From today issue 2 of the Drug and Alcohol Findings magazine
became available free of charge as downloadable PDF (Adobe
Acrobat) versions of the published content. Access the
entire issue from http://findings.org.uk/issuesResults.php5
or by clicking the BROWSE MAGAZINE link on the home page;
search for documents on specific topics at
http://findings.org.uk/doc-search.htm or by clicking SEARCH
BY TOPIC on the home page.
From within the as-published files, those who want to dig
deeper can access Word and PDF versions of the unpublished
background texts with full references and often substantial
extra information - click the EXTENDED TEXT... button.
After in issue 1 analysing the world's most prominent
alcohol treatment trial (Project MATCH), in issue 2 we moved
on to the UK's most important drug treatment evaluation -
NTORS, the National Treatment Outcome Research Study.
"You've done NTORS proud" said Dr John Marsden, an NTORS
researcher, but as well as recognising its strengths, we
raised significant queries.
Conceived at a time when a hardline health minister was
querying the value of addiction treatment, NTORS' headline
'£3 saved for every £ spent' estimate defended existing
services and underpinned substantial later investment in
treatment as a cost-effective anti-crime measure.
But both sides of that equation rested on highly
questionable assumptions. The most serious were:
1. The '£1' spent on treatment was not as most people
assumed the full cost of the treatments NTORS studied (£3
million), but the EXTRA cost (£1.6 million) compared to
treatments undertaken the year before. The underlying
assumptions were that spending the same amount again would
have had no further impact, and that the previous treatments
made no contribution to the cost-savings. The first
assumption alone nearly halved the costs against which the
benefits were compared.
2. The '£3' cost savings consisted largely of the value of
stolen property. Effectively the assumption was made that
these losses were a loss to society as a whole - yet some
parts of society benefited in the form of cheap or stolen
goods. Economists call these 'transfer payments' and cancel
them out when it comes to calculating the net loss to
society. Because these were the proceeds of crime, NTORS
decided not to treat them as transfer payments, considerably
inflating the cost-savings side of the equation.
There were benefits which NTORS did not include in its
calculations, not least the value of the lives saved and the
distress and disease averted. These might have tipped the
balance so far to the savings side that the queries raised
above would have been insignificant. But did the
calculations made by NTORS really show that treatment was
cost-beneficial? Nowhere near as conclusively as most people
think.
Also in issue 2, studies of arrest referral which informed
the criminal justice initiatives so prominent today, and
far-reaching findings on the prevention of substance use
problems in the young, including rare instances of
harm-reduction education. As a bonus, the 'Nugget' headed
COMMUNITY MOBILISATION... (access directly at
http://findings.org.uk/docs/nug_2-15.pdf) includes a link to
our later review of one the featured studies - the highly
influential Project STAR - click the EXTENDED TEXT... button
to access.
Finally we record our gratitude to the Pilgrim Trust
(http://www.thepilgrimtrust.org.uk) which has joined the J.
Paul Getty Jr. Charitable Trust
(http://www.jpgettytrust.org.uk) in enabling us make these
publications available to you free of charge, and to develop
the Effectiveness Bank which will enable you to search
through them and through source research papers to help
improve the effectiveness of drug and alcohol interventions.
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leading UK drug and alcohol information charities and the
UK's leading clinical/research centre.
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