Treatment for heroin addiction should have more focus on supporting patients to recover from their dependency, says the country’s top addictions expert.

In an interim report for the National Treatment Agency (NTA), Professor John Strang, head of the National Addiction Centre, signals the direction of new clinical guidance for treating the estimated 260,000 heroin addicts in England.

As chair of an expert group looking at how the range of treatments used in drug addiction can have a clearer recovery orientation, Prof Strang recommends that treatment should:

* incorporate wider social interventions as well as medication to support recovery outcomes
* include considered provision of medications including opiate substitution treatment (OST) to gain maximum benefit
* guard against incorrect provision or unnecessary drift into long-term maintenance on substitute prescriptions

In a checklist of good practice based on the scientific evidence, Prof Strang recommends that clinicians working in drug treatment should review all their patients to ensure they are working to achieve abstinence from their problem drugs, and give them the opportunity to come off medication when they are ready to do so.

The report updates the coalition Government about the work of the expert group after the 2010 Drug Strategy called for more recovery activities for those on a substitute prescription, and an increase in the numbers of heroin users leaving treatment free of their drugs of dependency.

The expert group will publish its full report and guidance early next year, but in his interim report on Recovery-Oriented Drug Treatment Professor Strang said: “The drive in recent years to reduce waiting lists and retain people in treatment has generally been successful with the result that much larger numbers of patients with addiction problems now enter treatment. This has undoubtedly been accompanied by significant benefits for many patients and the communities in which they live.

“However, the desire of clinicians to secure these benefits has led, in some instances, to over-reliance on medication and patients being allowed to drift into long-term maintenance. As a consequence, insufficient attention may have been paid to reviewing the actual benefits gained, reconsidering alternative methods to maximise the prospect of personal recovery, and adjusting treatments so that greater recovery could be achieved.

“The prescribing of any medication (and perhaps especially of OST) must not be allowed to become detached and delivered in isolation from other crucial components of effective treatment. Other elements of overall care need also to be considered, including individual recovery care planning, psychosocial interventions and integration with mutual aid and peer support. All of these, in different combinations with different patients, and adjusted over time, can and do support recovery.”

Professor Strang makes clear that while treatment needs to concentrate on helping users overcome their dependence, clinicians must also be wary of the threat of relapse. By calling on the full range of psychosocial and pharmacological approaches, the risk and severity of any setbacks to recovery can be reduced.