ADDICTION HEALTHCARE: Prevention. Intervention. Primary Care. Outpatient Continuing Care & Recovery.

ELIZABETH HEARN
Psychotherapist, London.
HP/NCH, SMAPPH
Registration no: 0615
+447894084788

Elizabeth Hearn is a UK based addiction healthcare clinician, psychotherapist and counsellor with 31 years of personal recovery from opioid addiction and 30 years of specialising in evolving addiction healthcare.

My areas of expertise include research, mental health, clinical practice, medication-assisted treatment, treatment innovation, co-occurring issues, detoxification, and heroin and prescription drug addiction.

I continue to spearheaded implementing addiction and mental healthcare A&E clinics within NHS Hospital setting where clinicians and peer-to-peer lived experience volunteers work side by side to assess for treatment people in a crisis who are seeking help in managing their additive behaviours.

This is high-level initiative to educate and train doctors, nurses, first responders, and all associated healthcare professionals in addiction medicine in partnership with the American Society of Addiction Medicine.

My recovery tribe is global. There are about 28 million people in recovery across the planet. Many of us maintain the importance of upholding anonymity, doing service and reaching out to the still suffering addict.

I learned a significantly valuable lesson when I lived in India amongst the local village women, to give people what they need, not what I think they need…ultimately we learned from each other…it was the end of suffering for me…my self-imposed “pain prison” no longer held any power over me decision making processes…

I begin and end each day with a silent meditation – a return to love, calmness and peace of mind.

My neurobiopsychosocial approach continues to evolve, influenced by social change, vulnerable people achieve recovery. Professionally sustained by up-to-date addiction medicine research, and evidence based therapeutic protocols.

April, 1988 I endured a family intervention that was exquisitely painful for all of us…my family and partner were worried about the progressiveness of my addiction to opioids and terrified I was going to kill myself…

I was angry, and hurt. I had been “found out.” The time for excuses, promises to change etc had run out… no longer an option, they knew enough to know I could not recover alone…

I spent a month in treatment. Sadly my denial and disconnecting from reality blocked me from fully engaging in the therapeutic process…eclipsed by shame, anger and fear – my critic grew louder day by day…telling me I pathetic, horrible, person…

With no defence against that first drink, by the time I arrived at the airport,I headed straight for the duty-free shop…and then the toilets to switch Vodka into an Evian bottle of water .to wash down the valium… I came out of blackout several hours later having no recollection of how I got home from the airport..and back into my apartment.

The next few months blurred into a cycle of craving, binge, purge, compulsivity, depression and anxiety. Every morning I would say, today I will I stop using….and for a few days, I would…eat, sleep, begin connecting with friends…but too ashamed to return to recovery meetings..I was disconnected from reality, family, friends, suicidal… eventually the pain of living became unbearable, despite a failed suicide attempt…I knew I needed to get help….

31 years ago the person sitting opposite me in A&E Hospital in NYC saved my life. Her training in addiction medicine meant that I was not dismissed, instead I was properly diagnosed, perhaps for the first time I accepted that I needed professional help.

I immersed myself in 12step meetings, found a longterm 12step sponsor to work through the 12steps and traditions and a therapist to support me as I went deep into healing from childhood trauma.

My compassionate approach, addiction recovery insights and personal disclosure embodies the complexity of addiction, the challenges of recovery, and the evolving existentialism of long term recovery: living life on life’s terms is surrendering my will to power on a regular basis.

That person who helped me begin to recover from addiction health crisis impacted and interrupted by a failed suicide attempt was an addiction trained psychiatrist, in a NYC, A&E Hospital setting.

Her suggestion, based upon her assessment of my propensity to relapse, began post rehab and I was too afraid of being judged a failure to re-engage with 12step meetings, and the recovery community.

This was different. I was desperate. I had nowhere else to go…so I followed all the suggestions in my early recovery to stay away from familiar people, places and things that would perhaps case me to relapse…fortunately the cravings stopped the day I committed to my recovery, 12th October, 1988 and have not returned.

Recovery is a process… my NYC therapist knowledge of the American Society of Addiction Medicine changed my thinking about “what is addiction?” from one of moral failing to medical disorder….

Beginning on a path to substance use recovery for many people may not begin the way mine did in an A&E setting with a choice: be admitted for a medically assisted detox, or return to 12step meetings and connecting with recovery community.

In my role as an additions clinician and recovery advocate I continue to seek out ways to reach people who aren’t likely to engage with traditional healthcare systems, and it is my wish to establish A&E Addiction Healthcare Clinics (more about in the attached document) when people are ready, that links them to many options for healthcare, mental health care, and substance use treatment.

I credit my addiction training as being key to this proposed addiction healthcare innovative approach to serving people with substance use disorders — from understanding the impact of social determinants of health, to respecting an individual patient’s autonomy.

Clinicians and Scottish Recovery Consortium recoverists/ lived experience paid workers working side side whose collective experience in addiction in an A&E setting will provide a supportive pathway of support to a vulnerable population.

Under-resourced clients face challenges in accessing add-on healthcare and or linking together the different aspects of their healthcare.

They may have a GP appointment in one location and a hospital visit in another. For a person without reliable transportation, having to arrive to an appointment on time can be a hurdle. For someone involved in the criminal justice system, stigma and can be a deterrent for engaging in care.

