15th March issue

American dream

Let’s stand back and share the view

President Obama’s drug strategy team has a monumental task on its hands if it is going to change the culture of addiction treatment in the United States. Visiting London this week his deputy drug czar, Thomas McLellan, explored some unpalatable truths. Incarceration has been shown to be as ineffective a ‘solution’ for addiction as it is here. Prevention and screening are non-existent or missing the mark. Options for recovery have been hampered by prejudice against essential types of treatment and medication. GPs are ignorant about addiction or not interested enough to make referrals to specialist services. It all sounds very familiar, yet if Professor McLellan has his way there will be change afoot and a determined campaign to broker a marriage between addiction services and mainstream healthcare. At the heart of this is the vital recognition that treatment cannot be effective without follow-up support, and the initiatives will also reach right through the prison service to make sure prisoners get the vital preparation for community life right up to their release. During our conversation, he drew on evidence that showed the massive difference that treatment and support made to prisoners in preventing them from returning to jail within a year. Of course we know all of this in this country – don’t we? So why don’t we see prison drug treatment and community integration as essential – in economic terms as much as for humane reasons? Why aren’t all our GPs well-versed in addiction, rather than just the good souls who take a special interest? Why aren’t we prioritising resources for young people’s prevention and treatment when we know that this is the greatest ‘at risk’ period in life? It’s a brave step to declare that all parts of the healthcare field, including addiction, need to work together with a shared aim – then to do something about it. It’s a dialogue we could learn from if we share the common goal of recovery

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