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

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

My biopsychosocial approach has helped 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.

Her compassionate approach, addiction recovery insights and personal disclosure of her recovery experience indicated there was another way …and I was not admitted and probably mis-prescribed antidepressants to treat my opioid addiction.

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 series of relapses after rehab and was to re-engage with 12step meetings, and the recovery community.”

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.

By creating an addiction healthcare environment that is, first and foremost, kind, the clici will provide an open gateway 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, the would visit regularly and share her experience, strength and hope..with us who remained in awe of her grace and effort with recovery…

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.

UNIVERSAL ADDICTION HEALTHCARE
Mobile: +447894084788
Email: ELIZABETHHEARN.COM

A VISION FOR THE FUTURE

A Public Health Approach: Addiction Recovery

“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

  1. 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.
  2. 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.
  3. 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.
  4. 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.
  5. 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.
  6. 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.
  7. 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.
  8. 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.
  9. Many individuals have co-occurring disorders with other mental illnesses, treatment should address both (and all), including the use of medications as appropriate.
  10. 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.
  11. 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.
  12. 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.
  13. 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.
  14. 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

Addiction recovery: person-centred healthcare.

What is addiction:

Addictions—whether to drugs or to behaviours—share the same brain circuits and brain chemicals. On the biochemical level the purpose of all addictions is to create an altered physiological state in the brain. This can be achieved in many ways, drug taking being the most direct. So an addiction is never purely “psychological. All addictions have a biological dimension.

Addiction is any repeated behaviour, substance-related or not, which brings temporary relief or pleasure, and in which a person feels compelled to persist, regardless of its negative long-term impact on his life and the lives of others.

Addiction is not a criminal justice issue but a human justice, public health issue which requires specialist training in addiction medicine, and knowledge about the treatment of addiction.

The pillars of addiction person centred healthcare: prevention, intensive inpatient and outpatient treatment that support each stage of recovery from intervention through to continuing self-care supported by established recovery communities.

2% of US service providers are trained provide medications for addiction treatment. In the UK, 1%. There are abundant resources available to change how people engage in addiction treatment and recovery.

With over 30 years of personal addiction recovery and 27 years as a clinician specialising in addiction and mental healthcare inpatient and outpatient continuing recovery programmes in the UK, India and Australia I recommend implementing the American Society Addiction Medicine’s “Fundamental of Addiction Training” to educate, empower and support first responders, doctors, nurses, and associated health care professionals.

Training addresses the biggest problem: accessing 24/7 addiction healthcare clinics. A&E -NHS is the only available limited treatment option for people in active addiction seeking help in managing active addiction.

The global addiction recovery communities shared addiction healthcare vision is raise awareness of the need for autonomous addiction person-centred clinics to prevent, treat, and promote remission and recovery from the disease of addiction, and to provide resources for continuing research, education, trainings, innovation, advancement, and implementation of addiction science and care.

Given Glasgow’s opioid and heroin epidemic, the benefits of MAT: Medication-Assisted Treatment is an important tool in treating the chronic, progressive and potentially fatal disease.

Establishing autonomous 24/7 addiction healthcare clinics within A&E-NHS settings, a safe clinical setting where clinicians and live experience volunteers can work, side by side to engage people in active addiction who want help in accessing addiction healthcare.

Treatment programmes that implement Medication-Assisted Treatment in the form of Methadone, Buprenorphine (e.g., Suboxone), or injectable Naltrexone Extended Release (XR) (Vivitrol) to opioid use disorders are what is needed.Rigorous, evidence-based tapering guidance and best practices would help give both clinicians and patients confidence in the detox, treatment, recovery process.

Medication is meant to be used as a supportive tool and managed by qualified healthcare professionals in collaboration with addiction treatment trained specialists as part of a comprehensive therapeutic programme.

The fundamentals of addiction training ensure safety in the administration of Buprenorphine or Injectable Naltrexone XR used for MAT in the face of active heroin and or opioid use because this will precipitate withdrawal and the need for medical management.

Person-centred addiction healthcare programmes that utilise a multi-disciplinary approach to address the co-occurring disorders often found with the opioid epidemic is an extensive biospychosocial approach.

