Sadly, I wasn’t shocked by the recent news that thousands of people in England died as a result of their drug use last year.
All of my colleagues working on the frontline of addiction psychiatry regularly see people whose lives have been destroyed by their addiction, and many die young. Yet there is a misnomer that addicts bring it on themselves, that somehow with a little more willpower and determination they could quit their addiction if they really wanted to. If only it was that simple.
Addiction is a complex and life-threatening health condition, one that effects both physical and mental health.
The people my team and I see admitted to the acute hospital following alcohol induced suicidal crises, physical injuries, early dementia and damaged livers are not there through choice, they are there because they have not been able to stop using alcohol or drugs. Unable to cope with overwhelming life challenges, or trauma or abuse from childhood or more recent times, many seek solace in things that numb their pain.
Falling through the cracks of an underfunded system
People living with this condition need the care and support given by specialist services. Teams of dedicated staff headed up by psychiatrists who can bridge the gap between physical and mental illness and who can prescribe potentially life-saving medication are key to successful treatment.
But these services have been decimated in recent times. Funding has been slashed by over 25%, the numbers of addiction psychiatrists and trainees are in rapid decline, and the commissioning model is broken. Little wonder then that as each year passes more people are dying and being hospitalised because of drug and alcohol use.
Some people are in such a desperate state they need inpatient care to address the severity and complexity of their condition. But places are at a premium. A lack of inpatient beds means people who need intensive inpatient treatment are often unable to access it and are either required to continue to use alcohol or are being offered medically assisted withdrawal in a community setting not adequately funded to manage the clinical risks involved.
Covid-19 means demand will continue to outstrip supply. More people are drinking at higher risk when compared to pre-pandemic levels. Millions more of us are now drinking at rates which will not only lead to physical and mental ill health but will also sadly lead to many becoming alcohol dependent. While the human cost of addiction is massive so is the financial cost with alcohol and drug use costing the NHS around £4 billion a year.
Social isolation is a fertile place for addiction to prevail – something that the pandemic has confirmed to be true. Without a support system in place, alcohol and drugs are often used a crutch to get through the day, and then becomes a habit, requiring increased levels to have the same effect. A lack of structure, disruption to people’s support systems, and alienation from friends and families often lead to people spiralling towards addiction.
Unfortunately, mental health services seem no longer able to address someone’s addiction. Many attend wanting help with the issue that’s causing them to use alcohol or other drugs, only to be told they can’t be helped because their addiction needs to be treated first. People in truly desperate states are bounced between addiction and mental health services, with many often falling through the gap. With the window of opportunity shut, many will never seek help again.
But while the picture is bleak, there is a glimmer of light at the end of the tunnel - the publication of Dame Carol Black’s recommendations for addiction services in December.
The report is an opportunity to ensure addiction services are properly funded, to fix the broken commissioning model and to bring the clinical part of treatment back into the hands of the NHS and out of local authorities.
The Lansley Reforms saw addiction services taken out of the NHS and given to local authorities. This has meant organisations bidding for contracts every three years, in what has proven to be a race to the bottom with contracts often awarded to the organisations providing the cheapest model, frequently at the cost of specialist staff and training places.
We need funding levels restored to the levels they were when the cuts first took hold in 2013/14. This means investing £374 million into adult services to ensure they can meet both existing and future demand for treatment.
While the third sector do incredible work in helping people recover from their addictions, and the role of peer mentors is crucial to this, it is time for the clinical part of treatment to be given back to the NHS and for the closer links to mental health services to be re-established.