Drug and Alcohol Findings update

Mike Ashton writes: From today issue 2 of the Drug and Alcohol Findings magazine became available free of charge as downloadable PDF versions of the published content. Access the entire issue from here or by clicking the BROWSE MAGAZINE link on the home page; search for documents on specific topics or by clicking SEARCH BY TOPIC on the home page.

From within the as-published files, those who want to dig deeper can access Word and PDF versions of the unpublished background texts with full references and often substantial extra information. After in issue 1 analysing the world's most prominent alcohol treatment trial (Project MATCH), in issue 2 we moved on to the UK's most important drug treatment evaluation - NTORS, the National Treatment Outcome Research Study.

"You've done NTORS proud" said Dr John Marsden, an NTORS researcher, but as well as recognising its strengths, we raised significant queries. Conceived at a time when a hardline health minister was querying the value of addiction treatment, NTORS' headline '£3 saved for every £ spent' estimate defended existing services and underpinned substantial later investment in treatment as a cost-effective anti-crime measure.

But both sides of that equation rested on highly questionable assumptions. The most serious were:

1. The '£1' spent on treatment was not as most people assumed the full cost of the treatments NTORS studied (£3 million), but the EXTRA cost (£1.6 million) compared to treatments undertaken the year before. The underlying assumptions were that spending the same amount again would have had no further impact, and that the previous treatments made no contribution to the cost-savings. The first assumption alone nearly halved the costs against which the benefits were compared.
2. The '£3' cost savings consisted largely of the value of stolen property. Effectively the assumption was made that these losses were a loss to society as a whole - yet some parts of society benefited in the form of cheap or stolen goods. Economists call these 'transfer payments' and cancel them out when it comes to calculating the net loss to society. Because these were the proceeds of crime, NTORS decided not to treat them as transfer payments, considerably inflating the cost-savings side of the equation.

There were benefits which NTORS did not include in its calculations, not least the value of the lives saved and the distress and disease averted. These might have tipped the balance so far to the savings side that the queries raised above would have been insignificant. But did the calculations made by NTORS really show that treatment was cost-beneficial? Nowhere near as conclusively as most people think.

Also in issue 2, studies of arrest referral which informed the criminal justice initiatives so prominent today, and far-reaching findings on the prevention of substance use problems in the young, including rare instances of harm-reduction education. As a bonus, the 'Nugget' COMMUNITY MOBILISATION includes a link to the later review of one the featured studies - the highly influential Project STAR.

Finally we record our gratitude to the Pilgrim Trust which has joined the J. Paul Getty Jr. Charitable Trust in enabling us make these publications available to you free of charge, and to develop the Effectiveness Bank which will enable you to search through them and through source research papers to help improve the effectiveness of drug and alcohol interventions.