A public health approach to universal addiction healthcare

I am not alone in addressing the Scottish health emergency by actualising Addiction Healthcare Emergency Care Clinics within the settings @ A&E-NHS Hospitals, in Scotland and England to treat the spectrum of substance mis-use related conditions. 

My aim is in implementing Addiction Emergency Clinics with A&E-NHS hospitals settings…clinician’s trained in addiction medicine working alongside lived experience volunteers treating people in need of a medically assisted detox, inpatient primary care, and longterm addiction recovery community outpatient support.

I am a person in longterm recovery (30 years) whose understanding of addiction healthcare is both personal and professional.

My aspirational commitment is in creating these clinics where the clinicians expertise is on people accessing free non-judgemental specialist addiction and mental healthcare.

I advocate for evidence-based drug addiction healthcare founded on principles of public health rather than a criminal justice approach to reduce mental and physical harm associated with drugs, and where those who use drugs are treated based on principles of human rights, dignity and equality.

We are over talked asking why…we know why..yesterdays, 1187 Drug Delated Deaths in Scotland in 2018, tells us all that it is time to take action. If cutbacks in policing, mental health had not been so severe perhaps people in need may have had a chance to access help..if they could manoeuvre ridiculously long waining time—up to Two years….

Having many spent many hours in the past few years @ meetings in Westminster, Criminal Justice conferences in Durham and Edinburgh to hear from learned speakers about criminal justice, and much more…ANY essential changes in policy failed to actualise…

Brexit’s financial and political catastrophe making has manifested unsolvable impasses/deep blocks to any kind of policy change….

…what to do? I live in hope that the catalyst for change in how people in need access addiction and mental healthcare will cause changes to breakthrough ……and we can open our Addiction Emergency clinics within existing A&E -NHS settings in Glasgow…….by our team of leading Scottish clinicians, and addiction professionals whose lived experience is augmented by our evidence-based clinical knowledge gained through decades of working with clients in primary care, outpatient settings, individual and family therapy programmes.

This addiction healthcare initiative is aimed at leading scientific and medical progression in the field of universal addiction healthcare. It also exemplifies a firm recommitment to providing continued education, training and support for first responders, doctors, nurses, and associated healthcare workers.

Drug Decriminalization in Portugal: Learning from a Health and Human-Centered Approach

Since Portugal enacted drug decriminalization in 2001, the number of people voluntarily entering treatment has increased significantly, overdose deaths and HIV infections among people who use drugs have plummeted, incarceration for drug-related offenses has decreased, and rates of problematic and adolescent drug use has fallen.

I am proposing we adapt the Portugal Decriminalisation model and translate this into an addiction and mental healthcare programme. Exactly the same procedure: a clinic within the A&E-NHS settings, a separate space where people in need of addiction healthcare can be assessed by an addiction psychologist, and medical team for appropriate inpatient primary care and they are given a choice…engage in a treatment process: medically assisted/supervised inpatient detox, inpatient primary care, and a total healthcare programme to begin their recovery process.

Upon discharge they will attend outpatient recovery programmes, in addition to SMART recovery and or 12step meetings to ensure their re-entry process is fully supported by people with lived experience…organisations like the Scottish Recovery Consortium has a solid volunteer programme, life skills trainings in and much more. Their ethos: Rights. Respect and Recovery is a sustainable framework, created to engender people in early recovery being fully supported to prevent relapse, engender renewal and thriving.

In January, 2019 I initiated a partnership with the American Society of Addiction Medicine primarily to introduce the “Fundamentals of Addiction Medicine Trainings” and a way forward in how the trainings can become the backbone of the proposed addiction healthcare initiative and Addiction Emergency clinics.

In my professional experience, effective addiction treatment must for everyone involved, contain the fundamentals of addiction trainings, monitoring and interventions to ensure the individual’s health and safety during detox, primary care inpatient treatment.

The ASAM “Fundamentals of Addiction Training” is designed to educate, empower and support first-responders, doctors, nurses, addiction counsellors, and associated healthcare care workers.

I am committed to recovery, to helping people ravaged by addiction to access addiction primary care treatment. Lived experience and recovery engenders in time a person who has sought help, becoming part of the solution, and an asset within their community.

The efficacy of ASAM trainings in addiction medicine, medically assisted impatient detoxing, addiction recovery primary care, and the continuum of care:
• Learn core competencies and knowledge needed to identify, and treat, patients with addiction
• Increase knowledge, skills and confidence for doctors, first responders, nurses and associated healthcare workers
• Experience content created specifically for primary care based on extensive needs-assessment

The ASAM “Fundamentals of Addiction Training” link to take you into the realm of addiction healthcare possibilities: https://www.asam.org/education/live-online-cme/funda

Enhancing the effectiveness of addiction and mental healthcare is in adapting the Portuguese Model for decriminalisation into an addiction medicine/healthcare model with a strong learning ethos in the fundamentals of addiction medicine trainings. Westminster needs to support this health initiative, and stop blocking Scotland’s need to take care of vulnerable to addiction community.

People are dying. Let’s transform that headline into “people are recovering” because they can readily access 24/7 addiction and mental healthcare within A&E settings.

We intend to make available 24/7 access to addiction healthcare within A&E settings to provide people in need of addiction healthcare the choice in how they receive their right to healthcare…the first priority is to make accessing healthcare as easy as possible…no more up to two year waiting times, nor having vulnerable people having to travel great distances to receive daily medication…

Healthcare is a human right…and we are facing the greatest healthcare emergency on record of our time…too many people are dying…I want to change the story from death to living in recovery…and yes it is long treatment process, but if nothing changes in the way people access addiction healthcare…then nothing changes…

The evidence- based principles for a recovery-oriented system are:
• 24/7 access to healthcare
• Inclusive of family therapy and support
• Individualised, comprehensive addiction medicine primary care programmes
• Recovery Services anchored in the community
• Continuum of of care
• Recovery resilience -based skill-building disciplines
• Commitment to peer recovery support services;
• Inclusion of the lived experiences of recovering individuals and their families;
• Prevention. Education. Person centred life-skills training

In my lived experience of working with people suffering with the spectrum of addiction: sex addiction, sugar, fat salt addiction, illicit drugs, prescription drugs, alcohol, and or workaholism…. whatever their drug of choice, there is hope…to break the cycle of deep suffering, and enter into a a primary inpatient recovery programme.

