First Six Months Of Treatment For Crack Or Heroin, But Not Both, Has High Rate Of Abstinence, England

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Main Category: Alcohol / Addiction / Illegal Drugs
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Article Date: 05 Oct 2009 - 6:00 PDT

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The largest ever study of heroin and crack cocaine treatment in England found that the first six months of treatment results in large proportions of addicts of one or the other abstaining, but that the effect is less pronounced for users of both.

The results of the National Treatment Agency for Substance Misuse (NTA) funded study are written up in the 2 October issue of The Lancet by Dr John Marsden of the Institute of Psychiatry at King's College, London, and Colin Bradbury Head of Delivery at the NTA, and colleagues. The NTA is part of the National Health Service (NHS).

Bradbury said in a separate statement that:

"The goal of all drug treatment is for the user to overcome their addiction, and this study shows that although that may take time, it is possible to tackle the harms caused by drugs by investing in drug treatment."

For the study, Marsden, Bradbury and colleagues analyzed data from the National Drug Treatment Monitoring System (NDTMS) covering more than 14,656 patients from all over England who were being treated for heroin or crack cocaine addiction or both. The patients received at least 6 months treatment starting between January and November 2008 and finishing by the end of the study period in May 2009.

The results showed that:

• During the 28 days leading up to review, about two thirds of heroin users stopped (42 per cent) or significantly reduced (29 per cent) their use of the drug.


• This proportion was slightly lower for crack cocaine users (with 57 per cent stopping and 8 reducing).


• Much higher proportions of users of only one of the two drugs abstained than did users of both heroin and crack cocaine.


• Overall heroin use went down from an average of 23 days per month pre-treatment to 8 days at follow up (an average drop in usage of 15 days per month).


• For crack cocaine usage dropped from an average of 13 days per month pre-treatment to 5 days at follow up )an average drop of 8 days per month).


• For clients given drug treatment, reduction in days of heroin use was smaller for those using both heroin and crack cocaine than for those using heroin alone (14 versus 16 days).

The authors concluded:

"The first 6 months of pharmacological or psychosocial treatment is associated with reduced heroin and crack cocaine use, but the effectiveness of pharmacological treatment is less pronounced for users of both drugs."

They suggested new treatment strategies were needed for people with combined heroin and crack cocaine addiction.

Bradbury told the media that:

"Drug treatment has been greatly expanded in the last few years and so it is very encouraging that this study of the most commonly available treatments in England shows that even those with entrenched addiction to heroin and crack cocaine respond well to treatment."

"Whilst users are in treatment, we know that their drug use declines and that crime significantly reduces, which is positive for their health and for communities which suffer from the harms caused by drug addiction," said Bradbury.

On Thursday last week, NTA Director of Delivery, Rosanna O'Connor attended the official opening of a large new residential theurapeutic community in Northern England. Withnell House is situated in Chorley in rural Lancashire and was developed by Inward House projects with support from DH Capital grants.

During her visit to the region O'Connor also attended a graduation ceremony for problem drug users in a small urban centre in Stockport, Cheshire. The facility is run by the Alcohol and Drugs Abstinence Service (ADAS) who with support from DH Capital grants is also opening another facility in Rochdale, Lancashire.

O'Connor told the press that:

"The NTA is committed to choice and improving Tier 4 provision is a key part of our Treatment Effectiveness strategy. At its best, Tier 4 service provision can provide effective responses to drug misuse in treating people whose use has been long and heavy, and people with complex needs. It can also enable drug users to move towards long-term abstinence when and where appropriate."

"The aim of all drug treatment is to help addicts become drug-free, leave treatment and reintegrate into society. There is no one-size-fits-all answer to every problem drug user and that is why the NTA advocates a balanced treatment system to allow individuals to access the treatment they need from a range of clinically appropriate services," she added.

In September last year, the NTA issued new guidelines for purchasers and commissioners of residential treatment, urging Drug Action Partnerships to review their arrangements for prolonged and heavy drug users.

Tier 4 is a range of treatment services covered by one of around 20 work areas of funded NTA activity.

Tier 4 includes inpatient assessment, stabilisation and assisted withdrawal services, residential rehabilitation services and aftercare as defined by the NTA Models of Care (Update 2006).

In June this year, the Department of Health made available a further 11.8 million pounds of capital money for drug treatment services, and about one quarter of this capital funding will be earmarked specifically for expanding the residential treatment sector.

This is over and above capital allocations of 10 million in 2007/08 and 54.3 million specifically for Tier 4 provision throughout 2006/07-2009/10.

"Effectiveness of community treatments for heroin and crack cocaine addiction in England: a prospective, in-treatment cohort study."
John Marsden , Brian Eastwood, Colin Bradbury, Annette Dale-Perera, Michael Farrell, Paul Hammond, Jonathan Knight , Kulvir Randhawa, Craig Wright, for the National Drug Treatment Monitoring System Outcomes Study Group.
The Lancet, Early Online Publication, 2 October 2009
DOI:10.1016/S0140-6736(09)61420-3

-- NTA

Source: NTA.

Written by: Catharine Paddock, PhD
Copyright: Medical News Today
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