CONSCIOUSLY LIVING CONSCIOUSLY

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

Consciously living consciously in recovery is more than possible, it can be a daily actualising process of positive traits…however it can be not be enough to ensure being happy in the most basic and most ordinary of ways if I let my mind drift into the frequency of addictive, hardwired behaviours: non-acceptance, procrastination, perfectionism, power-struggles, comparisons, and or the ego wanting more…attention, and wanting instant gratification.


In undertaking a life in recovery, what matters is simple: We must make certain that our path is connected 24/7 with our mind, body and soul. My relationship with myself sets the tone of all my relationships…

Spiritual life embodies the “coming close..going away” stages of intimacy…there are times when I need to be detach in the immediacy of daily life and retreat… into the calm…that depending upon the season, and time of day is eatery the garden, fully shaded, underneath the laurels or to the bedroom…fortunately my family support this by affirming how calm I am when I reappear!

I adore the quietude that defines my long term recovery…
self reflective “question-time” are my favourite… “Am I following a path with heart that regards the values I have chosen to live by?”

“Where do I need to put my intention and attention?” When I am still and listen deeply, even for a moment, I know if I am following a path with heart.


The things that matter most in my lives are fabulously simple… They are the tender moments I treasure… simple and profound intimacy is the love that I longed for prior to personal recovery.

Mother Teresa put it like this: “In this life we cannot do great things. We can only do small things with great love.”


I continue to have the privilege of being in community with the global recovery community whose collective intention is to do their best to consciously live consciously….LOVE. SERVE. REMEMBER.

I remember to remember by asking myself “Am I openhearted?” “Am I living fully? ” “Am I being the best version of me?” “Am I accepting?” “Am I trusting the process that is letting go?”

Simple, leaning into the deepness questions go to the very heart of living the spiritual life. When I consider loving well and living fully, I can see the triggers that hijack my serenity i.e an attachment to a person, place or thing that doe not love me back…is a red flag to self care…


I want to be able to so say on whatever day is the end of my life, “Yes, I have lived my path with heart.”

ADDICTION & MENTAL HEALTHCARE A&E

A Biopsychosocial treatment approach.

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.”

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.

Addiction is a dysfunctional survival mechanism which victims of trauma use as a means of re-regulating a chaotic nervous system; 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.

Addiction involves:

  1. compulsive engagement with the behaviour, a preoccupation with it
  2. impaired control over the behaviour
  3. persistence or relapse, despite evidence of harm
  4. dissatisfaction, irritability or intense craving when the object—be it a drug or other goal—is not immediately available.

Linking addiction with adverse childhood experiences is the relational template of addiction and mental healthcare.

There are 10 major types of adverse childhood experience. These include:
Abuse:
Physical
Sexual
Verbal.
Neglect:
Emotional
Physical.

Growing up in a home where:
There are adults with alcohol or drug use problems.
There are adults who have mental health problems.
There is domestic violence.
There are adults who have spent time in prison.
Parents have separated.
There are also other types of childhood adversity that can have negative long term effects. These include bereavement, bullying, poverty and troubles within communities.


Trauma that is experienced in childhood disrupts the body’s ability to self-regulate psychologically and somatically.

This profound dysregulation of the nervous system has a major impact on a person and possibly affects both psychological and physical functions.

In some cases, psychological development is delayed or distorted, and identity formation must proceed along the “trauma lines” that result from dissociative defences and compartmentalization.

Thus, trauma has a severe impact upon an individual’s natural ability to function day-to-day. They may struggle to manage their emotions, to handle normal stress in the workplace or to run their homes.

Survivors of trauma therefore find strategies which enable them to self regulate their minds and bodies. Without these self regulating strategies, life would be simply too overwhelming.


Self regulating strategies used by survivors are often behaviors learned during early childhood. Sometimes survivors reenact the trauma they experienced or use coping strategies such as self harm.