Easy access: programmes and interventions can be established to help people feel safe, regarded and welcome, and this approach is more likely to produce positive future outcomes.

The American Society Addiction Medicine frame synced in with my recovery continuum of self-care….1-1 and group therapy, developing boundaries, ego strengths, resilience and recovery from trauma was held within the safety of therapy rooms, and small 12step meetings.

My home group was started by Betty Ford, who visited regularly to share her experience, strength and hope with us who remained in awe of her humility, grace and calmness.

My recovery tribe has grown throughout the years, I love the sharing of wisdom from peers, colleagues and people who inspire me to thrive…our collective primary purpose is to end the silence and stigma of addiction and mental health issues.

We are not silent. We are not alone. We are courageous, compassionate human beings.

Self -discovery sounds so much inviting than self-seeking, being of service is about connection, communication and collaboration: being available, present, and purposefully in the moment- becoming an asset within the community takes time to establish trust, and confidence in the recovery process.

My long term recovery experience continues to evolve, I love to raise awareness and inspire change in others… a continuing compassionate inquiry into understanding how our greatest challenges transform us by becoming valuable resources, assets, insights in the the human condition, and expressed compassion for the benefit of others.

I have helped hundreds of people recover. My commitment to addiction recovery extends to the wider community, I am proposing to UK Health ministers that we work together to implement addiction medicine trainings for all healthcare professionals and front-line first responders – with people in acute to crisis stages of addiction.

Addiction is complex to treat. Recovery is sustainable when the process is supported by holistic well being therapies: nutrition, EMDR, hypnotherapy, acupuncture, mindfulness meditation for stress management,and regular engagement with recovery communities via meetings and workshops.

Addiction impacts the immune system, the recommend establishing autonomous ADDICTION HEALTHCARE CLINICS in A&E-NHS Hospitals. Interdisciplinary teams with the additional benefit of lived experience volunteers work side by side with clinicians, and healthcare professionals.

I am an evidence and research based addiction clinician. Saving lives is what is needed. The quality of addiction treatment needs to accessible, 24/7. Lets make that happen.

“A CALL FOR NATIONAL DIALOGUE”

“To be a more successful country we need to see an overall improvement in our population health, and we need to close the gap between the health of our wealthiest communities and the health of our poorest.

Only through an effective partnership can we make the best use of our collective resources and work together to tackle our most difficult challenges – making a real difference to the prosperity and wellbeing of our communities.”
Rt Hon Nicola Sturgeon MSP
First Minister of Scotland

Addiction is not a criminal justice issue but a public health issue which requires specialist training and insight into the medical and biopsychosocial nature of the illness.

Let’s transform the way in which vulnerable, people at risk access addiction healthcare. People have a right to be treated, not dismissed, and discharged.

However, due to cutbacks, long waiting times and lack of experienced in addiction trainings first responders, doctors, nurses and associated healthcare workers, people are being turned away instead of receiving treatment.

It is not good enough to say implementing addiction healthcare will cost millions, addiction and mental healthcare are already costing billions globally:
loss of income, loss of family, loss of life.

I am committed to overcoming prejudice, stigma, isolation and shame by personally striving for 24/7 within established A&E NHS Hospital settings, accessible inpatient and outpatient addiction public healthcare programmes to combat the opioid crisis, treat addiction and COD: the coexistence of both a mental health and a substance use disorder is referred to as co-occurring disorder.

ADDICTION HEALTHCARE RIGHTS & RECOVERY
Recovery-oriented care is prevention, intervention, medically assisted detox, inpatient and outpatient continuing support, and connecting with a recovery community. Recovery is a way of life, an attitude, and a way of approaching life’s challenges. The need is to meet the challenges of one’s life and find purpose within and beyond the limits of addiction while holding a positive sense of identity.

Since the inception of Alcoholics Anonymous in 1939, clinical and recovery evidence demonstrates that when people engage in primary care addiction treatment, they have better outcomes than those not retained in treatment. Providing a safe place in which at risk, vulnerable people can be given a choice to engage in treatment is addiction healthcare human right.

Addiction is characterized by an inability to consistently abstain or reduce substance use, impairment in behavioural control, craving, tolerance, and interference with interpersonal relationships, occupational responsibilities, recreational activities, and emotional response.

Like other chronic diseases, addiction often involves cycles of relapse and remission and recovery is about connection – lets engage vulnerable, isolated and disenfranchised, at risk people to a compassionate addiction healthcare care regimen.

Otherwise, without treatment or engagement in recovery activities, addiction is progressive and will often result in disability, or premature death.

And while the cost of addressing every facet of the addiction crisis is substantial, the cost of doing less than what is absolutely necessary is far more.

TOGETHER WE CAN: strengthen our nation’s addiction prevention and treatment infrastructure and expand access to evidence-based care is working in partnership with addiction trained clinicians to pursue bold, systemic solutions.

There is no time left for incremental policy changes – we need to come together as a UNITED KINGDOM to both implement and fund addiction healthcare programmes that will comprehensively combat untreated, complex, co-occurring chronic disease of addiction.

In January 2019 I initiated a partnership with the American Society Addiction Medicine to provide evidence based ASAM “Fundamentals in Addiction Trainings” and the ASAM Strategic Plan: a biopsychosocial evidence-based addiction healthcare treatment pathway that UK first responders, doctors, nurses need to be trained in to effectively treat addicted patients.

