Addiction in a time of crisis…

Mental health is suffering as we remain in lockdown. Those with poor mental health coupled with an alcohol/drug addiction seem to have worsened over recent weeks manifest in more and more bizarre and risky behaviours and an increased need for; antidepressants, anti-psychotics and anxiolytics. It’s time to rethink how we deal with addiction associated with poor mental health because we might not be getting it right.

Addiction NI, the local charity that does what it says on the tin, last year hosted its 40th Birthday conference in Belfast. Conference discussed ‘Changing the Conversation on Addiction’. We heard from leading experts on the latest developments in neuroscience, we listened to heart breaking stories of loss through addiction, there were impressive success stories of survival and off course we had the opportunity to have a chat and meet people with a common interest.

Addiction has a devastating impact on individuals and families, communities and the economy and also on health and social care and the criminal justice sector.

The problem is complex and overlaps health and social care with many other issues such as homelessness, mental health and community safety. It is an expensive problem with alcohol costing up to £900 million a year in Northern Ireland alone; £250 million of this cost is borne by the Health and Social Care Sector.  If we include the costs from drug misuse onto alcohol, this figure would likely be well over £1 billion. Interestingly the public see the lesser problem of drug addiction, pretty evident on the streets of Belfast at that time, but not the alcohol addiction problem as it is hidden within our social and moral tolerance.

As the conference day progressed, families, advocates, agitators and service users – we don’t like the pejorative monikers “drug-addict” or “alcoholic” – had lots of criticisms of current services. Why is “dual diagnosis” for example not part of the patient journey in N.I? This is where someone with mental health issues and a drug addiction problem must take different routes through the health system. Some small steps have been made to improve this since but we are not there yet.

An emotional mother wanted to know why her son who did not want to use methadone and who was trying “heroin assisted recovery” had to die unnecessarily. The system did not accommodate him and so he was left to use heroin of unknown strength supplied by dealers and he had to do so unsupervised. He died of a batch of heroin that was too strong.

A “survivor” got the noisiest applause of the day when he told his story of recovery and he is now working as a counsellor. He was particularly critical of our hosts, Addiction NI, for their Did-Not-Attend (DNA) rule. Seems he made an appointment while sober but before he got to the appointment he scored, got high and missed the appointment. When he came too he decided that he now really wanted to change but found he was identified as “DNA” and not allowed an appointment.

The two keynote conference speakers, Stanton Peele and Marc Lewis, really are top of their game and their work will I believe be highly influential on addiction policy in the future. So here’s a potted version of their ideas. Addiction is not “a disease” and “drugs are not addictive”. Rather addiction is an extreme manifestation of a pretty standard brain repertoire. This has been known for years and boils down to the statement “I didn’t become an addict because I had something better to do”. With good relationships and a purpose in life we don’t become addicted to drugs. Suffer from; social exclusion, low self-esteem or have ACEs (adverse childhood experiences) then we are more likely to grab forcefully onto behaviours that instantaneously bring relief from those negative emotions that burden us; anxiety, shame, boredom. Experimentation and peer pressure usually leads to these substances and, bingo, we begin an emotion-behaviour loop that spirals down into a habit and then with loss of higher cognitive control; the bridge of the ship cannot tell the emotional tanker to wise-up and change course, the compulsion becomes ingrained. It’s the route from; one-off behaviour (experiment), to habit, to compulsion (addiction).

The science is telling us that the impact of therapy/treatment is at best hit and miss and maybe not necessary at all. If you survive your addiction; and yes it will kill many who get ensnared, those who want to change invariably do. They literally grow new neurons so the brain works beyond the narrowness and intense self-interest that is addiction. They identify more attractive goals becomes motivated to follow them and they move on. Addiction is impaired development but it is not a disease.

I think many felt the purpose of the conference was an opportunity for service-users to beat service-providers with their heavy wish-lists. Many did and left not realising, had they listened closely, the experts were telling them that only the addicts have the power to change; they just need to get to a point where this happens, before it kills them. Sadly the service providers, those that design services for addiction, weren’t listening either.

Photo by jarmoluk is licensed under CC BY-NC-SA

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