obama had turned up for her husband's inauguration in jeans, trainers and no make-up, the howls of disapproval from media fashion commentators would have made the Bank of England's efforts look very mild indeed.

Kate Francis

London NW8

Corrections and clarifications

In a story last week on rehabilitation units, we stated that Dr David Best was from the Department of Psychiatry at the University of Birmingham. He is now Reader in Criminal Justice at the University of the West of Scotland. Apologies.

On 25 January, Janet Street-Porter wrote that in 19 per cent of claims made to the Child Support Agency, DNA tests showed that a man other than the named father was the true father of the child ("Fatherhood is for life...", 25 January). The Child Maintenance and Enforcement Commission points out that DNA testing is only done in 1 per cent of cases, and that, therefore, the true figure is 0.2 per cent of claims.

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