There is also a likelihood of ‘self medicating’ behaviors such as the misuse of alcohol, sex, drugs or gambling, which expediate the feeling of detachment by providing adrenaline and/or endorphins.

Adrenaline and endorphins cause a distraction and a temporary release from the feelings of depression, anxiety and fear, common to survivors of trauma.


For those struggling with often chaotic/disordered thinking, being motivated to cope with challenges, substance abuse makes sense on some level. It provides the substance user with the desired disconnection from reality at a high price.

In comparison with other forms of self destructive behaviour: self harm, eating disorders, sex or gambling addictions, drug abuse brings about a greater, more immediate dose of the desired brain chemicals. It is therefore an immediate way for the trauma survivor to find release.


Poor impulse control can trigger sabotaging patterns. An internal battle with invasive memories, fear, depression or anxiety, disembodiment or disassociation is a way of removing self from experiences, the body and the world.

Therefore when these individuals pick up drugs or alcohol as a way to disconnect, they are taking them to be relieved of the emotional pain. Without these substances they may be unable to deal with the psychological or physical symptoms which occur due to their trauma.

Disconnection is a destructive way of altering consciousness and changing psychophysiological experience.

Drug use could therefore be viewed as resourceful but also a destructive survival method for those suffering with complex trauma.

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.

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 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.

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 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.

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

STRENGTHS BASED SKILLS SET.

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

Who is your enemy? Mind is your enemy. No one can harm you more than a mind untrained. Who is your friend? Mind is your friend. Nothing can help you more that a trained mind, not even your loving parents. —Buddha

In recovery I have come to understand that forcing an outcome, only encounters resistance, disappointment and often suffering.


It often feels like I am pushing to no avail. When I surrender, I am letting go of the need to control an outcome…everybody and everything around me.

The need for control comes from fear; the fear of an inability to handle what I am are not ready or prepared for. There is a natural rhythm in the flow of life, and when I find it, life happens effortlessly…


Only then I fully understand the potency of projection my reality onto others…is the absence trusting in a power greater than ourselves.

SELF COMPASSION & CARE

Most of us still need to learn how to take care of our physical body. We need to learn how to relax and how to sleep. We need to learn how to eat and consume in such a way that our body can be healthy, light, and at ease. If we listen carefully, we can hear our body telling us all the time what it does and does not need.

Although its voice is very clear, we seem to have lost our capacity to listen to it. We’ve pushed our body too hard, and so tension and pain have accumulated. We’ve been neglecting our body so long, it may be lonely.

Our body has wisdom, and we need to give ourselves a chance to hear it.
In this very moment you may like to pause and reconnect with your body. Simply bring your awareness to your breathing, and recognize and acknowledge the presence of your whole body. You may like to say to yourself, “My dear body, I know you are there.” Coming home to your body like this allows some of the tension to be gently released. This is an act of reconciliation. It is an act of love.

  • Thich Nhat Hanh, in “The Art of Living”.

COMPASSION: CONSCIOUSLY LIVING CONSCIOUSLY

Eckhart Tolle:
“If your mind carries a heavy burden of the past, you will experience more of the same.The past perpetuates itself through lack of prescence.

The quality of your consciousness at this moment is what shapes the future.”

The Power of Now: A Guide to Spiritual Enlightenment

CONSCIOUS CONNECTION

COMPASSION. CONNECTION. COMMUNITY

‘The greatest damage done by neglect, trauma or emotional loss is not the immediate pain they inflict but the long-term distortions they induce in the way a developing child will continue to interpret the world and her situation in it.


All too often these ill-conditioned implicit beliefs become self-fulfilling prophecies in our lives. We create meanings from our unconscious interpretation of early events, and then we forge our present experiences from the meaning we’ve created.

Unwittingly, we write the story of our future from narratives based on the past…

Mindful awareness can bring into consciousness those hidden, past-based perspectives so that they no longer frame our worldview.

