Substance abuse overview.

1. Substance abuse:
Approaches,
Statistics,
Legislation,
Services, and
Methods
DSSC41 Spring2018
Lecturer Lauri Uljas

2. Your experiences with substance
abuse
1. What are the main addictive substances in your culture?
2. What are your experiences with substance abuse?
3. What is your definition of addiction?
4. What do you think about the topic: Finnish people and
alcohol?
5. What kind of attitudes do you have towards people with
substance abuse problems?
6. How do my attitudes affect my work with them?

3. Substance abuse
• Bad habit?
• Addiction?
• Sin?
• Disease?

4. Addictive Substances
• Tobacco
• Alcohol
• Prescription drugs (Diapam, Valium, Stesolid, Temgesic, Subutex,
cough syrups with codeine…)
• Drugs
• Central Nervous System (CNS) stimulants (amphetamine,
metaphetamine, cocaine, khat)
• CNS depressants (heroin,opium,morphin,GBL,GHB)
• Hallucinogens (LSD, Peyote, Psilocybin, PCP)
• Cannabis (Marijuana, Hash, Cannabis oil)
• Designer drugs (spice, synthetic cannabinoids)

5. Addiction
• Something gives physical and/or psychological
pleasure
• > The faster it affects, the more likely one becomes
addicted to it (instant gratification)
• One becomes addicted to the experience that one gets
from substances or certain activities
• One’s beliefs play a critical role in maintaining the
dependency

6. Substance Dependency
three (or more) of the following, occurring at anytime in the
same 12-month period
(1) Tolerance, as defined by either of the following:
(a) A need for markedly increased amounts of the substance to
achieve intoxication or desired effect.
(b) Markedly diminished effect with continued use of the same
amount of the substance.
(2) Withdrawal, as manifested by either of the following:
(a) The characteristic withdrawal syndrome for the substance.
(b) The same (or a closely related) substance is taken to relieve or
avoid withdrawal symptoms.

7. (3) The substance is often taken in larger amounts or over a longer period
than was intended.
(4) There is persistent desire or unsuccessful efforts to cut down or
control substance use.
(5) A great deal of time is spent in activities necessary to obtain the
substance, use the substance or recover from its effects.
(6) Important social, occupational, or recreational activities are given up or
reduced because of substance use.
(7) The substance use is continued despite knowledge of having a
persistent or recurrent physical problem that is likely to have been
caused or exacerbated by the substance.

8. • One can develop dependency not only on intoxicants
but also on various immediately satisfying activities
that do not involve the use of chemical substances:
• gambling, constant changing of sex
partners or excessive use of phone sex
services, bulimic eating, compulsive
physical exercise, shopping or other
activities that provide instant gratification.

10. Alcohol Consumption in Finland
• Year 2007: 10,5 l abs.alc./ person (=716 bottles of
beer)
• 10% of men, 13% of women don’t drink at all
• In 2007 in 25% of fatal car accidents alcohol
involved
• Connection to aggressive behavior

11. Why should we care about drinking
behaviors?
• The year 2012, 1 960 people died because of alcohol
(men 1 518, women 442. )
• (Alcohol poisonings 375 / 2012)
• Cost to society about one billion per year
• Other costs about 3,3-5,9 billion
• Taxation of alcohol creates tax revenue of
approximately 1,4 billion (in 2012)

12. Alcohol Use in Finland
• Nondrinkers: 10 %
• ”Normal” use: women 78 %, men 64 %
• High consumption: women10 %, men 20 %
• Alcohol addiction women 2 %, men 6 %
• Consumption of pure alcohol per capita 2012: 9,6 L (2007: 10,5 L)
(before 1969: 2,8 L >increase 40%). After 2009, no increase : 12, 3 per
capita
• EU alcohol taxes went down 2004 33% > deaths because of alcohol
increased 20 %, alcohol related diseases grew
• Easy access is increasing consumption> more harm At least 14 % of
Finnish population has tried drugs

13. Total Consumption of Alcoholic
Beverages Continued to Fall
• In 2015, the total consumption of alcoholic beverages equaled
10.8 litres of pure alcohol consumed per person aged 15 years or
older. Total consumption fell by 3.6 percent compared with 2014.
In total, Finns consumed 49.6 million litres of pure alcohol.
• In 2015, recorded consumption of alcoholic beverages equaled
8.5 litres of pure alcohol consumed per person aged 15 years or
older. Unrecorded consumption of alcoholic beverages was
estimated to be 2.3 litres. Recorded consumption fell by 3.4
percent and unrecorded consumption by 4.2 percent compared
with the previous year.

