Huseyin Djemil has worked in the drug and alcohol field for 18 years, having previously been a Class A drug user who went into residential rehabilitation. He is now Director of Green Apple Consulting, a specialist substance misuse consultancy he founded in 2009. As a member of the Centre for Policy Studies' Prisons and Addictions Forum, here he previews Breaking the habit: why the state should stop dealing drugs and start doing rehab by Kathy Gyngell, which is published today by the CPS.
In 1986 I needed help. I was smoking about £150 to £180 of heroin and freebase cocaine a day and had been for approx 7-years.
But I got into a rehab called Yeldall Manor, ran by a Yeldall Christian Centres, which despite my nominal Muslim background at the time, was as happy to have me, as I was to get in. Back then, the process for getting help was straightforward; I rang the rehab, arranged an interview/assessment date, attended the interview and was shown around the house and grounds.
Following the interview I was given an admission date which helped me to focus on getting off the drugs I was using so that the proper work of rehabilitation could begin. I toughed out my ‘detox’ at my sister’s flat and was admitted six weeks later. Two years later, I emerged from Yeldall Manor a different person.
The system for getting into rehab was simpler then, though there was far less money in the treatment system, no 'commissioning' but a national budget, administered by the DHSS (Dept for Health and Social Security) and accessed via a few simple forms at the rehab as part of the induction process. I would have preferred never to have been addicted at all, but given the state of access to rehabilitation today I am glad I am not seeking residential rehabilitation today.
I have been working in the current treatment system for eighteen years now and it pains me to say that despite the extra hundreds of millions of pounds of investment, the system is far worse now for those wanting to come off drugs completely. It is very good for finding people and getting them onto methadone, but that is pretty much it. If I was a drug user today I would probably still be on methadone with a very slim chance of ever making it to rehab, trapped in the types of scenarios described in Kathy Gyngell’s Centre for Policy Studies pamphlet.
I would probably still be on benefits and there would also be dreadful collateral damage to my family.
As it is, and because I got a chance to go to rehab and break free of addiction, I have had the chance to live a full and independent life – a second bite of the cherry. It has been great doing all the normal things people do and really enjoying the ordinary things we sometimes take for granted; being in work, being married, raising children, having a home, paying my way, going on holiday, helping others and so on.
There is a perception that rehab is expensive, that all other forms of treatment, particularly opiate prescribing, are less so. As Kathy Gyngell shows in her paper, this is not the case. The costs of poor treatment are huge, without the added welfare and child-care costs they sustain. In my case I have paid back the cost of my care many times over and contributed to the common purse so that others could receive help.
The fact is that rehab only seems expensive by contrast with prescribing because it is part of local, short-term (annual) DAAT (Drug and Alcohol Action Team) funding provision. Funding at a local level is very focused on targets, linked to a needs assessment that focuses on heroin and crack, (problem drug users) and on crime related to that cohort. There is no systematic and longer term personal planning, care and support that the good rehabs give in the mainstream community system, however dedicated individual workers might be.
When I completed my programme (23 months after I'd started) I had a bad experience after ten weeks of living independently. I went back to the rehab and asked for help. They offered to rent me a room for £40 per week, which I accepted and then paid for from my wages – from the job they had helped me to find.
Drug treatment has grown from a cottage industry to a corporation and a corporation needs administration and administration costs money. I acknowledge we need accountability. I would even argue that we need targets, quality standards, meetings, cups of tea, wireless networks, laptops and iPhones etc. But we also need a good dose of common sense.
Drug treatment is not an end in itself. It is about getting people better and helping them to get on with their lives. If we do that, then the rest of the stuff falls into line. If we try and micromanage that change, it doesn't seem to work. If we try and wrap people up in cotton wool, it’s just that much harder for them to take the reins of their own lives back. Unfortunately the way the Government has planned the Drugs Recovery Payment by Results Pilots risks continuing just that.
If we want to change the system, to orientate it to ensure addicts get free of addiction, then we need to build on the Government's new drug strategy. We can’t have a rehab revolution without rehabs. We can’t get addicts into recovery via a treatment system whose prime focus is keeping addicts addicted in order to reduce crime. We can’t help prisoners resettle if we pump them full of drugs in prison and when, against all the odds, they achieve abstinence, re-introduce them to substitute opiate prescribing because we perceive the risk of overdose on release is too high.
To progress the Government's new drug strategy we need to re-balance the commissioning and delivery mechanisms toward these new aims. Otherwise the danger is that that we’ll just rebrand the existing system and nothing will really change. How we do this, like good drug treatment, is a process and it won’t happen overnight.
A step in the right direction is taking heed of the title and contents of Kathy Gyngell’s pamphlet, and for the state to stop dealing drugs and start doing rehab.