Choice begins the moment you dis-identify from the mind and its conditioned patterns, the moment you become present…

Until you reach that point, you are unconscious.’ …In present awareness we are liberated from the past.”

― Gabor Maté

ADDICTION & MENTAL HEALTHCARE

I am a person in longterm recovery from addiction for over 31 years, my sobriety date 12th October, 1988 is one I intend to “one day at a time” maintain.

An integral aspect of recovery: service to at-risk people in the community is supported nationally within the UK.

The person best served to help another addict struggling with active addiction to engage them in a treatment programme are people like me who work in the voluntary sector.

Recently GOOGLE created “where to find” comprehensive addiction treatment services within the US – I have asked GOODLE to expand this service globally.

https://recovertogether.withgoogle.com

The #RecoveryMovement celebrates the 23 million Americans recovering from addiction, and paves the way for the 20 million still struggling to seek treatment. Our voices matter.

Connection. Community. Collaboration. At-risk people are not meant to be suffering in silence, alone.

Addiction is defined as repeating behaviours that have negative consequences, that reinforces disconnection from self, others, and the wider community. This felt sense of separation is experienced as abject loneliness, isolation and alienation.

When a person in an addiction and mental healthcare crisis is ready to seek help in stopping addictive behaviours…the benefits of engaging in a 24/7 recovery treatment programme that support all the stages of recovery from a psychosocial assessment that determines the entry point of a treatment plan, medically supervised detox, inpatient primary care, nutrition, and recovery counselling that is fully supported by a multidisciplinary addiction medicine team who work side by side with a lived experience volunteers.

My personal addiction recovery (31 years) and professional experience as a clinician remains focussed on effecting change, combatting stigma and promoting shared addiction and mental healthcare partnership and values.

Through the lens of recovery, different cultures and communities reveal the stages of recovery as a personal endeavour… the journey of lifetime… Though this lens there are many times of unprecedented challenges and polarisation.

CYCLE OF AWARENESS

Recovery community’s lived experience volunteers have the capability to deliver solutions that have the potency to build a better future for all who seek help in staying stopped, being authentic, autonomous, boundaries is actualising a continuum of self-care in the immediacy of daily life.

Implementing changes to healthcare policy through local and national community action, means progressive changes to healthcare policy can be achieved far quicker than ever before to respond to the addiction and mental healthcare crisis most pressing needs.

Upon reflection, having worked in the private sector for many years it is essential to recognise addiction and mental healthcare as a public health problem…ergo actively create something different – autonomous addiction and mental healthcare clinic that will not only help complement existing healthcare policy and efforts, but also advance the solutions addicts seeking help need most: 24/7 accessible addiction and mental healthcare.

30 years I had the privilege of volunteering at Marianne Willamson’s “MANHATTAN CENTRE FOR LIVING” founded upon the vision of creating a safe haven for people who were seeking help with living with a health crisis: AIDS and cancer.

In addition to helping people at MCL in need I helped coordinate an annual charity auction at Sothebys to raise funds and maintain Marianne’s high level of medical and therapeutic healthcare.

Marianne’s healthcare vision has evolved into one of universality. And champions the following policy changes:

