Public perceptions about addiction and mental health treatment reflect the prevailing non-medical approach to mental and addiction ill-health.
Accessing healthcare is a major policy problem, ergo a priority. How do we effectively meet individual health needs?How best to deliver quality care? How to raise the standard of continuing care?
Personally, when I left rehab 31 years ago, I relapsed within days because the re-entry process was overwhelming, escalating stress, triggered free-floating stopped me from going to 12step meets, leaving my house and answering the phone…fortunately my relapse took me to Payne Whitney Psychiatric Hospital.
The psychiatrist that listened to my cry for help and responded by recommending I return to 12step meetings, not take any medication, find a therapist who did not want to date me, who abused their power etc..saved my life.
I returned to 12step meetings, found a sponsor, and an empowered female psychotherapist who helped me recover phoenix-like from the ashes of my self self-destruction and suicidal ideation.
I am in longterm recovery – 30 years of continuing mind body recovery -that began in NYC 12th October, 1988… an important act of self accountability in early recovery is to ‘be of service’ …a few of us went regularly from our Park Avenue meeting to prisons, hospitals, and homeless shelters.
I connected with my tribe, web were committed to a 12step programme for living; for life. I went to individual and group therapy for 3 years, in addition to volunteering at the Manhattan Centre for Living, founded by Louise Hay and Marianne Williamson. Fabulously altruistic times.
We were a large recovery tribe in Manhattan, we formed 12stp study groups, sponsorship workshops and often went to upstate New York for immersive meditation retreats.
Therapists specialising in recovery began publishing books which served to enrich the foundation for change we were embracing.
I had been thinking about specialising in addiction counselling and decide to return to London, and retrain. Confident that my previous “life experience” as fashion imagine editor, film and video producer would find an a creative outlet – that would come later when I wrote a book about the male archetypes, and in my private practice, the majority of my clients were from the fashion, design, film, theatre, and finance industries…
The benefits of the timeless teaching of philosophy, mythology, spirituality, and psychology continue to ground, stimulate and inspire me. I love life. It is a privilege to pass the message of recovery on to the still suffering addict….if I can recovery you can…
21st century medicine/neuroscience scientifically shows us how the brains complex circuity systems function, moreover that the brain of the addict is not dissimilar to that of a stroke victim…
The ASAM busted the myths and introduced into biopsychosocial model for change, relapse prevention, and recovery.
ASAM- American Society Addiction Medicine states that:
Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry.
Dysfunction in these circuits leads to characteristic biological, psychological, social and spiritual manifestations. This is reflected in an individual pathologically pursuing reward and/or relief by substance use and other behaviors.
Addiction is characterized by inability to consistently abstain, impairment in behavioral control, craving, diminished recognition of significant problems with one’s behaviors and interpersonal relationships, and a dysfunctional emotional response.
Like other chronic diseases, addiction often involves cycles of relapse and remission. Without treatment or engagement in recovery activities, addiction is progressive and can result in disability or premature death.
The neurobiology of addiction encompasses more than the neurochemistry of reward.
The frontal cortex of the brain and underlying white matter connections between the frontal cortex and circuits of reward, motivation and memory are fundamental in the manifestations of altered impulse control, altered judgment.
The dysfunctional pursuit of rewards – despite cumulative adverse consequences experienced from engagement in substance use and other addictive behaviors.
A BioPsychoSocial approach (BPS)
With many differing theories all purporting to explain addiction, some sort of integrative approach was inevitable.
First articulated by George Engel in 1977, The BPS model was originally designed as an alternative to the prevailing biomedical model, which tends to reduce illness to a single source, then treat the illness with little regard for other contributing factors such as a patient’s psychological experiences or social behaviours.
A decade later, Donovan (1988) and Wallace (1990) articulated a BPS model for addictive behaviours in recognition that drinking behaviour and alcohol problems are multidimensional. Donovan recommended comprehensive assessment that could capture the biological, psychological and social aspects of the individual’s life that are affected by drinking. This information, Donovan hypothesized, would improve diagnosis and treatment.
It is important to understand the brains complex circuitry systems, that underpin the onset and maintenance of additive behaviours, it is necessary to place these systems in the context of the individual and their surroundings.
Epigenetics and individual differences in brain architecture do not adequately explain why particular individuals initiate drug taking, develop addictions and then may or may not respond to a variety of interventions.
Several psychological traits have been associated with addiction – impulsivity, depression, anxiety, reward sensitivity and learning capacity. Such characteristics are the product of biology, personality and circumstance.
Paying attention to healthcare organisations is not enough to actually improve people’s health. Healthcare around the world is often ineffective, or inappropriate for a patient’s condition, and can even leave patients worse off.
I want to introduce into the NHS a recovery room specific to assessing, referring, the addict in crisis who has come to A&E for help.
Specific programme objectives are to make available traction and peer-led healing regimes and for individuals to benefit from evidence-based wellbeing practices-that empower people, restore trust and faith that they can heal their lives.