In addition to the ASAM “Fundamentals of Addiction Trainings” I am proposing implementing 24/7 Addiction Emergency Care Clinics within A&E-NHS settings an autonomous clinic and ward for primary care inpatient care facilitated by trained in the ASAM “Fundamentals of Addiction Medicine” clinicians, first responders, doctors, psychiatrists, nurses, pharmacists, and associated healthcare professionals to work alongside the Scottish Recovery Consortium lived experience – support volunteers, 24/7 in addiction and mental health primary care integrated treatment programmes.

In my 28-year, professional role, as an addiction clinician, and a person in long term recovery (31years) I continue to advance the recognition of mental health and freedom from addiction as being essential to overall health. Such recognition and focus will help to improve access to and integration of addiction healthcare services, to support and sustain positive outcomes, and address gaps and disparities in service delivery.

Addiction medicine is a medical subspecialty, formally recognized since 1990, concerned with the prevention, evaluation, diagnosis, treatment, and recovery of persons with the disease of addiction, of those with substance-related health conditions, and of people who show unhealthy use of substances, including nicotine, alcohol, prescription medications, and licit and illicit drugs.

The American Society of Addiction Medicine, founded in 1954, by Dr. Ruth Fox, a psychoanalyst who in 1959 became the first medical director of The National Council on Alcoholism, an agency devoted to alcoholism prevention is a professional medical society representing over 6,000 physicians, clinicians and associated professionals in the field of addiction medicine.

She was founder and first president of the American Medical Society on Alcoholism and Other Drug Dependencies in 1954 and wrote, lectured and taught extensively on the subject. She also maintained a private practice and was one of the first psychoanalysts willing to accept alcoholics as patients.

She was a fellow of several groups including the American Psychiatric Association, the New York Academy of Medicine, the American Academy of Psychoanalysis, the American Health Association and the American Society of Clinical Hypnosis.

The ASAM is dedicated to increasing access and improving the quality of addiction treatment, educating physicians and the public, supporting research and prevention, and promoting the appropriate role of physicians in the care of patients with addiction.

The ASAM Patient Placement Criteria uses six dimensions to create a holistic biopsychosocial assessment of an individual to be used for treatment planning:

• Dimension one is acute intoxication or withdrawal potential.
• Dimension two is biomedical conditions and conditions.
• Dimension three is emotional, behavioural, or cognitive conditions or complications.
• Dimension four is readiness for change.
• Dimension five is continued use or continued problem potential.
• Dimension six is recovery/living environment.

The ASAM plan outlines ambitious research goals aimed at leading scientific and medical progression in the field with renewed and redesigned goals amass to form a robust foundation and profound course of action in the spirit of the organization’s mission.
In addition to the ASAM “Fundamentals of Addiction Trainings”

RIGHTS & RECOVERY
Recovery-oriented care is prevention, intervention, medically assisted detox, inpatient and outpatient continuing support, and connecting with a recovery community. Recovery is a way of life, an attitude, and a way of approaching life’s challenges. The need is to meet the challenges of one’s life and find purpose within and beyond the limits of addiction while holding a positive sense of identity.

In partnering with the ASAM the opportunity is in strengthening the focus on the full spectrum of addiction medicine, science, treatment and care:
prevention, treatment, remission, and recovery.

The continuing efficacy of the ASAM’s guiding principles will continue to set standards, pioneer research, educate professionals and the public, and challenge stigma. ASAM will always endeavour to enhance the goal of treating addiction and saving lives.

The American Society of Addiction Medicine’s evidence-based training and Strategic Plan:

The ASAM “Fundamentals of Addiction Training”
https://www.asam.org/education/live-online-cme/fundamentals-program

The ASAM Strategic Plan
https://www.asam.org/about-us/about-asam/theplan

MANY PATHS TO RECOVERY.

• The long overdue need for specialised addiction medicine training and treatment directives in which addiction/COD is treated concurrently with related physical health, and social issues.

• Addiction healthcare treatment that combines essential medical and psychopharmacology interventions uniquely tailored to each person’s needs.

The use of medications for the patient with addiction involving opioid use can be appropriate across all levels of care. Pharmacotherapy is not a “level of care” in addiction treatment but one component of multidisciplinary treatment. While medication as a stand-alone intervention has been utilized in North America and internationally, ASAM recommends that the use of medications in the treatment of addiction be part of a broad biopsychosocial intervention appropriate to the patient’s needs and to the resources available in the patient’s community.

Addiction should be considered a biopsychosocial co-occurring disorder, for which the use of medication(s) is but only one component of overall treatment.

A BIOPSYCHOSOCIAL ASSESSMENT TEMPLATE:
http://publichealth.lacounty.gov/sapc/NetworkProviders/ClinicalForms/TS/AssessmentToolAdultsPaperVersion.pdf

The following is an extract from the ASAM Strategic Plan and provides guiding principles:

• Positive changes are seen as starting points for the recovery process: reduced harm, safer use, reduced use, moderation and potential abstinence.

• A comprehensive initial assessment will determine an initial personalized treatment plan based on substance use severity, the psychobiosocial factors, multiple meanings and functions of the behaviour, motivation to change, and insight.

• Effective treatment has a primary focus on engagement and therapeutic alliance throughout the assessment process that “starts where the person is” with compassion, respect and acceptance, because creating safety and support are seen as essential to the therapeutic outcomes.

