Taking away benefits

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.

Not just a young person’s problem

Yesterday the media gave some coverage to a new report by Public Health England detailing the numbers of people in alcohol treatment.  In particular they picked up on the fact that increasing numbers of women over 60 are in treatment than were five years ago, compared with women under 29 where less are in treatment.  The same also holds true for men, but with slightly smaller fluctuations.

If you read my blog regularly you’ll know I get fed up with media stories about young people binge drinking.  That’s not to say there aren’t alcohol problems in young people, because there are.  However, there are problems in older people too, and these are rarely reported, which is why it was good to see so much interest in the figures.  I did seven media interviews yesterday alone on this topic, which gives some indication of the prominence it received, although most of these were in the morning/early afternoon, and by the evening, the story had dropped off the headlines and the websites.  However, something does remain:  for a taster, only a couple of minutes long, listen here to my interview with Sarah Montague on Radio 4’s Today

Radio 4: Addiction, part of the Summer Nights Series

I love radio, because it tries things out which television never would.  Radio 4 have been running a late night series at 11pm called Summer Nights, where each episode is a live discussion for an hour with a handful of guests in the studio.  I went along on Friday night to discuss addiction.

 

The production team had put a really good mix of people together.

James Nicholls is from http://alcoholresearchuk.org/  (I’ll admit a conflict of interest here as they fund my work).

Professor Andrew Samuels http://www.andrewsamuels.com/ is a psychoanalyst.

Sam Willetts is a poet with more prizes than I can list here, and recovering heroin addict http://www.poetryfoundation.org/bio/sam-willetts

Tim Sampney runs Build on Belief, a service user’s charity in London http://buildonbelief.org.uk/

Dr Richard Graham, a child and adolescent psychiatrist runs a clinic for internet addiction at the Tavistock and Portman  http://www.tavistockandportman.nhs.uk/ .

We were also joined from the BBC studios in Birmingham by Tanya from Overeaters Anonymous,http://www.oagb.org.uk/ ,  who has struggled with alcohol and food addiction.

Mariela Frostrup hosted us, and although I’m not sure whether we set the world on fire, we did at least have a good go at lots of different areas.  As I left Broadcasting House I thought how ambitious it was to try and cover subject like addiction in an hour.  We possibly raised more questions than we answered, but that’s the point of addiction – nobody really, truly understands what it is or why it happens.

The link if you’d like to listen is here  http://www.bbc.co.uk/programmes/b0388lr1

It’s different for girls

Here’s a piece I wrote for Druglink magazine about the differences between men and women when it comes to alcohol.  If it’s something you’re at all interested in, please do read it – I tried to summarise most of what we know, but in an accessible way.  It also contains a quote from the marvellous Dr Jane Marshall, a psychiatrist specialising in alcohol and women.  If ever I got ill with alcohol problems, she’s the person I’d want looking after me.

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Minimum Unit Pricing – my view

I think of myself as a libertarian.  I think there are areas of life where the state has no right to interfere, and that individuals are just that, individuals, with differences, and the right to behave differently.

However, on minimum pricing I have to ditch my philosophical position, in favour of the pragmatic, for what good is a philosophy if it doesn’t reflect how we should actually live?

The evidence that minimum unit pricing for alcohol would save lives is overwhelming.  There are now over 100 studies which have been analysed and re-analysed.  Some of these are natural experiments, where government changes in taxation both up and down have led to an inverse increase or reduction in alcohol related harms.  Others were set up as formal experiments, to see what would happen. And the results?  For every 10p the price of a unit of alcohol goes up, harms reduce by 5%.  The alcohol industry argues that these studies weren’t randomised controlled experiments, so don’t count as evidence.  This is exactly the same argument the tobacco industry used to use about the link between smoking and lung cancer.

The libertarian in me says so what?  It’s up to individuals whether they harm themselves or not.  But that’s where alcohol is so different to many drugs.  It causes harm not only to self, but also to others, in the form of accidental injury, increased rates of anti-social behaviour, domestic violence, family conflict, lost days at work, to say nothing of the cost in pounds sterling to the NHS, to the police force, to the courts system.

And the argument that minimum pricing will punish responsible drinkers is a nonsense, a total nonsense.  Go onto any supermarket website and do the maths.  It’s Tennents Super, Carlsberg Special Brew, and own brand strong ciders which have a unit price of less than 40p.  These are not drinks that responsible drinkers drink, but they are the drinks of the homeless, those who live in hostels, and the alcohol dependent.  In other words, the people most at risk of alcohol-related harm.

So, against all my principles, yes, I support minimum pricing.  There’s no debate really.

Radio 4: Constant Cravings – Does Food Addiction Exist?

Thanks to everyone who contacted me with comments about Constant Cravings, a documentary I presented on whether food or eating can be addictive, which was broadcast on Radio 4 this week.   I’ve answered all of these comments privately. 

The link to the programme is here http://www.bbc.co.uk/programmes/b01s4g7v.  Thanks also to the excellent producer Rami Tzabar, and to the people who took part in the programme, for making the whole process such an incredible experience.  The similarities between some of those struggling with food, and those struggling with alcohol are really striking.  After researching it for the programme, and talking to experts as well as those who are overeaters, I instinctively come down on the side of food addiction being a reality for some, but not all, of those with eating disorders.  But the science isn’t there to support it.  Yet.

Hidden

Yesterday I presented some work I’ve been doing to colleagues involved in alcohol research at the Institute of Psychiatry.  A lot of our research is concerned with treatment of people who have serious alcohol problems, or involves looking at how health services can intervene appropriately when someone has an alcohol problem.  The work I presented looks at a slightly different group – women with children, who may not be drinking so much that the wheels are coming off, but who are drinking to the extent that it is starting to affect their lives, and the lives of their families.  The interesting thing about this group of women is that it’s really hidden.  Excuse the generalisations, but in the main, these women may have an understanding that they are drinking too much, but they remain very wary of asking for help or support.  There is a huge anxiety that by doing so, the full might of social services will come down on them, and in a worst case scenario, their children will be taken away.  So, they battle their demons alone.  Some normalise their drinking, and deny to themselves and others that they have a problem.  Secrecy breeds shame, and shame triggers drinking.  Some try to cut down or quit, and find themselves in a cycle of binge/quit/shame (shame again…. will we ever escape it? )  Some turn to the internet and the anonymity of chatrooms to explore whether there is help available, but only under pseudonyms.  There they find support from others in the same situation, and the peer-to-peer advice, while powerful, is sometimes contrary to what we know is helpful.

There is an argument often put forward that this group of women do not need as much help as women whose alcohol problems have developed into something more serious, but I would argue that we need to take a both/and approach.  Treatment is absolutely vital for women who need it, but earlier action to help women on a pathway to serious problems would mean less reach the stage where treatment is necessary.  If we could find a way to reach these women and offer them support and anonymity, we could make a difference.  Perhaps this is an area where official bodies should be looking at a way to work with that powerful peer-to-peer mechanism to get the right advice and support out there, with respect for anonymity.

It’s a hugely problematic question – do you guarantee anonymity and reach many more people but perhaps miss instances of child neglect, or do you carry on as is, with social service involvement and child protection taking centre stage, but perhaps miss different instances of child neglect?

I don’t know where I stand on this one.  We simply don’t know how much harm stays hidden because we don’t provide anonymous help, but nor do we know whether more harm would be caused if we did.