Kristiina Kuussaari

Administrative Challenges in the Finnish Alcohol and Drug Treatment System

This article examines the National Plan for Mental Health and Substance Use Work (the MIELI plan), published in Finland in 2009. We place the plan into a wider context of changes in Finnish social and health services and have also studied responses to the plan. The data is provided by national documents, complemented by an online enquiry and some journal articles as feedback material. The MIELI plan is implemented in conjunction with a municipal and service system reform in Finland. While the proposals of the plan clearly carry a potential for change in the treatment system, there are also great challenges. For instance, to what extent can this kind of plan influence reality? Can the proposals really change anything in the treatment system, or does the potential change emerge from elsewhere? Responses to the plan indicate that referral-free access to treatment, the principle of a single entry point and primary-level services in general were considered important proposals in the MIELI plan. At the other end of the scale, the implementation of the plan and its medical orientation were received less positively.

Co-occurrence of substance use related and mental health problems in the Finnish social and health care system

Aim: Many studies have noted that substance abuse and mental health problems often occur simultaneously. The aim of the work reported here was to study the co-occurrence of mental health problems and problems related to substance use in a sample of clients visiting the Finnish social and health care services for issues related to substance use. We collected background information on the clients and considered the parts of the treatment system in which these clients were treated. Data and methods: Survey data on intoxicant-related cases in the Finnish health care and social services were gathered on a single day in 2011. During the 24 hours of data collection, all intoxicant-related cases were reported and data were obtained for 11,738 intoxicant-related cases. In this analysis we took into account the clients’ background variables, mental health variables, information on the treatment type and the main reasons for the client being in treatment. The χ2 test, Fisher’s exact test and binary logistic regression analysis were used. Results: Half of the visiting clients had both substance use related and mental health problems. The strongest factors associated with the co-occurrence of substance use related and mental health problems were female sex, younger age and single marital status. Clients with co-occurring problems were more often treated in the health care services, whereas clients with only substance use related problems were primarily treated in specialized services for the treatment of substance abuse. Conclusions: It is important to identify clients with co-occurring substance use related and mental health problems. In this study, half of the clients presenting to the Finnish social and health care treatment system had both these problems.

Measuring Concurrent Polydrug Use in General Populations: A Critical Assessment

Background/Aims: Polydrug use is a complicated phenomenon that is measured in a wide variety of different ways. Using Finland as an example, we aimed to demonstrate how the prevalence and prevalence trends of concurrent polydrug use (CPU) varied in the general population based on the different measurements used. Methods: Population-based Drug Surveys conducted every 4 years during 1998-2014 were used. CPU was measured with different measurements: strict, medial and loose definition of CPU, which were based on different combinations of alcohol, illicit drugs, pharmaceutical drugs and cigarettes used during the last 12 months/30 days. Logistic regression was used to estimate the p values for assessing trends. Results: Depending on the measurements used, the prevalence of CPU in 2014 varied between 2.0 and 18.7%. Different definitions also produced contradictory trends of CPU: there was a modest increase in prevalence if it was measured with a medial (p < 0.001) or strict (p = 0.054) definition, but when measured with the loose definition (only measure that included smoking), there was a decrease in prevalence (p < 0.001). Conclusions: The prevalence of CPU varies greatly depending on the measurement used, as does the course of the prevalence trends. The concept of simultaneous polydrug use may capture the phenomenon better compared to the concept of CPU.

171 Older people, alcohol and safety issues at home – the perspective of home care workers

Background Finland is a rapidly ageing society. The Finnish ageing policy prioritises older people living at home. Alcohol use of older people has become more common. Heavy drinking in particular leads to the need of increasing daily assistance and care. This paper discusses the challenging social situations of daily work of home care workers visiting alcohol consuming older people in their homes. This study, called “Ageing, alcohol and needs for services in home care” (2014–2015), is a part of the larger project “Harms to others from drinking: effects on health, wellbeing and the burden to society”. Methods The data consists of 13 thematic interviews with home care workers (n = 10) and their supervisors (n = 3). The interviews were conducted in one home care district in the metropolitan area in Finland. Results When making their home visits home care workers have to handle challenging safety issues, such as alcohol-drug interactions, injury prevention and their own safety at work. Home care workers encounter unpredictable situations where they for safety reasons cannot fulfil their professional intentions. Conclusions Home care workers are in need of further training about special skills to manage alcohol-related safety questions. Collaboration crossing professional and sectoral boundaries should be created to help those older people who are at the risk of alcohol-related safety issues. Further research is needed on older peoples’ alcohol use from the point of view of home care workers.