The government are considering taking benefits away from people with drug and alcohol problems, and those with obesity, unless they go into treament. Full story here http://www.bbc.co.uk/news/uk-31464897 This blog is much longer than I usually would post, but bear with me, there’s a lot of reasons why this idea is a nonsense.
1. We know that genes, environment and social factors all contribute to whether a person drinks too much/takes drugs/can’t control their weight. In other words, some people are more vulnerable than others. I recently looked at a sample of women who drink too much coming before the family courts. 71% had a history of psychiatric problems, inclding 58% who had attempted suicide. 23% of them had been in local authority care when they were children. 87% had experienced domestic violence. And we think the solution for these women would be to dock their benefits?
2. We know that under austerity measures all treatment services have had funding cut by local authorities over the last 4 – 5 years. In my role as a trustee of a charity which provides such treatment services http://blenheimcdp.org.uk/ I see how we are being asked to provide more and more for less and less.
3. So treatment services, currently undervalued and not a priority, are suddenly going to have to gear up to treat a new wave of people who CRUCIALLY do not currently want to be treated. In addiction treatment, the common model is called the Prochaska and DiClemente Cycle of Change, and it involves working with clients to find out where they are on a cycle of motivation. People who have been coerced into treatment do not do as well as people who have come into treatment of their own free will. You don’t have to be a rocket scientist (or an addiction scientist) to work out why. And for women with children going into treatment can be an extremely unattractive option – who is going to look after your children when you’re in treatment? Will they go into care? Will you lose them through the courts while you’re trying to address your problems in a system which is underfunded, without the resources to treat you properly?
4. Addiction is often described as chronic and relapsing. Chronic means long-term – this is not something people get for a few weeks, then go into treatment to get fixed, then come out again and all is fine. Relapsing refers to the fact that even after years of non-use of alcohol or drugs, people may slip back into addiction. Recent high profile cases include Phillip Seymour Hoffman, and Robin Williams who checked himself into treatment not because he was drinking again after years of not doing so, but because he was terrified that he would. It’s a myth that treatment works well for everybody. I see people in services who are back for the seventeenth, eighteenth time. The inspiring thing about these people is their resilience. It takes guts to keep picking yourself up and keep coming back, desperately hoping that this time you’ll be able to make it.
4. Governments very rarely take action to address any of these issues from prevention, yet there are some things we know would be effective in driving down rates of addiction and obesity in the population as a whole. These include measures affecting price and supply such as minimum unit pricing for alcohol and a sugar tax. WE HAVE ENOUGH EVIDENCE NOW TO KNOW THAT THESE WORK. In countries where they have been introduced, related problems have dropped, droppped, dropped.
5. And if goverments can’t do the easy things, listed above, then how bad are they when it comes to other prevention measures? Think back to my first point, and although it’s crude, let’s characterise a woman from my recent study who was drinking excessively: in care as a child, mental health problems, having experienced domestic violence. We’re rubbish at tacking social problems such as these – look at Rotherham as just one example. So, we punish those we’ve let down by taking away the safety net we promise to provide for those who are in trouble?
It might take a generation to see results, but if we start looking at causes, and putting our energy into that; plus if we gear up treatment services; rather than taking little bits of money away from people we have by and large failed, who knows? We might actually start doing the right things.