Co-morbidity in Addictions

addiction-alleyWe know there are significant numbers of people impacted by the co-morbity of addictions and mental-health but, are we confident our health services are addressing all the issues?

Writing in his blog – Thinking to some purpose – Will Haydock, a Senior Health Programme Adviser for drug and alcohol commissioning at Public Health Dorset, asked; Has substance misuse treatment been moved out of the NHS?

I’ve been struck recently by the number of articles and comments lamenting the state of substance misuse treatment in the UK (and England specifically), and the fact that some of the problems and solutions identified seem to be missing the point. (Will Haydock)

Now that is one of those questions which raises even more questions like; was addiction treatment always the responsibility of the NHS? If so, which specific clinical arm of the NHS held that particular remit? Given that some argue that addiction is not a disease/illness per se, is support for recovery from addictions not a matter for other social support functions, rather than our medical clinicians?

Or, as is (mostly) the preferred option; being that addiction finds its roots in myriad medical and social factors, with multifarious factors usually at play, shouldn’t recovery support be delivered within a multi-faceted framework with a more holistic structure, than perhaps it is sometimes?

Long-term sustained recovery from any addiction, especially an entrenched one,  requires so much more than simply ending the problematic behaviours, irrespective of the need for any clinical interventions, which may well be required to safely support that change.

One significant issue that always impacts upon ‘effective’ treatment provision and delivery is; time-frame i.e. how long does it take before a service-user/patient/client is considered to be ‘cured’. Usually and often, the prevalent consideration here tends to be; how long is our support system prepared (or able) to fund this individual’s recovery process, and for how long?

Some people are able to change with limited support and minimal interventions. Some people have more longitudinal or prolific problematic issues, but they are all issues that need to be factored into the efficacy of the recovery process. And, unless all those issues are addressed successfully, by the individual and his/her support network, that person is likely to be pushing on the revolving doors of his/her treatment provider again…in the near future. Always assuming they don’t succumb to a worse set of circumstances than the ones they have faced previously.

Haydock’s observations about “patchwork provision” and services that don’t deliver in a “seamless” or “flawless” manner are sadly correct. He was also concerned about suggestions  from some within the NHS that appear to point a finger of blame at local authority commissioning process (since 2013). But, as he explains; “most things weren’t in the NHS anyway, and those that were are still often delivered by the NHS.” How well any of these services are delivered (or not), after years of austerity, parochialism, and CCG issues, mostly born of budget constraints, is whole different question.

Despite all the evidence around co-morbidity factors with addictions and mental health issues, coupled with some examples of lacklustre ‘joined-up’ treatment provision, there is still what appears to be too much silo-thinking and finger wagging taking place. And. irrespective of all the standards, guidance and preferred structures in delivery models, many managers (by necessity) tend to focus upon budgets and expenditure. Instead of service purpose, ‘manufactured’ outcome measures and all irrespective of any individual patient needs.

Sadly, but with all political direction aside, the reality is that the public purse is not finite and there are now far fewer free lunches available. A factor Will previously alluded to in his piece for The Psychologist in July 2019, which examined the ‘bureaucratic frontline’ of addiction treatment and support.

A threadbare patchwork of support: Perhaps more than any area of healthcare, treatment for alcohol-related issues can involve myriad funders and providers. How is this network of provision working, and what are the lessons for other areas of health and social care? (The Psychologist)

Will provides a succinct summery of the issues: “The challenge isn’t where these responsibilities sit; it’s getting the right people to talk to each other, in the right way, at the right time” – and in a cost-effective manner!