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September 2012 |
drinkanddrugsnews
| 23
Soapbox |
Oscar D’Agnone
www.drinkanddrugsnews.com
SOAPBOX
DDN’s monthly column
offering a platform for
a range of diverse views.
ONE STEP BEYOND
It’s time to move clear of the
abstinence v prescribing debate
and agree on a holistic, pragmatic
approach, says
Oscar D’Agnone
HOW BEST TO TREAT PEOPLE WITH DRUG ADDICTION?
Nothing has been more contentious
and encouraged more passion than the divide between the proponents of the abstinence
approach and the defenders of substitute prescribing. As with every controversial debate,
each camp has its pros and cons. Those who promote abstinence argue that ‘parking people
on methadone indefinitely’ does not provide a solution as it is substituting one drug with
another drug without solving the issue of addiction itself. On the other hand, those who
recommend substitute prescribing highlight the extremely high rate of relapses among
addicts that undergo full abstinence and the very dangerous consequences of such relapses.
What has seemed to be a never-ending discussion within the sector might actually
come to an end with the NTA’s most recent report on prescribing substitute medication.
The report recognises that both sides have valid points and that the division between the
‘abstinence’ and ‘prescribing’ approaches is a false dichotomy. Indeed, drug treatment
services do not have to choose to favour one approach over the other but should move
towards a holistic approach that uses a wide range of interventions that are considered
best for the individual. When treating addictions, you cannot apply the same ‘medicine’
to every patient. Having come across thousands of individuals through my work at the
national health and social care charity, CRI, I have come to realise that there are so many
complex social and medical factors involved in each person’s addiction, that every
situation is intrinsically different.
On 5 September CRI and the University of Manchester will run a conference where
leading clinicians specialising in drug misuse treatment will be looking at the ways to
ensure the sector moves away from the dogmas of the past and develops a holistic
approach, integrating medical, psychological and social interventions, where each case
will be treated according to the individual needs.
Such a holistic approach must be based on a real partnership between individuals and
the clinicians involved in their care. It is the doctors’ responsibility not to apply a blanket
rule for all those seeking treatment but to tailor treatment options to their patients’
specific needs. It is also vital that individuals provide their informed consent by being
made aware of the benefits and risks involved in different treatment options.
For some individuals, seeking abstinence can be the most effective way of overcoming
their problem, but for many others this could lead to serious consequences and an
approach focusing on harm reduction will be more suitable. Indeed, individuals who are
not quite ready to be abstinent would benefit from being prescribed a substitute
medication for as long as they need in order to enable them to join structured recovery
programmes including psychosocial interventions, involving family members and friends,
addressing housing and educational needs and looking into other physical and mental
health problems. Methadone should not be an end in itself but a means to eventually
become totally free from drug dependence when ready.
Once doctors and patients have agreed on a treatment option, it is important that
individuals take ownership of their recovery programme. This should be reviewed and
adapted on a regular basis and progress evaluation should not only look at clinical
information but should also take into account quality of life factors. Doctors should ensure
individuals are involved in decision making on issues such as appropriate medications,
doses and regimes. They should also work jointly with patients to ensure they can come off
opiate substitute medications at a rate that is safe and they feel comfortable with.
Beyond clinical support, it is vital that people starting drug treatment programmes
are able to see exits from it at some point, for instance by developing links with a
recovery community or by having the opportunity to become peer mentors or coaches
once they have stopped using drugs.
We feel it is important that a holistic approach includes psychological help and support to
address other aspects of their lives which are intrinsically linked to their drug use. Whether it
involves helping them to get a job or find suitable housing, it is vital that we address all these
complex social issues to ensure drug users are able to get their lives back on track.
It is time for us as a community to end this division and come together to endorse a
more holistic, pragmatic approach focusing on individual needs, where the service user
(not the drug) is at the centre. Only then, will we be able to support drug users effectively
and will society reap the benefits of improving public health.
The Recovery and beyond conference – clinical research and practice for building the
holistic recovery model and policy of the future is being held by CRI and the University of
Manchester at the Midland Hotel in Manchester on 5 September. For more information
please visit www.cri.org.uk/clinical.
Dr Oscar D'Agnone is CRI’s clinical director