Addiction in all its various forms is now a common part of our cultural narrative. We see it being portrayed in Hollywood blockbusters like A Star is Born, Beautiful Boy and Ben is Back.
Hollywood A listers are prepared to stand up and talk about their own struggles with mental health and addiction. It is no longer purely part of academic, medical discourse but a growing conversation within our society.
Substance misuse can no longer be viewed as a stand alone psychiatric specialty. We are now aware of its complex interaction with varied mental disorders. Research has shown that unique contributing factors, such as particular environmental influences associated with specific genetics can result in addiction. We know that treatment can be hindered by the stigma associated with addiction and that, when left untreated, a whole host of negative consequences may occur including worsened mental health and economic insecurity. Addiction as a whole needs to be looked at from beneath the umbrella of mental health, it needs to be informed by and inform current mental health research. Substance abuse is rarely an individual’s only presenting condition. Often there is a dual diagnosis with various psychiatric disorders, most commonly anxiety, depression and psychosis. This means that addiction services and the research done through them could be and should be a vital element for all aspects of psychiatric understanding, development and research.
We are living in a time where substance abuse is on the rise. “Overall, drug-related deaths rose in England and Wales from 46·6 per million population in 2012 to 65·1 per million in 2015” (Link to https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(19)30145-2/fulltext)
. In 2017 The ONS reported that there were 3,756 deaths which was the highest number of deaths on record since recording began. Despite these horrifying figures, cuts to addiction services are happening throughout England and Wales.
The problem isn’t only impacted by the nationwide cuts to services either. Many people who do access these services don’t respond to standard addiction therapies. This is the same with many people accessing a standard addiction treatment centre here in the UK. Standardised treatment doesn’t always provide a thorough enough approach.
As separate pieces of research for The Lancet Psychiatry, conducted by John Marsen, Simon Gilbody and colleagues demonstrated, there are many people accessing services who are (current) treatment resistant. Marsden, who was studying patients who were being treated with oral maintenance opioid agonist therapy at an addiction services clinic in London. His cohort still used illegal opioids or cocaine on top of their oral maintenance opioid agonist therapy. Even after devising a more personalised approach only 16% responded to treatment. Gilbody also attempted to compare a personalised psychosocial intervention against standard treatment for smoking within a cohort of patients with severe mental illnesses. His results were more positive in the secondary outcomes as more participants became abstinent six months after the trial had ended. However the total percentage of individuals who successfully abstained was still fairly low.
The research undertaken by The Lancet Psychiatry (Link: https://www.thelancet.com/journals/lanpsy/onlineFirst
) only highlights how necessary more of these types of studies are. Addiction is a complex and complicated disease and as such a high proportion of addicts are (current) treatment resistant. We need a new, creative approach to addiction treatment, but with only 4.2% of what is spent on mental health research dedicated to substance abuse, it seems an unlikely ideal. However, can we morally and economically allow this to continue to be the case? Today the opioid epidemic is responsible for thousands of deaths worldwide. As a society we no longer think of addiction as a question of failed willpower. We are aware that it is a serious mental disorder. Does it not then follow that, as a serious mental disorder, it deserves investment in research and services in order for a new, creative approach to be considered.