Premature mortality due to alcohol and substance use disorders in Finland - a review

English abstract.Peer reviewe

Psychosocial difficulties and treatment retention in inpatient detoxification programmes

Aims: Treatment retention is associated with addiction treatment outcomes. Research regarding predictors of retention at inpatient detoxification treatment is limited. The aim of this study was to investigate whether psychosocial difficulties (PSDs) are associated with treatment retention among Finnish inpatients undergoing detoxification treatment. Design: This register-based study included real-life data on detoxification treatment episodes (n = 2,752) between February of 2016 and May of 2019 from several inpatient treatment units in Finland. The PARADISE24fin instrument was used to assess PSDs. Socio-demographic and substance use related variables, as well as PSDs, were analysed with regard to treatment retention. Multiple logistic regression models were used to identify predictors of treatment incompletion. Results: Of the 2,752 detoxification treatment episodes, 80.3% (n = 2,209) were completed. Men and women differed with regard to the variables associated with treatment retention. After adjusting for confounders, younger age (Peer reviewe

In-patient psychiatric care and non-substance-related psychiatric diagnoses among individuals seeking treatment for alcohol and substance use disorders : associations with all-cause mortality and suicide

Background The largest excess mortality risk has been reported for combinations of psychiatric disorders that included substance use disorders. Aims To study the associations of different non-substance-related in-patient psychiatric diagnoses with all-cause mortality and suicide up to 28 years of age after entering substance use treatment. Method National register data on psychiatric hospital admissions and death were combined with the treatment records of over 10 000 individuals in substance use treatment between 1990 and 2009. Cox regression was used to calculate hazard ratios (HRs) with 95% CIs for all-cause and suicide-specific mortality from the time of entering substance use treatment. Results Nearly one-third (31.4%; n = 3330) of the study population had died during follow-up or by their 65th birthday, with more than one in ten (n = 385) from suicide. Over half of the study population (53.2%) had undergone psychiatric in-patient care and 14.1% involuntary psychiatric care during the study period. Bipolar disorder and unipolar depression were associated with a 57% (HR 1.57, 95% CI 1.18-2.10) and 132% (HR 2.32, 95% CI 1.21-4.46) increase in risk of suicide, respectively. Involuntary psychiatric care was associated with a 40% increase in risk of suicide (HR 1.42, 95% CI 1.05-1.94). Conclusion Severe psychiatric morbidity is common among individuals seeking treatment for alcohol and/or substance use and specifically mood disorders appear to increase the risk of suicide. Treatment service planning needs to focus on integrated care for concomitant substance use and psychiatric disorders to address this risk.Peer reviewe

Associations between self-rated health, quality of life and symptoms of depression among Finnish inpatients with alcohol and substance use disorders

Background: Alcohol and substance use disorders (SUDs) are known to be associated with various health problems and somatic comorbidities however, not much is known on how individuals with SUDs themselves view their own health. Depression is common in SUDs and it is also associated with various health problems. The aim of this study was to assess how individuals undergoing inpatient treatment for SUDs perceived their health status and quality of life (QoL) and how having symptoms of depression affected these perceptions. Methods: Data regarding a convenience sample of eighty inpatients with a diagnosis of alcohol or substance dependence were analyzed. Data were collected through a clinical interview and validated questionnaires. Results: Individuals undergoing inpatient treatment for SUDs reported various somatic comorbidities and their self-rated health was moderate. Back pain, high blood pressure and liver disease were the most commonly reported somatic comorbidities. More severe symptoms of depression were associated with poorer self-rated health, more comorbidities and poorer QoL after adjusting for potential confounders such as age. Conclusions: Individuals with SUDs have many health-related concerns and their QoL is impaired. Symptoms of depression are associated with self-rated health and QoL in this population.Peer reviewe

Alkoholiongelmat ja masennus

English summaryPeer reviewe

The association of alcohol use and quality of life in depressed and non-depressed individuals : a cross-sectional general population study

