A new approach to treatment of addiction disorders
Oct 23, 2018
By Dr David Ward, Addiction Psychiatrist and Visiting Medical Officer, Northside Group
The 2016 Australian Institute of Health and Welfare National Drug Strategy Household Survey results (released in mid 2016), whilst showing some improvement, continue to draw attention to the impact of alcohol and other drugs in our community.
Specifically, just under 4 in 10 Australians either smoked daily, drank alcohol in ways that put them at risk of harm, or used an illicit drug in the previous 12 months.
Also of concern, in contrast to those aged under 30, people in their 40s, 50s and 60s were using alcohol and other drugs at similar or higher levels than was recorded in 2013 (including the misuse of pharmaceutical drugs).
The ongoing burden of illness as a result of addiction disorders manifests in considerable physical, psychological and social consequences. Nearly 1 in 20 deaths recorded in 2011 were from alcohol and illicit drug use and deaths where benzodiazepines or opioids were present have increased between the period 2006 - 2016.
Medical practitioners and their health colleagues are all too familiar with the acute and chronic physical manifestations of problematic substance use. What is also important to remember is the psychological and social implications of addiction disorders (including exacerbation of mood and anxiety disorders, impact on relationships, employment and relationships) that challenge so many in this field.
Successful treatment of addiction disorders (including behavioural addictions such as gambling and gaming) requires Specialist practitioners and hospitals to work with primary care, in particular General Practitioners, to identify and support those at risk.
Whilst inpatient hospital treatment is an important consideration, especially where a medically supervised detoxification is required, the most successful outcomes often result from detailed outpatient treatment plans with the patient’s General Practitioner and Specialist working collaboratively.
Specific goals of addiction treatment include medication optimisation where specialist opinion on anti-craving and other medications can be important. This, combined with development of psychological strategies to manage distress in the absence of substances, together with advice around peer support activities and other social interventions all play a significant role in the establishment of an individualised addiction recovery plan.
Many patients find the thought of inpatient treatment to be overwhelming, whether due to current life commitments (work, family etc), co-morbid anxiety issues, or feeling that “things are not really that bad”. In an effort to address these challenges, a new outpatient assessment clinic has been launched by the Northside Group, known as the Addiction Health Medical Clinic. This specialised clinic is offered at both the Wentworthville and St Leonards Clinics.
Utilising the MBS Item 291, General Practitioners are able to request a medical assessment and report of a patient’s substance use (including tobacco) by an Addiction Psychiatrist, who can evaluate the mental state and biological issues for the patient and provide recommendations with respect to specific medications, including titration regimes, monitoring and appropriate review. This may be especially helpful where more specialised treatment agents (such as Topiramate, Baclofen and Varenicline) are being considered for the patient.
The Addiction Psychiatrist will also provide a detailed assessment of the patient’s psychological and social issues with associated recommendations such that a 12-month bio/psycho/social management plan is developed for the patient.
It is important to note that, if the Addiction Psychiatrist recommends ongoing specialist treatment in the report to the General Practitioner, this can be discussed with the patient and a further referral made to an Addiction or General Psychiatrist as appropriate.
There is also provision for the Addiction Psychiatrist to review the assessment and report previously prepared by them after 6 momths (MBS Item 293).
A GP Mental Health Treatment Plan is not required for referral to a psychiatrist.
Successful treatment of any addiction disorder requires a detailed understanding of the aetiological factors associated with the substance use, combined with practical approaches to assist the patient reduce harm to themselves and others, in the context of their readiness for change.
It is hoped that the new Addiction Health Medical Clinic, together with the inpatient and day patient programs of the Northside Group will continue to support an individualised recovery-based approach for those with addiction disorders.