• Teaching self-management skills to address urges and difficult emotions is often essential. An ongoing assessment throughout treatment deepens both client and therapist awareness of the addiction severity and its meaning and functions.

• Exploring the client’s resistance to change reveals the issues that need new solutions. As these issues are clarified, positive change goals around the substance use and these issues can be established.

And, finally, a personalized plan for pursuing these positive changes can be developed collaboratively between client and therapist. The plan may include a variety of therapeutic modalities, lifestyle changes, health practices and medications depending on the client’s needs.

I believe that appropriately trained medical staff, supported by trained volunteers with lived experience in personal recovery, can save lives, stabilise chronic to acute stages of addiction and negative prejudices which are common when dealing with these patients.

These efforts, in turn, can save lives, reduce the financial burden of treating addiction to the health care system and support the interdisciplinary addiction medicine team.

RESEARCH AND EVALUATION
These specialised in addiction medicine clinics will conducts high quality research that can broadens and deepen the understanding of addiction treatment and care delivery.

Principles of Effective Treatment

Addiction is a complex but treatable disease that affects brain function and behaviour. Drugs of abuse alter the brain’s structure and function, resulting in changes that persist long after drug use has ceased.
No single treatment is appropriate for everyone. Treatment varies depending on the type of drug and the characteristics of the patients. Matching treatment settings, interventions, and services to an individual’s particular problems and needs is critical to his or her ultimate success in returning to productive functioning in the family, workplace, and society.
Treatment needs to be readily available. Because drug-addicted individuals may be uncertain about entering treatment, taking advantage of available services the moment people are ready for treatment is critical. Potential patients can be lost if treatment is not immediately available or readily accessible.
Effective treatment attends to multiple needs of the individual, not just his or her drug abuse. To be effective, treatment must address the individual’s drug abuse and any associated medical, psychological, social, vocational, and legal problems. It is also important that treatment be appropriate to the individual’s age, gender, ethnicity, and culture.
Remaining in treatment for an adequate period of time is critical. The appropriate duration for an individual depends on the type and degree of the patient’s problems and needs.
Behavioural therapies—including individual, family, or group counselling—are the most commonly used forms of drug abuse treatment. Behavioural therapies vary in their focus and may involve addressing a patient’s motivation to change, providing incentives for abstinence, building skills to resist drug use, replacing drug-using activities with constructive and rewarding activities, improving problem-solving skills, and facilitating better interpersonal relationships.
Medications are an important element of treatment for many patients, especially when combined with counselling and other behavioural therapies. For example, methadone, buprenorphine, and naltrexone (including a new long-acting formulation) are effective in helping individuals addicted to heroin or other opioids stabilize their lives and reduce their illicit drug use.
An individual’s treatment and services plan must be assessed continually and modified as necessary to ensure that it meets his or her changing needs. A patient may require varying combinations of services and treatment components during the course of treatment and recovery.
Many individuals have co-occurring disorders with other mental illnesses, treatment should address both (and all), including the use of medications as appropriate.
Medically assisted detoxification is only the first stage of addiction treatment and by itself does little to change long-term drug abuse. Although medically assisted detoxification can safely manage the acute physical symptoms of withdrawal and can, for some, pave the way for effective long-term addiction treatment, detoxification alone is rarely sufficient to help addicted individuals achieve long-term abstinence.
Treatment does not need to be voluntary to be effective. Sanctions or enticements from family, employment settings, and/or the criminal justice system can significantly increase treatment entry, retention rates, and the ultimate success of drug treatment interventions.
Drug use during treatment must be monitored continuously, as lapses during treatment do occur. Knowing their drug use is being monitored can be a powerful incentive for patients and can help them withstand urges to use drugs. Monitoring also provides an early indication of a return to drug use, signalling a possible need to adjust an individual’s treatment plan to better meet his or her needs.
Treatment programs should test patients for the presence of HIV/AIDS, hepatitis B and C, tuberculosis, and other infectious diseases as well as provide targeted risk-reduction counselling, linking patients to treatment if necessary. Typically, drug abuse treatment addresses some of the drug-related behaviours that put people at risk of infectious diseases. Targeted counselling focused on reducing infectious disease risk can help patients further reduce or avoid substance-related and other high-risk behaviours.
Moreover, engaging in substance abuse treatment can facilitate adherence to other medical treatments. Substance abuse treatment facilities should provide onsite, rapid HIV testing rather than referrals to offsite testing—research shows that doing so increases the likelihood that patients will be tested and receive their test results. Highly active antiretroviral therapy (HAART) has proven effective in combating HIV, including among drug-abusing populations, and help link them to HIV treatment if they test positive.
If nothing changes, nothing changes

Broken but not defeated…

You are not alone.

The global impact of COVID-19 huge suffering and loss that crosses culture, religion, class, age and gender…in the same way addiction is a global health emergency this pandemic is unstoppable.

The future is uncertain, therefor I see this as a time to pause, take stock of where you are, start there…begin each day with gratitude, remember you have choice – you can stay home and be safe or you can risk being within a super-spreaders range…

We are all walking one anther home – Ram Dass.

ADDICTION & MENTAL HEALTHCARE A&E

Everyone has the right to access addiction and mental healthcare and to be treated with respect and dignity and for their individual recovery journey to be fully supported.

