15 Dec 2005
By Professor K. Satku, Director Of Medical Services
A/Prof Wong Kim Eng
Chairman, Medical Board, IMH
Dr Munidasa Winslow
Chief of Addiction Medicine, IMH and
Director of the Community Addictions Management Programme
Distinguished guests,
Ladies and gentlemen,
I am very happy to join you today at the opening of the WE Centre for Addictions Recovery and Education (WE C.A.R.E.).
Addictions as a chronic illness
Chemical and behavioural addiction is a pervasive problem in every community around the world. It not only affects the physical and psychological well-being of the affected individual, but also has considerable impact on their families and communities.
Not too long ago, it was commonly believed that addictive behaviour was caused by character flaws and weakness of will. We now know that addiction is a chronic illness, a condition related to changes in brain physiology and function. Just like any other chronic illness, it can be treated with medication and lifestyle changes to support long-term recovery.
Community Addictions Management Programme (CAMP)
In 2001, the Ministry provided funding under the Health Service Development Programme to set up the Community Addictions Management Programme, or CAMP, at the Institute of Mental Health.
CAMP provides outpatient treatment for addictions, including medical and psychological assessment, medically supervised detoxification, and individual and group counselling services. After nearly five years in operation, CAMP is now a well-established provider of treatment for addictions. Clinical outcome data has shown that CAMP has been able to reduce the severity of addiction problems and increase the quality of life of their patients.
WE Centre for Addictions Recovery and Education (WE C.A.R.E.)
The WE Centre for Addictions Recovery and Education, or WE C.A.R.E. was set up by CAMP to complement their existing services, and I warmly welcome this new initiative. WE C.A.R.E. is the first community-based drop-in centre for addictions in Singapore, offering a wide variety of resources to recovering persons. I am told that more than 700 patients have benefited from the recovery support groups that operate from the centre, and that the patients and their families have found these support groups to be very helpful.
Primary Prevention of Addiction
I am pleased to see that CAMP has taken on an active role in developing many programmes to help people overcome their addictions in a comprehensive and holistic manner. However, we have to acknowledge that the treatment of addictions is not an easy task, especially when the addiction has firmly taken root and grown in severity over time.
You've all heard of the old adage "Prevention is better than cure". That phrase is particularly significant when we talk about chronic diseases such as addiction. Once people slide down the slippery slope of addiction, the road to recovery is hard to navigate. Let me use drug addiction as an example.
People generally start out using drugs without the intention of becoming drug addicts. They may use drugs because they think it will make them feel good, or help them deal with painful or difficult emotions. Young people may try it because of peer pressure, or because it makes them look "cool". Many young people will progress no further than the first one or two tries. But some of them will continue using the drugs, and over time, will cross the line that separates drug abuse from addiction. At this point, even if he wants to stop using drugs, he will find it extremely difficult to do so. He will need to have an honest desire to change, and the willingness to adhere to a recovery programme. He will need to learn how to cope with cravings, and to avoid situations that trigger relapses. His relationships with his family and friends will suffer. He will experience difficulties at work or in school. We know from experience that the family also will need support to understand the illness of addictions which is not just a moral or choice issue. Recovery is not easy and takes much time and effort. This is why I feel that preventive education is fundamental to the whole issue of addiction and we should invest as heavily in prevention efforts as we do in treatment.
I would therefore urge the staff of CAMP, and all professionals who work in the field of addiction, to come together to develop comprehensive prevention programmes, so that we can nip this problem in the bud. The challenge for you is to come up with innovative campaigns and programmes that target specific populations. We need to develop a team of prevention specialists who can work with the media to get the message across to our local population. It is not enough to turn out catchy and clever phrases; the messages we send to the public must be group-specific, culturally relevant, evidence-based, and stand the scrutiny of evaluation by researchers.
The initiative to launch WE C.A.R.E demonstrates that our experts are thinking innovatively; I am confident that this spirit of innovation and creativity will spill over into our preventive efforts, and I look forward to more developments in this area.
Early detection and intervention
There has been a great deal of publicity recently about gambling addiction. The decision to allow Integrated Resorts to be developed in Singapore has spawned an increasing interest in understanding, identifying, and treating gambling problems. A study done by MCYS late last year shows that 2.1% of our population could develop various forms of gambling problems, including pathological gambling or gambling addiction.
Many experts see gambling addiction as part of a wider spectrum of certain impulse control disorders that have commonly come to be called "behavioural addictions". Besides gambling, behavioural addictions include many normal activities like the compulsive use of the Internet and LAN games, and even shopping.
Besides gambling, Internet related addiction is the other behavioural addiction that has captured public interest, particularly as Internet use is so incredibly pervasive in the modern world. We use the Internet for work, to stay informed about current events, or for pure entertainment. However, anecdotes are emerging from clinicians around the world about people who appear to be addicted to the Internet. These individuals remain online for many hours at a time, disregarding their meals, sleep, personal hygiene, and family and work commitments. Their lives revolve around the Internet, and they gradually become estranged from friends and family. How do we know when someone has crossed the line that separates the Internet user from the Internet dependent person? Clinicians have developed tools to help them to do this. However, behavioural addictions pose a different, and perhaps more difficult, challenge to us than substance abuse and addictions. Almost everyone gambles at some point, and it is only a matter of time before every home has access to the Internet.
As we learn more about behavioural addictions, it is becoming increasingly clear that we need to educate the public about appropriate online behaviours, low or no-risk gambling, and so forth. Public education must be complemented with preventive education campaigns. Just like for substance addictions, preventive education needs to be customized for particular groups, which would include at-risk individuals, parents, educators, employers, and other relevant parties.
The young are especially vulnerable, and parents and educators must be taught to pick up on early warning signs that a young person could be developing a problem. With early detection and intervention, we hope to prevent or slow down the progression of the problem behaviour.
Encouraging research into addiction
I would also like to encourage all of you to engage in research in the field of addictions. Although numerous studies have been conducted in Western countries, few have been done in the local and Asian settings. The more we know about this addiction and how it affects our local population, the better we can prevent and treat it. Research in this area encompasses a whole range of possibilities - prevention and what works best in our culture, basic research into the biological and genetic explanations for addiction, epidemiology, effectiveness of different modes of therapy, and the needs of special groups such as the young, the elderly and women. Once we know what works, what doesn't, and what we need to do to make things work in our cultural setting, we can tailor our interventions accordingly and achieve our goal of reducing the impact of addictions on our society.
Conclusion
Addiction is a complex, multi-faceted illness, and its impact is far- -reaching. For every addicted person, numerous individuals close to him also suffer, and the ripple effect will slowly engulf the wider community. Therefore we need to tackle it effectively. We will need to engage our partners in the community, including government agencies, the business community, welfare organizations, institutes of learning, and religious and cultural groups. I am sure that close co-operation and collaboration with these multiple partners will allow us to make great strides in tackling this societal problem. I urge all of you to continue to work together, and applaud the efforts you have already made in improving the lives of our citizens.
I am now delighted to declare the WE Centre for Addictions Recovery and Education open.
Thank You.