Monthly Archives: December 2017

The Decline of Mental Illness Treatment from the 1980s On

By Dr David Laing Dawson

Through the 1970’s into the 1980’s I ran what we called Community Psychiatry Services. They were General Hospital based and consisted of teams of psychiatrists, nurses, social workers and psychologists. We used what we called an “Active Intake” process that ensured that the severely ill received appointments very quickly and the worried well were rerouted to other agencies. The “active” part of the intake process was a pre-appointment engagement of the patient, the family, the other caregivers. Doing this required that the clinic not become specialized, and that it did not have exclusionary criteria.

The second component necessary for this is a true team, with each member involved, the care plan decided by the team led by a psychiatrist, and that the nurses and social workers be willing to function as case managers. It also required that each member of the team be prepared to help with medication compliance and monitoring, medical care, budgeting, finding bus passes, talking to families, giving shopping lessons, helping with all activities of daily living and also counseling.

Doing this work requires a high tolerance for chaos, uncertainty, anxiety, and insanity.

What happened?

Several things I think, though it is difficult to see the forces of change while living within them.

1. The length of stay in hospitals for the mentally ill became shorter and shorter, driven at least in part by spurious management and budget ideals.

2. The mental hospitals continued to downsize, in some part as a naive ideal, but mostly as a means of shifting cost (and responsibility) from Province and State to Community and Federal Governments. (Note the stats of the Chicago area show an exact mirror image between the declining numbers in hospitals, and the inclining numbers in jails and prisons from 1970 to 2010)

3. The general Community Psychiatry Service is not a good academic career choice. Academics need to specialize for teaching and research opportunities. Hence the development of Anxiety Disorder and Bipolar Clinics. This doesn’t work for the severely mentally ill because to satisfy all the research and protocol needs the waiting list is long, the assessment phase onerous.

4. Again, based on naive idealism, many community services shifted location from the hospital to the community. But once a clinic is moved away from the hospital (geographically and managerially) several things happen:

a. They can no longer risk taking disorganized, chaotic and potentially dangerous patients and

b. Non-medical and non-psychiatric philosophies start to dominate, and the severely ill are excluded. And

c. (at least in my experience) away from the stable budget and managerial practices of a hospital, strange things happen, all the way from pop psychology to fraud.

5. I suppose it was inevitable that each discipline develop more of a sense of autonomy and independence. Social workers and other mental health professionals are no longer case managers working with psychiatrists. They are independent counselors. The development of simplistic models of counseling (CBT and DBT) which can be applied once per week for ten weeks helped this along. This has also contributed to something of an anti-pharmaceutical attitude. (By the way, there is no evidence that CBT is any more helpful than any other professional counseling relationship, but being a rigid simplistic set of responses it is easier to study)

6. I am also convinced that by putting addictions and mental health (illness) under the same umbrella, we diluted what sympathy and empathy the community was developing for the seriously mentally ill.

7. This was compounded by the so-called recovery model, which at its heart, really means (and this may be appropriate for addicts) that if you really try hard enough and think only good thoughts (CBT), and are sufficiently “supported”, you can get well and recover fully.

8. The corollary of this being that if a person with a psychotic illness is not recovering it just means he is not trying hard enough.

9. De-stigmatization. I just happened to watch “Big” the other night and noticed that the actor who played a walk through part, non speaking, looking homeless and mumbling to himself in downtown New York, was listed in the credits as playing “Schizo”. The real way to de-stigmatize any illness is not by feel good infomercials, but by providing adequate and successful treatment. Think Leprosy, AIDS, cancer.

10. Without a team to work with, to case manage, to field crisis calls, to make home visits, to check on progress more frequently, a lone psychiatrist will find it difficult to treat the severely ill.

