Recognising 60 years of specialised care in addiction medicine

1 June 2024 marks the 60th anniversary of St Vincent’s Hospital Melbourne opening Australia's first clinic for the care of people with alcohol problems and the study of alcohol use disorder (previously called ‘alcoholism’).

It was the first medical unit in Australia to focus on addiction.

After identifying a need in the community, SVHM clinicians established the clinic, then known as the ‘special clinic’, to reduce the stigma around alcohol problems.

While progressive in Australia at the time, the clinic had limited capacity, caring for an estimated 100 patients each year, and there were limited treatment options to provide to patients.

Sixty years later, the clinic employs a multidisciplinary team of doctors, nurses, nurse practitioners, psychologists, social workers, peer or Lived Experience workers and others who proudly care for some of the most vulnerable members of our community.

It is the only physician-led addiction medicine unit in Victoria, meaning it can address the full spectrum of physical and mental comorbidities that its patients experience. It received more than 2,000 presentations in 2022-23.

Psychiatric treatment options have also expanded to include medication, individual counselling, group therapy or a combination of personalised approaches.

Now under the leadership of Professor Yvonne Bonomo, as part of SVHM’s Addiction Medicine Unit, the clinic strives to make it easier for people to get treatment for addiction and to break down barriers to accessing treatment.

“We now know so much more about how alcohol problems arise, the various treatment options available and the key public health messages around alcohol that are getting through to the community,” Professor Bonomo said.

“These include the risk of alcohol consumption during pregnancy, the impact of alcohol on adolescent brain development, the connections between alcohol and some cancers and more recently the contribution of alcohol to interpersonal violence,” Professor Bonomo said.

A proud history of leading advancements in care

A key achievement in the clinic’s 60 years was discovering the importance of thiamine for those who drink alcohol heavily, work that was published by Chief Dietician at SVHM, Dr Beverly Wood.

Dr Wood has since been awarded a Member in the General Division of The Order of Australia for significant service.

In the 1970s, Australia had a very high incidence of permanent, yet preventable, brain damage in people with alcohol problems (known as the Wernicke-Korsakoff syndrome). It was thought at the time, but not proven, to be due to thiamine (vitamin B1).

Dr Wood executed a research program that documented the extent of the problem and showed how it could be prevented. Through her persistent advocacy, supported by physician colleagues at SVHM, she convinced Government that all flour must be fortified with thiamine, a step that was legislated in 1991, and since then, the Wernicke-Korsakoff syndrome has almost disappeared in Australia.

An ongoing commitment to delivering person-centred care

The Addiction Medicine Unit thinks about the patient as a whole and considers their social context, physical health, mental health.

“Our care is centred around the individual, so from the moment the come in they feel welcome, they feel there is no judgement or stigma, that we are really happy to see them and help and them and they feel calm, which is very important in this area of healthcare,” said Professor Bonomo.

SVHM continues looking for new ways to deliver innovative care to some of the most vulnerable groups in our community, including those challenged by addiction.

The Addiction Medicine Unit continues providing specialised, person-centred to care people experiencing alcohol use disorder, as well as expanding to include other drugs.

The unit initiated Victoria’s first addiction medicine ECHO – extending community health outcomes – so its specialists can assist professionals in addiction medicine across the state.

It now also has a strong, and growing, research component, with clinicians continuously pursuing new treatments in the form of new medications or different psychological or behavioural strategies and exploring the changing ways in which alcohol-related harms can present in the community.

SVHM’s expertise in addiction medicine has extended throughout the organisation.

In 2022, another key milestone for SVHM was opening Victoria’s first Mental Health, Alcohol and Other Drug Hub which is co-located in the hospital’s Emergency Department to provide specialised care to these patients.

The award-winning MHAOD Hub has been designed to optimise care outside the often busy and stressful setting presented in the ED that can become overwhelming at times, especially for patients experiencing mental health and/or alcohol and other drug problems. The Hub has now provided care to more than 8,800 patients.

Sixty years on, the legacy of St Vincent’s as a voice of experience in the treatment of problems with alcohol and now other drugs lives on.

“Progress has been made in delivering more integrated and holistic care to people experiencing alcohol addiction, but there remains further work to be done to help identify problems sooner and get people to the treatment they need,” said Professor Bonomo.