Implementing Addiction & Mental Healthcare A&E clinics within NHS-Hospitals is strategy that can address the opioid epidemic by making available accessible, 24/7 assessment, and treatment is a human rights-based, public health approach to ensure addiction and mental healthcare professionals are delivering the best possible care, and treatment in the immediacy of daily life, for individuals and communities.

COVID-19 uk lockdown and border closures has already influenced the quality and quantity of street drugs. With the focus upon COVID – people needing treatment will not be able to access help. Addiction and mental healthcare according to the NHS is now for the foreseeable future, a non essential service. Not permanent. But every day a person is turned away from A&E and denied help with their addictive behaviours will increase the number of overdoses.

I love giving people the tools that will change their lives.
I am in longterm recovery for 31 years. I came into recovery following an intervention by an addictions expert/clinician. It was choice. I was fortunate. Many are not. I am committed to establishing and implementing addiction and mental healthcare A&E Clinics within NHS Hospitals.

I am proposing implementing 24/7 Addiction Emergency Care Clinics within A&E-NHS settings. Autonomous clinics. Accessible primary care inpatient care facilitated by trained in Addiction Medicine clinicians, first responders, doctors, psychiatrists, nurses, pharmacists, and associated healthcare professionals to work alongside the Scottish Recovery Consortium lived experience – support lived experience volunteers, 24/7 in addiction and mental health primary care integrated treatment programmes.

24/7 ADDICTION & MENTAL HEALTHCARE: People can not recover from active addiction without medically supervised inpatient healthcare. Implementing autonomous Addiction & Mental Healthcare A&E Clinics within NHS-Hospitals will provide accessible healthcare: a biopsychosocial assessment to determine individual treatment protocols for medically assisted inpatient treatment, medically assisted detox, inpatient primary care, after-care, outpatient peer-led community care.

24/7 SUPPORT: Implementing mandatory addiction medicine trainings for first responders, doctors, nurses and associated healthcare workers is essential. as in digitised linkage of essential services from the moment a person is identified as needed help.

LINKAGE: of all addiction and mental healthcare services will save lives, waiting times and ease the financial burden upon the NHS.

Shattering the stigma, isolation and shame is what needs to happen, this barrier blocks people form seeking help in a crisis. I am personally striving for 24/7 within established A&E NHS Hospital settings, accessible inpatient and outpatient addiction public healthcare programmes to combat the opioid crisis, treat addiction and the coexistence of both a mental health and substance dependency ( co-occurring disorder) walk-ins, assisted and or ambulatory.

ADDICTION HEALTHCARE RIGHTS & RECOVERY
Recovery-oriented care is prevention, intervention, medically assisted detox, inpatient and outpatient continuing support, and connecting with a recovery community.

RECOVERY is a way of life, an attitude, and a way of approaching life’s challenges. The need is to meet the challenges of one’s life and find purpose within and beyond the limits of addiction while holding a positive sense of identity.

MANY PATHWAYS are available since the inception of Alcoholics Anonymous in 1939, clinical and recovery evidence demonstrates that when people engage in primary care addiction treatment, they have better outcomes than those not retained in treatment.

PATIENT SAFETY at risk, vulnerable to engage in treatment because addiction healthcare is a human right.

Addiction is characterized by an inability to consistently abstain or reduce substance use, impairment in behavioural control, craving, tolerance, and interference with interpersonal relationships, occupational responsibilities, recreational activities, and emotional response.

Like other chronic diseases, addiction often involves cycles of relapse and remission and recovery is about connection – lets engage vulnerable, isolated and disenfranchised, at risk people to a compassionate addiction healthcare care regimen.

Otherwise, without treatment or engagement in recovery activities, addiction is progressive and will often result in disability, or premature death.

And while the cost of addressing every facet of the addiction crisis is substantial, the cost of doing less than what is absolutely necessary is far more.

TOGETHER WE CAN: strengthen our nation’s addiction prevention and treatment infrastructure and expand access to evidence-based care is working in partnership with addiction trained clinicians to pursue bold, systemic solutions.

There is no time left for incremental policy changes – we need to come together as a UNITED KINGDOM to both implement and fund addiction healthcare programmes that will comprehensively combat untreated, complex, co-occurring chronic disease of addiction.

Implementing a biopsychosocial evidence-based addiction healthcare treatment pathway that UK first responders, doctors, nurses need to be trained in to effectively treat addicted patients.

In my 28-year, professional role, as an addiction clinician, and a person in long term recovery (31years) I continue to advance the recognition of mental health and freedom from addiction as being essential to overall health. Such recognition and focus will help to improve access to and integration of addiction healthcare services, to support and sustain positive outcomes, and address gaps and disparities in service delivery.

Addiction medicine is a medical subspecialty, formally recognized since 1990, concerned with the prevention, evaluation, diagnosis, treatment, and recovery of persons with the disease of addiction, of those with substance-related health conditions, and of people who show unhealthy use of substances, including nicotine, alcohol, prescription medications, and licit and illicit drugs.

MANY PATHS TO RECOVERY.

• The long overdue need for specialised addiction medicine training and treatment directives in which addiction/COD is treated concurrently with related physical health, and social issues.

• Addiction healthcare treatment that combines essential medical and psychopharmacology interventions uniquely tailored to each person’s needs.

The use of medications for the patient with addiction involving opioid use can be appropriate across all levels of care. Pharmacotherapy is not a “level of care” in addiction treatment but one component of multidisciplinary treatment.