11. The tightening of the mental health acts and processes in each state and province,  the protection of individual rights and the provision of due process (as defined by lawyers), again based on a sort of naive idealism, resulted in four unintended consequences: thousands of people suffering from untreated psychotic illnesses in the streets and shelters, a burgeoning population of mentally ill in the prisons, the dramatic growth of locked Forensic Psychiatry Units, and a sad return to locked doors for the rest of the hospital now dominated by the Forensic units.

Between 1900 and 1960 the severely mentally ill were mostly institutionalized, treated in mental hospitals for long lengths of stay, by doctors who were often imported and/or had limited licenses. Then as now, the Academic and North American trained psychiatrists worked in private offices treating a small number of patients over many years. These patients could be counted on to be articulate, educated, and at least middle class.

Between about 1960 and 1990, with new effective medications and the move to de-institutionalize, community clinics like the ones I worked in developed in many parts of North America; the General Hospitals developed psychiatric programs, and for at least two decades, perhaps three, we seemed to be moving in the right direction. In parts of Canada incentives were developed to keep psychiatrists working in hospitals with the severely ill or as they were called then, the seriously and persistently ill. And the University Departments of Psychiatry finally took an interest in the medical treatment of the severely mentally ill.

We were going in the right direction.

And now it seems we must re-invent the wheel.

For more information on schizophrenia, check out the documentary Schizophrenia in Focus

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Time to Scrap the Mental Health Commission of Canada

By Marvin Ross

Psychiatric care in Canada for those who are sickest is virtually non-existent according to a new study just published in the Canadian Medical Association Journal.

Looking at Ontario, the research found that the majority of people treated in emergency after a suicide attempt do not see a psychiatrist within six months after discharge. Two thirds of those released from hospital after a stay for a serious mental illness do not see a psychiatrist in the first month post discharge.

None of this is unique to Ontario. In a BC experiment referred to in the link above, researchers tried to book a patient from a family doctor’s practice quickly. Of 230 psychiatrists, only six could see that patient in a timely manner.

For those who read me regularly, none of this is particularly new. I’ve been pointing out the deficiencies of our mental health services for years and criticizing the Mental Health Commission of Canada (MHCC) which should be scrapped.

The MHCC arose out of the excellent Senate Committee Report called Out of the Shadows at Last — Transforming Mental Health, Mental Illness and Addiction Services in Canada in 2006. It received federal funding in 2007 to act as “a catalyst for transformative change” with the goal to “improve services and support.”

Today, MHCC’s vision according to its 2017-2022 Strategic Plan is to “raise awareness of the mental health and wellness needs of Canadians and to catalyze collaborative solutions to mental health system challenges”. That is far removed from the original goal to improve services for the mentally ill and their families.

The original research for the Senate Report was based in large part by submissions made by citizens from every region of Canada who were affected by mental illness. Many of them related their difficulties in accessing adequate care and treatment.

In 2015, the MHCC looked at indicators of mental health in Canada and found very few areas that were adequate despite eight years of funding to improve services and supports. Louise Bradley, the CEO of the Commission, was refreshingly honest when she was asked in 2016 if services are more readily available today compared to 10 years ago.

“I would really like to say yes, it is dramatically better but I can’t say that. Access to services is really a big problem.”

I am encouraged by the fact that the Federal Minister of Health appointed two experts to review Pan Canadian health agencies in order to improve their services to Canadians. These are federal organizations that deal in substance abuse, mental health, patient safety and information. The two reviewers requested submissions from the public and since I have been a very vocal critic of the Mental Health Commission of Canada, I submitted a critique with my advocacy colleague, Lembi Buchanan of Victoria, BC.

One very significant reason for the failure of the MHCC is its lack of jurisdiction on health and funding. The original Senate Report stated that the Federal Government cannot effect change in areas like health which are the jurisdiction of the Provinces but they can influence it with grants. They said that “the provinces and territories receive federal grants in exchange for agreeing to respect certain conditions on how they use these transfers. This is how federal legislation such as the Canada Health Act works.” (Sec 16.1.1). Therefore, improvements to mental health care in the provinces could be encouraged by providing the provinces with funds specifically for mental health.

