Eviljaffacake

With ACEs and trauma in general being a significant risk factor for people who use alcohol or substances - what advice would you give for those with trauma and active self-medicating behaviours? I'm aware of safety and stabilisation techniques but is there anything else that you might consider?

What's your evidence base behind what you offer? How does it align with MAT for opioid use disorders, protective medications like disulfiram for alcohol ise disorder, and access to BBV testing etc? What's your role in reducing both fatal and non-fatal overdose risk?

You'll have obviously worked out that I'm an addiction psychiatrist, albeit in the NHS in Scotland/UK. In addictions circles, American provision is considered a laughing stock compared to Europe, so its a wee bit reassuring that there's at least someone who takes a more pragmatic harm reduction approach with some modicum of evidence based medicine and a degree of consideration for our most discriminated/stigmatised/traumatised individuals. Easier said than done if there's massive barriers to accessing healthcare in the first place, but that's obviously not your fault.

Good luck in your endeavours and by all means contact me if you want a sense of how things work in Europe's largest drug service. Hope you get some interesting questions that promote robust discussion.

Surely its more important to work as part of a multidisciplinary service than providing a branded package of care (ie case working, recovery communities, MAT, BBV testing, naloxone, housing, social work, psychiatry, psychology)? Supporting is fine, but really the actions are more important. And why the branding anyway? Doesn't that perpetuate an ongoing belief system around recovery rather one based on scientific merit (though im not saying it should be exclusively one or the other)?

Of course the people who need the most help are the most chaotic and vulnerable people such as those that are homeless and using drugs by injecting. Given that this cohort are the priority group from a public health perspective and from a purely compassionate aspect, how do you support them?

Also what kind of interventions do you do around ARBD, including the challenges around capacity to make informed decisions on their recovery?

What's your advice on managing adhd or asd in those with alcohol/substance use disorders?

Im a UK consultant addiction psychiatrist.