An expansion of the addiction healthcare clinical protocols is needed to ensure that MAT is only one facet of a comprehensive continuum of care: intensive inpatient and outpatient treatment and recovery programmes.

Of the available choices for Naltrexone XR and Buprenorphine. These medications must be made available to all patients with an opioid use disorder. Buprenorphine is a detoxification medication/taper and, when clinically appropriate, is can be used as MAT maintenance. The decision between use of Naltrexone XR or Buprenorphine for maintenance is patient centered.

The ASAM is supporting National Addiction Treatment Week in the US. Each year, National Addiction Treatment Week (NATW) raises awareness that addiction is a disease, evidence-based treatments are available, and recovery is possible.

This year, October 21-October 27, the week will highlight the critical need for clinicians to enter the field of addiction medicine. Clinicians trained in addiction are essential to fill the treatment gap between patients who need evidence-based addiction treatment and the insufficient number of clinicians qualified to treat addiction.

Along with its supportive partners, the American Society of Addiction Medicine (ASAM) will be hosting the week with a dedicated twitter handle @TreatmentWeek and using #TreatmentWeek to build important conversations on social media.

More clinicians trained in addiction are needed to overcome the addiction epidemic overwhelming the United States today. In 2018, approximately 20.3 million people aged 12 or older had a substance use disorder (SUD) related to their use of alcohol or illicit drugs in the past year.

More people died from a drug overdose than from car accidents in 2017, 2,3 and nearly 88,000 people die from alcohol-related causes each year.

Only about 17% of those diagnosed with substance use disorder received the treatment they need.5 In 2018, an estimated 2 million Americans were addicted to opioids, yet only about 400,000 people received treatment at a specialty facility.6

“National Addiction Treatment Week amplifies the crucial message that when patients are treated appropriately by certified addiction medicine specialists, we can save lives and improve treatment outcomes.

The medical community must be at the forefront of communities proclaiming that addiction is a chronic brain disease, not a moral failure, and as such must be treated with evidence-based, research verified care.” said Paul H. Earley, MD, DFASAM, president of ASAM.

“To overcome the health crisis, we need to expand the number of medical professionals who understand the complexities of the disease and are trained to treat addiction. Only then will we see real progress.”

We are proud to stand with our dedicated National Addiction Treatment Week partners: Advocates for Opioid Recovery, the American Medical Association, the American Osteopathic Academy of Addiction Medicine, Beyond Definition, MI Cares, National Association of Addiction Treatment Providers, National Institute on Alcohol Abuse and Alcoholism (NIAAA), National Institute of Drug Abuse/NIDAMED (NIDA), and Office of National Drug Control Policy.

Join the engaging events of the week which include Twitter chats with ASAM and NIAAA on alcohol use disorder and NIDA experts on adolescents and addiction; a Facebook rebroadcast of a compelling conversation between David and Nic Sheff, from Beautiful Boy, and adolescent addiction medicine specialist, Dr. Marc Fishman; and inspiring social media posts from addiction medicine specialists throughout the week. Together, we can help more people receive evidence-based treatment and improve patient outcomes.

Learn more by visiting TreatAddictionSaveLives.org.

American Society Addiction Medicine: definition of addiction.

ASAM Releases New Definition of Addiction to Advance Greater Understanding of the Complex, Chronic Disease
by ASAM Staff | October 22, 2019


Incomplete Understanding of Addiction has Prevented an Adequate Response from the Medical Community, the Criminal Justice System and Policymakers in Addressing Prevention, Treatment, Remission, and Recovery and Reducing Overdose Deaths

Rockville, MD – The American Society of Addiction Medicine (ASAM) – the nation’s largest organization representing medical professionals who specialize in addiction prevention and treatment – has updated the society’s definition of addiction to explain more fully the complexity of this chronic disease with the intent of driving a bold and comprehensive national response that creates a future when addiction prevention, treatment, remission and recovery are accessible to all, and profoundly improve the health of all people.

The release of the updated definition of addiction coincides with National Addiction Treatment Week, which is recognized from October 21–27, 2019.

