Hi Rowdy,
You collelctively have enabled a very interesting discussion. It always
amazes me that the HM / abstinence debate has roared unabated for so long.
Surely the two are a single approach integrated into a continuum. It is not
either /or - Darren Britt's comments were so true.
There seems to be this PC fashionable view of harm min as being trendy,
young and what the users want and the reverse is true - there is a more
conservative, right wing view of abstinence. Both are impostors. I am
currently a Non Exec. of a NHS MH Trust Kent and Medway. We have an
excellent and new Detoxification Programme Plus -Bridge House in Datford.
The plus represents what I see as good old fashioned drug work ie preparing
the users throughout their relatively short stay (the LOS is different for
alcohol and drugs) with follow on residential and other day care with huge
helpings - referrals are made to TCs, 12 step all sorts of different
programmes and the local day programmes especially for those with families
at home or for those who have opted for this. This old fashioned drug work
attempts to remove the barriers that stop individuals realising their "own"
goals for improvement even if it is long term abstinence because they have
just had enough. We have funded 12 beds through the local PCT/DAAT and
there are 4 beds for purchasing. Being an old TC and Harm min practitioner I
can honestly say that the programme is excellent - new and good environment
and committed team yet we can not sell the over capicity even at a very
reasonable and competitive price. It seems to me a) some need this kind of
detox as they have tried and failed in the community before and b) It is
still cheaper to keep people on methadone scripts even though they in their
heart of hearts wish to stop using and although the accumulative costs mount
up to far in excess of detox/ rehab as it continues year on year and they
never seem to benefit or get well. I believe with all the mantra of choice
that is bandied about - it is choice as long as you choose to remain on
methadone for a relatively long time. So all power to Phoenix's elbow for
its approach which would have been heresy in years gone by. There is far too
much individual opinion rather than evidence based interventions. You night
what they say about opinions being like a***holes everybody has one!
The other even more worrying dimemsion is that treatment (once experienced)
is synonomous with methadone script in the perceptions of the majority in
the UK not the good old fashioned drug work that both you and I knew and
developed. I know the NTA is attempting to encourage more abstinence
especially after the recent press debacle with Paul Hayes challenged on the
3 people who abstained from drugs despite half a billion spend. Of course we
know loads who have but they were not counted by the NTA. Another problem is
"Old Fashioned" drug work skills are hard to find these days. A training
course perhaps?
Happy New year to all
Peter Martin
-----Original Message-----
From: Therapeutic Communities
[mailto:[log in to unmask]] On Behalf Of Rowdy Yates
Sent: 07 January 2009 23:19
To: [log in to unmask]
Subject: Re: [EFTC] Methadone residents study
Rex
Gosh. Now I feel stupid!! I've read that paper and cited it a couple of
times. Never occurred to me that Haigh, R. was you. Slow witted or what??!!
Rowdy Yates
Senior Research Fellow
Scottish Addiction Studies
University of Stirling
http://www.dass.stir.ac.uk/sections/showsection.php?id=4
http://www.drugslibrary.stir.ac.uk
On 7 Jan 2009, at 19:48, "Rex Haigh" <[log in to unmask]> wrote:
> As one of those wicked doctors, the first (and possibly only) real
> research I did was to compare medical and social models for detox:
> "Where and when to detoxify single homeless drinkers" Rex Haigh,
> George Hibbert: British Medical Journal 1990 (301) 848-9.
> And - stunning conclusion - no significant difference except people
> preferred the social model (in Simon House in Oxford, as opposed to
> the Warneford Hospital).
> But you're quite right about medicalising it too much - I remember it
> well (wielding the stethoscope and clinical gadgets as a means of
> protection for my fragile authority and clinical dignity). It was my
> first job in psychiatry, and would have put me off for ever if they
> didn't do a good group therapy programme as well - all long gone now,
> though.
>
> Rex
>
> -----Original Message-----
> From: Therapeutic Communities
> [mailto:[log in to unmask]] On Behalf Of Rowdy
> Yates
> Sent: 07 January 2009 12:24
> To: [log in to unmask]
> Subject: Re: [EFTC] Methadone residents study
>
> Wendy
>
>
>
> As you know, I think there are some real positives for your idea.
> Certainly, I feel the voluntary sector in general (at least in the UK)
> has lost touch with it's old skills-base in this respect. Certainly,
> when I was working at Lifeline in the 1970s we developed a real
> ability to do home-based detoxs (effectively and with low levels of
> discomfort)
> because that's all there was! By and large the medical profession
> didn'
> t want to know and if they did, they stuck folk on some godawful
> general psychiatric ward (usually excusing the appalling conditions as
> a "test of motivation"!!) and detoxified people with librium.
>
>
>
> The early Synanon was characterised by the fact that people could come
> in off the street and detox in the lobby of the hotel in which the TC
> was based. I've said before on this list, my view is that this had a
> positive impact on the dynamic of the community. When you started to
> get pull-ups, as often as not, the people doing the pulling up were
> the same community members who soothed your troubled brow and mopped
> up your sick when you first arrived.