To compare the associations of alcohol-related variables with Quality of Life (QoL) in depressed and non-depressed individuals of the general population. This cross-sectional study utilized data from the FINRISK 2007 general population survey. A subsample (n = 4020) was invited to participate in an interview concerning alcohol use. Of them, 2215 (1028 men, 1187 women; response rate 55.1%) were included in the analyses. Bivariate associations between mean weekly alcohol consumption, frequency of binge drinking, Alcohol Use Disorders Identification Test (AUDIT)-score and QoL were analysed according to categorization into depressed and non-depressed using the Beck Depression Inventory, Short Form. Linear regression models were calculated in order to determine the associations of the alcohol variables and QoL after adjusting for socio-demographic variables as well as somatic and mental illness. Depressed individuals had lower mean QoL and higher AUDIT-scores than non-depressed respondents. Bivariate correlations showed that mean weekly alcohol consumption, frequency of binge drinking and AUDIT-scores were statistically significantly associated with impaired QoL in depressed individuals. Abstinence was not associated with QoL. After adjustment for covariates, frequency of binge drinking and AUDIT-score were statistically significantly associated with QoL in depressed individuals and AUDIT-score in the non-depressed group. When analysing all respondents regardless of depression, both AUDIT-score and binge drinking were associated with QoL. Of the alcohol-related variables, binge drinking and alcohol problems indicated by AUDIT-score contributed to impaired QoL in depressed individuals and both should be assessed as part of the clinical management of depression.Peer reviewe

The FAST in screening for at-risk drinking among middle-aged women

Objective: There is a need for brief methods to screen for at-risk drinking. The FAST is a two-stepped structured questionnaire. In the FAST-1, one question categorizes into three groups: low-risk drinking, potential at-risk drinking or at-risk drinking. In the FAST-2, those with potential at-risk drinking are asked three additional questions. The aim was to study its effectiveness in screening for at-risk drinking among women and to define an optimal cut-off score. Method: The FAST was validated against the Timeline Followback (TLFB) utilizing data from a health check of a group of 40-year old women (response rate 69.2%; n = 907/1311). The TLFB-based definition of at-risk drinking was consuming >= 140 grams of alcohol weekly (6.1% reported at-risk drinking). Results and conclusions: Of all women, 54.5% could be correctly classified either as having low-risk or at-risk drinking with the FAST-1. The optimal cut-off score was >= 2 (sensitivity 0.82, specificity 0.86) which is lower than has previously been reported. Only those with a FAST-1 score of one needed further evaluation with the FAST-2. A FAST-2 score of >= 1 resulted in a positive screen for at-risk drinking. The FAST seems to be a valid and feasible method in screening for at-risk drinking among middle-aged women.Peer reviewe

Korvaushoitopotilaiden psykiatrinen sairastavuus ja koettu psyykkinen terveys

Korvaushoitopotilaiden (n = 32) psykiatrista sairastavuutta ja itse arvioitua psyykkistä oirehdintaa selvitettiin haastatteluilla avohoitopainotteisella korvaushoitoklinikalla. Samalla tarkasteltiin psykiatrisen sairastavuuden yhteyttä päihde- ja elämäntilannesidonnaisiin taustatekijöihin ja potilaiden kokemuksiin hoidon vaikuttavuudesta. Korvaushoitopotilaat olivat päihteiden käytön ja sosiaalisen syrjäytymisen näkökulmasta moniongelmaisia. Laaja-alaiset ongelmat olivat alkaneet jo nuoruusiällä. Psyykkinen oireilu oli hyvin yleistä, samoin olivat itsenäiset psykiatriset häiriöt. Vakavia itsetuhoajatuksia oli ollut lähes puolella ja itsemurhayrityksiä joka neljännellä. Itsetuhoisuus sekä ajatusten että käytöksen tasolla liittyi psyykkiseen sairastavuuteen. Tutkittavien oli vaikeaa erotella päihde-ehtoista oirehdintaa itsenäisiin psyykkisiin sairauksiin liittyvästä oireilusta, mikä korostaa järjestelmällisen psykiatrisen diagnostiikan tarpeellisuutta. Psyykkinen sairastavuus ei vaikuttanut tutkittavien kokemuksiin korvaushoidon tuomasta hyödystä millään kysytyistä elämänalueista

Huumeiden käyttöön liittyvät psykoosit

VertaisasrvioituPsykoottisen henkilön päihteiden käyttö tulee selvittää kattavasti. Psykoosioireet voivat liittyä päihtymys- tai vieroitustiloihin, päihdepsykoosiin tai päihteistä riippumattomaan, itsenäiseen psykoottiseen häiriöön. Itsenäinen psykoottinen häiriö on erotettava päihdepsykoosista. DSM- ja ICD-tautiluokitusten päihdepsykoosin määritelmät eroavat toisistaan. Akuutti psykoosi hoidetaan yleisten hoitolinjojen mukaisesti etiologiasta riippumatta. Päihdepsykoosin sairastaneita on seurattava. Merkittävällä osalla täyttyvät myöhemmin itsenäisen psykoosisairauden diagnostiset kriteerit.Peer reviewe