Transcript Attending self

Ministry of Public Health and Social
Development of the Russian Federation
The Moscow Research and Practical Centre
for Narcology of the Moscow Department of
Health
Psychoactive substances
demand reduction: Strategy
and methods.
The Moscow experience
E.А. Bryun
Malta, 23 September 2010
Number of patients registered in
narcological facilities in Moscow
150000
140000
130000
120000
110000
100000
90000
80000
70000
60000
50000
40000
30000
20000
10000
0
1998
1999
2000
2001
Alcohol psychoses
2002
2003
2004
Alcoholism
2005
2006
2007
Drug addiction
2008
2009
Toxicomania
Statistics of poisonings with psychoactive
substances in Moscow in 2005-2009
3940
4000
3000
2000
3013
2334
12571370
2135
2339
1697
2532
2116
2337
1969
1000
0
2006
Drug poisoning
2007
Poisoning with psychotropic medication
2008
2009
Poisoning with (surrogate) alcohol
Mortality due to drug overdose (data of the
Bureau of Medical Forensic Expertise)
00
825
00
656
00
555
00
454
00
398
00
00
00
00
0
658
150
Structure of admissions to narcological hospitals:
Diagnosed disorders
2002 г.
2009 г.
9%
1%
Alcoholism
Drug addiction
Other
disorders
91%
36%
63%
Risk factors
(primary prevention)
1. Genetic factors.
2.
Inborn risk factors: problems during pregnancy and
labor.
3.
‘Mother – Child’ complex.
4. Attention deficit/ hyperactivity disorders, intracranial
hypertension in children aged 2 to 6 years.
5.
Risk factors associated with psychological atmosphere in
the family: child neglect – too much or too little care.
Risk factors
(primary prevention, continued)
6.
Information environment as a risk factor.
7.
The puberty turmoil (early and fast sexual
maturation).
8.
Psychological problems in adolescence.
9.
Socialization problems in a peer group.
10.
Joining in the drug subculture.
Secondary Prevention
(dealing with focus groups)
1. Detection of risk groups in educational facilities
and at workplaces in accordance with WHO and
ILO recommendations (sociotherapeutic
interventions).
2. Educational programs for different age groups.
3. Active involvement of the mass media.
Tertiary Prevention
(treatment and rehabilitation program)
1. Intervention – patient’s involvement into
treatment and rehabilitation programs.
2. Detoxification.
3. Treatment of psychopathological disorders.
4. Psychotherapy and correction of personality
disorders.
5. Rehabilitation.
6. Development of a treatment subculture as an
opposite to a drug subculture.
Authorities and agencies involved in prevention of
alcohol- and drug-related disorders in Moscow:
Mayor of Moscow
Moscow Government
Anti-narcotic Commission of the city of Moscow
Department in the
Moscow government
responsible for
cooperation with security
bodies
Moscow Office
of the Federal
Drug Control
Service
Moscow
Department of
the Interior
Moscow Office
of the Federal
Security
Service
Department of
Youth Policy
Department of
Health
Department of
Education
Department of
Social Support
City Centre ‘Street
Children’
Department of Health of the City of Moscow,
Narcological Care
Moscow Research and
Practical Centre for
Narcology
НД №1
ЮАО
НД №5
ЗАО
НД №10 г.
Zelenograd
Clinical Narcological
Hospital No. 17
Local departments of
public health in
administrative districts of
Moscow
НД №2
ЦАО
НД №3
СЗАО
НД №7
СЗАО
НД №6
ЮВАО
НД №11
САО
НД №4
СВАО
НД №8
ВАО
НД №12
ЮЗАО
НД №13
СВАО
НД №9
ЦАО
НД №14
ЦАО
Alcohol- and drug abuse prevention
programs for families, business and
educational facilities
Individual prevention programs for concrete
organizations and for general population
Program for
addiction prevention
in organized groups
Educational programs
and information
concerning
prevention of
addictive behaviors
Scheme of social pressure on the ‘narcological’
population
Narcological care
Isolation in corrective facilities
of the prison system FSIN
Level V
Police control
Level IV
Treatment and rehabilitation
programs in out-patient care
system
Level III
Anonymous and confidential
treatment and rehabilitation
programs
Social pressure
‘Narcological’ population
Level II
Educational programs
Anti-drug information
campaigns
Level I
The standard of narcological care includes eight
stages that cover prevention, treatment and
rehabilitation of addiction disorders:
• Primary prevention
• Secondary prevention
• Intervention
• Detoxification
• Treatment of pathological craving
• Psychotherapy and correction of personality disorders
• Rehabilitation and relapse prevention measures
• Development of the treatment subculture as an
opposite to alcohol- and drug subcultures
Relation of a one-year-long remission to the
number of treatment stages
IV
Rehabilitation
programs
III
Psychotherapy
programs
II
Treatment of
psychopathological
disorders
I
Treatment of withdrawal
syndrome
1-5%
15-20%
25-30%
40-50%
Number of patients treated during recent five
years:
18000
16000
14000
12000
10000
8000
6000
4000
2000
0
Number of
patients admitted
since 2005
16927
persons
1343
persons
100%
7,9%
Number of
patients that
have completed
medicosocial
rehabilitation
Medicosocial rehabilitations (absolute
figures)
Incomplete
treatment course
(27,4%)
Complete course
of medicosocial
rehabilitation
(72,6%)
586
366
6 months
977
391
2 months
Duration of remission as it is on 1 June 2010
(on basis of inquiry among 812 persons)
30,00%
26,90%
219 pers.
25,00%
18,40%
107 pers.
20,00%
15,00%
10,00%
21%
170 pers.
10,90%
27 pers.
15%
121 pers.
12,80%
53 pers.
7,50%
12 pers.
5,00%
0,00%
Remission 5 years
4 - 4,5
years
2 years
1 year
> 1 year
<6
m onths
< 7 days
Comparison of the periods of remission after
rehabilitation and medical programs
Attending self-help groups
(NA, GA, АА)
Patients
with a remission
1 to 3 years attend
self-help groups
(82%)
3–5
times a
week
Patients
with a remission
longer than 3 years
attend self-help
groups
At least 2
times a
week
Patients’ employment
Patients
with a remission 4 to
5 years: 100% have
a job, with recent
employment history
of 3 years at least
Patients
with a remission 2 to
3 years: 98% have a
job
Patients
with a remission 1 to
1,5 years:
67% have a job
7 persons work as counsellors in
rehabilitation centers of Russia
3 persons work in rehabilitation
wards of the Moscow RPC for
Narcology
10 persons have resumed study in
educational facilities
7 persons work as counsellors
13% have resumed study in
educational facilities
2% have resumed study in
educational facilities
Rehabilitation ward
Activities in the open
air
Meeting of activists of the rehabilitation program
Thank you!