Addictions: Statistics and Systems

StatisticsLet me start off by saying… Bravo Scotland, the only UK nation where the alcohol related death rate has dropped this century…

But, as the Office of National Statistics have highlighted; these ‘shocking’ numbers are still twice those in England, where death rates actually rose.

Each death represents a life cut tragically short and many more scarred by loss. Every alcohol-related death is preventable and we should not be seeing these high numbers. (Alison Douglas – Chief Executive, Alcohol Focus Scotland)

Statistics & Stigma

I’m always concerned about some people’s prominent fixations around statistical information, almost to total exclusion of any other measurement process. Our politicians, the media and sadly, too many public sector managers, are prone to statistical love-affair traits. Despite the validity of data collation as a worthy business tool, without recognition of many other diverse factors, there is always a danger for creating perverse outcomes. Especially where organisations (and their managers) develop their business direction and purpose on the basis of statistics alone.

But all the above said, how do we also try to address the disparity of opinion (and stigma) which abounds and festers around alcohol consumption, whether those individual behaviours happen to be problematic, or not?

A recent piece at The ConversationAlcohol deaths in the UK – written by Ian Hamilton and Harry Sumnall, provided some observations on why these death rates are still… “the second highest since records began.”

It may be an inconvenient truth for politicians, the alcohol industry and those of us who enjoy a tipple, but alcohol is a toxic drug and its greatest harms are not spread equally in our society. If this situation is to change, then the alcohol industry must exert less influence over policy – easy to say, harder to realise. (The Conversation)

Overall, the ONS data has clearly shown that – UK alcohol consumption has decreased by 18% since 2004 – however; Messrs Hamilton and Sumnall also point to the fact, “this masks a significant increase in use in the heaviest drinkers” which in part, helps to explain some of the increase in deaths.

Addiction Services Delivery

Just like Hamilton and Sumnall – and I suspect many others of similar mind – I too worry that the ‘tools’ and systems that we use, to combat the alcohol-related harm in our society, are not only inadequate (in some respects) but also, they are “increasingly under threat.”

…there is little or no alcohol prevention and education work taking place in schools and further education; fewer GPs are screening new patients for high-risk drinking; and since 2012, alcohol and drug treatment services have faced an average 30% cut in funding. All of this has led to a costly burden on the NHS. (Hamilton & Sumnall)

If we assume that our society holds some genuine desire to (socially & politically) address the many of the problematic issues associated with ‘excessive’ alcohol (and drugs) consumption; why then the decline in our treatment and support services? Is the issue not a priority? Do we (as a society) really care?

In a slightly off topic but related recent article – Another drop in the number of young people in drug & alcohol treatment – Russell Webster, an independent consultant on substance misuse and crime, offered a succinct observatory conclusion.

It is dispiriting to cover yet another report in the social care sphere where the most obvious conclusion is that the public spending cuts associated with austerity have resulted in vulnerable people no longer able to access the services they need. (Russell Webster)

I recently wrote about some of the political impacts for addictions support services. Again, I’m not alone with my concerns. The vast majority of front-line treatment services are rightly demanding an end to all the “ideology-driven policy” so we can save lives (see below).

The number of drug-related deaths have nearly doubled in less than a decade. It’s no coincidence that these appalling figures show some correlation with government funding strategies. Current national/local policies governing our drug and alcohol treatment services also have an impact. The removal of centrally ring-fenced budgets (2012), transferring public-health service responsibility to local authorities, also presented additional and (arguably) negative impacts for those services.

Slightly off topic but still connected; the (small p) political ideology, along with KPI measurements for ‘success’ – that are (mostly) based upon people achieving outright abstinence – also created negative impacts for many lifesaving harm-reduction efforts.

At the risk of mounting my well-worn soapbox; dictatorial removal of any personal choice for ‘recovery’ from addictions (and the resulting outcomes), is simply wrong. Not only is it wrong but also… it doesn’t work.

One of the few bright spots for which the prohibitionists can present some supporting evidence is the decline in “alcohol-related deaths” during Prohibition. On closer examination, however, that success is an illusion. Prohibition did not improve health and hygiene in America as anticipated. (The Cato Institute)

The failed War On Drugs, along with the past [American] mostly politically motivated prohibition ideology, unfortunately still underpins some British strategic policy. Add this fact to the prominent and evident moral-superiority or virtue-signalling in society and it’s mostly understandable that we have [strategically] created counter-productive systems.

Systems & Impacts

The ‘system’ is nearly always where you will find the root cause of so many of the problematic issues, ‘unintended consequences’ and ‘perverse outcomes’ that impact our social support structures. But little changes, could there be some elements of the Dunning-Kruger effect at play here? Surely the ‘experts’ know how to do what they’re expected to do… don’t they?

Systems Thinking

In my experience, we rarely apply any System Thinking to our service delivery in our public services, at least not with application of long-term strategy or vision. The perverse outcomes from short-term cyclic contracts for commissioned services, evidenced many of these issues. As a consequence, organisations can end up actually delivering lack-lustre outcomes – results that lurch between the highs and lows of variable priorities, based around elements of silo-thinking and organisational parochialism.

Many of today’s clinical and social support functions are delivered by a mixture of ‘official’ (commissioned) and voluntary agencies. We now have organisations that (supposedly) operate as ‘partners’ – to deliver supportive services for our society. But, are they all focused upon that ‘common good’? Are they always improving the lives of individuals, or our society as a whole? Rather than working to enhance organisational ‘worth’ within that process or worse, could some individuals in the workforce actually be working towards personal career aspirations in the system?

I’m not convinced that some of the above issues aren’t presenting negative impacts within the service delivery of our systems. But, systems thinking provides us with a more holistic analytical process, one that allows us to properly evaluate what it is we are trying to deliver. By focusing upon how the constituent parts of ‘the system’ interrelate with each other – within the context of larger systems – we can start to improve those services.

There are many individuals, working within addictions services, who display masses of drive and conviction with undoubted purpose however; too often their enthusiasm for the task at hand gets diluted in management failings. But any workforce delivery and ‘purpose’ is also (often) impeded by external factors. Many of the ‘core tasks’ can and do get sidelined.

Sometimes, they aren’t even [adequately] factored into the organisational commissioning processes. As a consequence, expended ‘effort’ doesn’t always get effectively measured. But worse, sometimes the service process is obliged to waste inordinate resources, that feed the the voracious business appetites of external and remote entities. Rather than being able to effectively deliver their own ‘core’ functionality and sadly, this is usually to the detriment of those individuals who are looking for some support.

System Working Together

As with many of today’s social problems, resulting from fractured politics and self-interested silo-thinking; some organisations that are tasked with providing addictions treatment and recovery support services – just like the politicians – would really benefit from the application of some joined-up systems thinking (and improved partnership working). If they really want to enhance and improve service delivery!

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