Addiction is complex…and can be exacerbated by trauma from the past being triggered in the present…creating a cascade of obsessive thinking, (cravings) irrational behaviours (compulsivity) anxiety, depression and suicidal ideation.

I am a person in longterm recovery…. who benefitted from sitting across from someone in longterm addiction recovery intervention in an A&E clinic …. she offered me a choice…. engage in an outpatient recovery programme…or be admitted, I was at Payne Whitney psychiatric hospital where addiction would not be addressed, or treated…and I would be inappropriately prescribed medication to treat anxiety, depression and suicidal ideation…

….I chose recovery…went to an A.A. meeting around the corner from my apartment that she had recommended. It was a an alumni 12step meeting started by Betty Ford. And I signed up to have daily therapy at the Smithers Foundation.

Taking that initial step into recovery was made easier by the welcoming from people in long term recovery whose lived experience was so generously shared with me…

Betty Ford came regularly to the meeting, already well known for her openness as first lady—a trend that continued long after the Fords left the White House, when she created the Betty Ford Center for addiction. Her generosity of spirit is legendary.

Eventually when fear of drinking or using drugs was no longer my first waking thought I began to feel hopeful, about the “bridge back to “normal living” my recovery was manifesting…along with sober companies we felt inspired to take meetings into hospitals, not dissimilar to my own experience in A&E, to talk to people who were being abandoned by healthcare system failures to help them… and we took meetings into prisons…

I learned from others with lived experience new ways to rewire rogue addictive neural pathways from firing off an autopilot urge for instant gratification…knowing this would trigger relapsing back to my drugs of choice: vodka, valium and cocaine….

I came to believe the truism: feelings pass, and developed patience in trusting the process….hugely helped by a lived experience, continuum of care that included for many years: Ayurvedic and allopathic medicine when it is necessary. Weekly psychotherapy, and monthly naturopathic therapies transformed my mind, body and spirit into one of thriving and optimal wellbeing.

Quitting nicotine, sugar, fat and salt…over time has become easier to maintain with daily yoga, mindfulness and meditation.

I am trained in hypnotherapy and the benefits of self hypnosis is brilliant to apply when I need to destress my thinking…and hit reset…to restore my bodies natural ability to heal…

My therapeutic biopsychosocial approach is compassionate, mindful and is about empowering people, meeting them where they are….when they in need of help with addiction.

….that A&E intervention occurred October 12, 1988. And I have been sober ever since. My recovery tribe in NYC was back then a wild mix of people, new to recovery like me..doing 90 meetings in 90 days….is essentially counting days in recovery, so people get to know me, and initiated the process of being in recovery.

In addition to people in recovery whose lived experience with the spectrum of substance related conditions taught me about the importance of enhancing the effectiveness of recovery. whose compassionate wisdom and learned experience in recovery supported me, who loved me until I could love myself, taught me to never quit, and how to live sober..how to become an asset in my recovery community.

…addiction had decimated my personal and professional life.. episodic outbursts of anger when I did get not what I wanted….to fill the hole in my soul, and satiate feeling worthless…helpless and hopeless… feeling as though I had no skin, no separation from me or you..eventually settled into growth spurts…life was becoming manageable, I was learning how to live life sober…

For the past 27 years since retraining in addiction therapy and counselling in 1991, I continue to help people who may not want but need recovery to engage in SMART recovery programmes and or 12step fellowships.

The American Society of Addiction Medicine’s definition of addiction: a brain disorder, an illness, cognitive impairment impacted by drug use and trauma meant my brain was similar to that of a stroke victim…

With a new addiction healthcare initiative proposal gaining traction the outcome will be actualising clinics specific to addiction treatment and recovery.

Talking, debating discoursing the shocking opioid related deaths is not going to save lives…it is listening to our call for action that will generate a change in how people in need access and receive care,

We want to the opportunity to set standards, pioneer research, educate professionals and the public, challenge stigma, with endeavours to enhance the goal of treating addiction and save lives.

The following strategic plan provides a road map to guide and prioritize that way forward.

• 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 addiction trained doctors, nurses, healthcare workers, lived experience volunteers and holistic therapists. The plan may include a biopsychosocial approach to person centred healing… medically assisted detoxing, addiction primary care, addition centric therapeutic modalities, lifestyle changes, all depending on the client’s choice and needs.

An affordable way to introduce this fundamentals of addiction training is through training medical staff and first responders who are already working with people in a health crisis with the additional support of peer-led trained volunteers who will also be based within these services.

The following links reveal the backbone of the ASAM evidence-based research and teachings:

The ASAM definition of addiction: http:// https://www.asam.org/resources/definition-of-addiction

Recovery shape changes over time: from chaotic intensity to growing and thriving. … one keeps taking actions to maintain the momentum of recovery…I have never wanted to pick up an illicit drug, an alcoholic drink or disconnect from my recovery tribe by stopping going to meetings, isolating and falling back into self destructive behaviours.

You are not alone. Keep on doing your best to be your best. Recovery has turned my addiction into an asset – I am a person in longterm recovery, with a family, and a recovery community…I live life on life’s term, in the immediacy of daily life….with optimal lived experience, strength and hope.