Overview of Substance Misuse
Services in Ostrobothnia
Antti Koivukangas
MD, psychiatric resident
Hospital District of Ostrobothnia
Seinäjoki Finland
Finland
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Area 338,424 km2
People 5,391,699
District of Ostrobothnia
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People 198800
´”Capital” City
of Seinäjoki
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58 000 people
Central Hospital
Background

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Alcohol is the most popular psychoactive
substance in Finland
Consumption of alcohol has been
increasing years


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2010 10 litres (100%/year)
Highest in Scandinavia
Attitudes have changed more tight against
problem
Alcohol and problems?
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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

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ca. 3000 alcohol related deaths per year
Violent crimes and homicide (alcohol included
50-70%)
Alcohol causes lot of violence, suicide attempts,
burden, suffering
Finns and Substances
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Binge drinking is typical to Finnish way of
drinking
Misuse of bentsodiazepines are common

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hangover and poly SUD
Illegal drugs have become more common since
90´s

Cannabis and buprenorphin i.v , amphetamin i.v.
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heroin availability weak
13 % of adults at least once used some illegal drug
Yearbook of Alcohol and Drug Statistics 2010
Consumption of Alcohol
Consumption of
alcoholin in some EU
contries
100% alcohol litras per
capita
Years 1960–2003
World Drink Trends
2005.
Addiction Services in Finland Background

The Substance abuse treatment and
rehabilitation has been under the social service
and outside from medicine

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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)
SUD Services in Ostrobothnia
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Outpatient services in the area A-clinic
staff 4,5 persons + 2 Youth station
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Detox unit + K-clinic 24/7 10 nurses
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Doctor 4h per week
Psychiatrist 4h per month
Doctor 2h 2x/week
Health Centres
Psychiatry
SUD in psychiatry background
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Dual diagnosis are common (also in
Finland)

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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
SUD in psychiatry background

Periodic or parallel model of treatment in
SUD
1.
2.
First SUD rehab, then psychiatric care
Parallel care in two different clinics at the
same time
SUD services backgrounds…
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2000-development work
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National mental and SUD – strategia:
1.
2.
3.

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
Future visions
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The practice culture has been changed
Patient with Dual diagnosis get treatment
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Substance use is assessed in each patient
Treatment is given to both focuses
What we do in our hospital (to
all patients with or without Dual
diagnosis ?
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Audit to all patients
Alcohol lab tests (alat, gt, cdt) from all
patients
Mini-intervention, motivational interview,
disulphiram sekä naltrexone
What tools we need to face to
challenge of patient with Dual
diagnosis?
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Right attitude
Ordinary evaluation tools and ordinary
treating methods for Psychiatric conditions
Ordinary evaluation tools and ordinary
treating methods for SUD conditions