14. Alcohol consumption…
• In Finland, we consume almost as much alcohol as
people in the Netherlands, Belgium, and Greece and
slightly more than in Australia, Italy, Canada, Poland,
New Zealand, and USA.
• Approx. 10 % of alcohol users use almost half of all
alcohol.

15. Harm caused by alcohol (HTL, Pekka Puska)
DRUNKENNESS:
• ACCIDENTS
• DANGEROUS / UNSAFE DRIVING
• VIOLENCE
• POISONINGS
• HEARTATTACKTS
• SUICIDE
SOCIAL HARM
VIOLENCE,
POBLEMS IN MARRIAGE
CHILD ABUSE
RELATIONSHIPS
WORKING LIFE
UNEMPLOYMENT
LONG TERM
PROBLMS:
Multiple "diagnoses“
ORANIC DAMAGE
LIVER, PANCREAS
BRAIN,
FETUS
ADDICTION
MENTAL PROBLEMS

16. While dealing with substance abuse,
it is important to
• Understand different ways of seeing the problem
• To identify your own attitudes
• To be sensitive to the ideas the client has about his
situation
• To find common starting point for treatments
• To be aware about multiple diagnosis

17. Early intervention
• At different kind of family activities (Maternal health
>Audit of both parents to be)
• At schools
• Hobbies and activities for young people
• Home care
• Societal debate
• Third sector

18. In Finland the biggest problem in subsance abuse is
alcohol, But what kind of culture of drinking we have
got?…
• At the moment the most common reason for death among
working age people
• Approach is contradictory: being able to drink a lot is admired,
addicted drinkers are moralized, if you don’t drink, you have to
explain….
• Today's problem is that Finnish people still drink in order to be
drunken (Sauna and Saturday bottle) and also Finnish people
drink like in Middle Europe a little bit every day
• The combination of these two ways to use alcohol has its
challenges…

19. Different levels of using alcohol
Experiment, sometimes, ”normal use”
Not high risks if the amounts are not big, if they, are risks for
accidents increase
Heavy drinking
-starts step by step
-risks for health increase, tolerance increases
Addiction (1CD-10 classification F10.2 (International Statistical
Classification of Diseases and Related Health Problems, F
=problems in mental health and behavior)
-physical, mental and social addiction
-long lasting process
http://www.kaypahoito.fi/web/kh/suositukset/naytaartikkeli/..
./nix00353
(Diagnosis concerning alcohol)

20. WHO is heavy drinker?
• A man , who drinks more than 7 portions /day or more
than 24 portions/week
• A woman , who drinks more than 5 portions/day or
more than 16 portions/week
• About: 600 000 Finnish inhabitants

21. Alcohol/Drug addict
• Everybody has his reasons to use drugs
• What is the meaning of using drugs for the person?
• Drug addiction is chronical disease
• Different kind of explanations: medical, biological,
genetic, psychological, learning related, sociological,
social, physiological, personality problems…

22. Effects of drug addiction for daily
life
• Obsession to get alcohol/drugs
• Psychological, physiological and social addiction
• Brain chemistry>pleasure
• Hard to quit: motivation
• How to replace negative addiction with positive

23. Drug situation in Finland
• After the mid-1990s the drug situation in Finland
deteriorated according to nearly all indicators
• since 2000 drug use and the growth in drug-related
harm have leveled off and in recent years the
situation has remained stable
• the number of drug-related deaths has been
increasing (designer drugs, particularly MDPV)
• The number of annual drug-related deaths has
increased. According to the cause
• of death statistics compiled by Statistics Finland,
there were 213 drug-related deaths in
2012, compared with 197 in 2011.

24. Drug consumption…Vili Varjonen
Huumetilanne Suomessa 2014
• According to the 2010 population survey, 17% of Finns aged 15 to 69 had
tried at least one illegal drug at least once in their life. Experimentation
principally involved cannabis:
• 13% of women and 20% of men had experimented with cannabis. There was
a heightened incidence of experimentation, 36%, in the young adult age group
(aged 25–34).
• According to the national school health survey of 2013, 9% of comprehensive
school pupils, 13% of first-year and second-year upper secondary school
students and 21 % of first-year and second-year vocational education students
had tried illegal drugs at least once in their life.