>
>
>
> My view is that the medical profession has consistently demonised
> home-based non-medical detoxification in their inexorable drive to
> medicalise the whole of addiction. The tendency of most doctors
> (apologies to all the doctors on this list - but you know it's the
> truth!!) to revert to the security blanket of the disease model of
> addiction is profoundly depressing. It's as if the work of Zinberg,
> Engel, Kantzian, Schaz and all the other addiction theorists of the
> past four decades had never existed!!
>
>
>
> But maybe this is just the pining of an old man for those far-off good
> old days when drug workers were able to work out whether someone was
> stoned (and on what) without having to wait for the results of an
> observed urine test (shudder!!).
>
>
>
> One other thing though. You say:
>
>
>
> "indeed policy will not allow them to enter into a residential TC
> treatment until successful completion of a detox"
>
>
>
> Whose policy is this? It sounds completely daft to me. It should be
> up to the TC itself to decide the most appropriate entry
> conditions/regulations. Certainly, Phoenix Sheffield have for some
> time accepted clients on reducing doses of methadone - I'm not sure of
> the exact amounts/timescales and unfortunately, I don't think anyone
> from Phoenix Sheffield is on the list - and my impression was that it
> had been an extraordinarily uneventful development for them.
> Certainly when I was there about 18 months ago, it wasn't really
> possible to work out who the detoxing residents were (though I suppose
> other residents would be more critically aware.
>
>
>
> Rowdy Yates
> Senior Research Fellow
> Scottish Addiction Studies
> Sociology, Social Policy & Criminology Section Department of Applied
> Social Science University of Stirling
>
> E: <BLOCKED::mailto:[log in to unmask]> [log in to unmask]
>
> W: <http://www.dass.stir.ac.uk/sections/showsection.php?id=4>
> http://www.dass.stir.ac.uk/sections/showsection.php?id=4 (home)
> http://www.drugslibrary.stir.ac.uk
> <http://www.drugslibrary.stir.ac.uk/> (library)
>
> T: +44(0)1786 - 467737
> M: 07894- 864897
>
> ________________________________
>
> From: Therapeutic Communities
> [mailto:[log in to unmask]] On Behalf Of Wendy
> Dawson
> Sent: 07 January 2009 11:31
> To: [log in to unmask]
> Subject: Re: [EFTC] Methadone residents study
>
>
>
> Hi
>
>
>
> This is disturbing news!
>
>
>
> Particularly as I am keen to challenge NTA guidelines by developing a
> detox unit without prescribed medication here at the Ley. We have 15
> people waiting to come into the Ley but their funders and indeed
> policy will not allow them to enter into a residential TC treatment
> until successful completion of a detox. However with increasing demand
> and waiting time for detox these people may possibly be dead, change
> their mind or decide to be maintained for the rest of their lives on a
> script
> - where is the client choice in all of this?
>
>
>
> Best wishes
>
>
>
> Wendy
>
>
>
>
>
>
>
> Wendy Dawson
>
> Chief Executive
>
>
>
> The Ley Community
>
> Sandy Croft, Sandy Lane
>
> Yarnton
>
> Oxford
>
> OX5 1PB
>
>
>
> Tel: +44 (0) 1865 378600
>
> Fax: +44 (0) 1865 842238
>
>
>
> Email: <mailto:[log in to unmask]> [log in to unmask]
>
> Website: <http://www.ley.co.uk> www.ley.co.uk
>
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>
> Company No. 3736193
>
>
>
> The email message is intended solely for the above mentioned recipient
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> ________________________________
>
> From: Therapeutic Communities
> [mailto:[log in to unmask]] On Behalf Of Anthony
> Slater
> Sent: 07 January 2009 11:20
> To: [log in to unmask]
> Subject: [EFTC] Methadone residents study
>
>
>
> Hi,
>
>
>
> This study is now being promoted in Norway via various news groups.
>
>
>
> In some ways this will be, I think, unfortunate for drug free
> addiction tc's, as we have already been under a great deal of pressure
> to take people on methadone in to treatment, in drug free recovery
> tc's.
>
> A real dilemma is that the medical authorities / advisors strongly
> also recommend that individuals stay on it for life.
>
>
>
> More to come on this topic no doubt...........
>
>
>
> Best wishes,
>
> As ever
>
>
>
>
>
>
>
> Anthony Slater,
>
> Director - Phoenix House Haga,
>
> President, E.F.T.C.
>
> Folkenborgveien 198,
>
> 1850 Mysen, Norway.
>
> tlf. +47 69 89 82 50 / fax. + 47 69 89 82 51.
>
> E-post: [log in to unmask]
>
> www.phoenixhouse.no
>
> www.eftc-europe.com
>
>
>
> http://www.tc-of.org.uk/wiki/index.php/RadioTC_International_Norsk
>
>
>
>
>
>
>
> ________________________________
>
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