UK DRUG REHABILITATION SERVICE IS 'COLLAPSING'

Private clinics struggle to get funding as government policy favours
less effective - but cheaper - methadone clinics.

Britain's rehab services are facing collapse. No fewer than 15 of the
UK's 100 rehab centres have closed in the past 15 months, despite an
increase in the number of people seeking help for addictions.

Because of changes in government health policy, private rehab centres
are finding fewer and fewer health authorities are willing to foot the
bill for addicts to have residential treatment, despite that fact that
it is much more effective in getting them off drugs, according to the
Addiction Recovery Foundation.

The Independent on Sunday learnt this weekend that a flagship rehab
centre - UKP 26m Winthrop Hall in Kent - is preparing to shut after
only one year of operation.

According to the latest Department of Health figures, 202,660 drug
users were seen by addiction services in England in 2007-08.

The National Treatment Agency (NTA) has spent millions of pounds
getting thousands more drug users into contact with addiction services
since it was set up in 2001. Yet last year only 3 per cent of cases
were referred to a residential rehab service, while two-thirds were
prescribed heroin-substitute medication by GPs and NHS doctors working
in addiction services.

Critics claim there are few long-term benefits of this
medication-centred approach. The majority of rehab services use a
version of the 12-step programme, and abstinence - becoming drug free
- - is the goal after four to six weeks of intense therapy. Clinics are
run by large companies such as The Priory or small charitable
organisations such as the Providence Projects in Bournemouth.

Up to now, rehab has been paid for by the drug abusers themselves or
their local health service. But, increasingly, government policy
supports putting as many addicts as possible into methadone-substitute
programmes because they are cheaper.

As a result, rehab clinics such as Winthrop Hall have become reliant
on private clients. The hotel-style addiction clinic was opened in
October 2007 by Jon Moulton, a venture capitalist and millionaire, to
provide specialist treatment in luxury surroundings for high-flying
City executives. But yesterday, staff confirmed that the UKP
32,000-a-year clinic is no longer accepting new patients.

Advocates of rehab say that the closure encapsulates the problem with
government thinking on rehab. They point to research by the University
of Glasgow, which found drug users who go through residential rehab
are seven times more likely to be drug-free after three years than
those who go to methadone clinics.

The Health Care Commission last week identified the low use of
residential rehab services as a weakness.

Dr David Best, from the Department of Psychiatry at the University of
Birmingham, said: "Commissioners have spent bigger and bigger slices
of the pie on harm reduction services at the expense of rehab, despite
the evidence that rehab works. Users now have to jump through so many
hoops to get there, it has become much harder, and rehab centres have
closed as a result. It's not because we don't need these services but
the system has become saturated in methadone clinics, which are a much
cheaper and easier way to 'treat' people."

Professor Neil McKeganey, director of the Centre for Drug Misuse in
Glasgow, said: "When we stop patting ourselves on the back and look
back on this period, we will see that this was a shameful dereliction
of our responsibility and we failed the majority of drug users by
keeping them locked into addiction. Drug services fail addicts,
contrary to official figures which report overwhelming success. Our
research shows that those lucky enough to get residential rehab are
seven times more likely to be drug free after three years. This is an
inconvenient finding for politicians and civil servants who have
preferred to support cheaper services that deal with large numbers of
people."

Anecdotal evidence suggests addicts who want to come off drugs are
often met with reluctance from drug workers. In some areas, primary
care trusts will only pay for rehab if the individual's health or
public safety is deemed to be in imminent danger because of their
chaotic drug use. And there are growing reports of desperate addicts
committing crimes as they try to convince the authorities to pay for
rehab.

The not-for-profit Providence Projects in Bournemouth was forced to
open its doors to private clients in 2005 after a drop in NHS
referrals pushed it close to ruin. Paul Spanjar, the treatment
director, said: "We get calls on a regular basis from friends and
relatives who are desperate because the user's primary care trust will
not pay for rehab. Don't get me wrong, there are great NHS trusts, but
in some areas it is impossible for an addict to get funding."

The NTA points to research that shows substitute prescribing reduces
dangerous injecting and crime rates among addicts. It also claims that
overcoming dependence is the ultimate goal of all treatment it
supports. Paul Hayes, the NTA's chief executive, disputes the number
of rehab closures and believes the proportion referred to rehab is
closer to 8 per cent.

Road to rehab: 'You must learn why you're an addict'

Andy Hayden, 40, a former addict, lives and works with ex-offenders in
in Weymouth, Dorset. He has been clean for five years.

"I started on alcohol, glue and gas when I was 12, but within a few
years I'd progressed on to anything I could get my hands on. At my
worst, my girlfriend and I spent UKP 600 a day on crack and heroin.
Eventually I ended up living on the streets, picking food up off the
floor, and was in and out of hospital with abscesses and cellulitis.

"About six years ago I suddenly realised that if I didn't do something
I was going to die. I went to the local methadone clinic and was
immediately prescribed 50ml 'maintenance' a day. This was enough, but
I told them I needed more so they doubled my dose. I still had no idea
what was wrong with me; we never talked about that. So I kept stealing
to buy drugs because while methadone stops you feeling ill, it doesn't
give you a high. When the clinic threw me out for using extras, my
addiction was even worse. Methadone is a horrible drug to come off,
much harder than heroin.

"In 2003 I heard about a project that sent prolific offenders into
rehab. I was so desperate by this point that I made up loads of
offences, just so that I'd get in. I was eventually referred to the
Providence Projects in Bournemouth and have never looked back since. I
know rehab is more expensive, but you have to learn why you're an
addict before you can stop."