7f NTORS Study: A realistic perspective

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7f. NTORS: Two Years On.

The National Treatment Outcome Research Study

Brought Into Realistic Perspective

A short 2000 conference presentation given by

Kenneth Eckersley

Less than two thousandths of one percent of the population, namely 1,075 known drug users, form the subject of the National Treatment Outcome Research Study being carried out by the National Addiction Centre at the Institute of Psychiatry / Maudsley Hospital in London, funded by U.K. taxpayers through the DoHealth.

Not very 'national' you may think, but survey groups of between one and four thousand form the 'sample base' for many public relations surveys in our marketplace today. More important is the question of whether the sample is in fact truly representative of the whole field of drug use.

Informed observers estimate the number of steady users of all classes of prescription, legal and illicit drugs to be more than one million and approaching two million, with around 200,000 (over 10%) of them classed as "addicts" - both reported and otherwise. However, the accuracy of that figure depends on which definition one uses for the word 'addict'.

Obviously it excludes experimental and occasional drug use, but it is extremely difficult to find agreement on when regular use becomes habitual use, when habitual becomes dependent use and at what level dependant use becomes regarded as addiction. Addiction is officially defined by our Home Office against the provisions of the 1971 Misuse of Drugs Act, and describes an addict as a person who - as a result of repeated administration of a controlled substance - has become so dependent as to have developed an overpowering desire for the administration of that substance to be continued.

However, many anti-drug workers would say that addiction has already set in when regular use is apparent. This is because researchers note that, anybody "using" on a steady weekly or even monthly basis any substance - controlled or otherwise - which has the potential to be addictive, is extremely unlikely to reduce that consumption. A threshold has been crossed and the majority will eventually use increasing amounts and / or shorten the dose intervals as time goes on.

In other words, whilst the Home Office definition covers any individual recognisable by anyone as an addict, if one includes the not so obvious regular, habitual and dependent users, then that 200,000 figure can be increased five or ten-fold, i.e. to between one and two million addicts.

It is therefore interesting that the NTORS sample group is comprised of 580 users (54%), who had been admitted to Accident & Emergency hospital departments in the two years before the treatment started, some 110 users (10%) who were already being treated in psychiatric hospitals for serious depression and suicidal tendencies in the three months before the NTOR Study of them commenced, and some 644 addicts (61% of the study group) who had committed an average of more than one crime per day - a total of nearly 70,000 mainly acquisitive offences - in the three months prior to the onset of the NTOR Study.

In other words, at outset the sample represented only the most heavily committed users, in the very worst stages of addiction, with more to gain and less to lose than anyone else in the society. As a result, the NTOR Study sample does not include any treatment results for the main group of over one million U.K. drug users, who are the currently developing 'near death's door' addicts of the future. Members of this larger group of users know they have problems, but have not yet confronted and understood that their problems might just have something to do with their habit.

The most tragically addicted users KNOW where they are at, and want OUT. Consequently, the 1,075 poor souls in the NTOR Study are amongst those most likely to have a good outcome from any form of 'treatment'. Merely by a) handling any straightforward medical / health problems they may have, b) by giving them some decent food and nourishment for a change, c) by getting them cleaned up clothing and bodywise, and d) by seeing they get some good nights of sleep in warm clean surroundings, it is easy to start making them feel like human beings again and thus restore a major part of their self-esteem. As long as they can also continue inexpensively supporting their addiction or can supplement their drug supplies with no cost methadone, there is little doubt that their crime rate will drop rather than rise.

So any NTORS claimed improvements in crime figures are mainly due i) to enhancing the life-quality of the users during the treatment period, ii) to the users' absence from the streets and their separation from pusher 'friends' in those same periods and, iii) to their receiving free supplies of substitute drugs (such as methadone) on a regular prescription basis.

Astonishingly, after two years, headline comments about the study include:

* "The big message is that treatment confers important benefit for clients".

Surprise, surprise. But surely the whole intention and definition of 'treatment' is the conferring of benefits on the recipients. Otherwise, why bother to treat them at all?

and,

* "About 20% of clients on methadone programmes became abstinent from all target drugs".

