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