There comes a point where we need to stop just pulling people out of the river. We need to go upstream and find out why they’re falling in.”
– Desmond Tutu
The universal addiction and mental health care crisis has been building for decades—due to decades of neglect by political leaders.
Positive changes are seen as starting points for the recovery process: reduced harm, safer use, reduced use, moderation and potential abstinence.approach that tackles this crisis with the urgency and care it deserves.
Implementing Addiction Care Clinics within A&E-NHS settings where all healthcare professionals, doctors, nurses, first responders are trained in the fundamentals of addiction will saves lives.
It is time to include recovery into every aspect of the continuum including peer support, housing, and employment.
I am proposing a frontline lifesaving addiction healthcare services that tackle this health emergency crisis with the urgency and care it deserves.
Our aim is to provide comprehensive training for front-line medical staff, nurses, first responders and volunteers, in order that they can provide a compassionate and holistic response to drug or alcohol addicted adults who present themselves in crisis at Accident and Emergency Departments.
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 right to health does not differentiate between mental and physical health. They are both central to human wellbeing. In reality, this is not often recognised.
Despite the significant social and economic burden of mental illness, provision for mental health often comes a very poor second to physical illness.
Mentally disordered individuals are often subject to multiple inequities, and to significant burdens of stigmatisation and marginalisation.
In the absence of resources, harsh restraint is used. Realising the right to health means refusing to discriminate against the mentally ill at all levels.
I believe in the efficacy of holistic addiction healthcare and of a client’s right to safe prescribing, effective, inclusive and compassionate carewithout prejudice, fear of judgement or negative consequences.
Mental health issues and addiction are often inextricably intertwined. Some individuals begin their descent into addiction by trying to self-medicate untreated mental illness; others develop mental illness as a result of years of substance abuse. In either of these cases, successful long-term recovery hinges on addressing both of these issues in treatment.
Physical health can also be extremely damaged in multiple ways by long-term drug addiction. Effective drug addiction treatment must contain medical monitoring and interventions to ensure the individual’s health and safety during detox, treatment, and beyond.
Many individuals often fall prey to addiction in an effort to treat underlying chronic pain or other issues. Medical services can provide alternative, non-addictive ways of treating these triggering conditions.
Addiction doesn’t just destroy individual lives; it devastates families as well. By the time that drug abusers finally enter treatment, they have often caused considerable damage to their family relationships as well.
The guilt and shame over these damaged family bonds can often cause addicts to relapse even after treatment if they are not acknowledged and repaired, making family services an essential element in effective drug addiction treatment.
I envision implementing Addiction Emergency Care and Recovery Clinics within the A&E – NHS Hospitals for 24/7 people in a health crisis to be able to access to addiction primary care:
- Biopsychosocial assessment
- Medically assisted detox
- Medically assisted treatment programmes
- Long-term recovery community support services
A biopsychosocial model treatment plan is a meaningful approach to trauma, pain and suffering.
A proactive way forward would be to make addiction medicine directives including trauma recovery and, suicide prevention training mandatory for all NHS staff who receive mandatory physical health training: doctors, nurses, psychologists, allied health professionals and pharmacists will help children, young people and adults.
Addiction is a complex interaction of these vulnerabilities and is unique to each person giving rise to the reinforcing quality of the addictive personality.
In this context, substance use intensity/risky behaviours take on complex personal and social meanings and functions that contribute to the addictive process.
Common examples of addiction are in the self-medication of emotional pain. People whose substance use serves important, often life-saving functions experience the substance as helpful; they are frequently in pre-action Motivational Stages of Change in which they are not ready or able to consider changing their behaviour. A
The need for specialised addiction medicine training and treatment directives in which addiction is treated concurrently with related physical health, mental health and social issues combines essential medical and psychopharmacology interventions uniquely tailored to each person’s needs.
The treatment plan should begin “wherever the person is” in terms of a health crisis. There should be no “jumping through hoops” such as having to produce clean urine samples in order to access treatment services
A new strategic plan strengthens the focus on a full spectrum of addiction care: prevention, treatment, remission, and recovery.