1.Require our healthcare system to reimburse medical professionals for a broader array of lifestyle and nutrition support, focused on preventing disease and/or addressing root causes.
2.Longer visits with doctors and/or their support staff to better equip patients with skills necessary to make lifestyle changes.
3.Provide patients with more robust ongoing support from nutritionists, health coaches, therapists and mental health, exercise specialists, and other peripheral lifestyle treatment providers.
4.Integrate world-class technology and systems for better collaboration and cost-savings among healthcare providers.
5.Fund programs in all our educational systems, pre-k through college, designed to teach nutrition and lifestyle skills to help cultivate long-term health.
6. Restrict the marketing of overly-processed and sugary foods to our children.
7.Stop subsidies for agricultural production of unhealthy foods, like high-fructose corn syrup and hydrogenated fats, and incentivize and subsidize farmers, ranchers and food companies for more healthy food production, making it more affordable and available.
8. Shape food policies using cutting-edge public health science instead of following the lead of lobbyists for industries whose sole focus is profit.
9.Secure and expand the role of the EPA and the FDA to keep toxins out of our environment and food supplies.
10.Take a national look at stress levels, and develop ways to lower stress societally. That means adding vacation time, protecting a manageable work week, and taking a close look at how our electronic devices impact our lives. Just as the FDA is supposed to make recommendations about how we eat, the FDA should study, and make constructive recommendations, on how we consume data from our phones and devices.
11. We need to develop healthy habits at a community level. Towns and cities can, and should, look collectively at how active their populations are, and institute more ways to increase physical activity through walking paths, bike paths, and community events. The diet of entire cities should be reviewed, as well as ways that communities can contribute to one another’s daily health.
12. The Consumer Financial Protection Bureau should investigate how hospitals overcharge patients, and the Justice Department antitrust division should explore ways to remove as much of the profit motive out of medicine as we can.
13.The Center for Disease Control should invest more research into preventing disease, rather than treating symptoms and look broadly at vulnerabilities in the system (like avoiding pandemics by encouraging healthy disease avoidance behaviors).
14.We also need to find non-pharmacological ways to treat mental health issues, and to take all mental health issues as seriously as physical issues, and reduce the stigma of mental health illnesses, so that more will seek and receive treatment.
15.We need to treat drug addiction as a mental health issue, and not as illegal activity. Only by de-criminalizing drugs can we break the back of cartels and drug dealers, while getting addicts into recovery.

This is how a mature debate begins on the issue of health care. As with most issues, the underlying problem is the corporate dominance of American governmental policies. With Marianne Williamson in the White House, Americans would be well aware that on a daily basis, their president is working to realign governmental policies with the health and well-being of the American people.

Meanwhile in Westminster, UNIVERSAL HEALTHCARE strategies for changes in healthcare policy need to be actualised…”we are done talking” people like myself, clinicians in longterm recovery whose training treating addiction works…we know what to do…let us do what we do best..save lives…restore dignity, respect, purpose and most important of all wellbeing because it is basic human right to be able to access and receive healthcare.

Governments work for us, the people, not for health insurance companies or other corporate entities, whose short term profits may or may not align ultimately with the vision of community wellbeing.

We are experiencing a global health crisis, environmental crisis, that continues to impact the quality and length of our lives.

Healthcare policies changes that help prevent and reverse chronic illness, addiction and mental illness will cultivate optimal health, and engender people living healthier, longer and happier lives.

From drug policies, health policies, food policies, agricultural and environmental polices, to pharmaceutical policies the health and wellbeing of our humanity needs to be the greater concern of global governments, and not the profits ofcoprvate entities that are not held accountable for the toxicity their products produce.

Many will argue that we “cannot afford” universal healthcare” – when in fact the burden upon the A&E -NHS would be be dramatically reduced if autonomous addiction and mental healthcare A&E clinics were established within A&E -NHS settings where clinicians and lived experience volunteers work together side by side to treat people in a mental and or addiction healthcare crisis. The clinics would be 24/7 treatment hubs.

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 people seeking help in an addiction and mental healthcare crisis 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 ending 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

COMPASSIONATE ADDICTION & MENTAL HEALTHCARE

A VISION FOR THE FUTURE

A Public Health Approach to an Epidemic of Addiction

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.

I will be updating on the 20th January, 2020 the compassionate care Addiction & Mental Healthcare initiative vision into four main parts:

Aims


Objectives: to actualise a addictions training network among a group of A&E- NHS- hospitals that will voluntarily commit to expanding their response to the opioid epidemic and sharing their experience with the network.

I have identified three overarching aims which I would like Addiction & Mental Healthcare initiatives to achieve:

CONNECTION. COLLABORATION. COMMUNITY

The Vision: Inspire change, educate, empower and clinicians, and healthcare professionals best practice in the treatment of vulnerable at-risk people who are seeking help.