In commentary published in Medium, the president and vice president of ASAM, Drs. Paul Earley and Yngvild Olsen respectively, note the updated definition “underscores the complex interplay of unique biological, psychological, and environmental conditions that have a role in any one individual’s addiction.”

Moreover, the two assert that a better understanding of addiction “… may lead us to bolder policy interventions that save and improve more lives. Ultimately, public perception and public policy must reflect this nuanced understanding if our nation is to recover.”

The updated definition reads:

Addiction is a treatable, chronic medical disease involving complex interactions among brain circuits, genetics, the environment, and an individual’s life experiences. People with addiction use substances or engage in behaviors that become compulsive and often continue despite harmful consequences.

Prevention efforts and treatment approaches for addiction are generally as successful as those for other chronic diseases.

The American Society of Addiction Medicine (ASAM), founded in 1954, is a professional medical society representing over 6,000 physicians, clinicians and associated professionals in the field of addiction medicine. 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.

Since 2011, the public understanding and acceptance of addiction as a chronic brain disease and the possibility of remission and recovery have increased. At the same time, there is growing acknowledgment of the roles of prevention and harm reduction in the spectrum of addiction and recovery.

In response, ASAM’s Board in 2018 recognized the need for an updated definition of addiction that would be more accessible to many of ASAM’s stakeholder groups, including patients, the media, and policymakers. Accordingly, the Board appointed a Task Force to Update Terms Related to Addiction and the Treatment of Addiction. With the input of internal and external stakeholders, the Task Force revised the definition of addiction for use in ASAM’s policy statements.

The Task Force also recommended that definitions for “medication-assisted recovery (MAR)” and “medication-assisted treatment (MAT),” which had been identified by the DDTAG as transitional terms, be retired from use in ASAM documents. With the evolution of addiction treatment and its increasing integration with general medical care, the Task Force recommended ASAM adopt general medical terminology to describe addiction treatment.

Therefore, ASAM recommends using the term “medication” to refer to any FDA-approved medication used to treat addiction. However, ASAM recognizes the continued widespread use of the acronym “MAT” in laws, regulations, academic literature, the media, and the vernacular, and ASAM suggests “MAT” be read and understood as “medications for addiction treatment.”

For more information: ASAM.com

TRAUMA: THE ROOT CAUSE OF ADDICTION

Where justice and treatment meet:

Trauma is at the nature of addiction, according to Dr. Gabor Mate.

“Addiction is only a symptom, it’s not the fundamental problem. The fundamental problem is trauma,” said Mate.

He believes that anything we’ve ever craved helped us escape emotional pain. It gave us peace of mind, a sense of control and a feeling of happiness.

And all of that, explains Dr. Maté, reveals a great deal about addiction, which he defines as any behaviour that gives a person temporary relief and pleasure, but also has negative consequences, and to which the individual will return time and again.

At the heart of Dr. Maté’s philosophy is the belief that there’s no such thing as an “addictive personality”. And nor is addiction a “disease”. Instead, it originates in a person’s need to solve a problem: a deep-seated problem, often from our earliest years that was to do with trauma or loss.

Dr. Maté, a wiry, energetic man in his mid-70s, has his own experience of both childhood trauma and addiction, more of which later.

Well-known in Canada, where he lives, he gives some interesting reasons why Britain is “just waking up to me” and his bestselling book In the Realm of Hungry Ghosts.

There’s a generational conflict here, he says, around being open about past trauma: he cites Princes William and Harry opening up about their mother’s death, and says it’s something the Queen’s generation would never have done.

He applauds the new approach: “I think they [the princes] are right to be leading and validating that sense of enquiry, without which life is not worth living.”

William and Harry opening up about their mother’s death is something the Queen’s generation would never have done
The infamous British stiff upper lip is something Dr. Maté has watched with fascination over the years.

Born of our imperial past, he says, it was maintained for as long as there was something to show for it. Boarding school culture and traumatic childhoods played out into dominance of other countries and cultures, giving the “buttoned-up” approach inherent value. But once the empire crumbled, lips quavered.

“With rising inequality and all the other problems there are right now,” he says, “people are having to question how they live their lives. People in Britain are beginning to realise they paid a huge price internally for all those suppressed emotions.”