“The creation of the Mental Health Commission is, in the (Senate) Committee’s view, one of the two key components of what could be called a “national strategy” contained in this report. The second involves the creation of a Mental Health Transition Fund. If agreed to by the federal government, this Fund will permit the transfer of federal funds to the provinces and territories for their use in accelerating the transition to a mental health system predominantly based in the communities in which people with mental illness and addiction live. (S16.1.4)”

The MHCC was doomed from the very beginning because of the lack of jurisdiction and funding, The Transition Fund was never approved. Had it been given, it would have made available $519 million/year for 10 years:

When the MHCC was established, it was to develop a mental health strategy. The 2011draft strategy was leaked to the press and universally criticized for “the scant reference to the urgent needs of people with severe mental illnesses including individuals who have been diagnosed with schizophrenia and bipolar disorder.”

While the sickest of the sick cannot get timely treatment, the MHCC, we pointed out, has spent money, time and resources trying to destigmatize mental illness. Part of the MHCC’s stigma strategy was to influence how the press writes about mental illness. The Commission spent time and money holding seminars across Canada to convince journalism students to write more positive stories. But, the very nature of journalism is to write about violence.

The futility of this exercise was summed up by Andre Picard who took part in those seminars with students. He said, “We don’t cover normalcy, we’re drawn to the spectacular.”

If these destigmatizing campaigns are successful and more people seek out services, they simply won’t find them.

Another focus of the commission is Mental Health First Aid. Like conventional first aid, the purpose of the program is to offer assistance and relief to someone experiencing a mental health crisis until expert help arrives. Sadly, there is no evidence that the program benefits anyone for whom it is intended.

A very large evaluation of the program at 32 colleges in the United States found that the program helped those who took the course but no one else: “Training was effective in enhancing trainees’ self-perceived knowledge and self-efficacy, but these gains did not result in effects for the target population. The trainees were more likely to seek professional mental health support for themselves, a finding consistent with at least one other recent study.”

Our suggestion is to end the commission and spend the money to provide services and to improve a health care sector that is more reminiscent of a third world country than one in one of the wealthiest nations in the world.

More Musings on Addiction

By Dr David Laing Dawson

As some have suggested, I didn’t say addictions were brain diseases, I wrote that the trend to think of them as brain diseases has not helped and is coincident with a dramatic increase in people addicted. I also said little about “cause” other than those causes for which we can do something: prescription practices, maintenance of addiction in a least harm approach for long standing addictions, parents and family more involved with teens. I did mention some illnesses that lead to self medication and I should have included trauma (PTSD) in that list. These are all illnesses that can be treated without opioids if we have available and accessible services.

The other purpose of this particular blog was to get past all the BS we tell ourselves, and find a little truth.

I have never seen an addict wake up one morning and decide “today is the day I go clean because overall that is probably a better life choice”. On the other hand, just as I say tomorrow I will start my exercise program, addicts frequently say tomorrow is the day I quit using. When they actually do stop ‘tomorrow’ it is because of a realization that: I will be dead in a couple of weeks otherwise, I will lose my license to practice medicine, I will be fired, my wife and children will leave me, I will not be allowed to live at home unless I stop. They quit when they have to. I am not disparaging addicts saying this. It is true of most habitual human behaviour.

I am getting tired of “childhood trauma” being blamed for everything. First of all if that were true, all of these everythings should be drastically reduced by now in most western countries, for the prenatal and postnatal lives of children are dramatically safer than they were just a couple of generations ago. Yet teen suicide is up, addictions are up, and rates of serious mental illness persist unchanged but for changes in diagnostic criteria. Besides, we can’t go back and remove childhood adverse events, we can only continue to improve the various ways we prevent such trauma.