While medication as a stand-alone intervention has been utilized in North America and internationally, evidence supports and recommends that the use of medications in the treatment of addiction be part of a broad biopsychosocial intervention appropriate to the patient’s needs and to the resources available in the patient’s community.

Addiction should be considered a biopsychosocial co-occurring disorder, for which the use of medication(s) is but only one component of overall treatment.

A BIOPSYCHOSOCIAL ASSESSMENT TEMPLATE:
http://publichealth.lacounty.gov/sapc/NetworkProviders/ClinicalForms/TS/AssessmentToolAdultsPaperVersion.pdf

The following is an extract from the ASAM Strategic Plan and provides guiding principles:

• Positive changes are seen as starting points for the recovery process: reduced harm, safer use, reduced use, moderation and potential abstinence.

• A comprehensive initial assessment will determine an initial personalized treatment plan based on substance use severity, the psychobiosocial factors, multiple meanings and functions of the behaviour, motivation to change, and insight.

• Effective treatment has a primary focus on engagement and therapeutic alliance throughout the assessment process that “starts where the person is” with compassion, respect and acceptance, because creating safety and support are seen as essential to the therapeutic outcomes.

• Teaching self-management skills to address urges and difficult emotions is often essential. An ongoing assessment throughout treatment deepens both client and therapist awareness of the addiction severity and its meaning and functions.

• Exploring the client’s resistance to change reveals the issues that need new solutions. As these issues are clarified, positive change goals around the substance use and these issues can be established.

And, finally, a person centred plan for pursuing these positive changes can be developed collaboratively between client and therapist. The plan may include a variety of therapeutic modalities, lifestyle changes, health practices and medications depending on the client’s needs.

I believe that appropriately trained medical staff, supported by trained volunteers with lived experience in personal recovery, can save lives, stabilise chronic to acute stages of addiction and negative prejudices which are common when dealing with these patients.

These efforts, in turn, can save lives, reduce the financial burden of treating addiction to the health care system and support the interdisciplinary addiction medicine team.

SELF COMPASSION

When I act with self-compassion, this triggers the release of oxytocin, the love hormone that facilitates safety and connection.
Our endorphins are natural feel-good neurotransmitters.

Self-compassion’s three elements are found in mindfulness, kindness, and universal humanity.

Self acceptance

We’re always our harshest critic. We know that we have made choices and decisions throughout our life that we may regret or torture ourselves about. But they are carved in stone, and we must accept them, forgive ourselves, and make better choices in the future.

A lot of self acceptance really comes down to awareness. The more aware we are – of ourselves, of our words, of our actions, of their impact, of other’s emotions, of our surroundings – the more conscious we are.

When we are more conscious, we are more aligned with the universe… allowing us to flow love more easily, experience deeper meaning in the moment, and live lives of greater balance and happiness.


We are in this together…

Connection and community.

We are in this together. Do not worry about the tomorrow, bring your focus into the present moment.

The introduction to A Course in Miracles states: “ The Course can be summed up very simply :

Nothing real can be threatened . Nothing unreal exists . Herein lies the peace of God .” What that means is this: Love is real. It’s an eternal creation and nothing can destroy it. Anything that isn’t love is an illusion. Remember this, and you’ll be at peace.

A Course in Miracles says that only love is real: “The opposite of love is fear, but what is all-encompassing can have no opposite.” When we think with love, we are literally co-creating with God. And when we’re not thinking with love, since only love is real, then we’re actually not thinking at all. We’re hallucinating.

And that’s what this world is: a mass hallucination, where fear seems more real than love. Fear is an illusion. Our craziness, paranoia, anxiety and trauma are literally all imagined . That is not to say they don’t exist for us as human beings. They do. But our fear is not our ultimate reality, and it

does not replace the truth of who we really are. Our love, which is our real self, doesn’t die, but merely goes underground.

The Course teaches that fear is literally a bad dream. It is as though the mind has been split in two; one part stays in touch with love, and the other part veers into fear. Fear manufactures a kind of parallel universe where the unreal seems real, and the real seems unreal.

Williamson, Marianne. A Return to Love (Kindle Locations 367-380). HarperOne. Kindle Edition.

BREATHWORK

Go deep. Stay there…

Challenging times. I can easily feel overwhelmed when I drift into thinking about the future, or the past…this triggers a need to be in control…which I know is an exercise I futility.

Start where you. Do what you can. Move more. Think less.

Belly breathing supports strengthening your constitution.

You are not alone. Recovery is about connection. Isolation during COVID-19 lockdown may trigger a need to self medicate…it doesn’t have to….pick up the phone, ask for help from another member in recovery.

We are in this for the together. We continue to overcome adversity.

Just For Today Card
A popular sobriety aid is the Just for Today card that some AA members carry in their pocket or purse and refer to when thinking of a drink or they are disturbed by a life event.