Part of that price was addiction – whether to alcohol or drugs, gambling or sex, overwork or porn, extreme sports or gaming – but essential to understanding it, says Dr. Maté, is to realise that addiction is not in itself the problem but rather an attempt to solve a problem. “Our birthright as human beings is to be happy, and the addict just wants to be a human being.”

And addictive behaviour, though damaging in the medium or long term, can save you in the short term. “The primary drive is to regulate your situation to something more bearable.”

So rather than some people having brains that are wired for addiction, Dr. Maté argues, we all have brains that are wired for happiness. And if our happiness is threatened at a deep level, by traumas in our past that we’ve not resolved, we resort to addictions to restore the happiness we truly crave.

Life is certainly a lot more work than I anticipated
He speaks from experience: Dr. Maté is a physician who specialised in family practice, palliative care and, finally, addiction medicine. He became a workaholic and lived with ADHD and depression until, in his 40s and 50s, he began to unravel the root cause – and that took him all the way back to Budapest, where he was born in January 1944.

Two months later, the Nazis occupied Hungary: his mother took him to the doctor because he wouldn’t stop crying. “Right now,” the doctor replied, “all the Jewish babies are crying.” This is because, explains Maté, what happens to the parent happens to the child: the mothers were terrified, the babies were suffering, but unlike their mothers they couldn’t understand what the suffering was about.

Later, Dr. Maté’s mother, fearing for his survival, left him for a month in the care of a stranger. All this, he explains, gave him a lifelong sense of abandonment and loss which had an impact on his psychological health. It affected his marriage and his own parenting experience. To compensate for his buried trauma, he had buried himself in work and neglected his family.

Opening up to the trauma, exploring it and investigating it, was incredibly difficult. “The problems for me showed up in the dichotomy between my success as a physician and my miseries as a husband and a father,” he recalls.

“There was a big gap between them, and it’s taken me a long time to work through what I needed to work through.” As Oscar Wilde believed, pain is the path to perfection; and nearly five decades on from the day of their wedding, Maté says his marriage is better than ever.

“We’re happier, but it’s taken many years of work,” he says. In a few weeks it will be the couple’s 49th wedding anniversary. “We’ll go out for dinner and raise a glass to five happy years,” he quips. He’s already chosen his epitaph: “It’s going to say, this life is a lot more work than I anticipated. Because it takes a lot of work to wake up as a human being, and it’s a lot easier to stay asleep than to wake up.”

It takes a lot of work to wake up as a human being, and it’s a lot easier to stay asleep than to wake up
For Dr. Maté, self-awareness is the bottom line: when we wake up and become properly self-aware, we are able to address the traumatic childhood issues that leave us vulnerable to addiction.

But because the process inevitably involves pain, we don’t address the issues until we absolutely have to – until something happens that forces us to face up to the fact that our lives aren’t working as they should. And as with the individual, so too with society: although all around us in politics and the wider world is mayhem and chaos, Dr. Maté holds on to the fact that this discomfort – which we are communally aware of – will force us to examine what’s gone wrong in our collective psyche, and to seek to correct it.

Unsurprisingly, given his central message, Dr. Maté is in favour of drug decriminalisation. He points to Portugal, where it is no longer illegal to possess a small amount of heroin or cocaine, and says the country has seen a reduction of drug-taking, less criminality and more people in treatment. In his view, it’s not really the drugs that are being decriminalised, it’s the people who are taking them – and given that they are, in his view, always victims of trauma, and never merely “bad” or “dangerous”, that’s entirely logical. But decriminalisation is only the beginning: reform must cut much deeper.

“The whole legal system is based on the idea that people are making a choice,” he says. “This is false – because no one chooses to be an addict, or to be violent.”

And when readers tell him – sometimes accusingly, sometimes gratefully – that his work humanises addicts, he can only answer: addicts are human. The only question for him is, why has it taken us so long to realise that?

Dr. Maté was in Regina on Wednesday to speak at the sixth International Training Symposium on Innovative Approaches to Justice: Where Justice and Treatment Meet.

