This was just posted on Update - an Australian discussion list.  I thought EFTC members might be interested.


Rowdy Yates
Senior Research Fellow
Scottish Addiction Studies
School of Applied Social Science
University of Stirling
Scotland

T: +44 (0) 1786-467737
F: +44 (0) 1786-466299
W: http://www.dass.stir.ac.uk/sections/showsection.php?id=4  (home)
W: http://www.drugslibrary.stir.ac.uk/ (online library)

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From: [log in to unmask] [[log in to unmask]] On Behalf Of [log in to unmask] [[log in to unmask]]
Sent: 24 January 2011 19:36
To: [log in to unmask]
Subject: [Update] NSW Opposition funding commitment

Substance use is a complex issue requiring a number of solutions

The commitment by the NSW Opposition to provide $10 million to drug treatment programs is welcomed by the Australasian Therapeutic Communities Association (ATCA), the peak body representing therapeutic communities in Australia and New Zealand.  The 33 members of the ATCA operate 65 programs in Australia and New Zealand, with 12 of these in correctional settings.  There are 19 therapeutic communities in NSW, forming part of a larger group of residential services.  Therapeutic communities treat more that 10,000 people annually and traditionally work with a more chaotic population group for whom many other forms of drug treatment have failed.

As an Association we support the concerns of others working within the substance use field.  Funding to residential treatment should not come at the expense of methadone and other substitution programs.  All are needed as part of a broad range of treatment options in order to meet the needs of people seeking treatment for substance use.  While all residential services provide an illicit drug and alcohol-free environment for people undertaking treatment, prescribed medications are seen as part of the treatment program, with a number of therapeutic communities in community and correctional settings accepting people on methadone. Indeed, research has shown that combining the two forms of treatment will provide the best treatment option for those people for whom a single solution has not proved effective.

Certainly drug abuse needs to be seen in the context of a health issue, and hence requiring a health outcome.  However, the analogy with diabetes or other diseases requiring life-long medication may not be the reality for some people.  For those entering residential treatment, the opportunity to address underlying psychosocial issues, past abuse and trauma, and to develop prosocial attitudes and behaviours, are key motivating factors for treatment.  Not that this is an easy path.  Some studies have found reports of childhood sexual abuse as high as 70 – 80 percent amongst clients of therapeutic communities.  Rates of comorbidity with mental health problems are also high, with 50 – 80 percent of clients presenting with mental health problems, including low prevalence psychiatric disorders.

However, cost effectiveness cannot be solely measured in direct treatment dollar terms.  Effectiveness of the therapeutic community model has been shown in positive outcomes for drug use, criminality and employment in single-site and multi-site studies employing pre-post designs.  Their efficacy is supported by evidence based research in Australia, the United States and the UK through drug abuse treatment outcome studies, with a longitudinal study of 100 heroin users conducted by the National Drug and Alcohol Research Centre (NDARC) finding support for residential treatment.

In 2001, a study undertaken as a “single day snapshot” of 345 clients in therapeutic community treatment, found the personal daily use of drugs in the 12 months prior to treatment to be estimated at $302 per day, or approximately $110,242 per person per year.  The yearly total for the whole cohort of 345 people was $46,742,608.  After adding in an estimated cost for law enforcement and court costs ($10,302,500); health care costs ($1,211,952); and welfare benefits ($4,510,272) this represents a staggering total overall cost to the community of $62,767,332.  Treatment within a residential program is estimated at $98 per day.  The overall cost of treatment for the 345 people in this study for one year would therefore be $12,340,650. This provides a savings of $50,426,682 over a 12 month period – or $146,164 per person per annum; a savings of $400 per person per day!
A number of therapeutic communities also work with families, providing a very real chance to break the cycle of addiction and to address the intergenerational issues which have often lead to substance use.  With an estimated 60,000 Australian children having a parent in drug treatment, the hope for these children in the future is that their parents will recover and that their lives will change.

No single drug treatment intervention will meet the needs of everyone seeking treatment.   We continue to support all interventions.  There are more similarities than differences across treatment types and with a growing number providing psychosocial and medical interventions in combination, the chance of success is increased.


Associate Professor Lynne Magor-Blatch is the Executive Officer with the Australasian Therapeutic Communities Association and a Forensic Psychologist with the University of Canberra where she teaches within the Master of Clinical Psychology Program.




-- 
The Sunday Times Scottish University of the Year 2009/2010
The University of Stirling is a charity registered in Scotland, 
 number SC 011159.




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