Addiction can manifest itself in less obvious but equally destructive ways through problems with gambling, shopping, sex, food, gaming and even use of social media. Including addiction in mental health discussions will improve services and save lives
It’s another Mental Health Awareness Week, where we campaign for mental health to be acknowledged, understood and placed on a par with physical health. In this endeavour, I wholeheartedly support the campaigners. However, one thing that seldom appears to be part of the wider conversation is an addiction – a destructive illness that, according to Action on Addiction, affects one in three of us.
If we take alcohol alone, statistics published on Alcohol Change UK estimate that in 2017, there were an estimated 589,101 dependent drinkers in the country, of whom 82 percent were not accessing treatment. In other words, four out of five people with alcohol dependency are receiving no help for their addiction.
And that’s just the tip of the iceberg. Drug addiction comes in many forms – from those who access drugs from street dealers to those who have become dependent on medications prescribed by their own GPs.
In addition, addiction can manifest itself in less obvious but equally destructive ways through problems with gambling, shopping, sex, food, gaming and even use of social media.
At the Road to Recovery Trust, we host many types of 12-step meetings that all cater for the above problems, as well as meetings for individuals struggling with emotions, co-dependency and eating disorders. To summarise, we do not pick and choose which types of addiction are welcome in our recovery building. After all, many problems share similar route causes.
And yet, when it comes to the big conversation about mental health and the treatment pathways, drug and alcohol services are rarely part of the wider discussion.
Shadow Health Secretary, Jonathan Ashworth, has pledged to raise the issue around cuts to services with parliament this week. And I am encouraged that there is a front-bencher who takes this issue so seriously.
However, even if we can increase access to services, will we be offering people the most effective treatment?
Many individuals experiencing addiction problems also experience other mental health conditions – depression, anxiety or schizophrenia. Many have experienced trauma in early life. And yet the current system suggests that these co-morbidities don’t exist, because there are rarely services that will respond to a person’s issues in the whole. It’s chicken and egg – do you start with the addiction problem or do you start with the mental health problem? And can you be treated for a mental health crisis if you are under the influence? Personally, I believe that many people, sadly, give up on trying to get the right mix of treatment and simply fall through the gaps.
But when you think about it, it’s not such a huge leap from the services that already co-exist. Think about individuals who self-harm to obtain a sense of relief. Or people who restrict their food to find a degree of control over their lives. They would be treated in mental health services and yet, people using drugs, alcohol or gambling, for example, would need to access these services separately.
Self-harm and eating disorders can have catastrophic effects on an individual’s physical health. But the same is true of drug and alcohol problems – from overdoses to liver failure, cancer and heart attacks. Substance misuse can cause damage in various parts of the body including brain, kidney, gastro-intestinal area, immune and respiratory systems. And then, of course, there are the physical injuries caused by brawls, falls and other accidents that can happen when somebody is intoxicated.
Put simply, addiction takes lives and no addict chooses to be in that predicament. Who would?
If the two matters are treated in isolation, we can also find other issues such as the high number of alcoholics receiving antidepressants. Alcohol is, itself, a depressant, and chronic use will restrict a person’s ability to produce serotonin. So why not look at the two problems simultaneously. It’s a complex cause and effect conundrum that appears to baffle our frontline services – perhaps because of the set protocols in which they have to work.
The problem lies with the design of services, not the staff working within them, and, given the age of austerity that shows no sign of moving on, surely a more holistic approach would not only improve outcomes, but also save the NHS and local authorities millions of pounds. In order to do this, however, we’ll need to see investment in making it work and designing the right services in the first place.
We talk of person-centred care, but I believe it’s time we considered person-centred assessment as well. People seeking help should not be turned away because they have too many problems.
Peter Mitchell is Chair of the Road to Recovery Trust)
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