A Fresh Look at the Topic of “Addiction Hospice”

We seem to be moving toward formalizing what I have called “Addiction Hospice” (palliative SUD care, both as a clinical process and as an endpoint goal).

Toward supplying a back story, I’ll say that I started to identify this trend and called it “Addiction Hospice” around 2007 or so (during the final years of our Behavioral Health Recovery Management project).

By that time in the BHRM project our agency’s programming had moved beyond clinically-derived care, and beyond person-centered care.  We had become person-driven.

Our services were so tipped toward allowing patient preferences to drive care that both fidelity to core evidence-based practices and the potential benefits of using evidence-based approaches were too often largely lost in the wider framework of doing what the patient said and wanted. 

Currently, in the field at large, we likewise seem to have an ever-widening distribution of addiction hospice as an individual care plan, treatment program component, treatment program total identity, and as a presumptively-applied framework of care to the unnecessary and a priori exclusion of other menu options.  

Consider the following:   

480,000 deaths a year due to smoking don’t get our attention and don’t cause us to adopt a smoke-free model of addiction treatment. 

“Tobacco use is the leading preventable cause of death in the United States”.

“Cigarette smoking causes about one of every five deaths in the United States each year.”

Smoking is associated with 5 times the risk of relapse 3 years later.

Tobacco use is correlated with relapse.  Addressing tobacco in treatment improves outcomes.

Questions to consider:

Does the patient have a right to die slowly while we watch? If it was any other disease, we would do a wellness check, or call an ambulance, or have the person who is allowing themselves to die involuntarily committed as a danger to themselves.

Has the patient been asked to sign a “Do Not Resuscitate” order in case of heart attack or stroke while they continue to smoke under our care?  Have we offered transfer to an “Addiction Hospice” type of SUD care if such a program exists nearby, where dying slowly is the pre-determined plan?  Do we realize the implications of the care we do provide and do not provide, and discuss those plainly in our informed consent?

Where are we heading as a field?

It seems to me that a significant portion of addiction professionals and advocates are tipping toward privileging using over abstinence. 

That is to say, there seems to be a trend toward making using the more sacred goal and the more hoped-for experience, over sobriety. 

And it seems I notice a move toward defining recovery in a way that includes using as the normal and central feature of recovery. 

A final consideration

For those that are of the opinion that if substances are culturally accepted, low cost, widely available, natural and not from a tainted supply, and of low or lower potency – then that arrangement will mean the harms of use come to an end – I encourage the reading of this work: Study Betel Nut Before You Finalize Your Public Health or Harm Reduction Policy.

Why do I suggest that reading?

Because I grew up in South East Asia in the 1970’s.

And in Southeast Asia, betel nut has traditionally been low-cost, culturally accepted, widely available, natural and not from a tainted supply, and of low potency.  And despite those factors, betel nut has long been a public health nightmare.

I often think of betel nut while I listen to arguments in favor of heroin that could be:

• low-cost
• widely available
• pharmaceutically pure
• culturally accepted, and
• not tainted with high potency but pure opioid additives like fentanyl.

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Sources and Resources

Our Unconscious Relationship with Tobacco

The Four Pests: recovery, sobriety/abstinence, addiction illness, and treatment

“Recovery Oriented Systems of Care” and “Recovery Management” are slowly becoming “Using-Oriented Systems of Care” and “Using Management”

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Suggested Reading

We All Need to Learn “Prevention”

Peer Support, or Harm Reduction, or Recovery Coaching?

“Harms of Use”: A List of References