Yesterday's post and the discussion around it brought up a lot of good questions. Among them was the question, does it really matter whether we call it a disease? It prompted me to look at some old posts. I'll share versions of a few of them in the coming days. A few variations of this … Continue reading Defining addiction and problem ownership
The complexity of addiction requires an equally complex notion of recovery. Holistically, recovery is generally conceptualized across three classes of variables- individual, social, and ecological. The biopsychosocial model of recovery fits well within this framework. Expanding recovery conceptually to include the environmental sphere of variables has allowed for new contextual and structural factors to be … Continue reading Understanding the Relational Dynamics of Recovery
The New York Times published a guest essay this weekend challenging the disease model of addiction. I've read several similar pieces over the years and frequently have the same experience. I agree with most of the writer's points, but disagree with his conclusions. Let's walk through it. Annual U.S. overdose deaths recently topped 100,000, a record … Continue reading Is it misleading to call addiction a disease?
Earlier this week, I had the opportunity to testify in front of the PA Senate Judiciary Committee in favor of legalizing Fentanyl Test Strips. One of the other testifiers, talked about the role of harm reduction in his own recovery process. Harm reduction was life saving for him. As he indicated in his testimony, his … Continue reading What Are We Doing Once We Keep People Alive?
A tweet from a colleague affected me this week. The subject was stigma in substance use disorders and he related how, at the funeral of a relative who had died very young from a heroin overdose, a family member callously slandered the dead man and skillfully ‘othered’ him. The message was ‘he was not at … Continue reading Top ten of 2021 #1 – Nothing to mourn; just a drug addict
Reducing the stigma associated with addiction – the word itself now tagged with a degree of stigma – is a priority in drugs policy. Stigmatising attitudes contribute to drug harms and deaths through delaying access to treatment, leaving treatment early and increased risk-taking behaviour. Brea Perry and her colleagues at Indiana University took a look at … Continue reading Top ten of 2021 #2 – Wiping out stigma
Switching from doctor to patient was not an easy transition for me. My first attempt at recovery was medically assisted, but only got me so far. What I needed was something more profound: hope, healing and connection to other recovering people. In this podcast for the National Wellbeing Hub, Dr Claire Fyvie interviews me about … Continue reading Top ten of 2021 #3 – The genesis of hope: a recovery story
In a compelling study from Dublin, Paula Mayock and Shane Butler (Trinity College) make the point that little is known about the stigma experienced by individuals attending drug treatment services over prolonged periods. They explored this through the lived-experience narratives of 25 people prescribed long-term methadone. Their findings ‘reveal the intersection of stigma with age … Continue reading Top ten of 2021 #4 – Growing older and more stigmatised on methadone
As a GP in inner-city Glasgow in the 1990s, I looked after patients with heroin addiction. I got to know many of them well, I knew their families, I immunised their children and, distressingly, I saw some of them die. Because of the nature of general practice, I saw the dreadful impact of those deaths … Continue reading Top ten of 2021 #5 – Choice in addiction treatment
In opioid use disorder treatment, there’s been a persistent (though not always acknowledged) tension between what’s good for public health and what individuals and their families want from treatment. I’ve written about it before. For public health, there’s plenty of evidence that MAT (medication assisted treatment) reduces illicit drug use, improves health and reduces crude mortality … Continue reading Top ten of 2021 #6 – Opioid replacement treatment. Great! What’s next?