The conference started Tuesday and runs until Friday at the Hotel Saskatchewan. Judges, lawyers, counsellors and professionals who work in treatment courts from across the country are in attendance, along with a handful of people from the United States. The conference is held every two years, with the last one being held in Vancouver.

“A lot of issues that people have are related to a trauma in their life … so we’re bringing in professionals to talk about the nuts and bolts of how you deal with that population,” said Saskatchewan Provincial Court Judge Clifford Toth, one of the organizers of the conference.

Dr. Mate a doctor from Vancouver, is one of the keynote speakers. He worked for 12 years in Vancouver’s downtown east side, which is one of the most concentrated areas of drug use in Canada. He also wrote a book about addiction entitled In the Realm of Hungry Ghosts.

His talk at the conference, A Bio-physical Perspective on Addiction, focused on the nature of addiction, what causes it and the way to best approach people who are suffering from it.

“Before we ask how we handle something, we have to understand what are we handling,” Dr. Maté said.

Addiction connects back to trauma that people have experienced in their life. Once people understand this, then treatment can happen.

“Unfortunately most of the medical profession and the legal system does not understand addiction. Therefore our treatment and legal solutions tend not to be helpful, and in fact they often tend to be harmful,” he said.

Dr Maté sees drug treatment courts, like the one that is operated in Regina, as a step in the right direction. The courts are a step away from the traditional punishment approach. There is recognition in the courts that there is no justice without health, Mate said. These courts recognize that people are acting out because of their trauma.

Dr Maté: “When we understand that the people who are addicted are traumatized people, now we have to take an approach that will help them heal that trauma, rather than make it worse.”

Mate sees the conference as a way to open peoples’ minds to giving people that treatment.

“What I get about the conference is that it’s a real earnest and well- organized attempt to broaden the conversation and to bring together people from different disciplines,” Dr. Gabor Maté.

https://youtu.be/bqKfy-l422w

arobinson@postmedia.com

twitter.com/ashleymr1993

RECOVERY

When you asked me thirty one years ago: “What do I want to achieve in sobriety?”…..I replied “I want to be free…. from obsessively overthinking everything….”

On the 12th October I celebrated 31 years of continuing addiction recovery.

I am free.

Acceptance of what is….non-judgement, compassion and loads of now too just be present….for daily walks and talks in the local park with my husband, and our gorgeous son whenever he visits, drinking my greens, present moment pranayama, all the while consciously living consciously.

My service commitment to the global recovery movement is to continue to maintain the momentum of person-centred addiction healthcare clinics within A&E -NHS settings.

Addiction clinics where clinicians and lived experience volunteers work together to save lives. Addiction is a public health emergency.

Initially I leaned about the American Society of Addiction Medicine in 1989 from my then psychotherapist, it was their addiction criteria and addiction medicine research that change the course of my recovery….I no longer felt as though addiction was a socially stigmatised “sickness” instead it was a brain disorder…which made perfect sense based upon my generational knowledge of addiction….

This prompted me to introduce into Scotland in 2019, the ASAM “Fundamentals of Addiction Medicine Trainings” so that frontline healthcare professionals, and first responders, know how best to manage people in active addiction.

Safe prescribing is essential…as is can confidently prescribing and supervise medically assisted detox programmes, inpatient addiction primary care programmes, intensive outpatient programmes all the while knowing their individual process is fully supported.

Recovery is an individual process that can be sustained by the support of the global recovery movement.

You are not alone.

Ask for help.

RECOVERY & SERVICE WITHIN THE RECOVERY COMMUNITY

Service

“Red flags that warn that a bottom or relapse is coming involve: dropping out of meetings and isolating; being argumentative or unreasonable; gossiping; losing focus and returning to one of the family roles of hero, lost child, or mascot; general non-commitment to recovery; avoiding the Steps and intellectualizing; failing to give service to ACE; binging on sex, drugs, food, or other compulsive behaviors; and acting with perfectionism and failing to talk about feelings and critical inner messages.”

