Everybody is talking about drug treatment these days. If the drugs czar, Keith Hellawell, is to be believed, it can slash crime, smash addiction and set thousands of drug users on the road to a morally useful life. His baby, Drug Treatment and Testing Orders, a pilot programme which offers crime-committing drug users treatment as an alternative to jail, has just celebrated its first birthday, and the government says that results so far are encouraging.
Over the next three years, £70.5m will be spent on drug treatment, with a view to increasing existing provision by one third. But what is actually on offer, and is the government right to hype it? There are a plethora of treatments available from the 551 drug services in England and Wales - in-patient detox, out-patient detox, rehab based on therapeutic, Christian or Alcoholics Anonymous-style 12-step programmes, and maintenance programmes, usually with methadone but also with synthetic drugs such as lofexidine.
Problem drug users are hooked either on opiates like heroin or on stimulants like crack, although more are becoming addicted to both and may well have an alcohol problem to boot. Many programmes are aimed at opiate users and have long waiting lists, while there is a dearth of provision for stimulant or multi-drug users.
Reliable data on the effectiveness of treatments is hard to come by because those who drop out of treat ment programmes - or who never go near them in the first place - do not show up in the statistics. While some treatments undoubtedly work for some people, there are plenty of users who come away from programmes with a stock of horror stories.
Arthur, a methadone and valium user, was admitted to a detox bed on the psychiatric ward of his local hospital. The physical and mental pain of his withdrawal was punctuated by harassment from a naked psychiatric patient with serious mental health (not drug) problems and the witnessing of two attempted suicides by other patients on the ward.
"I relapsed. I'd had enough," he says. "It's the last place that you should be coming off the gear. Maybe in different surroundings it could have been OK, but I was back to square one within a week."
The department of health started the biggest ever study of success and failure rates - the National Treatment Outcome Research Study - two years ago. Now in its third and final year, it has revealed that almost half (48%) of opiate users who entered residential programmes are currently clean, with around one third of users who are on community-based methadone programmes abstinent at the moment. The results are encouraging - but the survey began with 1,075 users and now has 572. Presumably the outcomes for those who dropped out are less favourable and would propel the success rates downwards.
It's a similar story with smaller-scale programmes. City Roads, a detox facility which has 14 beds for users across London, asks residents if it can check up on their progress four weeks after release from the programme, which lasts two or three weeks. Those who say yes to follow-up are more likely still to be clean after four weeks than those who say no. "We have no idea what happens to any of them in week five or week 52," says Bob Baker of City Roads.
Erin O'Mara, 30, has been a heroin user for 14 years and is currently receiving methadone prescriptions from her GP. After countless treatment regimes did not work for her, she decided that the best person to help her reduce her drug taking is herself. "I felt so relieved when I got off all these programmes and began to take back control of my life," she says. "You may as well have an invisible prison around you on a programme because you're not allowed to go away for a few days or deviate from this totally unreasonable contract they give you. It feels like signing your life away."
O'Mara says the fundamental flaw of existing treatment programmes is the attitude of those running them - junkie stereotypes are perpetuated, and it's easy to fail, feel worse and end up using more drugs in search of oblivion. "Everything you say is a lie because they assume you always want to cheat," she says. "You have to prove, prove, prove everything. I started to take drugs when I was young. I said I'd have fun for a few years and then buckle down and get back to work. But what I didn't realise was that society doesn't let you back in. You're tainted, and you spend your time internalising all the negative things they tell you about yourself."
O' Mara speaks of a friend who wanted to get an extra day's methadone script because he had to go to the dentist to have a tooth extracted at the same time as he was supposed to pick up his methadone. His clinic told him that he could only get his drug after he brought his extracted tooth along as proof. Another illicitly used heroin while she was on a methadone programme, and was so terrified she'd be caught that she considered burning off the fresh track marks on her arm with a lighted cigarette.
A third arrived at his clinic late. They locked the glass door on him, and a member of staff waved his script at him before tearing it up. "We're all treated as scumbag junkies," she says. "Some users fit that description but there are plenty of kind, special people in the drug-using world. If you go into the House of Commons you can find plenty of scumbags there, but they don't get treated the way we do."
So many of the stereotypes don't hold up, she says. "We're portrayed as hanging around outside schools hoping to get children hooked. But I don't know a single person who has done that. It's junkie etiquette never to give a person their first fix."
As for detox, she shudders at the memory: "You have to be almost dead before they let you in. By the time you go to a place like that everyone else has dumped you, you're perceived to be an abject failure and treatment is punishment."
O'Mara's mother Wendy has supported her daughter since she began using heroin; she too is appalled at the attitudes of those meting out treatment. "The centres are places of reprehensible attitudes and unbridled, unregulated power for psychiatrists and psychiatric nurses and powerlessness for the users," she says. "The system of sanctions backed up by punitive regimes is unsustainable in moral, ethical, scientific and economic terms."
Jill Britton, a policy officer at the Standing Conference on Drug Abuse, accepts that the attitudes and quality of some drug treatments leave a lot to be desired. Her organisation, along with Alcohol Concern, is about to launch quality standards for drug and alcohol programmes. "It is important that they work with users rather than impose treatment," she says.
Chris Drouet, 50, also on a methadone programme, is cynical about therapies used in rehab: "You are encouraged to talk to a chair and pretend it is your mother or say your goodbyes to a dead person - a pile of cushions under a blanket. These exercises become competitions in who can cry the most. You are so close to leaving because your body is screaming for a fix. They pull up all this painful stuff about your past and then expect you to walk out of the door. I know of people who have committed suicide after leaving rehab. One guy came out and was found soon afterwards with a syringe in his arm, several cans of Special Brew by his side and a plastic bag over his head."
For O'Mara, the key to the new-found tranquillity in her life and the stabilisation of her drug use with prescribed methadone has been belated self-belief - the realisation that her views are just as valid as those of the professionals who criticised her.
If Hellawell's treatment solution really is to work, then listening to users, respecting them and moving away from junkie stereotypes is as essential as putting money into programmes. "No more bad girl, naughty girl, not good enough, fail, fail, fail," says O'Mara. "I will not be squashed and humiliated any more."
&#'149; O'Mara and Drouet are members of North by North West, a branch of the English National Drug Users Network. Info: 0181-986 5475.