What is addiction:
Addictions—whether to drugs or to behaviours—share the same brain circuits and brain chemicals. On the biochemical level the purpose of all addictions is to create an altered physiological state in the brain. This can be achieved in many ways, drug taking being the most direct. So an addiction is never purely “psychological. All addictions have a biological dimension.
Addiction is any repeated behaviour, substance-related or not, which brings temporary relief or pleasure, and in which a person feels compelled to persist, regardless of its negative long-term impact on his life and the lives of others.
Addiction is not a criminal justice issue but a human justice, public health issue which requires specialist training in addiction medicine, and knowledge about the treatment of addiction.
The pillars of addiction person centred healthcare: prevention, intensive inpatient and outpatient treatment that support each stage of recovery from intervention through to continuing self-care supported by established recovery communities.
2% of US service providers are trained provide medications for addiction treatment. In the UK, 1%. There are abundant resources available to change how people engage in addiction treatment and recovery.
With over 30 years of personal addiction recovery and 27 years as a clinician specialising in addiction and mental healthcare inpatient and outpatient continuing recovery programmes in the UK, India and Australia I recommend implementing the American Society Addiction Medicine’s “Fundamental of Addiction Training” to educate, empower and support first responders, doctors, nurses, and associated health care professionals.
Training addresses the biggest problem: accessing 24/7 addiction healthcare clinics. A&E -NHS is the only available limited treatment option for people in active addiction seeking help in managing active addiction.
The global addiction recovery communities shared addiction healthcare vision is raise awareness of the need for autonomous addiction person-centred clinics to prevent, treat, and promote remission and recovery from the disease of addiction, and to provide resources for continuing research, education, trainings, innovation, advancement, and implementation of addiction science and care.
Given Glasgow’s opioid and heroin epidemic, the benefits of MAT: Medication-Assisted Treatment is an important tool in treating the chronic, progressive and potentially fatal disease.
Establishing autonomous 24/7 addiction healthcare clinics within A&E-NHS settings, a safe clinical setting where clinicians and lived experience volunteers can work, side by side to engage people, who want help, in accessing addiction healthcare.
Treatment programmes that implement Medication-Assisted Treatment in the form of Methadone, Buprenorphine (e.g., Suboxone), or injectable Naltrexone Extended Release (XR) (Vivitrol) to opioid use disorders are what is needed.Rigorous, evidence-based tapering guidance and best practices would help give both clinicians and patients confidence in the detox, treatment, recovery process.
Medication is meant to be used as a supportive tool and managed by qualified healthcare professionals in collaboration with addiction treatment trained specialists as part of a comprehensive therapeutic programme.
The fundamentals of addiction training ensure safety in the administration of Buprenorphine or Injectable Naltrexone XR used for MAT in the face of active heroin and or opioid use because this will precipitate withdrawal and the need for medical management.
Person-centred addiction healthcare programmes that utilise a multi-disciplinary approach to address the co-occurring disorders often found with the opioid epidemic is an extensive biospychosocial approach.
An expansion of the addiction healthcare clinical protocols is needed to ensure that MAT is only one facet of a comprehensive continuum of care: intensive inpatient and outpatient treatment and recovery programmes.
Of the available choices for Naltrexone XR and Buprenorphine. These medications must be made available to all patients with an opioid use disorder. Buprenorphine is a detoxification medication/taper and, when clinically appropriate, is can be used as MAT maintenance. The decision between use of Naltrexone XR or Buprenorphine for maintenance is patient centered.
The ASAM is supporting National Addiction Treatment Week in the US. Each year, National Addiction Treatment Week (NATW) raises awareness that addiction is a disease, evidence-based treatments are available, and recovery is possible.
This year, October 21-October 27, the week will highlight the critical need for clinicians to enter the field of addiction medicine. Clinicians trained in addiction are essential to fill the treatment gap between patients who need evidence-based addiction treatment and the insufficient number of clinicians qualified to treat addiction.
Along with its supportive partners, the American Society of Addiction Medicine (ASAM) will be hosting the week with a dedicated twitter handle @TreatmentWeek and using #TreatmentWeek to build important conversations on social media.
More clinicians trained in addiction are needed to overcome the addiction epidemic overwhelming the United States today. In 2018, approximately 20.3 million people aged 12 or older had a substance use disorder (SUD) related to their use of alcohol or illicit drugs in the past year.
More people died from a drug overdose than from car accidents in 2017, and nearly 88,000 people die from alcohol-related causes each year.
Only about 17% of those diagnosed with substance use disorder received the treatment they need. In 2018, an estimated 2 million Americans were addicted to opioids, yet only about 400,000 people received treatment at a specialty facility.
“National Addiction Treatment Week amplifies the crucial message that when patients are treated appropriately by certified addiction medicine specialists, we can save lives and improve treatment outcomes.
The medical community must be at the forefront of communities proclaiming that addiction is a chronic brain disease, not a moral failure, and as such must be treated with evidence-based, research verified care.” said Paul H. Earley, MD, DFASAM, president of ASAM.
To overcome the health crisis, we need to expand the number of medical professionals who understand the complexities of the disease and are trained to treat addiction. Only then will we see real progress.