Review of NICE Guidelines – Drug misuse psychosocial – some comments from stakeholders

The original document is life-threateningly flawed and must be reviewed – Here are some comments that we have seen and agree.

Only 2% of people in the so-called treatment system are enabled to get drug free. This because the original document is life-threateningly flawed and must be AMENDED not merely updated/reviewed. In particular, Chapter 8 on Psychological Interventions omits 12-Step Facilitation which has been proven to yield the most clinically effective as well as cost effective service. 8.6.5 refers to “intensive referral” and links to 12-Step-based treatment programmes but it does not discuss the proven technique of 12 Step facilitation. Below is a list of only some errors.

Clause states that addicts who have had community-based psychosocial treatment cannot be referred to abstinent rehabs – thus fatally blocking continuum of care and sacrificing the principle of “first do no harm”. This clause has led to such incidents as patients being admitted to rehab after years on methadone and being found to have, despite reports saying no physical problems, broken clavicle and limbs, a stroke and vomiting blood

Point is erroneous in a related context when it suggests that referrals to residential treatment should be restricted to those who have 2not benefited from previous community based psychosocial treatment”. This contradicts the basis of treatment interventions being ‘person centred’ and flies in the face of experience which has shown clearly that gains from community-based psychosocial interventions can stabilise patients enough to be admitted to residential rehabilitation, leading to sustainable long-term recovery.

In Chapter 8 and elsewhere, there is no mention of the NHS’s own research on how amending existing therapeutic techniques even slightly to entice clients into free after/mutual-aid groups can save money and lives.

It omits mention of the eclectic therapeutic techniques developed by providers of “classic” recovery which can be used by rehabs and community and prison settings to encourage same, to enable addicts to sustain drug-free recovery and all the attendant benefits of rebuilding relationships, gaining work, reducing recidivism and breaking the generational chain of addiction and dysfunctional behaviours.

Residential and other treatment are not adequately compared, nor the different diagnoses of clients using residential rather than non-residential.

The current document does not provide a balanced set of guidelines to assist practitioners in delivery treatment focused on recovery. The Guidelines reflect the priorities of research rather than the effectiveness of psychosocial interventions. In particular, they are over weighted in respect of contingency management and poorly weighted in terms of 12-step based recovery. In this latter respect, even Prof John Strang commented: “Worldwide 12 Step Recovery is probably the single most commonly utilised pathway for recovery – both community based and also through specific residential structured 12 Step Recovery Programmes”. This is not reflected in the guidelines which instead rely on research studies on the effectiveness of contingency management while ignoring the experience of the millions who have recovered through a 12 step programme. It is not reasonable to ignore the experience of millions simply because they have not been subjected to selective ‘ double blind ‘ research.

Further the guidelines do not fully articulate the benefits of self help groups 12 Step or Smart ( which is not referred to ) to be of any use to practitioners again in contrast to the amount of space devoted to contingency management. This imbalance should be addressed in revised guidelines. The best research on this is collected in Circles of Recovery by Professor Keith Humphreys Due to the fatal errors and omissions in the first version of the Psychosocial Guidelines, psychological interventions with a track record of getting people off drugs have been excluded from commissioning and contracts, leading to loss of lives including methadone becoming the second-greatest drug killer in the UK. This preventable loss of lives has led to demoralisation across the whole spectrum of care in best-practice agencies which are denied the ability to give appropriate care, including NHS and tier 2/3 agencies as well as tier 4.


“It is palpably absurd that all the richest reserves of knowledge re the delivery of recovery-oriented treatment are ignored.” (plus comments within main section).

“It will be a travesty to the recovery agenda if these guidelines are not reviewed and take into consideration the wealth and depth of knowledge and experience from recovery providers who believe recovery is a reality and have evidence to support this.

“I find it very hard to understand that when the Government wants to focus on recovery, the Department of Heath / NICE exclude nearly all the smaller organisations with the most experience and proven success of delivering recovery. This will lead to a ‘Ratner’ style treatment field with cheap, poor quality treatment and more people suffering.”

“I wholly endorse the amendments to CG51 proposed by the Addiction Recovery Foundation. The Clinical Guideline Review (CG51) will be negligent and failing in its duty and objectives if it continues to ignore and exclude the type and scope of the recovery-based treatment provided by Tier 4 services.”

Addictions UK endorses this submission to NICE and thanks Deirdre Boyd of the Addictions Recovery Foundation for submitting our comments for us along with the other stakeholders. Addictions UK is a leading provider of Home based Addictions Treatment working throughout England, Scotland, Ireland, Wales and the Republic of Ireland. For further information telephone 0800 140 4044 or contact us

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