COMPASSIONATE ADDICTION & MENTAL HEALTHCARE

Elizabeth Hearn, HP/NCH. SMAPPH
+447894084788

Since 1988, I have had the privilege of working at different times and destinations in both the voluntary and private health sectors, all the while specialising in adult attachment disorder, addiction, anxiety, and depression.

My approach is person centred: trauma-informed, gender-specific, culturally relevant, family-focussed that meets the individual needs of the person’s life and stage of recovery.

I am. an accomplished presenter and broadcaster. And was privileged to asked to advise the then Australian Government on policy and legalisation in my capacity as the VP of National Association of Addictions Counsellors.

In academia; former visiting faculty member at the Jansen Newman Institute of Psychology lecturing on addictive behaviours and Transactional Analysis and Gestalt.

My narrative today is on matters relating to recovery from addictive behaviour, continuing care, reengagement in the family, and community.

I have implemented inpatient and outpatient treatment programmes, individual, group and family therapy in my former Harley Street Private Practice, in addition to residential healthcare settings within the UK. Australia, America, and India.

My professional background, (former co-editor Mode Magazine-Australia) and Video/Film Producer in Sydney, Tokyo, NYC and Los Angeles from the 70’s to the 80’s nearly…. fulfilled lifelong need for creative expression…however to an outsider, passing me on Fifth Avenue, everything looked perfect…but for me nothing was enough…

I felt an imposter, and a failure which exacerbated stress and an addiction to opioids, vodka and cocaine, Initially to cope, sleep at night and “act normal” to my partner, work colleagues and friends….

Addiction is progressive, dark, isolating and lonely… Post rehab, October 12th, 1988, a new life in recovery began, one that inspired retraining, initially as an addiction counsellor, 28 years ago.

I have continued with professional development up until 10 years ago completing training in hypno-psychotherapy.

I learned from the regular attendance of 12step fellowship meetings in the power of doing service in the community.

We, with their permission, if they wanted help, intervened to ensure their needs were met.

We took meetings into hospital, prisons and the Manhattan Centre for Living, Marianne Williamson’s and Louise Hays downtown community centre for people with HIV – Aids.

A forever lesson I learned in India was to give people what they need….connection, nurturing nutrition and shelter…

I am a person in long term recovery (31years) who continues to advance the recognition of mental health and freedom from addiction as being essential to overall health.

Since January, 2019 I have been meeting with various organisations to discuss with their support, the implementation of an autonomous, 24/7 accessible high threshold addiction healthcare clinics within A&E-NHS settings, a recovery hub designed to meet the needs of at risk, vulnerable people in a health emergency.

A safe place, with judgement or dismissal, where clinicians and lived experience recovery peers work side by side in treating vulnerable people in need of addiction and mental healthcare inpatient and out patient continuing care which includes a period of in-patient treatment detoxification or the low-threshold programme, which focuses on harm reduction, in outpatient settings.


Dependent upon the individual’s needs, people at risk, must have access to medical and bio-psychosocial support under both programmes.

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.

The world of power and privilege is one I inhabited for many years. Clients from film fashion and finance are comfortable with me, they feel safe with my background and trust that I will support them during the diverse stages of recovery.

My clinical strength is empowering clients to want to reclaim their authenticity, heal feeling disconnected from themselves, their family, friends and the wider community.

Intensity, isolation and alienation will manifest as addictive behaviours, mood swings, anxiety, depression and stress-related illness.

Addiction crosses cultures, class, age, gender and faith. Diagnosing addiction has evolved away from the punitive approach of the last century. Treatment centres back then lacked the insights of 21st century neuroscience into addiction as brain disorder, ergo a primary cause of addiction.

I know that inflammation, stress and compromised nutrition creates illnesses such as metabolic syndrome ergo imagine what drugs and alcohol do the body?

When the alcoholic drinks to excess their brain literally is floating in alcohol…the sugar/salt addict bingeing on process food, their vital organs become fat-saturated…the opioid addicts brains hardwiring is effected in exactly the same regions by ANY & ALL drugs…

No-one recovers from addiction alone, in isolation. People wanting help in recovering from active addiction must be empowered and or given the choice regarding their addiction and mental healthcare, recovery planning and lived experience/peer-led support.

In my role as a clinician, I recommend a holistic therapeutic approach that includes current knowledge of evidence based fundamentals of addiction addiction medicine.

Addiction & Mental Healthcare is a wellbeing initiative that can empower people to engage in medically assisted detoxing, inpatient primary care, and when appropriate medically assisted outpatient treatment support.

A strategic continuum of care is a seamless connection within and among various recovery organisations for as long as recommended and or need by individuals in recovery.

In the capacity of an addiction clinician, an integral part of multi-disciplinary team embodies my personal longterm recovery: a continuum of trust, and transparency in the delivery of addiction and mental healthcare.

We have lost the “war on drugs” a term coined by former US President Richard Nixon…policies that criminalise the large proportion of drug users, incarcerate instead of treat addiction, needs to end…we need to implement a Portuguese-style drug policy – considering drug addiction as a chronic disease to be treated.

Many people in active addictive addiction know what to do to stop, BUT they can’t do recovery alone….they MUST have access to addiction medicine, treatment programmes, recovery support clinics in place to begin their recovery.

We must collaborate to change how vulnerable addicts in need of treatment access addiction healthcare…

Currently cutbacks, politically motivated delay tactics means people are unable to access addiction healthcare… because there is no where to go to begin their recovery in a safe addiction medicine setting supported by people with lived experience and clinicians trained in the fundamentals of addiction medicine…

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 is essential for change to occur.

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.

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.

A personalised 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