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Peter Dunne Speech: Address to NZ Drug Foundation

Hon Peter Dunne
Associate Minister of Health
Speech Address to NZ Drug Foundation Symposium on Addiction Treatment Issues
Te Papa, Wellington 9.00am, Tuesday 30 August 2011

Good morning and firstly, welcome to Dr Tom McLellan, from the United States, and other distinguished visitors, and contributors to this symposium.

I would like to begin by congratulating the New Zealand Drug Foundation for organising this important event.

As a Member of Parliament, and also as a Minister, I get to meet all sorts of people.

Often in the course of my electorate work I come across individuals and families whose lives have been directly affected by alcohol and drugs.

Even after all this time, it is hard not to be staggered by the harm that someone's drinking or drug abuse can inflict not only on themselves, but on those nearest to them, or indeed even at times on innocent bystanders.

We need to convince people that no, they cannot just manage their alcohol or drug abuse by themselves, that it will not go away, and yes, it does need dealing with and it is not something that can be swept under the carpet.

An obvious message is that people need to seek help at an early stage, and that help must be immediately available to them when they do.

In this regard I noted with interest recent comments by the Drug Foundation and the Society on Alcohol and Drug Dependence that:

"we have a flawed understanding of how addiction works and how best to treat it. As a result we're reaching only a fraction of the people we should."

I agree with those concerns.

One size does not fit all and the treatment or help we provide will often take many different forms:

* from a talk with a trusted friend or family member;
* a confidential chat over the AlcoholDrug Helpline or through accessing the DrugHelp website;
* through a community support group such as Alcoholic Anonymous;
* through a general practitioner;
* or through a more specialised alcohol and drug counsellor, or treatment programme.

I understand that someone's abuse generally affects four other people.

This persuades me that investment in treatment is particularly worthwhile because treatment can potentially benefit those same four or five people, in addition to the addicted person.

Yet too often we have ducked the hard questions of what treatment services should be provided because of doubts some have raised about whether treatment really works.

From my perspective, prevention and treatment lie on the same continuum.

While preventing problems from arising is almost the preferable option, it is not always the most realistic, and we therefore need good treatment networks to assist those who require them.

Earlier this year, I represented New Zealand at the 54th Session of the Commission on Narcotic Drugs (CND 54) in Vienna.
The New Zealand delegation hosted a side event on the Tackling Methamphetamine Action Plan - The New Zealand experience of addressing methamphetamine.

This event showcased the strategies being applied using cross government approaches - Customs, Justice, Health and Police - and the outcomes identified to date.
What struck me was talking with a number of people from other delegations that supported New Zealand's approach to including a strong emphasis on treatment as part of this strategy.

New Zealand was commended by many for a well balanced approach that was tough on crime but prepared to improve access to treatment for those who needed it.

I believe that this joint agency approach focusing on all three pillars of the National Drug Policy - limiting the availability, reducing demand, and problem limitation, including treatment - is an effective model we ought to be using not only for methamphetamine but for other drugs as well.

I am keen to build on the opportunities to improve collaboration between Health and other government agencies, particularly where those other agencies have programmes to improve and protect community outcomes where alcohol and other drugs are undermining those communities.

I am aware that my ministerial colleague Dr Jonathan Coleman is working to develop a high quality addiction treatment system.
Work now underway includes a new mental health and addiction service development plan; the refreshing of the mental health and addiction 'Blueprint' resourcing model, originally developed in 1998, and a mental health and addiction workforce review.
I am also mindful of the call from the Law Commission that this country needs an alcohol and drug treatment strategy.

It seems to me that a national service development plan is essential to provide guidance to the decision-makers on the relative priorities and arrangements that need to be in place to provide effective treatment and assistance to those concerned about their own or someone else's alcohol and drug abuse.

An issue of concern for me is that we reduce any variance in the quality of treatment and services across the DHBs and various NGO providers, particularly if people move to another area.

For a relatively small country, can we afford too many different local models of care?

How do we ensure the best mix of services at a local, regional and national level?

I am interested in value for money, and earlier this year I was pleased to receive the report prepared for the Ministry of Health on the value for money we get from problem gambling services.

That report highlighted some of the key strengths of those services that I personally would like to see translated across the whole addiction treatment sector.

