“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
In order to positively impact the financial and emotional burden upon the A&E-NHS of vulnerable people seeking help with mental and addiction healthcare issues it is time to actualise expanded acute care clinics that can be implemented into the public health sectors.
I am a person in longterm recovery – 31 years of lived experience that began with an encounter in A&E following a failed suicide attempt.
I failed not because I am alive today, I was fortunate to not have the courage to kill myself… flipping this into having the courage to live, is primarily because of an intervention by a psychiatrist in recovery who offered me choice: return to 12step meetings. OR be admitted, and medicated but not be treated for substance mis-use (cocaine) alcohol dependency (straight vodka), and prescription pill abuse (valium).
I returned to 12step meetings, which takes courage to admit defeat, and humility to ask for help…which I did as I spoke about the past 24 hours, walking through Central Park looking for someone to murder me…and that familiar feeling of desperation….something shifted… and I knew I needed to get help…I left Central Park and caught a cab to Payne Whitney, a psychiatric hospital where the intervention took place…
From that moment on I have never been alone in my recovery. I ask for help. At different stages in my recovery it has been of great value to work though the 12steps with my A.A. sponsor.
The befits of recovery are numerous…one is that I am kinder, compassionate, happier and available to do service in the recovery community: starting step and topic meetings in remote rural Indian Villages and Chelsea, London.
When I lived in NYC I went along with a few people in recovery to learn how to take meetings into hospitals and prisons. It is challenging to see, hear and and witness incarcerated people whose entire existence is absent from love, care and community, they are so isolated yet the ones who want help seek us out…even if their “recovery world may be unconfined space…their recovery world is huge–millions of people are in recovery and available online to talk about how to not relapse and shift the focus from self sabotage to one of self care….
In my longterm recovery experience, I will have 31 years on the 12th October, 2019…and my trainings in the fundamentals of addiction, coaching, counselling, psychotherapy, life is incredibly fulfilling.
Despite people in need of recovery resisting engaging in treatment….I know from experience that if that person sitting opposite them is in recovery they will have better chance of surrendering… as a clinician that people suffering who are within the spectrum of addiction: sex addiction, sugar, fat salt addiction, illicit drugs, prescription drugs, alcohol, and or workaholism…. whatever their drug of choice is, they can recover…there is hope…to break the cycles of deep suffering.
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.
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.
Vulnerable, at risk 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 away instead of receiving treatment.
We are experiencing a health emergency. A radical restructuring of mental and addiction healthcare needs to actualise how people in need access and receive healthcare.
It is not good enough to say universal addiction will cost millions, actually addiction is costing people their lives…. addiction and mental healthcare is already costing billions globally: loss of income, loss of family, loss of life….
Changes in how vulnerable people access treatment is what I am suggesting for them to have a choice: a medically supervised impatient detox, impatient primary treatment plan with aftercare upon discharge to support the varying stages of addiction recovery or be discharged with appropriate medicine.
The NHS Health Scotland “Burden of Disease” study highlights that alcohol and drug dependence are major contributors to absolute inequalities and recommends that alongside other measures we must tackle conditions that are more prevalent within higher levels of deprivation.
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 2018-19 death toll 1,127, 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, but they aren’t consistently getting into the hands of the individuals or the communities that need them most.
What motivates me to continue to do service in the wider recovery community, to raise addiction awareness, and strive for essential changes in the dismissive, negative, judgemental language and perceptions that defines addiction? In my daily commitment to recovery I know I ned to reach out to my recovery tribe. It is my connecting with other recovering people that I feel “at home” accepted, seen and heard.
It is by overcoming prejudice, and stigma, (which stopped me initially from getting help when I most needed it) and making accessible inpatient and outpatient primary care, inpatient and outpatient addiction medicine treatment programmes that will save lives, NOW that is needed.
Let’s stop talking about what to do about addiction recovery ….we know what to do, and we know why people are dying from opioid overdoses…
I am currently engaged in forming strategic partnerships with Scottish recovery organisations to strengthen the focus on a full spectrum of addiction care: prevention, treatment, remission, aftercare, and re-generation of relationship with family, workplace and recovery communities.
The plan includes: patients and their families and will highlight the personal experience of addiction in much closer view 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 recovery from active addiction.
With a strategic plan in place, the opportunity to set standards, pioneer research, educate healthcare professionals and the public, challenge stigma, endeavours to enhance the goal of holistically treatments from medically supervised detoxes, to save lives, and reduce the financial burden upon the person in need of recovery, their family and community..
This strategic plan provides 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 empathy, 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 about 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.
It is time for sustainable addiction healthcare programmes, that are accessible 24/7.
Elizabeth Hearn, HP/NCH. SMAPPH