But, if the taking of methadone results in abstinence in only 20% of cases, then it has failed to create abstinence from all target drugs in the other 80%! Bearing in mind that the U.S. Government General Accounting Office study revealed that between 30% and 50% of individuals receiving daily free methadone continued to use heroin, cocaine and other drugs and to commit crimes to finance them, NTORS seems to be revealing that U.K. methadone results are getting worse rather than better!

But none of this is about curing drug-users for life, or about restoring freedom of choice. Comfortable continuing abstinence from the date of completion of treatment onwards is the only acceptable outcome having regard to the time, effort and money being devoted to NTORS.

In fact NTORS appears as nothing more nor less than an expensive and long-winded search for what might work best from amongst the rag-bag of current psycho-pharmaceutical treatment practices. To describe it as "national" when it covers less than 0.00002 of the population, is a gross exaggeration of its scope solely for PR purposes. The word "research" is included for the same reason, as there is no evidence that any new forms of treatment will be undertaken, nor will any rehabilitation programmes outside the psycho-pharmaceutical field be examined.

So we find that NTORS is in fact no more than a Study of the Outcome of various existing psycho-pharmacological Treatments - which everybody already knows DO NOT WORK when it comes to procuring a permanent cure for any form of addiction.

Can we in fact expect the psychiatrists at the Institute of Psychiatry and the National Addiction Centre, who are conducting the NTOR Study, to show the necessary detached scientific independence, when they have restricted that study to their own field. Especially as they are the very people who consider it right to promote the feeding of drugs like Ritalin to 6 year old children and the dosing of teenagers and adults with Luvox and Prozac. A sure way of creating addiction for life!!!

It is absurd that it is subjectively interested psychiatrists rather than independent objective statisticians who are collecting and analysing the "outcome" reports of other locally based psychiatrists. One has only to read the aptly described 'cover story' (or should it be 'cover-up story'?) on two years of NTORS in this month's edition of "Addiction Today", to find that psychiatric interpretation rather than scientific analysis of results is the order of the day at the National Addiction Centre.

Insofar as this is a study backed by the medical profession via Department of Health funding, the appointment of local health authorities as local services commissioners brings a wry smile to one's lips.

This is because one major NHS Trust requested the professional help of one of my co-authors for his help in providing policy to solve their own in-house drug problems - both illicit and prescription. In doing so they confirmed that medical personnel at all levels, are amongst the most established of professional drug mis-users! . . . . Talk about "physician heal thyself"!

As a result, NTORS is now appearing as a very doubtful vehicle for improvement, when one recognises that psychiatric medical personnel are amongst the main research participants involved in this study! In fact built into the NTORS concept is validation of the fact that current psycho-pharmacological practitioners cannot cure addiction - otherwise, why would they be rummaging around amongst their 'treatment procedures' to desperately try and find something which will do better than their record of the last decade?

An interesting and totally independent "proof" of this has recently been provided by the "DRUGS at the sharp end" survey and study carried out by the Big Issue in the North Trust.

The "treatment" services that users said they received were mainly medical interventions such as prescribed methadone (70%). Of this percentage, 80% also used street drugs - particularly heroin. This means that 56% of the addict study group are using both methadone and heroin or other street drugs. Because a majority are either homeless or without regular employment (89%) it is clear that they are still having to rely on crime to support their street purchases !

One-third had been receiving drug services for over 5 years, and 12% for over 10 years, and there is no evidence in the report of any of those receiving such treatments having been cured of their addiction. In fact half the group would like to have other forms of treatment.

Insofar as the only acceptable and compassionate treatment result is a permanent cure, and especially as such cures are delivered in 69% of cases by other forms of practice outside the U.K., the report is a revelation of gross failure on the part of our psycho-pharmaceutical practitioners. And it is this failure that they continue to try and hide within the NTOR Study.

____________________________________________________________________

All World Rights Reserved.

Kenneth Eckersley, CMS, HSDC, FInstD, FCMI, MCIM, HonMPHMA(Int), is a former Magistrate and Justice of the Peace, a qualified drugs policy consultant to both employers and employees, Chairman of a PLC., Chief Executive Officer of Addiction Recovery Training Services (ARTS), author and broadcaster.

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