Those strengths included:

* The combination of a preventive approach alongside innovative and well-designed intervention services;
* National coverage and services targeted to ethnic groups most at risk of harm;
* Awareness campaigns that achieve good levels of recall of key messages;
* A comprehensive dataset of service usage;
* An industry levy that recognises the industry taking responsibility;
* Good relations between the funders, either the Ministry of Health or DHBs, and service providers;
* Reasonable administration costs;
* Good levels of client satisfaction with intervention services; and
* Improved value for money.

Some of these considerations will also be picked up in the work the Mental Health Commission is undertaking on a revised Blueprint for Mental Health and Addiction Treatment services.

I believe the Blueprint model has worked well, but it has probably not kept up with changes in the health sector.

Future-proofing strategic documents to have the flexibility to take account of changing circumstances, and particularly in the Health sector, changing structural arrangements is critically important and difficult to achieve.

I am mindful of the changes proposed for the people at the Mental Health Commission, the Health Sponsorship Council, and also the Alcohol Advisory Council.

I would like to take this opportunity to express my appreciation of the work that organisations such as ALAC have done to promote awareness of alcohol as an issue, and to reduce its harm.

I have enjoyed working with you over a long period of time.

Often I hear that people need to be motivated to seek treatment.

This is true to some extent, but my view is that all too often people will only seek treatment when there is sufficient pressure from family, an employer, or quite often through the Justice system for them to do so.

A lack of motivation does not excuse professional staff from seeking to engage the person in their treatment.

I understand that there are appropriate techniques and training available to clinicians to increase someone's motivation.

There is a large responsibility on the professional as well as the client to engage and to increase motivation.

I am also aware that there are those people at the very hard end of the addiction spectrum for whom everything else has been tried, but for whatever reason they fail to engage in treatment.

The Government is well aware that the Alcoholism and Drug Addiction Act 1966 is not working well for individuals or their families to get them the help they need.

I am looking forward to the opportunity to introducing a Bill into Parliament that will update the tired old legislation we have now.

This Bill will improve the access to treatment and the likely outcomes for those people with severe alcoholism and drug addictions.

The proposed legislation will include a rigorous framework to protect an individual's rights while they are undergoing compulsory treatment.

Compulsory alcohol and drug treatment is a last resort option for severely addicted substance users who are chronically unwell, incapable of helping themselves, and require life-saving intervention.

Without intervention, these people are likely to become progressively worse and require increasingly intensive health and social services.

With intervention, many will improve significantly and with good after-care and support are likely to enjoy a much improved quality of life.

Implementing this legislation will require some careful thought.

Not least is identifying the best configuration of services to deliver the outcomes we are seeking.

For those people who have serious alcoholism and drug addiction issues but that do not qualify under the strict threshold for compulsory treatment, we need to ensure that they and their families are not turned away without help

How our services have been funded in the past has concentrated on that 3% of the population with the severest mental health and addiction needs.

I would expect that future consideration assesses whether we need to have a funding plan beyond the 3%, and to what extent we are dealing with the moderate to severe cases.

Increasing capacity may well depend on increasing funding, but we should also consider other issues, such as service configuration; the role of technology; and, research and planning into not just today's problems, but attempting to forecast future needs.

I said at the beginning I meet all sorts of people in this job.

Often it is those affected adversely; at this sort of meeting it is people who are trying to address the problem.

I should also add that I encounter the people that are contributing to the problem.

It is a matter of public record that I am not sorry to see people associated with pushing synthetic cannabis quitting that industry.

The recent issues that we faced in limiting the availability of Kronic and other cannabis-type products reinforce the need for effective legislation.

Though both the immediate actions we have taken through the establishment of temporary drug class notices, and the clear indications we are giving that effective legislation, but ultimately the Government backs the Law Commission's recommendation to shift the onus of proof to manufacturers and supplier to prove their synthetic drugs are not harmful.

In closing, then, it is my view that if we are to reduce the harm from alcohol and other drugs, then a series of components need to be in place:

* A plan for the future development of addiction treatment services;
* A funding stream flexible enough to match future needs; and
* Legislation that is responsive to limiting the availability of harmful substances, and assisting those most affected by alcohol and other drugs into treatment.

All of these need to be underpinned by a workforce that is well-trained and capable of delivering the treatment for individuals and support for families they need.

I wish you all well for your deliberations today, and I look forward to seeing them put into practice.

Thank You.

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