In emergency medicine, the “golden hour” refers to a period lasting for one hour following traumatic injury during which there is the highest likelihood that prompt medical treatment will prevent death. It is well established that the patient’s chances of survival are greatest if they receive care within this window after a severe injury.
I want to suggest that with substance use disorders (SUDs) or addiction, we don’t have that golden hour, we have only a “golden moment.”
This golden moment would be the precise point in time when someone is willing to get into treatment. There might be uncertainty, but presenting available services the moment people are ready for treatment is critical, as the National Institute on Drug Abuse (NIDA) agrees. If we are unable to locate treatment for someone right away—if treatment is not immediately available or readily accessible—there’s a very good chance they will change their mind and continue using.
As with other chronic diseases, the earlier treatment is offered in the disease process, the greater the likelihood of positive outcomes. And sadly, these days, one more high can have lethal consequences.
So, it is that we must seize the opportunity of the golden moment to help individuals with SUD or addiction. This effort requires a multipronged approach, including:
- Increasing immediate access to effective treatment;
- Reducing stigma; and
- Raising awareness among clients, families, the community and healthcare professionals of the value of addiction treatment.
We are dealing with a shortage of quality addiction treatment programs. Individuals struggling with SUD who have worked up the courage to seek treatment are being placed on waiting lists, leading some to give up on treatment altogether and continue using, while prompting others to view short-term sobriety during the waiting period as proof they do not need treatment.
Research indicates that the longer the delay between the initial phone contact and a scheduled first appointment, the less likely a client is to attend an appointment. One possible reason may be that clients are often in crisis when contacting the agency, and that crisis subsides after a time. Another possibility is that clients may have only temporarily overcome internal or external barriers to treatment, including stigma.
Whatever the case, it is critical that we have enough quality treatment programs to handle the multitude of clients who need us, and that we act immediately on the golden moment of opportunity. It has been demonstrated that waiting for long periods without receiving some form of treatment is associated with decreased functioning, an increase in criminal justice involvement, and decreased motivation for ever starting treatment.
Treatment programs can and should be able to admit clients 24 hours a day, seven days a week. Ideally, they should have interventionists on call and 24/7 nursing staff if they offer detox as well. Being prepared for someone’s golden moment could mean life or death.
Scientific progress has helped us understand that addiction or SUD is a chronic disease of the brain. It is a disease that can be treated successfully. No one chooses to develop this disease. Instead, a combination of genetic predisposition and environmental stimulus—analogous to other chronic diseases like diabetes and hypertension—can result in physical changes to the brain’s circuitry, which lead to tolerance, cravings, and the characteristic compulsive and destructive behaviors of addiction that are such a large public health burden for our nation.
The idea that addiction is simply a moral failing or weakness is patently false. It’s time we erase the stigma that can so often be a huge barrier to treatment and negatively impact someone’s recovery from the disease.
Family and friends can play critical roles in eliminating stigma, getting their loved ones into treatment during that golden moment, and motivating individuals with SUD to stay in treatment. Communities are increasingly aware of the toll opioids in particular have taken in their neighborhoods and are organizing to help reduce the stigma, encourage prevention, and increase awareness of treatment options.
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