"My son's experiences of using addiction services"

After having dealt with various addictions teams over the last 12+ years, I'm not surprised that tragically, drug related deaths are still rising.

I found that senior staff especially do not listen to concerns from close family members.  I've been excuded from meetings even when my son has asked for me to be present. This is because when I see or hear something that I don't think is in his best interests, I challenge it. Addicts can tend to be passive, accepting and unable to speak up for themselves. Parents who care are none of these things.

There seems to be a reliance on consultants who work part-time when the requirements of the role are clearly full-time. This results in unacceptable wait times following triage before commencing substitute prescribing. There is no redundancy.  Service users face bottlenecks because consultants are on leave or on training or the consultant simply can't say when they will be able to see a patient. This is unacceptable. Someone else should be available to sign off repeat prescriptions.

Similarly, following relapse, it takes too long to restart a prescription, leading to increased drug tolerance, move to IV use, risk of criminal behavior, financial hardship for both the service users and families. Excuses include things like that the last prescription didn't work", that the patient needs a period of reflection before restarting, that a staff member is on leave and no one can write the prescription.  In the space of a month, my sons use escalated, he lost his job and broke the law. All of this could have been avoided if his prescription had been reinstated when he asked for it. Not a month later.

There is absolutely no interest in getting to the root cause of why someone has abused drugs for all of their adult life (my son is now in his 30's and has been using heroin and cocaine since he was 20, before that it was marijuana, ecstasy, diazepam, etc since his early teens).  This is despite my son exhibiting a range of symptoms that are (in the words of his current psychiatrist, likely consistent with an ADHD diagnosis.

When asked if they could perform the ADHD diagnosis this was declined as they only work with things related to addictions. When asked if she could make an onward referral to Community Mental Health for an ADHD assessment,  they said the waiting list is currently around 4 years and they could only make that referral if my son was to come off drugs for a month! So effectively my son is prevented from accessing mental health services because he has an addiction.  An addiction likely caused or exacerbated by a mental health condition. Surely this is discriminatory?

The team that my son currently engages with are preoccupied with where he lives. I live in Lisburn and when my sons health deteriorates he  reluctantly moves back in with me. This happens regularly.  His GP is there and has no issue with the arrangement.  But because my son has a rented flat in Belfast, Lisburn expect him to transfer to Belfast. But my sons life is chaotic and doesn't neatly fit into a box. Because of loneliness and mental health issues, he doesn't want to be on his own so regularly spends days or weeks with me in Lisburn or at friend's homes. He can't change Trust area, GP etc every time he spends time living at a different address. He needs some measure of continuity. His entire family reside in Lisburn, his GP is in Lisburn, he's requested a housing transfer to Lisburn, so why Lisburn CAT can't just park the residency issue and get on with what they're paid to do is beyond me.

A general criticism common to both Belfast and Lisburn Community Addiction Teams and linked to 4. above, is that they are severely restricted in their remit. The old saying that "If the only tool at your disposal is a hammer, then every problem becomes a nail" has never been more apt. Dual diagnosis, co-morbidity or co-occurring disorders, however you want to describe it, are completely disregarded. Drug use and addiction to drugs is always seen as the problem. The possibility that drug use could be a symptom of the real problem is never even considered.  So my son has been trapped in a cycle of addiction, treatment and relapse for over 12 years.

Windows of opportunity to make investigations into why my son is the way he is have come and gone. No one seems interested.  Once he inevitably relapses, it takes months to get him back in treatment again and no attempt is made to look at his history and previous treatments to try and break the cycle.

I have read with equal amounts of optimism and despair a number of research documents about addiction services. It seems that it is generally accepted that existing Addiction Services are inadequate for both the present and moving forward. I would venture that the extent of the inadequacies is underestimated. 

One report is particularly critical concluding that performance monitoring is virtually non-existent in the sector with too much emphasis on footfall and numbers through the door rather than outcomes for service users and impacts on peoples lives. It can't even be determined if we are getting value for money.