ACOA – Adverse Childhood Experiences: characterises deep attitudes and behaviours that sometimes are difficult to stay conscious of. The blaring ones are easy to recognize and to admit into our consciousness. But others lie beneath multiple layers of self-deception or socially-celebrated attributes. When we miss meetings on a consistent basis.

it may seem like a way of avoiding unwanted pain and disappointment. But it also provides the opportunity for our critical parent to distract us from our healing journey. This false self is masterful at finding ways to avoid doing the work that gives us a lifeline of hope.

In ACA, one way that keeps us coming back is to give service from a space of love. This is a sure-fire way of keeping ourselves tuned into our True Selves and our inner loving parent, which leads to taking care of our Inner Child.

By having consistent check-ins with ourselves, we can stay focused on what is right with our program and how to best help fellow ACAs begin their recovery process. On this day I will give service to my ACA group as a way of staying conscious and focused on my recovery process.

INC., ACA WSO. Strengthening My Recovery: Meditations for Adult Children of Alcoholics/Dysfunctional Families . ACA WSO INC.. Kindle Edition.

DR. L. DUPONT. RECOVERY. CONNECTION. COMMUNITY. ORGANISATION & LEADERSHIP

“Recovery leadership rules with heart. ” William White

As the second White House “Drug Czar” and the first Director of the National Institute on Drug Abuse (NIDA), Dr. DuPont was in the midst of a concerted effort by President Nixon and Congress to address the rising heroin and marijuana epidemics of the 1960s and 70s.

He was recently asked by the Nixon Foundation to discuss his unique perspective on the 50th anniversary of the July 14th, 1969 Special Message to the Congress on Control of Narcotics and Dangerous Drugs, in which Nixon insisted that “A national awareness of the gravity of the situation is needed; a new urgency and concerted national policy are needed at the Federal level to begin to cope with this growing menace to the general welfare of the United States.”

Looking back, Dr. DuPont sees Nixon’s Message as a “remarkable document” that anticipated and drove the development of many aspects and institutions of research, law enforcement, treatment, and international cooperation that still form the core of US drug policy to this day.

In particular, Dr. DuPont observes that Nixon’s Message broke new ground in two areas that were key in Dr. DuPont’s own career: the recognition that law enforcement and treatment are synergistic rather than competing components of effective drug policy, and the promotion of medically-assisted treatment (MAT), which Dr. DuPont helped pioneer in 1969 with the first large-scale MAT program in Washington, DC.

The interview concludes with Dr. DuPont offering his perspective on today’s drug policy landscape, including the marked shift from “cultivated” drugs to “synthetic” drugs, the drug legalization movement, and the new threat of what he calls “commercialized recreational pharmacology”, with businesses now a key driver of developing and marketing stronger, more addictive drugs and new delivery systems such as vaping and edibles.

As he succinctly observed in a 2018 interview with Opiod Watch, “drug users are able to buy more drugs, at higher potency, and lower prices, with more convenient delivery, than ever before.”

https://soundcloud.com/nixonfoundation/robert-dupont-on-the-50th-anniversary-of-president-nixons-message-dangerous-drugs

Current deaths in America involving synthetic opioids, such as fentanyl, increased from roughly 3,000 in 2013 to more than 30,000 in 2018. This analysis provides decisionmakers, researchers, media outlets, and the public with insights intended to improve their understanding of the synthetic opioid problem and how to respond to it. Limiting policy responses to existing approaches will likely be insufficient and may condemn many people to early deaths.

The Future of Fentanyl and Other Synthetic Opioids (RAND), consider examining a text edited by David F. Musto, One Hundred Years of Heroin (Auburn House 2002).

Cited in several national conference presentations in the past year, it is a compilation of 14 articles dovetailed to form a coherent history of the archetypal opioid of misuse.

The book provides multiple perspectives ranging from neurophysiology to the political response to the endemic, and featuring authors of such diversity as Bill White, Herb Kleber, Bob DuPont, and Daniel Patrick Moynihan.

…Why the plug? Because of the serialized hype surrounding synthetic opioids of misuse, of which only the most recent are fentanyl and sufentanil (sic).

As misuse of historical accounts and abuse of citations have returned to vogue among too many politicians, it is more important to make use of an informed, deep examination of the oldest player in the opioid addiction world.I recommend exploring a new groundbreaking book

“The Future of Fentanyl and Other Synthetic Opioids’ Paperback – 15 Oct 2019
by Bryce Pardo (Author) to learn about the past 100 years of heroin up until todays global opioid epidemic.