I have identified conscious objectives which should enable the aims to be delivered. There are interdependencies between the objectives, the aims and the overall outcomes to be achieved.
The objective is to:
Ensure that at-risk people are supported at all stages
of addiction and mental healthcare programmes.
Address the incidence and impact of trauma in all its forms
End stigma
Support individual and family recovery

This plan will be accompanied by a primary compassionate care plan which will contain details of treatment which will be undertaken to achieve the objectives and identify who is responsible for delivering them.

A compassionate approach will aid the achievement of each of the aims, objectives and outcomes. These define key innovative ways this plan will work. The approaches are:

  • Implementing addiction medicine trainings for doctors, nurses, clinicians, first responders, and associated healthcare professionals.
  • Communicating and linking with peer-led recovery communities.
  • Collaborating with NHS partners.
  • Being innovative.
  • Delivering efficient services.
  • Operating strong governance and accountability arrangements.
  • Clinicians and lived experiences volunteers working side by side.
  • Communicating and linking with peer-led recovery communities.

POLICY AND INDUSTRY
For Hospitals, A Blueprint for Fighting the Opioid
Epidemic
A new report collects evidence-based strategies to help hospitals stem the tide of opioid use and overdose deaths.
Getty Images By Michael Botticelli, Donald M. Berwick, Maia Gottlieb, Mara
Lederman

December 20, 2019
Hospitals are on the front lines of the opioid epidemic. Nearly 500,000 people with an opioid use disorder (OUD) are discharged from the hospital each year. Rates of opioid-related emergency department visits and inpatient stays have risen dramatically, as have rates of serious infections such as endocarditis and hepatitis C stemming from opioid use. Total hospital costs related to opioid overdoses have been estimated at $2 billion annually.
These stark statistics show the mounting pressure on hospital capacity and resources. But the numbers also reveal the tremendous opportunity hospitals have to influence the opioid epidemic. No other setting provides as many touchpoints to engage people with OUD and connect them with effective treatment.

For any hospital, transforming OUD treatment is a challenge. Fortunately, hospitals have more access than ever before to a wide array of evidence-based tools and strategies, ranging from effective medications for opioid use disorder to detailed guidelines for opioid prescribing. As the evidence for these and other best practices increases by the day, the urgency increases as well. With so many best practices available to us, hospitals cannot delay in creating a systems-level approach for addressing the opioid epidemic.

To help hospitals meet the need and overcome challenges, the Institute for Healthcare Improvement (IHI) and the Grayken Center for Addiction at Boston Medical Center teamed up to document effective strategies that hospitals can put in place to respond to the opioid crisis and support their patients. The resulting report, a synthesis of evidence-based guidelines and lessons learned from around the country, serves as a blueprint for hospitals.

The blueprint: Key strategies
Many hospitals across the United States are already responding to the opioid epidemic in strategic and innovative ways. The full IHI/Grayken Center report contains dozens of these examples, along with specific actions hospitals can take. Below are three broad areas in which hospitals can have an immediate impact.
Identifying and treating individuals with OUD at key clinical touchpoints

The emergency department (ED) remains an underused touchpoint for treating acute withdrawal and initiating treatment. EDs everywhere should be equipped to provide this frontline care. (In some states, including Massachusetts, this standard of care is already required by law.) Medication initiation in the ED works. When patients are given buprenorphine in the ED and referred to ongoing treatment (versus screening or referrals alone), they are more likely to remain in treatment and reduce their use of illicit opioids after 30 days, research from the Yale School of Medicine has shown.
Given the rise of opioid-related inpatient stays, addiction consult services are another key opportunity to reach patients and connect them to ongoing care.

These services, which engage patients during acute hospitalizations and often provide key harm reduction, have the capacity to improve care quality and reduce readmissions.
Hospitals often cite the lack of community-based referral capacity as a barrier to implementing substance use disorder services.