25. …continues
• Drug users in social and health services in 2014
• 46% opiate users (buprenorphin, heroin)
• 19% stimulant users
• 10% cannabis users
• 7% sedatives
• 7% mixed
The number of annual drug-related deaths has increased.
• of death statistics compiled by Statistics Finland, there
were 213 drug-related deaths in
• 2012, compared with 197 in 2011.

26. Finland’s alcohol policy
Alcohol Programme 2012-2015:
• is focused on co-operation for reducing alcohol-related
harm
• is based on the joint efforts of the state, municipalities
and various associations and organizations
• Aims to reduce harm for children and families, decrease
the consumption of alcohol and effects of alcohol abuse

27. Finland’s drug policy
• is based on the government's Drug Policy Action
Programme for 2008-2011
• In its drug policy Finland complies with and applies
the UN's conventions and resolutions on drugs, as
well as the EU's drug strategy for 2005-2012.

28. Finland makes use of social policy, national legislation
and international agreements to
• prevent the demand and supply of drugs
• reduce the harm caused by drugs
• ensure that those suffering with drug problems
receive treatment as early as possible
• investigate criminal proceedings against those guilty
of illegal activity

29. Many actors, divided
responsibilities…
• Ministry of the Interior: police
• Ministry of Finance: customs
• Ministry of Justice: legal issues, punishments etc.
• Ministry of Education and Culture: prevention
• Ministry of Social Affairs and Health: rehabilitation
• Coordination task

30. Occupational Health care
• About 70 % of heavy drinkers are in working life
(Terveys 2000 kysely ks. Sepä, Alho, Kiianmaa 2010)
• Occupational Health Care Act (1383/2001)says that
in the organizations there has to be a program how
to take care of alcohol problems if they make drug
tests
• There has to be a plan for treatment
• Early intervention

31. Substance abuse work in Finland
• preventing use: to promote alcohol and drug-free
lifestyles and awareness raising
• preventing risks, harm and problems associated with
substance use
• treatment for substance abuse

32. Co-operation in social service work
• Respect your client
• Confidence
• Try to understand, realistic dialogue, estimating of treatments and
care
• Open peaceful behavior
• Patience
• Honesty, love
• Beeing humble
• Hope and empowerment

33. Different kind of methods
Avoid risks
-mini-intervention
Psychosocial methods
-motivational interviewing
-short therapy
-cognitive method
-psychodynamic (alternatives)
-functional rehabilitation
Taking care of the symptoms while person stops drinking/using drugs

34. Mini-intervention
• 1. To regognize risks: Tests (Audit, Cage, Mast)
• 2.Motivational interviewing: the situation, support. What should be
changed
• 3.To plan changes, to follow consuming,
• 4. Support for the changes. Appointments, monitoring, diary,
clinical tests
• Bloodtesting: MCV, CDT and GT «Yleisin syy MCV:n, GT:n ja
CDT:n poikkeavuuteen on alkoholin ongelmakäyttö.»(Käypä hoito)
• High bloodpressure
• Breathalyzer

35. How to prevent relapse
• First one relapses from the decision not to drink
• ”Good” Reasons for drinking
• >stress, insomnia, worries, work,relationship
problems,” I buy alcohol for guests..”
• One has learn to recognize pitfalls and plan how to
avoid them

36. Psychosocial care
Good relationship between social worker and the
service user
Professional, based on some theory or method
Information, dialogue, training, homework
Individual support or group support

37. Services
( Niemelä 1998, 36. )
MUNICIPAL
Privete
ORGANIZATIONS
(PROFESSIONAL
HELP)
services
ORGANIZATION OF
CLIENTS
CHURCH AN
CHRISTIAN
ORGANIZATION
(professional help
and volunteerst)
Social care,
health care
Basic level
Special level
Outpatients
department (A-
klinikka,
Nuorisoasema
STATUTORY
RESPONSIBILITY
Based on AA-
program
For ex.
Myllyhoitoyhdistys
Kalliola
Christian
Organizations
For ex. .
Sininauhaliitto
Salvation Army
AA
-AA
-Alateen
-Alanon
-AAL*
-NA
A-kiltojen liitto
-A-killat
Parents clubs
Peer support
Evl. Church
-diakonia work
-work among
addicted
-work in prisons
-specil youth work
(SAAPAS)
Other Churches
and spiritual or
ideological
communities