Fascinating read!

PERSON CENTERED: ADDICTION HEALTHCARE & RECOVERY

Dr Gabor Maté is a leading addiction medicine, healthcare, educator in treating addiction. His trauma informed approach in the treatment and healing of addiction is profoundly transformative.

“In the final analysis, it’s not the activity or object itself that defines an addiction but our relationship to whatever is the external focus of our attention or behaviour. Just as it’s possible to drink alcohol without being addicted to it, so one can engage in any activity without addiction.

On the other hand, no matter how valuable or worthy an activity may be, one can relate to it in an addicted way. Let’s recall here our definition of addiction: any repeated behaviour, substance-related or not, in which a person feels compelled to persist, regardless of its negative impact on his life and the lives of others.”

The distinguishing features of any addiction are: compulsion, preoccupation, impaired control, persistence, relapse and craving. Although the form and focus of addictions may vary, the same set of dynamics is at the root of them all.

Dr. Aviel Goodman writes, “All addictive disorders, whatever types of behaviors that characterize them, share the underlying psychobiological process, which I call the addictive process.”

It’s just as Dr. Goodman suggests: addictions are not a collection of distinct disorders but the manifestations of an underlying process that can be expressed in many ways. The addictive process—I will refer to it as the addiction process—governs all addictions and involves the same neurological and psychological malfunctions. The differences are only a matter of degree. There is plenty of evidence for such a unitary view.

Substance addictions are often linked to one another, and chronic substance users are highly likely to have more than one drug habit: for example, the majority of cocaine addicts also have, or have had, active alcohol addiction.

In turn, about 70 per cent of alcoholics are heavy smokers, compared with only 10 per cent of the general population.3 I don’t believe I’ve ever seen an injection drug user at the Portland Clinic who wasn’t also addicted to nicotine.

Often nicotine was their “entry drug,” the first mood-altering chemical they’d become hooked on as adolescents. In research surveys more than half of opiate addicts have been found to be alcoholics, as have the vast majority of cocaine and amphetamine addicts, and many cannabis addicts as well.

Dr Gabor Maté . “In the Realm of Hungry Ghosts: Close Encounters with Addiction.” Knopf Canada. Kindle Edition.

PERSON CENTERED: ADDICTION HEALTHCARE & RECOVERY

“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

In order to positively impact the financial and emotional burden upon the A&E-NHS of vulnerable people seeking help with mental and addiction healthcare issues it is time to actualise expanded acute care clinics that can be implemented into the public health sectors.

I am a person in longterm recovery – 31 years of lived experience that began with an encounter in A&E following a failed suicide attempt.

I failed not because I am alive today, I was fortunate to not have the courage to kill myself… flipping this into having the courage to live, is primarily because of an intervention by a psychiatrist in recovery who offered me choice: return to 12step meetings. OR be admitted, and medicated but not be treated for substance mis-use (cocaine) alcohol dependency (straight vodka), and prescription pill abuse (valium).

I returned to 12step meetings, which takes courage to admit defeat, and humility to ask for help…which I did as I spoke about the past 24 hours, walking through Central Park looking for someone to murder me…and that familiar feeling of desperation….something shifted… and I knew I needed to get help…I left Central Park and caught a cab to Payne Whitney, a psychiatric hospital where the intervention took place…

From that moment on I have never been alone in my recovery. I ask for help. At different stages in my recovery it has been of great value to work though the 12steps with my A.A. sponsor.

The befits of recovery are numerous…one is that I am kinder, compassionate, happier and available to do service in the recovery community: starting step and topic meetings in remote rural Indian Villages and Chelsea, London.

When I lived in NYC I went along with a few people in recovery to learn how to take meetings into hospitals and prisons. It is challenging to see, hear and and witness incarcerated people whose entire existence is absent from love, care and community, they are so isolated yet the ones who want help seek us out…even if their “recovery world may be unconfined space…their recovery world is huge–millions of people are in recovery and available online to talk about how to not relapse and shift the focus from self sabotage to one of self care….