The plan includes: the voice of patients and their families and will highlight the personal experience of addiction in much closer view.
Grounded in integrity, the plan outlines ambitious research goals aimed at leading scientific and medical progression in the field. It also exemplifies a firm recommitment to providing continued education for all treatment providers.
Renewed and redesigned goals amass to form a robust foundation and profound course of action in the spirit of the Universal Addiction Healthcare’s mission.
The opportunity to set addiction healthcare treatment standards, pioneer research, educate professionals and the public, and challenge stigma is in treating addiction and saving lives.
The following strategic plan provides a road map to guide and prioritize that way forward.
- 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 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.
Recovery treatment plans are an affordable way to introduce this model through training experienced staff who are already working at the sharp end of the service with the support of peer-led trained volunteers who will also be based within these services.
I am a person longterm recovery. I have over 30 years of continuing abstinence from addictive substances. In 1989 I volunteered at the “Manhattan Centre For Living” co-founded by Marianne Williamson and Louise Hay that prompted my training in addiction counselling and psychotherapy in 1991.
My work continues today in the capacity of Addiction recovery advocacy as a compassionate interventionist, counsellor, clinician, group facilitator, outpatient director, government advisor, broadcaster in addition to my role as the former Vice President to National Association Drug & Alcohol Counsellors (N.S.W) in Sydney. Primary Care Clinician in residential care settings in Melbourne, NYC, Pune, Delhi, London & Edinburgh.
Author, former fashion magazine editor (Mode, Australia) art director, film and video producer (NYC, Tokyo, L.A. London, & Sydney.
I believe that by integrating the fundamentals of addiction training, providers as part of the dialogue with respect to the opioid epidemic can change the focus from a criminal justice perspective to a medical perspective.
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 other licit and illicit drugs.
I am dedicated to the universal recovery vison of overcoming prejudice, and stigma, (which stopped me initially from getting help when I most needed it) by making accessible inpatient and outpatient addiction medicine treatment programmes.
Motivating people to engage in the multiple programmes available, i.e. 12step fellowships, SMART Recovery, means addiction recovery continues to evolve into being better organised and supported.
We are still very behind in the UK in treating addiction as a chronic primary disease of brain reward, motivation, memory, and related circuitry dysfunction, and how this leads to characteristic biological, psychological, social, and spiritual manifestations.
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. Without treatment or engagement in recovery activities, addiction is progressive and will often result in disability or premature death.
In addition, I want to highlight that Overdose Presentation Centres (Supervised Injection/Consumption Sites) need to be a part of the conversation and the strategy. Unfortunately, they remain illegal.
This is in spite of their successful operation and multiple scientifically valid studies that provide clear and convincing evidence of their efficacy in the opioid crisis.
From the recently published Scottish Drug Policy Reform:
A deadly snapshot – change is needed
- At a record 867 drug deaths in 2016, and 247 deaths per million people, Scotland has the highest drug death rate in Europe: 12 times the EU average, 42 times Portugal’s rate, and 4 times the rate in England and Wales.
- There is an HIV epidemic. Among Glasgow’s 500 street injecting population alone, there have been over 100 infections since 2015. In the 10 years prior to that, there were 10 infections per year in this group.
- This is a financial time-bomb – lifetime treatment costs for someone with HIV are £360k.
Like many international cities, Glasgow has been ravaged by the opioid epidemic. Since 2000, annual overdose deaths involving opioids have increased tenfold, with a dramatic spike over the past few years driven by the spread of the highly lethal opioid fentanyl. In a recent survey, more than 1 in 4 Glaswegians reported knowing someone who had died from an opioid overdose.
The death toll is even more tragic in light of the many effective treatments for opioid use disorder that exist. Overdose-reversal drugs, naloxone and -approved medications for opioid use disorder — buprenorphine, methadone, and naltrexone — have all been shown to reduce overdose deaths.
Together we can actualise life saving services and dramatically reduce loss of life.