ministry of public health and social development of the russian federation the moscow research and...
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Ministry of Public Health and Social Ministry of Public Health and Social Development of the Russian FederationDevelopment of the Russian Federation
The Moscow Research and Practical CentreThe Moscow Research and Practical Centre for Narcology of the Moscow Department of for Narcology of the Moscow Department of
HealthHealth
Psychoactive substances Psychoactive substances demand reductiondemand reduction: : Strategy Strategy
and methodsand methods..The Moscow experienceThe Moscow experience
MaltaMalta, 23 , 23 SeptemberSeptember 2010 2010
EE.А. .А. BryunBryun
Number of patients registered in Number of patients registered in narcological facilities in Moscownarcological facilities in Moscow
0100002000030000400005000060000700008000090000
100000110000120000130000140000150000
1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
Alcohol psychoses Alcoholism Drug addiction Toxicomania
Statistics of poisonings with psychoactive substances in Moscow in 2005-2009
2334
12571370
23391697
2135
3013
21162532
3940
23371969
0
1000
2000
3000
4000
2006 2007 2008 2009
Drug poisoning Poisoning with psychotropic medication Poisoning with (surrogate) alcohol
Mortality due to drug overdose (data of the Bureau of Medical Forensic Expertise)
825
150
398
454
656 658
555
0
100
200
300
400
500
600
700
800
900
2003 2004 2005 2006 2007 2008 2009
Structure of admissions to narcological hospitals: Diagnosed disorders
91%
9%
20020099 г. г.
63%
1%
36%Alcoholism
Drug addiction
Otherdisorders
2002 г.2002 г.
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 MoscowMayor of MoscowMoscow GovernmentMoscow Government
Anti-narcotic Commission of the city of MoscowAnti-narcotic Commission of the city of MoscowAnti-narcotic Commission of the city of MoscowAnti-narcotic Commission of the city of Moscow
Department in the Moscow government
responsible for cooperation with security
bodies
Department in the Moscow government
responsible for cooperation with security
bodies
Moscow Office of the Federal Drug Control
Service
Moscow Office of the Federal Drug Control
Service
Moscow Department of
the Interior
Moscow Department of
the Interior
Moscow Office of the Federal
Security Service
Moscow Office of the Federal
Security Service
Department of Health
Department of Health
Department of Education
Department of Education
Department of Social SupportDepartment of Social Support City Centre ‘Street
Children’City Centre ‘Street
Children’
Department of Youth Policy
Department of Youth Policy
Department of Health of the City of Moscow, Department of Health of the City of Moscow, Narcological CareNarcological Care
Moscow Research Moscow Research and Practical and Practical
Centre for Centre for NarcologyNarcology
Local departments of public health in
administrative districts of Moscow
Local departments of public health in
administrative districts of Moscow
Clinical Clinical Narcological Narcological
Hospital No. 17Hospital No. 17
НД №1 НД №1 ЮАОЮАО
НД НД №2 №2 ЦАОЦАО
НД №3 НД №3 СЗАОСЗАО
НД НД №7 №7
СЗАОСЗАО
НД НД №8 №8 ВАОВАО
НД НД №9 №9 ЦАОЦАО
НД №13 НД №13 СВАОСВАО
НД №12 НД №12 ЮЗАОЮЗАО
НД №11 НД №11 САОСАО
НД №10 г. НД №10 г. ZelenograZelenogra
dd
НД №4 НД №4 СВАОСВАО
НД №6 НД №6 ЮВАОЮВАО
НД НД №5№5
ЗАО ЗАО
НД №14 НД №14 ЦАОЦАО
Alcohol- and drug abuse prevention Alcohol- and drug abuse prevention programs for families, business and programs for families, business and
educational facilitieseducational facilities
Alcohol- and drug abuse prevention Alcohol- and drug abuse prevention programs for families, business and programs for families, business and
educational facilitieseducational facilities
Individual prevention programs for concrete Individual prevention programs for concrete organizations and for general populationorganizations and for general population
Program for Program for addiction prevention addiction prevention in organized groupsin organized groups
Educational programs Educational programs and information and information
concerning concerning prevention of prevention of
addictive behaviorsaddictive behaviors
Anti-drug information campaigns
Anonymous and confidential treatment and rehabilitation
programs
Treatment and rehabilitation programs in out-patient care
system
Isolation in corrective facilities of the prison system FSIN
Level I
Educational programs
Level III
Level II
Level V
Level IV
Narcological care
‘Narcological’ population
Social pressure
Police control
Scheme of social pressure on the ‘narcological’ Scheme of social pressure on the ‘narcological’ populationpopulation
The standard of narcological care includes eight The standard of narcological care includes eight stages that cover prevention, treatment and stages that cover prevention, treatment and
rehabilitation of addiction disordersrehabilitation 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 Relation of a one-year-long remission to the number of treatment stages number of treatment stages
1-5% 15-2015-20% 25-3025-30% 40-5040-50%%
Treatment of psychopathological
disorders
Treatment of withdrawal syndrome
Psychotherapy programs
Rehabilitation programsIV
III
II
I
02000400060008000
1000012000140001600018000
Number ofpatients admittedsince 2005
Number ofpatients thathave completedmedicosocialrehabilitation
Number of patients treated during recent five years:
16927 persons
100% 7,9%
1343persons
391
366
586
977
Incompletetreatment course(27,4%)
Complete courseof medicosocialrehabilitation(72,6%)
6 months
2 months
Medicosocial rehabilitations Medicosocial rehabilitations ( (absolute absolute figuresfigures))
Duration of remission as it is on 1 June 2010 Duration of remission as it is on 1 June 2010 ((on basis of inquiry amongon basis of inquiry among 812 812 personspersons))
7,50%12 pers.
10,90%27 pers.
12,80%53 pers.
18,40%107 pers.
26,90%219 pers.
21%170 pers.
15%121 pers.
0,00%
5,00%
10,00%
15,00%
20,00%
25,00%
30,00%
5 years 4 - 4,5years
2 years 1 year > 1 year < 6months
< 7 daysRemission
Comparison of the periods of remission after rehabilitation and medical programs
Attending self-help groupsAttending self-help groups((NANA, , GAGA, АА), АА)
Patientswith a remission
1 1 to to 3 3 years years attend self-help groups
(82%)
3 – 5 3 – 5 timestimes a a weekweek
Patientswith a remission
longer than longer than 3 3 yearsyears attend self-help
groups
At leastAt least 2 2 times a times a weekweek
Patients’ employmentPatients’ employment
PatientsPatients with a remission 4 to 5 years: 100% have
a job, with recent employment history of 3 years at least
7 persons7 persons work as counsellors in rehabilitation centers of Russia
3 3 personspersons work in rehabilitation wards of the Moscow RPC for
Narcology
10 persons have resumed study in educational facilities
PatientsPatients with a remission 2 to 3 years: 98% have a
job
7 7 personspersons work as counsellors
13% have resumed study in educational facilities
PatientsPatients with a remission 1 to
1,5 years: 67% have a job
2% have resumed study in educational facilities
Rehabilitation ward
Activities in the open air
Meeting of activists of the rehabilitation program
Thank you!Thank you!