The other two human characteristics I am trying to address in this blog are: 1. We are often satisfied with the appearance of doing something to help. Hence “national strategies” that are written, publicized, and shelved, television awareness programs, more money devoted to programs that don’t work. 2. We take the easy route of “more of the same” even if there is no evidence the same has made any difference to date. More counselors, more officers, more money spent.

I remember all too well sitting in on a case conference reviewing a patient who had been in “psychotherapy” with at least three counselors over 10 years, and was once again in hospital. At the end of the discussion the treatment recommendation was “psychotherapy”.

“But, but…..”. I said.

******

Historically rates of addiction and the particular demographic addicted have varied exactly with availability and promotion of the addictive substance. That is, to whom the substance was being promoted by pharmaceutical companies, other business interests (legal and illegal), and peers. At one point 3.5 percent of the Egyptian population were addicted to heroin, at the time promoted and sold as a cheap cure-all. In the late 1800’s in North America the people most likely to be addicted to morphine and heroin were older women of some means.  From the Peruvians chewing coca leaves only during religious ceremonies to the present, the history of cocaine use follows just this pattern: cultural and peer acceptance (Peruvian religious ceremony, subduing a population of workers, cure-all for malaise, heightened sexual abilities (Freud), Coca Cola, the entertainment industry, jazz performers, jet setters and businessmen, University students, and then teenagers) plus promotion by business interests, from the farmers to the producers, shippers, the cartels to the low level dealers.

Marvin mentioned American soldiers in Vietnam previously. Research at the time showed up to 20% were addicted to Heroin. But more importantly, those kept in Vietnam to dry out and become abstinent showed only 5% relapse after being sent home.

Those sent home while addicted and who were then treated in the U.S. (in treatment centers in the US) had a relapse rate of 95%.

All of this information speaks to several points:

1. Though some of us may be more vulnerable to addictions, any of us can become addicted.

2. The possibility or probability of becoming addicted depends a great deal on availability and promotion of the substance and the social acceptability of using it. (in Vietnam within companies of soldiers in 1970, women of means in the late 1800’s, 56% of teens using cocaine say they were introduced to it by peers as a cool thing to do.)

3. Coerced, socially enforced or necessary abstinence plus a new social environment when abstinent, has worked very well.

I would add another fact. Smoking cigarettes, being addicted to smoking, has dramatically decreased over the past 40 years in Canada. Two things are responsible: cigarettes are a little less accessible, but more importantly it has become NOT socially acceptable to smoke. In the background we became more and more aware of all the health hazards of smoking, but this is background. Simply presenting this information to teens in the 1950’s increased their smoking. Only when it became not a cool thing to smoke did smoking decrease.

One of the most difficult aspects of keeping a teenager abstinent from opioids, amphetamines, ‘shrooms once he or she is “dried out” is finding new friends. That is, finding a social environment, becoming part of a social environment, where doing drugs is NOT cool.

And these facts underline a fourth point.

4. De-stigmatizing drug use and addictions is more likely to increase drug use and addictions than to decrease it. At least with adults. All bets are off with teens. They are contrary creatures. Though I must admit, from what I have seen, even young adults who are addicted seem to derive some satisfaction from being “outlaws”. The long list of colorful nicknames for each drug tells the story of the ambivalent relationship addicts have with their drug of choice. This is just the list of phrases created for the act of using heroin:

  • Chasing the Dragon
  • Daytime (being high)
  • Evening (coming off the high)
  • Dip and Dab
  • Do Up
  • Firing the Ack Ack Gun
  • Give Wings
  • Jolly Pop
  • Paper Boy
  • Channel Swimmer

We are about to embark on a social experiment in Canada. Will the legalization of marijuana decrease or increase the number of teenage Canadians who go to school stoned?

******

We are the only species needing a set of Ten Commandments. Moses didn’t finish with the humans, send them away and say, “Okay, all you other species, gather round. I have some rules for you too.”