However, successful models exist for growing ongoing care capacity internally. For instance, office-based addiction treatment, developed first at Boston Medical Center, centers around a nurse care manager model of primary care in which nurses oversee patient care and offer medications for OUD such as buprenorphine when appropriate.

This model keeps patients engaged, destigmatizes the experience, and minimizes disruption to patients’ employment and other responsibilities. Research from Marc Larochelle, MD, at Boston Medical Center and others found that medication for opioid use disorder (specifically, buprenorphine and methadone maintenance treatment) was associated with reduced opioid related mortality and all-cause mortality over several months.

The office-based addiction treatment model has already spread throughout the country, and the “Massachusetts Model” treats hundreds of patients, with dozens of community health centers adopting the model.

Changing the way that hospitals treat pain:
Many hospitals have already responded to the opioid epidemic by rethinking how they prescribe opioid medications—often reducing the number of pills prescribed—and the settings in which they’re prescribed. The Michigan Opioid Prescribing Engagement Network, affiliated with the University of Michigan, has been a leader in the field, bringing together hospital systems and clinicians to develop evidence-based prescribing guidelines, encourage safe opioid disposal, and develop patient education materials.

However, in some cases the increased attention has led providers to be overly wary of prescribing opioids, to the point that the Centers for Disease Control and Prevention (CDC) decided to clarify that there are many situations where opioids are indeed appropriate.

Providers are also learning to emphasize alternative medications and treatments for acute pain management and newly identified chronic pain.

For patients already on high-dose chronic opioids, providers should cautiously manage those prescriptions; abruptly tapering patients is not clinically advised. Prescription drug monitoring programs are now regularly required by state governments, and pharmacies have become crucial partners in using existing data to identify patients, providers, and prescribers who may need additional attention. While this requires oversight to be effective, it represents true progress.

Clinicians are being more thoughtful about how to prescribe opioids effectively and safely, and hospitals are beginning to incorporate this thinking across specialties—from primary care to dentistry to post-surgical care. In Massachusetts (as well as a few other states) there’s a phone line that clinicians can call with prescribing questions.

Training stakeholders on the risks of OUD and how to reduce stigma
The prevalence of substance use means that many more individuals than ever before need to learn about opioid use, opioid use disorder, and substance use disorder more generally.

This includes not only people working in addiction medicine, but health care professionals outside of the addiction sphere, patients, and the public at large. Widespread stigma around opioid use disorder and the medications to treat it persists, even among medical professionals.

A survey from RIZE Massachusetts found that only one in four providers had received training on addiction during medical education. Startlingly, less than half of providers in emergency medicine, family medicine, and internal medicine believed OUD is treatable.

The stigmatizing attitudes about patients with substance use disorder among medical providers are well documented, and the consequences are severe, leading to the undertreatment of patients with substance use disorders. This stigma leads them to hesitate before sharing important information about their substance use with providers for fear of judgment and retribution.

It may also cause patients to use drugs in secret, which could lead to a fatal overdose or cause people with an OUD to forgo potentially lifesaving drugs, such as methadone or buprenorphine, because of the negative stories they may have heard.

Hospitals, given their direct line to patients, families, and employees, can dismantle this stigma. One way to do this is to teach all faculty and staff the facts about substance use disorder.

Another is to encourage a hospitalwide commitment to using clinically appropriate terminology—for example, referring to “people with a substance use disorder” rather than “addicts.” Hospitals can also be incubators for positive community change.

As employees unlearn the stigma they’ve been taught, they’ll share this view with family and friends, helping the community at large to reframe the way they think about addiction.
Hospitals working together
Some hospitals—including those we highlight in the report—have done all this and more; others are just beginning to take a systematic approach to taking on the opioid epidemic. In either case, the efforts to date have largely been independent and disconnected.

To achieve the size, scale, and sense of urgency needed to turn the tide of the epidemic, hospitals must work together to accelerate learning and secure buy-in from their organizations.

