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Overview of Substance Misuse Services in Ostrobothnia

Overview of Substance Misuse Services in Ostrobothnia. Antti Koivukangas MD, psychiatric resident Hospital District of Ostrobothnia Seinäjoki Finland. Finland. Area 338,424 km 2 People 5,391,699. District of Ostrobothnia. People 198800 ´”Capital” City of Seinäjoki 58 000 people

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Overview of Substance Misuse Services in Ostrobothnia

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  1. Overview of Substance Misuse Services in Ostrobothnia Antti Koivukangas MD, psychiatric resident Hospital District of Ostrobothnia Seinäjoki Finland

  2. Finland Area 338,424 km2 People 5,391,699

  3. District of Ostrobothnia • People 198800 • ´”Capital” City of Seinäjoki • 58 000 people • Central Hospital

  4. Background • Alcohol is the most popular psychoactive substance in Finland • Consumption of alcohol has been increasing years • 2010 10 litres (100%/year) • Highest in Scandinavia • Attitudes have changed more tight against problem

  5. Alcohol and problems? • App. 300 000-600 000 problem drinkers • 1/4-1/3 of emergency visits are due to alcohol • Alcohol related situations the most important cause of death in 18-65 both in male and female since 2005 • ca. 3000 alcohol related deaths per year • Violent crimes and homicide (alcohol included 50-70%) • Alcohol causes lot of violence, suicide attempts, burden, suffering

  6. Finns and Substances • Binge drinking is typical to Finnish way of drinking • Misuse of bentsodiazepines are common • hangover and poly SUD • Illegal drugs have become more common since 90´s • Cannabis and buprenorphin i.v , amphetamin i.v. • heroin availability weak • 13 % of adults at least once used some illegal drug Yearbook of Alcohol and Drug Statistics 2010

  7. Consumption of Alcohol Consumption of alcoholin in some EU contries 100% alcohol litras per capita Years 1960–2003 World Drink Trends 2005.

  8. Addiction Services in Finland - Background The Substance abuse treatment and rehabilitation has been under the social service and outside from medicine Doctors and Psychiatry only in role of consults Paradigma differ from medicine SUD services are produced by communities and organized by Foundation based A-clinics Resources have been limited and have not been increased (as in medicine field)

  9. SUD Services in Ostrobothnia • Outpatient services in the area A-clinic staff 4,5 persons + 2 Youth station • Doctor 4h per week • Psychiatrist 4h per month • Detox unit + K-clinic 24/7 10 nurses • Doctor 2h 2x/week • Health Centres • Psychiatry

  10. SUD in psychiatry background Dual diagnosis are common (also in Finland) 40% drinkers (harmful or dependence) have some life-time psychiatry diagnosis 30% Psychiatry patients have life-time SUD Attitude in psychiatry have long been negative to SUD Delirium tremens vs. active drinking problem

  11. SUD in psychiatry background • Periodic or parallel model of treatment in SUD • First SUD rehab, then psychiatric care • Parallel care in two different clinics at the same time

  12. SUD services backgrounds… • 2000-development work • National mental and SUD – strategia: • Strengthening the Position of a Client • Focus in Prevention • All services to one organisation • National guideline in Treatment of alcohol abuse “Current Care” since 2005 • updated 2009

  13. Future visions • The practice culture has been changed • Patient with Dual diagnosis get treatment • Substance use is assessed in each patient • Treatment is given to both focuses

  14. What we do in our hospital (to all patients with or without Dual diagnosis ? Audit to all patients Alcohol lab tests (alat, gt, cdt) from all patients Mini-intervention, motivational interview, disulphiram sekä naltrexone

  15. What tools we need to face to challenge of patient with Dual diagnosis? Right attitude Ordinary evaluation tools and ordinary treating methods for Psychiatric conditions Ordinary evaluation tools and ordinary treating methods for SUD conditions

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