Questions About Alcohol and Drug Treatment in Bristol
Meeting 1 on 25 April 2009
by Paul Hazelden

Background

Graham Donald, the chair of the board of Crisis Centre Ministries, wrote to Stephen Williams on 25 March 2009 about some of the problems people with addiction problems in Bristol have in accessing treatment.

A meeting was arranged for 25 April 2009. Present were Stephen Williams, MP, Graham Donald (CCM Chair), Paul Hazelden (CCM General Manager) and Alan Goddard (CCM Drop-in Centre Manager).

More details of the background to this meeting and related documents can be found at:

• Questions About Alcohol and Drug Treatment in Bristol.

Some Basic Observations and Questions

  Alcohol Addiction

There is a serious lack of funding of residential treatment for alcoholics from Bristol.

There is no funding for a wet house in Bristol. Yet we fund the Police to deal with the problems caused by the people who continue to drink, and who drink in the street because there is nowhere else for them to go.

Has anyone looked at the cost of coping with the problem of street drinking, and compared it with the cost of providing a wet centre?

Alcohol addiction and street drinking cost Bristol a significant amount of money, in many different ways: policing the street drinking ban is just one of them. If alcoholics could have direct access to rehabs in Bristol, this would get more people off the streets, and reduce the number of people causing a nuisance and needing medical attention. Can we quantify this additional cost of limited access to treatment for alcoholics?

  Drug Addiction

There is a serious problem with Bristol's strategy for providing residential treatment for drug addiction.

Bristol has a policy of sending local people in addiction only to local residential treatment. It doesn't work because once the treatment finishes, the addict is back in contact with the family, friends and associates who were involved in developing and sustaining the addiction.

It is almost impossible to stay clean if the people you associate with (your friends and family) are using, and even more difficult if (as is often the case) they are encouraging you to use.

This raises the obvious question: why does Bristol have this policy? Our assumption is that it is driven by two basic concerns:

• the need to save money; and
• the need to support local business - the local drug treatment providers.

In a subsequent meeting, Safer Bristol confirmed the first point: they have a bulk purchase agreement with some local residential drug treatment providers, which enables them to place addicts in treatment at a lower cost, and therefore they achieve more results for their money.

We questioned the wisdom of this strategy: it clearly achieves more results, but does it achieve better results? You can get more people through treatment this way, but if more of them lapse after treatment, surely the end result is worse?

Safer Bristol made two points in their response to this challenge.

Firstly, successful treatment is defined as the addict completing the treatment program. What happens afterwards is not relevant, and does not affect the way their performance is measured. Their job is to maximise treatment success, as defined by the Government, and this is exactly what they are doing.

Secondly, we have no evidence to support our belief that more people lapse following local residential drug treatment. Our own observations do not count as evidence. It is mere 'anecdotal' evidence. There have been no formal studies on this subject, so we cannot possibly know if our claims are true.

In response to this second point: our own observations are very clear about the different relapse rates for local and non-local residential drug treatment, and are confirmed by the observations of support workers from numerous other agencies. In addition, we feel that the point is fairly obvious, and common sense strongly supports it. And we have also been told that the European Union have actually undertaken comparative studies of local and non-local residential drug treament. We are in the process of trying to track these studies down.

However, it is clear that Safer Bristol are right on one point: our assumption that their policy must contravene the best practice guidelines was wrong. There are, incredibly, no best practice guidelines in the UK on this matter.

We should make two other points. One is fairly obvious, the other a little less so.

The obvious point is that we are talking about relapse rates - statistics - here. The policy must make sense for the majority of the people affected by it. But the policy does not have to treat everyone the same. A few drug addicts have helpful and supportive families who are capable of and prepared to help their family member get clean and stay clean. And, sometimes, that family support is more important than the need to get the addict away from their drug-using friends and dealers. Allowing people to access non-local residential drug treatment is not the same as forcing people to go to non-local treatment even when local treatment would work better for them.

It is also the case that drug users are sometimes willing to go to local residential treatment, and not willing to go to non-local residential treatment. This seems less clear to us. We suspect that, unless there is very strong personal local support, and a clear strategy for avoiding the dealers and drug-using friends, the majority of people in this position are willing to go through the treatment because they know they will be able to start using again immediately afterwards. Of course, from the point of view of the official statistics, this does not matter: they complete the course of treatment, and count as yet another success of the current policy.

While there are no formal best practice guidelines, other local authorities seem to be relying on common sense rather more than Bristol is in this matter. Many of the people who have places in our local residential drug treatment centres are funded by local authorities outside Bristol.

Which brings us on to the second major consequence of this policy: as well as producing more relapses after treatment is complete, it also results in the number of local addicts increasing at a greater rate than in the rest of the country.

While residential drug treatment has a higher success rate when it is non-local, there are inevitably some relapses among the people who come for treatment in the Bristol area.

So Bristol based drug addicts go for treatment to Bristol, and many of them relapse. Drug addicts from outside Bristol come for treatment to Bristol, and some of them relapse. Both groups swell the numbers of drug addicts in Bristol.

So as well as reducing the chances of a successful outcome, Bristol's policy also has the effect of increasing the concentration of addicts in Bristol in comparison to the rest of the country.

We wonder if any study has been undertaken of the associated costs of this inevitable consequence of their policy.

  Some Related Observations

Housing Benefit

The policy of not paying Housing Benefit directly to landlords results in many people getting into arrears with their rent, and frequently the end result is that they lose the accommodation and become homeless again.

When people are stable enough to manage their finances well, it is entirely right to give them control over their money, and take responsibility for paying all their bills. But to give that responsibility to people who have no history of managing their finances, who still have chaotic lives despite beinghoused, and who have a high chance of lapsing back into a number of addictions, that is just asking for problems.

Pathways

Pathways is the new centralised system for accessing Supporting People accommodation. It is much slower than the previous system, so people are not helped as quickly, they often develop worse problems as a consequence, they continue in this period to access other sources of help which the taxpayer is paying for, and the houses have more empty places. The new system does not benefit anyone.

Facts and Figures

It would be helpful to know some basic facts and figures. The table below identifies a useful starting point for talking about comparative costs for alcohol and drug treatment.

We have been told on numerous occasions that this information is 'readily available' and 'in the public domain'. But, to date (as of January 2010), we have not been given the figures.

It would also be helpful to know what Safer Bristol does, how it reaches decisions about the various aspects of its work, what the structures are, and who works for it. Who is responsible for what areas and which decisions?

Finally, in passing... we have been told that Safer Bristol was responsible for getting 152 people treated in the 2008-2009 financial year. Over the two financial years 2007-2008 and 2008-2009 CCM has managed to get something over 300 people off the streets, at no cost to the taxpayer.