Tuesday, 6 May 2008

Does the type of care system for addiction fit the problem?

In my latest DDN Background Briefing, I continue looking at the nature of addiction and the care system we have developed to help people overcome substance use problems.

I point out that whilst addiction is a chronic disorder, we have developed an acute care model. This means that the successes the treatment system has in helping people overcome serious substance use problems are likely to be limited. There are two important consequences of this serious limitation.
For the field, it means that there will be an erosion of confidence in addiction treatment as a social institution. 
For the individual, this means that they are often blamed for their relapse (i.e. showing a symptom of their disorder), rather than the system accepting there are basic flaws in the design or execution of the treatment protocol.
American addiction experts realised the negative ramifications of this mismatch between disorder and care model in the late 1990s. They argued for a shift from an acute care model to a model of sustained recovery management.
I emphasise in my BB that we need to come to the same realisation in the UK and start thinking about a chronic or continuing model of care.   


Peter O'Loughlin said...

No, of course it doesn't. How can a 'treatment' protocol which lacks the concept or hope of recovery possibly be effective with what is a chronic mental and behavioural disorder, not to metion the attendant comorbdity.

How can a protocol which focuses on the addiction, rather than the addict expected to be able to cope with a condition which is not only misunderstood, but which frequently defies understanding.

How can a protocol which has no ongoing assessment to deal with the issues emerging from whatever progress the client is making, be expected to be successful.

Prof David Clark said...

Excellent points

raging bull said...
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raging bull said...

The only needs the current system of care for addiction meets are its own, i.e. meeting targets by whatever means necessary. Primarily by providing an addictive drug for twelve weeks going on months and years and calling that 'treatment'. Within the statutory sector there are only small pockets of workers who understand the nature of addiction. The majority are readily and continually stigmatising and writing off the very people who provide them with their salaries each month. There is a wealth of evidence available as to what does work to produce long term change, i.e. the thousands of persons who via the mutual help meetings, have engaged in the process of an abstinence based attitudinal and lifestyle change. Yet if the majority of workers happily perpetuating chemical addiction were to be asked how those mutual support fellowships or dare I even say the 12 steps work, the same old ignorant stereotypes would be churned out, i.e. religious cults out to ensnare people for life and produce compliant clones via a brainwashing program. The abstinence based day programs and residential units which for some provide a necessary 'watershed' at the outset of the process of recovery will no doubt continue to flounder as the flow of funding streams dry up. And no approach or methodolgy is going to ever be a 'cure all' from a condition present to some extent in most individuals but chronically so in a sigificant minority of humanity. However a system which increasingly denies the opportunity of a sustained abstinence based option which takes a long term holistic view in favour of a 'quick fix' for itself is bound to reach rock bottom eventually. The Agenda For Change and initiatives like that being proposed by WiredIn offer hope, but the current system does fit the problem inasmuch as it is a major part of the problem.

Prof David Clark said...

Raging Bull
You have summed it major concerns really well. I agree with you wholeheartedly on each of the points you have raised. What is the Agenda for Change you refer to?