Drug 'rewards' given to addicts October 18, 2007 - BBC
Heroin and cocaine addicts on the government's treatment programme are being given drugs as a reward for clean urine samples, the BBC has learned.
The National Treatment Agency (NTA), which runs the £500m a year scheme, admits the practice is "unethical".
Its own survey of almost 200 clinics in England found users were being offered extra heroin-substitute methadone or anti-depressants for good behaviour.
The NTA said it wanted to see certain practices "squeezed out of the system".
'Best principles'
A third of clinics in the survey said users who produced a drug-free urine sample may be offered increased doses of heroin substitute as a reward - known as "contingency management".
A quarter admit that clients can choose the type of substitute drugs they want.
The survey also found clinicians offering anti-depressants, cash vouchers or access to detox as a reward.
The NTA said offering drugs for anything other than clinical need was wrong.
The agency's chief executive Paul Hayes told the BBC: "It isn't a practice we would advocate.
"One of the things that's important before we start rewarding people through things like contingency management is to make sure that we're doing it according to the best principles for drug treatment.
"There are a range of practices associated with drug misuse in this country that are not what we would want them to be.
"One of the reasons the NTA was set up wasn't only to expand the provision of drug treatment but was also to improve its quality."
'Very different'
He added: "It is entirely appropriate to prescribe other drugs alongside prescription drugs that are to deal with withdrawal. Not as a reward, which is why we wouldn't advocate it.
"What we would say is the dose people get ought to be determined by the individual's needs not by whether or not they're co-operating with the regime.
"That's why the contingency management programme that we're thinking of introducing based on American research is going to be very different to the ad hoc rewards that operate in not very well managed services in this country at the moment."
The drugs treatment project is the centrepiece of government strategy.
Only about 6% of users on the programme leave free of drugs each year.
However, there is evidence that giving addicts access to services can reduce crime and improve health even if they continue to take drugs.
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"Contingency Management", offering incentives for a particular behavior (e.g. money for clean urine) has been done time and time again, with (generally) very good results.
Since it is an established practice, current research usually focuses on what types of contingencies to offer (e.g. money, vouchers, good etc.) and under what terms and how often.
Making a blanket statement like : "users were being offered extra heroin-substitute methadone or anti-depressants for good behaviour" is absurd and does not take into account what is actually being done.
-------------------- ...the whole experience is (and is as) a profound piece of knowledge. It is an indellible experience; it is forever known. I have known myself in a way I doubt I would have ever occurred except as it did. Smith, P. Bull. Menninger Clinic (1959) 23:20-27; p. 27. ...most subjects find the experience valuable, some find it frightening, and many say that is it uniquely lovely. Osmond, H. Annals, NY Acad Science (1957) 66:418-434; p.436
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