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A Public Health Approach to an Epidemic of Addiction


“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
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.

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”

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”

The ASAM Strategic Plan


• 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.


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.

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