People dependent on drugs or alcohol who refuse treatment could lose their welfare benefits

The Home Office is considering withdrawing benefits from people who are dependent on alcohol or other drugs who refuse the offer of treatment, while exempting them from the requirement to seek work if they do undergo a treatment programme.

The idea is one of a range put forward in a consultation paper on the Coalition Government’s Drug Strategy for England, Wales and Scotland.

The same idea was put forward by the previous Labour Government as part of the Welfare Reform Bill, introduced into the House of Commons by the then Work and Pensions Secretary, James Purnell. The rationale of the measure is also essentially the same for both Governments – using the benefits system to provide incentives for people dependent on drugs, including alcohol, to overcome their problems and to re-engage with the labour market.

A strong prompt for such an initiative is provided by the high number of people who receive incapacity benefit, a weekly payment for people who become incapable of work through illness or disability while under State Pension age. Figures from the Department of Work and Pensions show that in 2008, there were over 2.6 million people claiming incapacity benefits, of whom nearly 54,000 were claiming because of alcohol dependence and 51,000 because of drug dependence.

The new consultation document asks people for their views in regard to whether more use should be made of the potential to use the benefit system to offer claimants a choice between:

a) some form of financial benefit sanction, if they do not take action to address their drug or alcohol dependency; or

b) additional support to take such steps, by tailoring the requirements placed upon them as a condition of benefit receipt to assist their recovery (for example temporarily removing the need to seek employment whilst undergoing treatment).

The proposal to withdraw benefits was immediately attacked by Martin Barnes, Chief Executive of DrugScope, who said he “seriously questioned” whether linking benefit sanctions to a requirement to undergo medical treatment was either fair or effective.

He told BBC Radio 4’s Today programme there was no evidence that such an approach would for work for a “particularly vulnerable and marginalised group”.

“Also, we have to bear in mind that under the principles that are enshrined in the NHS Constitution, medical intervention should be therapeutic, consensual, confi dential - and I just don’t see that’s compatible with using the benefits system to require people to undergo a complex form of drug treatment intervention,” he added.

Simon Antrobus, Chief Executive of Addaction, was also critical. He said that while getting more people into drug treatment was always a good thing, attempting to force them into that process by taking away their benefits would be a mistake as it could increase their chances of turning to crime to find an alternative income.

The previous Labour Government’s similar proposals were attacked on the same basis. Then, the Royal College of Psychiatrists and the civil rights lobby group ‘Liberty’ protested that the proposals amounted to a gross intrusion into privacy and jeopardised patient confidentiality, as well as being based on a “fundamentally flawed” understanding of the nature of drug dependence.

In a briefing on the Welfare Reform Bill to the House of Lords, the Royal College and Liberty stated that the proposals would “discourage many problem drug users from applying for benefits and may mean a number of people will withdraw from the system to ensure that their dependency does not become public. Many people dependent on drugs hide the problem from their friends and family and, indeed, do not even admit their addiction to themselves. Imposing what, in effect, amounts to forced treatment also shows a failure to understand the fundamental nature of addiction and the method by which it is treated. These provisions are likely to act as a further barrier to employment; may increase the risk of social exclusion; and risk increasing crime rates and entrenching the cycle of dependency.”

However, these views were themselves regarded as questionable by others in the field. This journal commented that arguments about patient confidentiality and alcohol and drug dependents being in denial were strange ones, given that the question arose in relation to people claiming benefi ts precisely on the basis of a medical diagnosis of alcohol or drug dependence. And forcing people to confront their dependence on alcohol and other drugs and to do something constructive to overcome the problem was normally accepted as a legitimate, indeed indispensable, element of the social response to alcohol and drug dependence.

In the criminal justice system, for example, the return of the driving licence to drink drive offenders with a serious alcohol problem was conditional upon their providing convincing evidence to the authorities that they had overcome their problem and were fit to drive.

The same principle of conditionality applied in workplace alcohol and drug programmes, which normally offered alcohol or drug dependent employees a hobson’s choice between agreeing to overcome their dependence by, for example, undergoing a treatment programme, or accepting normal discipline, which would often mean being fired. Far from being attacked as counterproductive intrusions into privacy, likely to entrench dependence and bring about relapse, workplace programmes were actively promoted as highly desirable responses to alcohol and drug problems. Indeed, in one of its major reports on alcohol, the Royal College of Psychiatrists itself claimed that “in companies where such policies exist and are genuinely operated, the extra motivation provided by the opportunity to remain employed greatly enhanced treatment outcome.”

On the face of it, it was difficult to see why the proper approach to treatment for dependence should take not just different, but exactly opposite forms in the employed compared with the unemployed.