Dr Neil Brener, MBBS, MRCPsych
The world of addiction treatment is changing. The concept of what addiction is, and how it affects the lives of individuals and their families, has become more prominent, and this has allowed treatment programmes to develop.
Up until recently, there has been a misperception in the medical profession that detoxification from a drug is tantamount to a treatment programme. Outcome results have therefore been poor, and this has led to a debate around total abstinence versus controlled use and harm reduction.
Due to changes in our understanding of addiction via a better understanding of the neuropathology (how the brain chemistry works), we are starting to re-evaluate this. If we start from the premise that addiction is much wider than just drug and alcohol problems, and includes areas such as gambling, codependency, eating disorders and some sexual behaviour, we start to see that addiction includes both chemical and behavioural addiction.
We then have to start thinking about where this all comes from. Not all of it can be explained by neurochemistry – some of it comes from an understanding of a person’s emotional world. Ideas around this are also changing.
For the understanding of the treatment of addiction, we need to constantly re-evaluate what we do. Over the years, I have been an exponent of trying out different treatment modalities to aid the addict’s recovery. This has led to the introduction of different types of treatment, including equine therapy and trauma work.
From working in the addiction field for a number of years now, I have always been struck by the idea that addiction is a progressive, fatal illness. It is not only destructive to the individual, but it can also have devastating effects on family, children, the workplace and society at large. If we accept this, the goal that we must always be working towards with our patients is total abstinence in all of the multifaceted ways that addiction can present.
The addictive process is ‘sneaky’, and when you feel you have it under control, it can emerge in other forms, such as over-exercising, workaholism, etc.
It is essential that the whole patient is treated, rather than just their drug or alcohol issues. While this is all happening, there has to be some help and support for families if the addict is going to make a sustained recovery. The more a family understands about the problems, and how they can contribute to the recovery, the more likely it is to happen and be sustained.
I feel we’re on the cusp of the medical profession and politicians seeing addiction differently. Hopefully this will be a catalyst for more treatment to become available to members of the public and their families.
All too often, addiction treatment has been seen as a method for reducing crime, and while this is, of course, important, it doesn’t take into account the devastating effect of addiction on individuals’ lives. When the addiction pebble is dropped in the river, the subsequent ripples affect us all in different ways.
I got into working in addiction by mistake. It has always been seen as one of the Cinderella subjects of psychiatry, but it is amazing when you see a patient turn their life around from their active addiction into an abstinence/recovery. The effect it has on them and everybody around them is transforming and a joy to behold.
I believe that books like Who Says I’m An Addict will help people to understand what addiction is, enable them to recognize it in all its forms, and allow people into therapy to make this transformation. I have worked with David Smallwood for many years, and have found his approach to be a constant revelation into our understanding of the devastating effects that addiction has on individuals, families and society.
I hope that his book will be a stepping stone for many people to get further help and support in their recovery.
Dr Neil Brener is a consultant psychiatrist with over 25 years’ experience of working with adult patients in the UK’s National Health Service, and in the private sector.