Recovery from addiction: can social investment help to find what works?

Recently the independent charity the UK Drug Policy Commission (UKDPC) published the findings from a 6-year review of drugs policy which included input from a wide range of sector experts. The report made a number of recommendations, but two stood out:

  1. ‘We should focus on how society and government can enable and promote recovery.’
  2. ‘There is not enough evidence, or examination of the evidence, to make a judgement of the effectiveness, let alone cost-effectiveness, of existing or potential drug policies.’

Social Finance’s analysis supports these conclusions: we identify that there are two barriers to making more effective drug policy: a financial barrier and an evidence barrier. Promoting recovery means helping people recovering from addiction get their lives back on track. New services are required yet there remains a lack of evidence about which interventions are successful. We believe that the Social Impact Bond (SIB) can help foster an evidence-based approach. SIBs provide additional funding to test innovation and the government only pays if outcomes are improved. The outcomes that form the basis of the SIB contract are, therefore, a critical part of this project.

Today Social Finance publishes a report assessing which outcomes metrics could provide a framework for measuring recovery as part of a SIB. Our aim has been to propose a series of metrics that capture what it means to make a positive change in the life of someone recovering from drug or alcohol addiction. This is not straightforward and we understand the uniqueness of each individual’s recovery journey. We have tried to bring together the features of recovery that are objective and that represent progress for society too. Alongside capturing the essence of recovery, the metrics need to be robust so that investors and commissioners have confidence that improvements on this scale are genuine improvements – that individual and society are better off. Finally, the metrics should not create perverse incentives (that is, the incentive to act against the overall aim of promoting recovery).

Social Finance brought knowledge of SIBs and financial analysis to this task but this report required detailed knowledge of the addictions. We enlisted the expert help of Dr Samantha Gross and Professor John Strang from the National Addictions Centre who have helped us understand what is acceptable from a service user and service provider’s viewpoint, as well as ensuring that the metrics proposed cannot be “gamed” or cheated. We are grateful for their time (and patience) and have found working with them to be a valuable learning experience. Dr Gross & Professor Strang can now speak with fluency and accuracy about what a SIB is and the Social Finance team is much more familiar with the physiological effects of different drugs, how to test for their presence and even how long traceable elements of drugs stay in a person’s blood stream and in sewage systems (one way to understand if less drugs are being taken in an area is to look in their waste water). For both sides, valuable information with applicability beyond the report itself!

The metrics we propose are intended to measure areas which are sufficient to indicate an individual is moving towards recovery. We propose measuring and paying for: reduced substance use through to abstinence, reduced crime and improved employment. Alongside these measures we would intend to collect a large amount of further data regarding housing status, health and well-being amongst others – these aspects of someone in recovery’s life are important but we do not believe financial incentives should be attached to them as they are not sufficiently robust to satisfy commissioners or investors. We tested the proposed metrics at a roundtable with sector specialists and appreciated the helpful feedback which has contributed to our thinking.

The metrics proposed provide rewards for progress towards abstinence, whilst keeping abstinence as the end goal; reduced criminal behaviour which can be measured robustly and represents a good outcome for users and society; and, finally, employment which is the long-term goal, recognising that this may be a stretch target for some but a worthwhile target for many.

There is a need for additional investment in services to promote recovery. We believe SIBs can provide the funding to test new innovative approaches, paid out on the basis of improving outcomes that matter for both users and society. This has the potential to make a significant contribution to the evidence base and help government commission services that work. There is a strong social and financial case for promoting recovery through SIBs. This could opportunity to test interventions that, once properly tested and evidenced, could be rolled out at scale and help tackle this entrenched social issue.

We hope that a system using these metrics would improve outcomes for service users and society at large. The report represents our thoughts and we hope to continue to refine our thinking over time as we hear from critical friends.

By Harry Hoare and Peter Sebastian, Social Finance 

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