Most of them, I suspect, especially the seagulls, would have had issues with the ‘thou shall not covet’ clause.

There is a reason we put stop signs at cross roads and don’t leave it to individual motorists to choose to stop.

Methadone is a replacement addiction, albeit one that can be monitored, controlled, with a goal of careful weaning. But the urine test at the methadone clinic is not a standard medical test. It is a lie detector.

The veterans who became addicted in Viet Nam and came home addicted and received “treatment” in America were introduced to a drug culture here, and within that culture 95 percent relapsed. The ones treated (forced abstinence) in Viet Nam came home to the suburbs and small towns where drug use was not part of the culture. 95 percent stayed clean.

When I say addicts lie, that they only stop using when they have to, that if they don’t change friends and social groups they will relapse, I am not making a moral judgment, I am just trying to observe human behaviour without blinders. Only if we do that can we develop good programs to assist those addicted and prevent more people from developing addictions.

For alcohol, prohibition is known to not have worked. In fact, it did reduce alcoholism and it did reduce the rates of cirrhosis of the liver and all other medical consequences of drinking. But it did, as we know, support organized crime, start an inner city war between cops and rival gangs, create an industry of illegal alcohol production and smuggling, and provide the fodder for numerous novels, movies and TV programs.

Our compromise in Canada has been provincially controlled sales, thus providing each province and the Feds with billions in taxes, some of which are earmarked to publicize the dangers of drinking, and to treat or deal with some of the consequences of drinking in excess. In a sense the addiction has shifted to the state, now dependent on the revenues from alcohol sales.

Throughout recorded history we humans have sought elixirs, roots, potions, quaffs and smoke that might alleviate our tiredness, our aches and pains, our anxiety, our weariness, our sadness. Most of them used in excess become addictions. Most of them used in excess cause disability and disease. And now, thanks to modern chemistry, some of them kill with simple overdosing. (60,000 Americans last year)

The excess use of these substances does not satisfy the concept of disease, any more than smoking cigarettes is a disease. And thinking of this behaviour as a disease is not helpful.

On the other hand, we live in a time when multiple civilized, industrialized, educated, organized societies have tried different approaches to common social problems. This is a laboratory from which we can learn (not the USA, for they learn from nobody, but at least Canada). What are the rates of marijuana use among teens in Holland? Does the legalization (with interesting controls) of marijuana reduce use of more dangerous drugs? Is it true that the “legalization” of all drugs, plus mobile clinics to deliver these drugs to addicts, reduced the rate of addiction in Portugal?

Undoubtedly the administration of Naloxone in a timely fashion saves lives, but will having it readily available reduce the overall death rate from overdose?

Has combining addiction detoxification and treatment of the mentally ill within one facility helped either population or has it simply led to more injuries, more need for security in these institutions, along with a hardening of attitudes?

 

 

 

 

 

 

 

Addictions and Mental Illness: We Need To Stick Together

Guest blog by Angie Hamilton

A response to Marvin Ross and Dr. David Laing Dawson

Thank-you Marvin Ross for this opportunity to respond to your article Addictions and Mental Illness Do Not Belong Together and Part Two of that article by Dr. David Laing Dawson.

PART 1

In your article you state that addictions are quite separate from mental illness but that, for some inexplicable reason, addiction has been lumped in with mental illness.

However, the reality is that they occur together more often than not. How is it possible to separate addiction and other mental health conditions? Dr. Kim Corace, a psychiatrist at The Royal in Ottawa, recently presented a paper at the Issues of Substance Conference by the Canadian Centre on Substance Use and Addiction (CCSA) entitled “Opioid Use Disorder in Youth: Mental Health Comorbidities and Treatment Outcomes”. It showed that 100% of the youth with opioid use disorder also had depression, 70% had anxiety and many had other co-occurring mental health conditions. In my experience attending support groups for parents of addicted youth for over three years, all of the teenagers had co-occurring mental health conditions (although statistics usually range from 70% to 90%).