In my longterm recovery experience, I will have 31 years on the 12th October, 2019…and my trainings in the fundamentals of addiction, coaching, counselling, psychotherapy, life is incredibly fulfilling.

Despite people in need of recovery resisting engaging in treatment….I know from experience that if that person sitting opposite them is in recovery they will have better chance of surrendering… as a clinician that people suffering who are within the spectrum of addiction: sex addiction, sugar, fat salt addiction, illicit drugs, prescription drugs, alcohol, and or workaholism…. whatever their drug of choice is, they can recover…there is hope…to break the cycles of deep suffering.

Addiction is complex…and can be exacerbated by trauma from the past being triggered in the present…creating a cascade of obsessive thinking, (cravings) irrational behaviours (compulsivity) anxiety, depression and suicidal ideation.

My therapeutic biopsychosocial approach is compassionate, mindful and is about empowering people, meeting them where they are….when they in need of help with addiction.

Vulnerable, at risk 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 away instead of receiving treatment.

We are experiencing a health emergency. A radical restructuring of mental and addiction healthcare needs to actualise how people in need access and receive healthcare.

It is not good enough to say universal addiction will cost millions, actually addiction is costing people their lives…. addiction and mental healthcare is already costing billions globally: loss of income, loss of family, loss of life….

Changes in how vulnerable people access treatment is what I am suggesting for them to have a choice: a medically supervised impatient detox, impatient primary treatment plan with aftercare upon discharge to support the varying stages of addiction recovery or be discharged with appropriate medicine.

The NHS Health Scotland “Burden of Disease” study highlights that alcohol and drug dependence are major contributors to absolute inequalities and recommends that alongside other measures we must tackle conditions that are more prevalent within higher levels of deprivation.

Like many international cities, Glasgow has been ravaged by the opioid epidemic. Since 2000, annual overdose deaths involving opioids have increased tenfold, with a dramatic spike over the past few years driven by the spread of the highly lethal opioid fentanyl. In a recent survey, more than 1 in 4 Glaswegians reported knowing someone who had died from an opioid overdose.

The 2018-19 death toll 1,127, is even more tragic in light of the many effective treatments for opioid use disorder that exist. Overdose-reversal drugs, naloxone and -approved medications for opioid use disorder — buprenorphine, methadone, and naltrexone — have all been shown to reduce overdose deaths, but they aren’t consistently getting into the hands of the individuals or the communities that need them most.

What motivates me to continue to do service in the wider recovery community, to raise addiction awareness, and strive for essential changes in the dismissive, negative, judgemental language and perceptions that defines addiction? In my daily commitment to recovery I know I ned to reach out to my recovery tribe. It is my connecting with other recovering people that I feel “at home” accepted, seen and heard.

It is by overcoming prejudice, and stigma, (which stopped me initially from getting help when I most needed it) and making accessible inpatient and outpatient primary care, inpatient and outpatient addiction medicine treatment programmes that will save lives, NOW that is needed.

Let’s stop talking about what to do about addiction recovery ….we know what to do, and we know why people are dying from opioid overdoses…

I am currently engaged in forming strategic partnerships with Scottish recovery organisations to strengthen the focus on a full spectrum of addiction care: prevention, treatment, remission, aftercare, and re-generation of relationship with family, workplace and recovery communities.

The plan includes: patients and their families and will highlight the personal experience of addiction in much closer view aimed at leading scientific and medical progression in the field. It also exemplifies a firm recommitment to providing continued education for all treatment providers.

Renewed and redesigned goals amass to form a robust foundation and profound course of action in the spirit of the recovery from active addiction.

With a strategic plan in place, the opportunity to set standards, pioneer research, educate healthcare professionals and the public, challenge stigma, endeavours to enhance the goal of holistically treatments from medically supervised detoxes, to save lives, and reduce the financial burden upon the person in need of recovery, their family and community..
This strategic plan provides to guide and prioritize that way forward.

• 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 empathy, 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 about 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.

It is time for sustainable addiction healthcare programmes, that are accessible 24/7.

Elizabeth Hearn, HP/NCH. SMAPPH
ELIZABETHHEARN.COM
+447894084788