Ultra Abstinence Approach?

I’m glad I’m not a drug addict in Ireland:

Two doctors specialising in treating substance abuse in Dublin have called for new thinking in treatment services and say doctors need to be aware that the evidence-base shows that abstinence in opiate drug addiction treatment does not work.

…Dr Quig­ley believes some doctors take an “ultra abstinence approach” which doesn’t necessarily work in drug addiction.

Says Dr Quigley: “As we have gone along with the metha­done programme we have abandoned some previous processes like attempting to pressure addicts to detox. On the basis of medical evidence, that just doesn’t work and creates more difficulties.”

Dr McGovern supports this view: “Unfortunately, evidence doesn’t support this [abstinence] approach and very few would remain free of opiates, and with any illicit substance, relapse is the norm.”

Both doctors say most general adult psychiatrists seem to advocate an abstinence ap­proach for opioids, and say the historical approach of abstinence and Alcoholics Anony­mous for alcoholism simply does not work in drug addiction treatment. “If you bring that sort of thinking in automatically into drug addiction, you are liable to get it wrong. You have to leave that approach outside the door of the surgery,” Dr Quigley adds. He also expresses concern about the abstinence ap­proach taken by the country’s forensic psychiatry services. “The Central Mental Hospital is strongly abstinent in orientation and that is where the problem arises with retaining dangerous addicts in treatment,” says Dr Quigley.

If that doesn’t convince you that they’ve got an addiction stigma problem, it appears that they have a problem finding treatment for all of the violent drug addicts:

While there is a debate over whether patients who are violent should be excluded from treatment, either for a period, or for good, Dr McGovern says he believes that the patients who are violent are the very ones who most need treatment.

Both doctors believe the lack of services in which to refer violent patients on to is a major flaw in the system.

Dr Quigley adds: “Some people threaten the medical staff, and smash our vehicles or assault us. If they manifest that, we have to be able to pick up the phone [to the central treatment centre in Trinity Court]. If you can’t say that, and have to say ‘you’re barred from the clinic,’ you’re likely to be assaulted personally.”

Dr McGovern calls for better training for staff in dealing with violence. “Such patients need to be treated in a unit that is safe for both staff and other patients. The unit needs to be staffed by professionals who have specialist forensic psychiatric experience. I also believe that treating patients in a secure unit is only half the battle. Patients need to be offered treatment that ad­dresses aggressive behaviour.”

But often, no help is available to violent drinkers, says Dr Quigley. “They are getting no help because the addiction services that exist are not attractive to them, they are too rigid and not geared to people who are still drinking,” adds Dr Quigley.

While working in an agency that’s treated over 10,000 of the poorest and most severely addicted people in our region, this has never been more than a rare problem.