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Richard

 

Fair point.  I accept that the problem MAY be more complex than it was in the past (but actually, at Lifeline we were detoxing poly-drug users all through the 1970s – mainly diconal + palfium + pethedine + barbiturates + mandrax – I’ve no idea where this daft idea came from that poly-drug use is a recent phenomenon).

 

However, your argument that a more complex problem needs a more sophisticated detoxification approach is undermined by two crucial issues:

 

  1. What we are seeing on offer, generally is not by any standards a sophisticated approach.  Virtually all detoxification interventions in the UK are heavily reliant on two major staples – methadone and valium.  It rarely gets any more sophisticated than that and even then this tends to be done to a standard template that barely changes from patient to patient.

 

  1. Doctors are VERY fond of quoting the “evidence base”.  What this glib term really means is “what I read in the Lancet, the BMJ, JAMA etc. plus what it says in the NICE guidelines”.  What it does not mean is “evidence base”.  The medical profession has spent years trying to convince us that anything other than research published in medical journals and undertaken under RCT conditions is worthless.  Thus most medical professionals in the UK will ignore (or – worse – be unaware of) 40 years of outcome research into TC methodology and tell you that there is no “evidence base” for TCs

 

Try Thomas Szaz’s “Ceremonial Chemistry” – still a good read.  The mythologising and self-agrandisement of the medical profession by the medical profession is not new and it is not unique but it is very silly and self-limiting.

 

 

 

Rowdy Yates
Senior Research Fellow
Scottish Addiction Studies
Sociology, Social Policy & Criminology Section
Department of Applied Social Science
University of Stirling

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From: Therapeutic Communities [mailto:[log in to unmask]] On Behalf Of Richard Phillips
Sent: 07 January 2009 12:57
To: [log in to unmask]
Subject: Re: [EFTC] Methadone residents study

 

As an ex-Phoenix (Bob & Karen are on the list I think.. can perhaps clarify or bring up to date) my recollection is that we tried to keep the detox period to 30 days; most of the Phoenix houses did detox, as do a significant proportion of other abstinence based rehabs in the UK. 

 

There are some tensions with doing this in an abstinence program and many managers of TC's would *prefer* clients to come in having done the detox.  The reasons for not doing that are pragmatic, because it creates an upstream block to admissions.  

 

The question for many rehabs thus becomes one of whether they can find a way of overcoming the tensions of prescribing within an abstinence program - and many services find they can do this. 

 

In a TC, I think one of the debates is whether to get medicated clients as fully involved in the TC structure immediately or whether (given time / resources) to keep them a little separate until they have completed the detox period.  I think other residents *do* know who is on detox, and with methadone staff report there to be some interference with ability to engage in the therapeutic work (less so with buprenorphine) - but with care these issues can be managed. 

 

Oh, and to be provocative - YES Rowdy, you do seem to be pining for the bad old days of horrible detox and with poly drug / alcohol pretty much the norm now, un-medicated detox is riskier than it was. Clinical Governance matters to the voluntary sector and explaining to a court (and your insurers) is more than a little tricky if you haven't followed evidence based clinical guidelines.  Rant over! 

 

Regards

 

----------------------------
Richard Phillips
----------------------------

2009/1/7 Rowdy Yates <[log in to unmask]>

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

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T: +44(0)1786 – 467737
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From: Therapeutic Communities [mailto:[log in to unmask]] On Behalf Of Wendy Dawson
Sent: 07 January 2009 11:31

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

 

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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.

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www.phoenixhouse.no

www.eftc-europe.com

 

http://www.tc-of.org.uk/wiki/index.php/RadioTC_International_Norsk

 

 

 

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Academic Excellence at the Heart of Scotland.
The University of Stirling is a charity registered in Scotland, number SC 011159.