THERE'S NO EASY FIX FOR DRUGS PROBLEM

ABSTINENCE

"The advantage of being clean and sober is that you can do anything
you want in life, except drink and take drugs," says Dr Alasdair
Young. "If I am on methadone, I can't practice as a doctor, I can't
drive a railway train. You might not want me as your car mechanic or
teaching your children in school.

"It also causes problems if you want to go on holiday. It's not a
normal lifestyle. The idea that people on long-term methadone live
perfectly normal lives is wrong."

Young is an addict psychiatrist who most recently worked at Castle
Craig, a residential hospital treating drug and alcohol dependency in
Peeblesshire. He thinks the only viable solution is abstinence.

Of course it's not a new idea. The "Minnesota model" and the
fellowships associated with it, such as Alcoholics Anonymous, has
been around for more than 50 years. Young believes it's not been
taken up here because methadone is seen as a cheaper alternative.

"Abstinence is perceived by politicians as an expensive option and
it's true over the six weeks or six months that an individual is in
treatment it's probably more expensive than simply putting them on
methadone. But if after that they are clean and sober, they are
costing the state nothing compared to 15 to 20 years on methadone -
and those costs include the medication, the cost of supervising them,
and the fact that they're unlikely to work so don't contribute to the economy."

One of the prime figures in Scotland's drugs fight also believes that
an abstinence option should be made more available.

Tom Wood, Edinburgh's drug tsar, has said he would like to see the
abstinence model being given more prominence in the whole of Scotland
- - and he's keen to see a pilot set up in Edinburgh.

But abstinence - a physical residential detox with counselling on how
to survive, followed by support back out in the community through
fellowship meetings - does sound suspiciously naive.

"It is a simple idea," agrees Young. "But it's not easy. It's
uncomfortable, painful, frightening and undignified."

And he says it's not just a matter of detoxing people then throwing
them back out into a situation where old temptations still lurk.
"Detox is about safety, it's getting people clean and sober, but it
doesn't allow people to stay that way. You have to go on and teach
them how to do that."

Abstinence is also claimed to have a high failure rate compared to
methadone but Young does not accept this. "Do you know what the
failure rate for methadone is?" he asks. "The difference is that the
people who try to teach abstinence tend to measure their success in
terms of total abstinence, while harm minimisation or whatever you
want to call it is measured in terms of arrests, or imprisonment, or
going to hospital."

He adds: "What we need is a groundswell change. If you go back to the
1750s, the use of alcohol and drugs was horrifically widespread. And
then the temperance movement came along. This didn't come from the
politicians, it was a public movement.

"It was very powerful in Scotland. There was a popular groundswell of
opinion which said enough is enough. It was dramatically effective.

"I don't want to rubbish methadone. There is no doubt that for some
people it has a place as part of their addiction career, but I think
even someone who chooses the long-term methadone pathway should still
be offered the option of abstinence from time to time." HEROIN PRESCRIBING

Martin Bonnar, service manager for Turning Point Scotland, which runs
a number of services in Edinburgh, including a needle exchange,
believes there may be some use for this idea which has been promoted
by former Scottish drugs minister Richard Simpson.

Bonnar says: "There is a small group of individuals who have been
through drug treatment and are still using it chaotically and still
at risk of overdose, injury and death. Because of that, if the pilots
from Canada, Switzerland and Germany are showing there are benefits
then we have to look at it."

Indeed, in one Swiss project in Bern, half the drug users on the
heroin programme had moved into work and away from the drug scene
after 12 months, while the numbers living on illegal income had
plummeted from 69 per cent to 12 per cent by the end of the same
period. The Scottish Drugs Forum also believes that heroin
prescribing could be the way ahead - for some addicts.

Director David Liddell says: "Scotland should have its own pilot on
heroin prescribing because we have one of the largest heroin problems
in the UK - there are an estimated 51,000 problem drug users here, of
whom nearly 23,000 are injectors.

"There seems to be strong evidence that heroin prescribing can work
by helping people who have failed to engage with other treatment
programmes and who would otherwise have no contact at all with services.

"Some may argue that the Scottish public is not ready for such an
approach. Yet the people of Scotland - drug users, their families and
the communities where they live - are desperate for new solutions. A
pilot in Scotland could establish the facts so that the public could
see for themselves the benefits of this new approach." STICKING WITH METHADONE

The problem some - including addicts - see with methadone is there is
no reduction programme and their lives are stuck as a result because
they are still regarded as addicts by potential employers.

Bonnar says: "Until about five or six years ago, the concentration
was on controlling infectious diseases... HIV, Aids, hepatitis. The
focus was on getting people away from high-risk behaviour. Methadone
was very effective, but recently we have started to ask: What happens next?

"If there are a number of reasons why people take drugs, we need a
menu of options. Every drug treatment which is available will benefit
some and not others. In the end it might not be about being
drug-free. It may just be having a stable lifestyle - which is what
methadone does."

David Liddell adds: "The evidence is people often choose to withdraw
from substitute drugs when other aspects of their lives start to come
together - housing, relationships, education and training. Treatment
is only part of the equation - a high degree of motivation and
crucially, optimism about living a life without being drug-dependent
is as important, if not more so.

"The problem in Scotland is that the credibility of methadone as a
viable treatment has been undermined by the failure to provide the
essential support measures to make it work properly. It's like buying
a bike without wheels and complaining it isn't working."