Just for today

  • Just for today I will try to live through this day only, and not tackle all my problems at once. I can do something for twelve hours that would appall me if I felt that I had to keep it up for a
    lifetime.
  • Just for today I will be happy. Most folks are as happy as they make up their minds to be.
  • Just for today I will adjust myself to what is, and not try to adjust everything to my own desires. I will take my luck as it comes, and fit myself to it.
  • Just for today I will try to strengthen my mind. I will study. I will learn something useful. I will not be a mental loafer. I will read something that requires effort, thought and concentration.
  • Just for today I will exercise my soul in three ways: I will do somebody a good turn, and not get found out; if anybody knows of it, it will not count. I will do at least two things I don’t want to do just for exercise. I will not show anyone that my feelings arehurt; they may be hurt, but today I will not show it.
  • Just for today I will be agreeable. I will look as well as I can, dress becomingly, keep my voice low, be courteous, criticize not one bit. I won’t find fault with anything, nor try to improve or regulate anybody but myself.
  • Just for today I will have a program. I may not follow it exactly, but I will have it. I will save myself from two pests: hurry and indecision.
  • Just for today I will have a quiet half hour all by myself and relax. During this half hour, sometime, I will try to get a better perspective of my life.
  • Just for today I will be unafraid. Especially I will not be afraid to enjoy what is beautiful and to believe that as I give to the world, so the world will give to me.

REMEMBER TO REMEMBER

The remains of the day. Yesterday in the park. Walk & talk with my Beloved.

Present moment awareness:
Sit back.

Bring your attention to your breath.

Let your body settle.

Relax your body.

Welcome the silence.

Embrace the stillness.

Tune into the tenderness of gently inhale and exhale.


Allow your breath quieten your mind, moment after moment.

Words of wisdom from Pema Chödrön. The Wisdom of No Escape: And The Path of Loving-Kindness (p. 105). HarperCollins Publishers.

The traditional four reminders are basic reminders of why one might make a continual effort to return to the present moment. The first one reminds us of our precious human birth; the second, of the truth of impermanence; the third, of the law of karma; and the fourth, of the futility of continuing to wander in samsara.

The first reminder is our precious birth. All of us sitting here have what is traditionally called a good birth, one that is rare and wonderful. All you have to do is pick up Time magazine and compare yourself to almost anyone on any page to realize that, even though you do have your miseries, your psychological unpleasantnesses, your feelings of being trapped, and so on, they’re kind of rarefied compared with how it could be in terms of being run over by tanks, starving to death, being bombed, being in prison, being seriously addicted to alcohol or drugs or anything else that’s self-destructive.

The second reminder is impermanence. Life is very brief. Even if we live to be a hundred, it’s very brief. Also, its length is unpredictable. Our lives are impermanent.

It’s sobering to me to think that I don’t have all that long left. It makes me feel that I want to use it well. If you realize that you don’t have that many more years to live and if you live your life as if you actually had only a day left, then the sense of impermanence heightens that feeling of preciousness and gratitude. Traditionally it’s said that once you are born, you immediately start dying.

The teachings say, ‘Well, that’s why we sit. That’s what mindfulness is about. Look carefully. Pay attention to details.’ Remembering impermanence motivates you to go back and look at the teachings, to see what they tell you about how to work with your life, how to rouse yourself, how to cheer up, how to work with emotions.

Still, sometimes you’ll read and read and you can’t find the answer anywhere. But then someone will tell you, or you’ll find it in the middle of a movie, or maybe even in a commercial on TV. If you really have these questions, you’ll find the answers everywhere. But if you don’t have a question, there’s certainly no answer.

Impermanence means that the essence of life is fleeting. Some people are so skillful at their mindfulness practice that they can actually see each and every little movement of mind – changing, changing, changing.

They can also feel body changing, changing, changing. It’s absolutely amazing. The heart pumps blood all the time and the blood keeps going and the food gets digested and the whole thing happens. It’s amazing and it’s very impermanent.

‘What’s this fear? Where did it come from? What am I scared of?’ Maybe you’re scared of the most exciting things you have yet to learn. Impermanence is a great reminder. The third reminder is karma: every action has a result.

One could give a whole seminar on the law of karma. But fundamentally, in our everyday life, it’s a reminder that it’s important how we live. Particularly it’s important at the level of mind.

Every time you’re willing to acknowledge your thoughts, let them go, and come back to the freshness of the present moment, you’re sowing seeds of wakefulness in your unconscious.

After a while what comes up is a more wakeful, more open thought. You’re conditioning yourself toward openness rather than sleepiness. You might find yourself caught, but you can extricate yourself by how you use your mind, how you actually are willing to come back just to newness, the immediacy of the moment.

Every time you’re willing to do that, you’re sowing seeds for your own future, cultivating this innate fundamental wakefulness by aspiring to let go of the habitual way you proceed and to do something fresh. Basically this is letting go of thoughts, the churning of thoughts, and coming back to the present moment. In one of our chants we say, ‘Whatever arises is fresh, the essence of realization.

Grant your blessings so that my meditation is free from conceptions.’ Freshness here means willingness to sit up if you’re slouching. If you want to stay in bed all day with the covers over your head, it means willingness to get up and take a shower with really good soap, to go down to the drugstore and buy something that smells good, to iron your shirt, shine your shoes, whatever it takes to perk up. It means doing whatever it takes to counteract your desire to throw everything on the floor, push it under the bed, not wash, just dive into this darkness.

When these feelings come on, it does feel as if the whole world is collaborating with your own state of mind, acting as a mirror. Darkness seems to be everywhere. People are irritated at you, everything is closing in. Trying to cheer yourself up isn’t easy, and sometimes it feels hypocritical, like going against the grain. But the reminder is that if you want to change your habitual stuckness, you’re the only one who can do it.

According to the law of karma, every action has a result. The law of karma says, ‘Well, how do you want to feel tomorrow, next week, next year, five years from now, ten years from now?’ It’s up to you.

