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Improving treatment for people with addiction's

27th September 2006

“To Cure Sometimes, To Relieve Often, To Comfort Always”

'Improving treatment for people with addiction problems in Aotearoa New Zealand'. University of Otago, Christchurch School of Medicine & Health Sciences

More than a century has passed since TB physician Dr Edward Trudeau used these words to guide his practice. Yet they are still central to the philosophy of addiction specialist, Professor Doug Sellman from Otago University’s Christchurch School of Medicine and Health Sciences, who will deliver his Inaugural Professorial Lecture on Thursday September 28.

As a psychiatrist and Director of the National Addiction Centre, Professor Sellman will address “Improving treatment for people with addiction problems in NZ”. His wide-ranging and stimulating lecture will detail the nature and causes of addiction, and progress in treatment in NZ over the last decade.

“There’s no doubt that the last ten years have seen major progress in treating addiction, but there’s no silver bullet, neither with drugs, alcohol, tobacco nor gambling,” he says. “Some people still think that addiction can be solved by a number-eight-wire mentality and common sense. Nothing could be further from the truth. Addiction is a complex medico-social problem, hand-cuffed to a society obsessed with consumption. There’s no one-size-fits all approach.”

Professor Sellman’s says in his lecture because of this complexity, addiction often runs a chronic relapsing course in the majority of patients. Further many addicts have underlying psychological problems that need addressing. This aetiology means drug substitution treatments such as methadone may need to be used for decades.

At present there are approximately 4300 people on methadone in NZ, up from 2500 a decade ago, but waiting lists are just as long. The cost is high, but is cheaper than imprisonment ($50,000 p.a.), or crime because of heroin and other addictions says Professor Sellman.

He says that alcohol, our most problematic drug, is a similar challenge. Pharmaceuticals such as the anti-craving drug naltrexone have revolutionised treatment since the mid 1990’s, but have still not solved growing problems around the NZ ‘booze’ culture. Part of the challenge is that so few medical specialists practise in this area (around 3% of the addiction workforce) and therefore the uptake of pharmacotherapy is slow.

“Although anti-craving drugs aren’t the complete answer to alcohol dependence, they’re definitely a major advance in early treatment,“says Prof Sellman, “ and should be part of any comprehensive addiction management.”

Professor Sellman details advances over the last ten years in the use of psychotherapies such as motivational enhancement, and the professional development of the addiction workforce. The University of Otago’s, National Addiction Centre, has played a major role in all these improvements since 1996, with 37 staff now engaged in a wide range of research, postgraduate teaching and workforce development programmes. It has defined the direction of evidence-based addiction treatment in this country.

“I think it is fair to say that without the dedicated work by staff at the NAC we wouldn’t have made the progress we have in understanding and treating addiction problems in NZ, and improving the quality of the workforce, “ says Sellman.

However he makes it clear that there is still much to be done, and that treating and understanding addiction is a never ending battle in a society devoted to conspicuous consumption.

“This is not irrational pessimism. It’s simply based on an analysis that the changes needed to alter our addictive behaviours are probably too radical for most politicians. The power and influence of big business is increasingly moving beyond accountability to democratic governments, and is likely to maintain the status quo, while delivering victims in increasing numbers for addiction care and treatment.”

Professor Sellman’s public lecture is on Thursday September 28 at 5.30pm in the Rolleston Lecture Theatre, Christchurch School of Medicine and Health Sciences.
A photo is available.


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