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Dear all As Rowdy said yesterday ( and all those emails ago) at all the Phoenix UK residentials ( adult TCs and the family services ) we offer assisted withdrawal at the start of someone's stay. This would normally be using methodone or subutex and we would aim to get people off within 4 weeks. This medically monitored withdrawal involves those dastardly GPs within service and requires our staff to be well trained. We have as you would expect a fairly tight policy around it and local procedures that are rigorously audited. Working in a regulatory framework as we do we have a number of standards to comply with but from my position that allows me an additional level of quality and risk assurance across the 7 residentials in England and Scotland that I welcome. In relation to the impact of this practice it doesn't interfere with the effective running of the TC in our opinion. As Rowdy I think said, actually there is a hugely beneficial element to doing your withdrawal within the TC setting. It allows peer support within a structured environment, it allows a focus on recovery through withdrawal and avoids an interruption in treatment from 'detox' to 'programme' which inevitably increases the risk of drop out. We hear all the time that access to detox is a barrier to access to residential services and we are able to offer an alternative that for most people is in line with what they want. I am doing some work at the moment to look at the numbers of admissions who use the assisted withdrawal and whether that has increased over time. I wont be drawn on the whole abstinence / harm reduction issue in this forum, needless to say it is a febrile debate in England at the moment and as a provider of the whole spectrum of drug treatment services in England I pine for the day that we can value services for their ability to meet the needs of the individual. Karen Biggs Chief Executive Phoenix Futures 3rd Floor, ASRA House 1 Long Lane London SE1 4PG Tel: 020 7234 9781 www.phoenix-futures.org.uk -----Original Message----- From: Therapeutic Communities [mailto:[log in to unmask]] On Behalf Of Daren Britt Sent: 08 January 2009 08:56 To: [log in to unmask] Subject: Re: [EFTC] Methadone residents study Hi Rowdy, In my experience the workers locally are tolerant to both approaches (abstinence and HM); however a large part of that may be down to the effort that we have put in across all levels of training to emphasise the benefits (and shortfalls) of both. Where I meet most resistance to abstinence approaches tends to be amongst non-specialist medical staff and some academics. It is, of course, never as simple as it sounds and I am constantly struck by the on-going misconceptions held by practitioners new to the field or new to training. It is one reason, amongst many, why training at HE level is so important; the existing FE training frequently just doesn't allow for the development of a meaningful critique of both approaches. Dr. Daren Britt (01273) 643548 Senior Lecturer in Substance Misuse School of Applied Social Science University of Brighton Falmer Brighton. BN1 9PH -----Original Message----- From: Therapeutic Communities [mailto:[log in to unmask]] On Behalf Of Rowdy Yates Sent: 07 January 2009 23:15 To: [log in to unmask] Subject: Re: [EFTC] Methadone residents study Henrik Great contribution. I think you're absolutely right. Interestingly I've just been discussing with a colleague his concerns about an authenticated series of incidents where drug workers have actively discouraged clients from attending AA/NA meetings tearing down NA posters in waiting rooms etc. So. Without being too melodromatic I wonder if we have reached a point where those of us who believe abstinence to be an option have become the enemy. I have begun to feel that at some conferences I am starting to be perceived as a threat. Anyone else experienced that or is it just the altzheimers setting in? 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 20:00, "Henrik Thiesen" <[log in to unmask]> wrote: > ".....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!!..." > > Isnīt the problem that most of the guidelines are made of people who > has > never seen a TC or any other kind of drug-facility but only out- > patient MMT > and detox-facilities? > > Itīs always been the basis of my medical treatment that it should ma > ke it > possible for the patient to enter treatment and stay in it - not > that the > chemicals are treatment in itself. Itīs the patients right to stop > medication at any time even if I donīt agree and it can be necessary > for me > to say that I think the idea is problematic but Iīll never deny furt > her > treatment if they decide to try. > > Right now we treat a young street-homeless man with multiple drug > use, ADHD > and drug-elicited psychoses - to get him into in-patient treatment > we had to > refer him to the official treatment system - and they wanted to put > him on > methadone - even if he doesnīt use heroin more than occasionally. > > To many MDīs methadone has become the answer to anything (instead of > talking > to the people who seek them) and I donīt even think they really have > reverted to any disease-model - they just want people to stay quiet > and in > their "right" place and they have heard that methadone is evidence- > based so > thats what they use. > > I see a lot of non-creative and and un-focused medical "treatment" > on people > who are so doped from their medication that they canīt have two cons > ecutive > thoughts and the explanation is that some people just want and need > to be > "closed down" and I have seen how these people begin to blossom and > develop > on proper medication with planning on how to taper it. > > Henrik Thiesen > MD :o) > > > > > ----- Original Message ----- > From: "Wendy Dawson" <[log in to unmask]> > To: <[log in to unmask]> > Sent: Wednesday, January 07, 2009 5:49 PM > Subject: Re: [EFTC] Methadone residents study > > >> Hi Rowdy >> >> I absolutely agree with you regarding how the medical profession have >> demonised non-med detox. Re my reference to policy it's stated in >> the NTA >> guidelines which seem to be being religiously followed! However I >> recently >> mentioned the idea in a meeting at the regional NTA office and it >> was met >> with an interesting ummmmm. Its very much in the embryonic stage >> so far. >> >> 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: [log in to unmask] >> Website: www.ley.co.uk >> Registered Charity No. 1074874 >> Company No. 3736193 >> >> The email message is intended solely for the above mentioned >> recipient and >> may contain confidential or privileged information. If you have >> received >> it >> in error please notify us immediately by telephone. You must >> neither copy >> nor distribute the email transmission, nor cause nor permit such >> copying >> or >> distribution. >> >> -----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 >> >> Registered Charity No. 1074874 >> >> Company No. 3736193 >> >> >> >> The email message is intended solely for the above mentioned >> recipient >> and may contain confidential or privileged information. If you have >> received it in error please notify us immediately by telephone. You >> must >> neither copy nor distribute the email transmission, nor cause nor >> permit >> such copying or distribution. >> >> ________________________________ >> >> 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 >> >> >> >> >> >> >> >> ________________________________ >> >> Academic Excellence at the Heart of Scotland. >> The University of Stirling is a charity registered in Scotland, >> number >> SC 011159. >> >> >> No virus found in this incoming message. >> Checked by AVG - http://www.avg.com >> Version: 8.0.176 / Virus Database: 270.10.3/1879 - Release Date: >> 06/01/2009 17:16 >> >> >> >> No virus found in this incoming message. >> Checked by AVG - http://www.avg.com >> Version: 8.0.176 / Virus Database: 270.10.3/1879 - Release Date: >> 07/01/2009 >> 08:49 -- Academic Excellence at the Heart of Scotland. The University of Stirling is a charity registered in Scotland, number SC 011159. Phoenix Futures brings positive change in the lives of individuals, families and communities affected by substance misuse. We reduce the impact of drug and alcohol related harm and enable our service users to rebuild their lives. Our purpose is achieved through the skills and dedication of our staff. Phoenix House (operating as Phoenix Futures) is a registered charity in England and Wales (No. 284880) and in Scotland (No. SC039008); Company Limited by Guarantee Number 1626869; Registered Housing Corporation Number H3795; National Housing Federation Member; Patron HRH Prince of Wales. Disclaimer: This e-mail is from Phoenix Futures. This message is confidential and intended for the addressee(s) only. If you are not the addressee(s) please notify the sender immediately so that the error can be corrected. 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