Certainly it doesn't seem possible to judge how successful the
methadone programme in the Lothians - which costs around AUKP1.5m a
year - has been.

According to NHS Lothian there are no success rates for those on
methadone, because such information is not recorded in a direct
fashion. Director of Public Health and Health Policy, Dr Alison
McCallum, says part of the problem is that what GPs hope to achieve
with patients on methadone varies according to their needs, but that
things are set to change. "If you talk of 'cure' in relation to drug
use, you set yourself up to fail which is similar to any addiction,"
she says. "GPs have been operating a relatively new system over the
last two years which they use to monitor improvement rates. But this
is done on an individual basis and information is not collated formally.

"But a single shared assessment form between NHS Lothian, local
authority services and the voluntary sector is in the process of
being piloted. This will enhance assessment processes and
communication between services working with drug users."

Ultimately it's hoped this will show what does and doesn't work for
patients on methadone. HOW RECOVERING ADDICTS CAN PROGRESS

TRANSITION, based in Blair Street, is one of the new breed of drugs
agencies which look beyond just stopping people injecting street heroin.

The organisation, which has been running for three years, is designed
to get recovering drug and alcohol addicts into work or further education.

Manager Sian Fiddimore explains: "The idea is that when they come
here they are no longer using. Although we have people here on
scripts of some sort - the majority methadone - they are stable. And
we have people who are clean as well.

"We are partners with Jewel and Esk and Telford colleges and offer
accredited qualifications. The idea is that they come here to get
some structure to their lives and progress to further education.

"In the last 11 months we have had 326 referrals with 136 people
starting on programmes."

In the same time period, clients have collected 50 assorted qualifications.

Rather than a casual drop-in centre, Transition is structured more
like a workplace or a college course. Clients are required to turn up
at a certain time each day, or call with an explanation if they are
late. If they need time off it has to be arranged in advance.

Sian believes this kind of service helps push people towards a goal -
the kind of push that's not always evident on methadone programmes.

"I don't think methadone in isolation works. It needs to be coupled
with something like Transition. There doesn't seem to be a reduction
approach and often people want to move on in their lives."

However, she says there is some misunderstanding with methadone - all
Transition's methadone-taking clients are on low enough doses to
concentrate for a full day of classes. "The Scottish Drugs Forum has
recently issued a methadone leaflet which says in some circumstances
you can drive or operate machinery on methadone. People should be
taken on an individual basis." No-one's going to give you a job
knowing you're on methadone

SCOTT RUTHERFORD, 22, from the city centre is a recovering addict.

"It probably starts with my childhood. I was abused as a child
sexually. It only went on for a few weeks, though that's long enough,
obviously. I was 11 or 12. This guy was 17 or 18.

"Around about the same time my mum and dad told me my dad wasn't my
dad, he was my stepdad. I didn't get on with him after that. As soon
as I was 16, I had to leave. I started to get involved in alcohol.

"I had a job at a car showroom on Seafield Road and I packed that in
and went to Glasgow, and went to live in a hostel with 260 other people.

"There were these guys who had lived in hostels for years. They knew
the streets. I wanted to be one of the boys. I started trying heroin.
I smoked it for a week, then I went straight on to injecting.

"I funded it by begging. I used to dress so that I was quite clean
and respectable and put a couple of rucksacks on my back and
pretended I just needed my bus fare to Dundee or wherever. I'd stay
until I got AUKP60 to AUKP70."

This continued from the age of 17 until Scott was 20. He also stole
from shops and his family to fund his habit.

"I have been in prison several times, for house-breaking,
shoplifting, theft, fraud, breach of the peace through my alcohol
use. I used to spend AUKP40-AUKP50 a day on heroin. The rest would go
on stuff like cream cakes and cigarettes - the usual stuff that drug
addicts eat when they are off their face.

"I'm eight and a half stone - it's the heaviest I've been for years.
I was 19 when I first asked for help."

So began a string of attempts to come off drugs, including methadone.
"I was prescribed 70ml of methadone but within eight days I was up to
110ml. I just kept asking to go up and they just put it up because it
shuts you up."

He moved back to Edinburgh seven weeks ago and is still determined to
get clean - although now he is battling with his doctor.

"The doctor is adamant if I come off methadone I will go back on
heroin. But I'm attending Narcotics Anonymous and Cocaine Anonymous
meetings and I want to do the 12-step recovery programme and I want
to be clean.

"I tell the doctor I want to come down 10mls a week and she writes me
a script coming down 5mls a fortnight. I think it's stopping me
getting clean. It's holding me back from a decent lifestyle. I want a
job, and in a few years to have a wife, kids, a house, a car.
Methadone holds you back.

"You have to declare that you're taking it to an employer because you
have to get away to pick up your script. No-one's going to give you a
job knowing that.

"There's a whole attitude towards addicts. There is no respect for us
at all. I used to say people looked down on addicts, now I say they
don't look at us at all. [People in authority] speak to you as if you
are a piece of s*. It's horrible, I don't think they know how much it hurts.

"I'm in touch with my family and that's pushing me to get clean -
that my family are giving me a chance.

"I've got two things to say on the [prescribed] heroin idea. It would
be safer, cleaner and more hygienic, but I believe it would have just
given me an excuse to use. I believe it would create users and
increase their use."