To turn the tide of the epidemic, hospitals must work together to accelerate learning and secure buy-in from their organizations.


In the next phase of our partnership with the IHI, we will be using the IHI’s Leadership Alliance to formalize a learning network among a group of hospitals that will voluntarily commit to expanding their response to the opioid epidemic and sharing their experience with the network.
Invariably, as hospitals band together, we will encounter policy and payment barriers.

The learning networks we develop to scale effective strategies can also be used to advocate for policy and practice change. The willingness to work together collaboratively will continue to be essential as hospitals collectively heed the call and assume a leadership position in fighting the opioid epidemic.
Authors’ Note As noted in the piece, the Institute for Healthcare Improvement and the Grayken Center collaborated on a report outlining effective strategies for hospitals to address the opioid epidemic. Neither party received financial compensation for their input on this report.

This article originally appeared on the Health Affairs Blog (12/20/19), 10.1377/hblog20191217.727229. Copyright © 2019 Health Affairs by Project HOPE – The People- to-People Health Foundation, Inc.
Topics: Opioids |

ADDICTION & MENTAL HEALTHCARE EMERGENCY

ADDICTION & MENTAL HEALTHCARE.
Mobile: +447894084788
Email: ELIZABETHHEARN@ME.COM

A VISION FOR THE FUTURE

A Public Health Approach to an Epidemic of Addiction

“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 family, loss of life does…unlike loss of income… is why many addicts turn to crime, prostitution…. to survive…

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.

I want people in an addiction healthcare crisis be given the same opportunity I was given after a failed suicide attempt, and desperate for help, because I wanted the pain and suffering to end.

Elizabeth Hearn
LONGTERM RECOVERY
12th October 1988 –

Rewind to:

I am a person in longterm recovery. April, 1988 my family and partner were worried about the progressiveness of my addiction to opioids, valium and vodka… and were terrified I was going to kill myself…

I was angry, and hurt at being “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 chaotic behaviour, mood swings kept me barricaded….incapable of fully engaging in the therapeutic process…I was trauma reactive, ergo incapable of feeling safe enough to engage in treatment…so I complied, lied and faked being “on the programme…” which the counsellors decided was good enough to remain in treatment….

Nothing prepared me for leaving…I relapsed within a few hours…at the airport…with no defence against that first drink, I headed straight for the duty-free shop…and somewhere to switch Vodka into an Evian bottle of water….and make it onto the plane.

…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 cycles of craving, binge, purge. Obsession, compulsivity, depression and anxiety meant I hid in my apartment, and wold come out of a blackout not know if if it was 5am or 5pm…and worst of all, not caring….

Every morning, my mantra: today I will I stop using….would stick, sometimes but not for long enough to get me back to recovery meetings…just long enough to feel better… I would…eat, sleep, begin connect with friends..… eventually the pain of living became unbearable, despite a failed suicide attempt…I knew I needed to get help….

After a horrible night of freebasing in a a crack den…I staggered into Central Park…looking for someone to kill me…

It was the darkest early morning in my life.. I left the park and jumped in a cab to get help at Payne Whitney Psychiatric Hospital…

Waiting for the admissions office to open I sat in the garden, so confused and scared…I had a moment of clarity…everything stopped….I heard a voice say: “Addiction is not going to kill you…you will lose your mind”….I saw “my movie” ….me….alone and insane..

Just as quickly as “spiritual awakening” happened….life resumed…and ….I knew I could get sober…simply because I wanted to … I was called in to talk to one of psychiatrists, a woman… sitting opposite me in A&E Hospital in NYC saved my life.

I sensed I could trust her…and shows speaking the language of recovery…plus sash explained to me…her training in addiction medicine meant that I was understood…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’s 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 ability to initiate an immersive process the day of the night of my begging into addiction recovery….I would experience a spontaneous remission from addiction, and I have not used a mood altering drug or drunk alcoholically since that day: October 12th, 1988.

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