The law of karma is that we sow the seeds and we reap the fruit. To remember that can be extremely helpful. So when you find yourself in a dark place where you’ve been countless, countless times, you can think, ‘Maybe it’s time to get a little golden spade and dig myself out of this place.’

I remember my first interview with my teacher, Chögyam Trungpa, Rinpoche, very well, because I was somehow hesitant to talk to him about what was really the problem in my life. Instead, I wasted the whole interview chattering. Every once in a while he said, ‘How’s your meditation?’ and I said, ‘Oh, fine,’ and then just chattered on. When it was over, I blurted out, ‘I’m having this terrible time and I’m full of anger and blah-blah-blah,’ in the last half-second. Rinpoche walked me toward the door and said, ‘Well, what that feels like is a big wave that comes along and knocks you down. You find yourself lying on the bottom of the ocean with your face in the sand, and even though all the sand is going up your nose and into your mouth and your eyes and ears, you stand up and you begin walking again.

Then the next wave comes and knocks you down. The waves just keep coming, but each time you get knocked down, you stand up and keep walking. After a while, you’ll find that the waves appear to be getting smaller.’

That’s how karma works. If you keep lying there, you’ll drown, but you don’t even have the privilege of dying. You just live with the sense of drowning all the time. So don’t get discouraged. The waves just keep coming and knocking you down, but you stand up again and with some sense of rousing yourself, standing up.

As Rinpoche said, ‘After a while, you find that the waves seem to be getting smaller.’ That’s really what happens. That’s how karma works. So let that be a reminder. It’s precious and it’s brief and you can use it well.

Chödrön, Pema. The Wisdom of No Escape: And The Path of Loving-Kindness (p. 105). HarperCollins Publishers. Kindle Edition.

CALMING IN CHAOS

The power of prayer and meditation. Pausing. Quieting ourselves reduces stress and restores a sense of calm in this time of coronavirus, a time of collective fears and difficulty, it is crucial to find ways to steady the mind and heart, to connect compassionately with ourselves and with each other. Reciting a silent mantra for compassion will ease us into a silent meditation. This practice can help us meet whatever arises with presence and courage, intelligence and love.

The Mantra of Compassion, OM MANI PADME HUM, is pronounced by Tibetans: Om Mani Pémé Hung. It embodies the compassion and blessing of all the buddhas and bodhisattvas, and invokes especially the blessing of Avalokiteshvara, the Buddha of Compassion. Avalokiteshvara is a manifestation of the Buddha in the Sambhogakaya, and his mantra is considered the essence of the Buddha’s compassion for all beings. Just as Padmasambhava is the most important master for the Tibetan people, Avalokiteshvara is their most important buddha, and the karmic deity of Tibet.

There is a famous saying that the Buddha of Compassion became so embedded in the Tibetan consciousness that any child who could say the word “mother” could also recite the mantra OM MANI PADME HUM. Countless ages ago, it is said, a thousand princes vowed to become buddhas. One resolved to become the Buddha we know as Gautama Siddhartha; Avalokiteshvara, however, vowed not to attain enlightenment until all the other thousand princes had themselves become buddhas. In his infinite compassion, he vowed too to liberate all sentient beings from the sufferings of the different realms of samsara.

Before the buddhas of the ten directions, he prayed: “May I help all beings, and if ever I tire in this great work, may my body be shattered into a thousand pieces.” First, it is said, he descended into the hell realms, ascending gradually through the world of hungry ghosts, up to the realm of the gods. From there he happened to look down and saw, aghast, that though he had saved innumerable beings from hell, countless princes had themselves become buddhas. In his infinite compassion, he vowed too to liberate all sentient beings from the sufferings of the different realms of samsara.

“May I not attain final buddhahood before all sentient beings attain enlightenment.” It is said that in his sorrow at the pain of samsara, two tears fell from his eyes: through the blessings of the buddhas, they were transformed into the two Taras. One is Tara in her green form, who is the active force of compassion, and the other is Tara in her white form, who is compassion’s motherly aspect. The name Tara means “she who liberates”: she who ferries us across the ocean of samsara.

It is written in the Mahayana Sutras that Avalokiteshvara gave his mantra to the Buddha himself, and Buddha in turn granted him the special and noble task of helping all beings in the universe toward buddhahood. At this moment all the gods rained flowers on them, the earth shook, and the air rang with the sound OM MANI PADME HUM HRIH.

To learn more go to: The Tibetan Book Of Living And Dying: A Spiritual Classic from One of the Foremost Interpreters of Tibetan Buddhism to the West . Ebury Publishing.

May you be well

May you be calm

May you treasure this moment

May your tenderness be expressed

May you be happy

May you BE YOU

COMPASSION IS CONTAGIOUS

I hold onto a self care frame and continue to let go of control.

Breathe. You are exactly where you need to be.

Zen Buddhism teaches a concept called “zen mind,” or “beginner’s mind.” They say that the mind should be like an empty rice bowl. If it’s already full, then the universe can’t fill it. If it’s empty, it has room to receive. This means that when we think we have things already figured out, we’re not teachable.

There is great freedom in trusting in the unknown. The wise person doesn’t pretend to know what it’s impossible to know. “I don’t know” can be an empowering statement. When we go into a situation not knowing, there is something inside then ask how can we know what result to try to achieve in a situation when we don’t know what’s going to happen tomorrow?