38. Serivices for intoxicant abusers
• local authorities are responsible for arranging services for
intoxicant abusers: content and scope reflecting the need arising
within their districts (Alcohol and Drug Abuse Act 1986/41)
• This can be done by developing general social Welfare and health
services and by providing special care services for intoxicant
abusers.
• This should be primarily arranged as non-institutional care
services open to voluntary enrolment

39. • When providing services the client must also be assisted
in resolving any problems pertaining to income, housing
and employment
• The situation of service user’s possible children must
always be checked
• Special services: outpatient clinics for intoxicant abusers,
short-term treatment centers for young drug abusers,
institutional care services at detoxification centers and
rehabilitation units, housing services (halfway houses and
residential housing), low-threshold services at health
advisory points for narcotics abusers…

40. Alcohol and Drug Abuse Act
1986/41
• 7§: Services must be arranged to people suffering from
substance abuse related problems and to their families
• The need for help, support and care is the criteria for
these services
• You don’t need to have alcohol or drug addiction
diagnose to get services
• You have a subjective right to the services but not to
choose the services

41. Substance abuse services
• Open-care services:
• Primary way of arranging services
• E.g. assesment and social support, detoxification, group therapy, family
therapy, rehabilitation
• Institutional rehabilitation
• If open-care services are not sufficient or possible
• From one month to 1½ years
• Detoxification services
• physiological or medicinal removal of toxic substances from a person’s
body, to reduce or relieve withdrawal symptoms
• From 1-2 weeks
• Supportive services
• Housing, activities etc.

42. Substitution therapy for opioid
dependency
• Detox for opioid dependents: 2-4 weeks
• buprenorphine or methadone treatment together
with psychosocial treatment
• The dependency must be assessed in special expertise
instituion

43. Benefits of substitution therapy
Benefits of substitution therapy for the community:
• Significant reduction in criminal activities of the patient:
no need to find money for drugs.
• Reduced risks of contact infections for the society in
general – Hepatitis B and C, HIV – as the patients
decrease or avoid injecting practices.
• Reduced levels of promiscuity and sex work among drug
using women.

44. Benefits for the users
• Normalization of life style and improved social functioning
• Possibility for causal treatment of HIV, Hepatitis B and C
• Increased availability for social and psychological support
• Reduced overdose mortality
• Discontinued or reduced drug injecting
• Improved physical and mental health
• Reduced risks of HIV and Hepatitis
• Distancing from the community of drug users

45. Harm reduction
• reducing health hazards by providing low-treshold
health counselling
• testing for contagious liver diseases and HIV-infection,
• vaccination for hepatitis A and B free of charge,
• distribution of condoms free of charge and
• replacing used needles and syringes with clean ones

46. Recovering from alcohol/drugs
• Spontanious (largest group),
http://www.julkari.fi/bitstream/handle/10024/1005
29/604kuusisto.pdf?sequence=1
• Faith
• Professional help
• Peer support
• Mini-intervention, 10 %
• Psychosocial rehabilitation and recovering 30-60 % in
the long run
• Medical help
• Minnesota modell 1998-2005, 78 % sober

47. References and reading materials
• https://www.thl.fi/fi/web/alkoholi-tupakka-ja-
riippuvuudet
• Päihdelinkki. http://www.paihdelinkki.fi/
• Taitolaji. http://www.taitolaji.fi/
• Irti huumeista. http://www.irtihuumeista.fi/
• http://www.irtihuumeista.fi/yhdistys/in_english

48. More References
• Havio, Marjaliisa, Inkinen Maria, Partanen, Airi (toim.). 2008. Päihdehoitotyö.
Jyväskylä: Tammi
• Päihdelinkki. Www.paihdelinkki.fi
• Salaspuro, Mikko. Päihdelääketiede.
http://therapiafennica.fi/wiki/index.php?title=P%C3%A4ihdel%C3%A4%C3%A4k
etiede
• Seppä, Kaija; Alho, Hannu; Kiianmaa,Kalervo (toim.) 2010. Alkoholiriippuvuus.
Duodecim
• Sulkunen Irma. 1986. Raittius kansalaisuskontona: raittiusliike ja järjestäyminen 1870
– luvulta suurlakon jälkeisiin vuosiin. Helsinki: Suomen historiallinen seura
• https://www.youtube.com/watch?v=3nA8JnHY-Wc
• (100 days without alcohol)