Burgered: Quality of Life and Addiction Treatment

Mike Ashton is continuing to update this paper and later versions will be available from da.findings@blueyonder.co.uk

The author is grateful for the comments and encouragement of Peter McDermott, Gillian Tober, Jon Derricott, Maggie Rogan, and John Witton.

Sample extract :

Would you rather be feeling and functioning well and having the odd glass of wine or snort of cocaine or abstinent with a poor social life and feeling bad? For most alcohol or drug treatment outcome studies, it's no contest. Rarely do these forefront what matters most to the patient their quality of life as they define it. Such measures are especially rare in relation to illegal drug users (Graham et al, 1999). Instead the focus is on the outcomes that matter most to the broader society eliminating illegal drug use, reducing crime, and curbing the burden placed on medical and law enforcement systems. This would not be an issue if in practice objectives coincided and national and local target-setters, services, and service users were pushing in the same direction. We know little about this, but the little we do know indicates that often this is not the case. Realising this casts an entirely new light on 'poor' outcomes as such as 'relapse' after detoxification, 'drop out', and the 'inability' of methadone services to prevent their patients continuing to use heroin. Seen as signs of failure by the services and their funders, from the client's point of view these outcomes may be generated by a successful co-option of the service in the pursuit of their own agenda. Using the client's assessments of their quality of life as a yardstick would often give a very different impression of well a client has done and how well a service is performing. For national policymaking, the implications of this simple and unsurprising observation are profound.

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This is very much a work in progress. Comments welcome. Correspondence to mike.ashton@blueyonder.co.uk