Numerous studies point to the overlap between addiction and other mental health conditions and we are not, as yet, able to determine causation. Did self-medication of the other conditions lead to addiction or did addiction cause the other conditions or did something else lead to both?

Your article also states that lumping addiction in with mental illness does a disservice to the mentally ill because addiction, at some point, involved a choice whereas there is no choice involved for schizophrenia, bipolar or depression. It is true that, at some point, addiction involved a choice to use an addictive substance. With respect to alcohol, it is a decision that has been made by 80% of Canadians. When you add in prescribed medications that can lead to addiction it is a decision that maybe all Canadians have made. There are many patients who have become dependent on, or addicted to, painkillers taken as prescribed by their doctors. Rather than vilify people for making a choice that most of us make, it would make more sense to ask “Why do some people who use an addictive substance become addicted and others do not?”

Addiction is a pediatric illness. Early initiation is a major risk factor. Seventy to ninety percent of addiction develops during adolescence. The decision to use or overuse a substance that leads to addiction is usually being made by a teenager. The adolescent brain, in layman’s terms, has been described as all gas and no brakes. Because the pre-frontal cortex (home of executive function) is not fully developed we have all kinds of laws designed to protect minors because we acknowledge that their ability to understand the consequences of their behaviour is not developed.

Other risk factors include genetics (which accounts for 40-60% of the risk), co-occurring mental health conditions, personality traits (risk-taking, impulsivity, anxiety and hopelessness) and environmental factors especially adverse childhood experiences (trauma). Adolescents do not choose their genetic predispositions, personality traits, environments (with the exception of peer groups) or to be traumatized. And they don’t choose to become addicted. It happens without them knowing. By the time they figure it out, it’s too late.

As to where the experts stand with respect to addiction being a choice or a disease, The National Institute on Drug Abuse (NIDA), a U.S. federal government drug use and addiction research institute, defines addiction as a chronic, relapsing brain disease that is characterized by compulsive drug seeking and use, despite harmful consequences. While most experts and professionals do not dispute the disease model of addiction, it is not without controversy.

You quote Dr. Sally Satel in your article. In her article Addiction and the Brain Disease Fallacy she states:

First, we do not address the question of whether addiction is a “disease.” With the potential exception of certain organic brain syndromes, the field of psychiatry recognizes “disorders” or syndromes, rather than diseases because the etiologies of mental illness are not yet well understood. So, addiction fits the notion of disorder insofar as persistent craving and/or continued, excessive use leads to dysfunctional behavior. We are more concerned with the very different issue of whether addiction is best construed as a brain disease or brain disorder.”

It is clear that while she takes issue as to whether addiction is a disease or not, she still views it as a disorder. If we are focused on treatment and recovery, does that distinction really matter?

PART 2

The gist of Dr. Dawson’s article is that people with addiction choose to use and choose to continue to use. Accordingly, they are to blame for their addiction. They are immoral and should be criminalized for any crimes they commit because of their addiction, unlike people with other mental health conditions who are engaged in criminal activities (those deemed not criminally responsible). But many have developed an addiction while trying to self-medicate other mental health conditions.

Disease or not, all experts would agree that addiction creates changes in the brain that result in compulsive drug seeking in spite of adverse consequences. At its core, addiction is about self-harm. It is a slow death (or quick in the case of overdose). At the severe end, people struggling with addiction do not make decisions in their own best interest with respect to all aspects of their lives and they lose everything that matters to them – jobs, family and friends. They lose control over their lives which become chaos. And so yes, they consume substances that could kill them.

It is estimated that eighty percent of overdoses are accidental and twenty percent are deliberate. Which side of that equation is more horrific? Dr. Dawson wants to blame them for their self harming behaviours. I believe Dr. Dawson would say that those without addiction who are depressed and take their lives are not to blame and are innocent victims of their depression. Their decision is not their own, as they are struggling with a serious mental illness or disorder that impairs their ability to make decisions in their own best interest. To which I would say yes, just like addiction.

