The National Institute for Clinical Excellence (NICE) have extended the range of drugs to be used in the treatment of Attention Deficit Hyperactivity Disorder (ADHD). They are all variations on amphetamines (Speed). Of course these drugs ‘treat’ ADHD. So would cocaine or heroin. I see ADHD as an early sign of an addictive tendency. I suppose what NICE is doing is to give these children amphetamines now in preparation for life-long dependency on methadone when they are adults. That’s not nice – it’s very nasty.

The drinking habits of 50,000 people between 50 and 65 years old in Denmark were studied for an average of almost 6 years. The conclusion of the study, published in the British Medical Journal, was that the risk of coronary artery disease is lowest in the most frequent male drinkers. For men, consuming one or two drinks a day is healthier than drinking only once a week. This should not be surprising. Alcohol stimulates liver enzymes. Drinking regularly causes the liver to get into training. Drinking sporadically overwhelms it. This may appear to be good news for consistent heavy (more than three drinks a day) drinkers but it is not: they do badly. In other words the study is not good news for serious drinkers, such as those we treat at PROMIS. It is the worst news possible for them: heath benefits come only from consistent sensible drinking – and that is precisely what they cannot do.

‘Too many UN members have been content to obstruct reform, mindlessly citing the US as an obstacle to change, when their own narrow interests have limited the international humanitarian response’, says an editorial in The Times. Quite right, the UN does not live up to the reasonable hope that it should be supra-national and moral. It is factional and fundamentally corrupt. The Times, supporting President Bush and Prime Minister Blair, calls for the UN to be reformed. It needs a good bit more than that. How about closing it down altogether? Perhaps it will sort itself out only when confronted with this stark alternative.

I went to Amsterdam and back yesterday, Bank Holiday Monday, but I am less tired tonight that I usually am on a Tuesday. I did my normal work at the weekend so this implies something pretty demanding about my normal Mondays. I didn’t realise that until I wasn’t here. I suppose it is the constant pressure that gets to me. I enjoy it and I have no intention of changing my routine – but it is wearing.

The boy Walcott looked very nifty in the ‘friendly’ against Hungary. That’s good. He may be needed when the real action starts.

A couple of months ago I wrote about my friend and University contemporary, Paul. He looked so young and fit and healthy and he had kept his good looks and full head of hair. Yesterday, he died of a heart attack (or something like that, possibly an aneurysm or pulmonary embolus).

I am very fortunate in having lots of friends but I make most of them as I go along. Paul was one of the very few who go right back. Meg has more friends from the old days, partly because she invests more time in them than I do. Sadly, a fair number of them are widows. Now she had got another. I have got a void. His family have an even bigger one.

At present we are on a roll. Patients are pouring in. Paradoxically this is the time to go flat out in our marketing activities. People we approach will see the living proof of our claims.

These days I don’t get hurt or angry if I am misunderstood, nor even if I am scorned or maliciously attacked. I am not in the business of taking on easy clinical challenges. It is inevitable that some patients will feel that we are attacking them when we try to separate them from the ones they love the most – their drugs or other addictive substances or processes. Some feel so resentful that they attack PROMIS, and inevitably as the head of the organisation, me. That goes with the territory.

There is no point in me getting upset. If my ideas are under attack, that is fair game and I may learn new ideas in the process. If my staff are challenged I need to find out the truth of the situation as best I can and as quickly as possible, preferably the same day. Occasionally I may need to put into effect the full grievance procedure and go through the formal process, with evidence from witnesses, opportunities to challenge and cross-challenge. Very rarely we resort to law.

When I myself am under fire I have to check out my own behaviour. This is usually straightforward because mostly I work alongside other counsellors and we always go through the substance and process of each group therapy session immediately afterwards, prior to dictating my notes. If I am accused of an action taken when there was only one other person involved, I have to rely upon my own memory and perceptions and subsequently check in with my professional mentor, my Twelve Step Fellowship guide, (termed a Sponsor) and my clinical supervisor. They should hopefully be able to see if I am going off.

Having done all that I can do to ascertain the truth, I have to let the subject go, rather than worry myself silly over it.

One of the patients attending aftercare this evening has a three hour journey each way. Far from him paying me for the one and a half hour session, I feel that I should reward him.

How very satisfactory. I got a diagnosis right: impetigo. The young man had had a skin rash on his arms for a month and nothing had got it better. With most skin rashes you either know what they are or you don’t. There are all sorts of scrapings and cultures that can be done but giving the correct immediate diagnosis and therefore treatment for the specific condition is quicker and cheaper and generally better for the patient. There is no substitute for experience, sitting in the office seeing one patient after another day after day after day.