Prior to 1972 it was illegal in Canada to attempt to kill yourself. We look at that law now and think how irrational it is. Criminal law is meant to punish people who harm other people, not to prevent people from harming themselves. It is time we realized the same for people struggling with addiction.

It appears Dr. Dawson thinks persons with addiction don’t deserve treatment because their harms are self-inflicted (their choice). So we should not treat the obese? Those who smoke? Those who do not wear their seat belts or bike helmets?

Finally, Dr. Dawson does not believe that treatment exists for addiction. He states “I put treatment for addiction here in quotation marks because there is no treatment as such.” Like most primary care physicians and psychiatrists, he does not know that there are very effective evidence-based treatments for addiction, like medication assisted treatment (MAT), cognitive and other behavioural therapies and motivational interviewing.

To quote one of Canada’s most pre-eminent addiction medicine specialists, Dr. Meldon Kahan, Women’s College Hospital, Toronto:

The scandal is that there are evidence-based treatments for substance use disorder which are effective that are not being used. META:PHI presentation, May 24, 2017.

WHY WE NEED TO STICK TOGETHER

Most addictions start during adolescence and the vast majority of adolescents struggling with addiction have other mental health conditions. It is widely accepted that treating these conditions concurrently is most effective. We do not yet know which causes which, or if something else causes both.

Instead of fighting amongst ourselves, we need to stick together to eliminate the discrimination in health care funding and treatment against those with addiction and/or other mental health conditions.

Stigma in the U.S. health care system contributes to disparities in funding for research and treatment of mental disorders in comparison with physical disorders and to the negative attitudes, beliefs, and behaviors of health care professionals toward people with mental and substance use disorders. Structural stigma is manifested in the health care system in the low quality of care for people with mental and substance use disorders and the limited access to behavioral health treatment and other services (Institute of Medicine, 2006; Schulze, 2007; Schulze and Angermeyer, 2003…”(at p.45-46) Ending Discrimination Against People with Mental and Substance Use Disorders: The Evidence for Stigma Change published by the National Academies Press.

In Canada we spend just over 7% of our public health budget on mental illness and addiction but the burden of these diseases in Canada in 2013 was between 10% and 11% (Global Burden of Diseases, Injuries, and Risk Factors Study, 2013). By comparison, countries like New Zealand and the UK spend 10%-11% of their public health budget on mental illness and addiction. In 2012, the Mental Health Commission of Canada in Changing Directions, Changing Lives, The Mental Health Strategy for Canada, called for Canada to increase the amount it spends on mental illness and addiction from 7% to 9% over 10 years. This recommendation pre-dates the federal government’s commitment to legalize cannabis, which will generate income for the federal and provincial governments, and the current opioid overdose epidemic which is killing thousands of Canadians annually, many of them our youth and young adults with addiction and mental health conditions.

This sad state of affairs is the result of decades of discrimination in how society, including physicians, continue to view addiction as the moral failing that it is not, instead of the illness that it is. And so it is that doctors have overprescribed opioids, their patients have become dependent or addicted, and yet they do not know how to prescribe suboxone or methadone to treat opioid use disorder. They are also unaware of, and do not know how to prescribe, the medications available for treating alcohol use disorder (Campral and Naltrexone). Addiction medicine is not taught in medical school yet it affects one in seven. No wonder we are in the midst of an opioid overdose epidemic. In the words of another pre-eminent addiction medicine specialist, Dr. Evan Wood, British Columbia Centre on Substance Use (BCCSU):

Oftentimes, I hear people say that the addictions system is broken … Actually, the system isn’t broken, we need to build a functioning addictions system.” CBC Interview, Sept. 16, 2016.

Angie Hamilton is the Executive Director of Families for Addiction Recovery and has lived experience as the parent of a child with substance use disorder.