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Addiction And Co Morbidity
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Addiction And Co Morbidity Addiction And Co Morbidity Presentation Transcript

  • Drugs, Co-morbidity and Suicide 2011
    Greg Burgess SAMH
    Stephen Malloy SDF
    ScottishdrugsForum
  • What will be covered
    Prevalence of Suicide and drug use Globally/European/Scotland
    Challenges/barriers that exist
    Examples of good practice
    Questions
    ScottishdrugsForum
  • Global suicide WHO
    Every year, nearly one million people die from suicide. For every suicide 6 people on average are affected (WHO)
    Risk factors
    Mental illness-primarily depression and alcohol use disorders,
    Prevention
    identification persons suffering from mental and substance use disorders,
    http://www.who.int/mental_health/prevention/en/
  • Suicide and Scotland
    746 deaths in 2009
    2 a day in Scotland
    Confidential enquiry into Homicide and Suicide (Manchester Uni 2008)
    Twice as likely in Scotland to die by suicide - alcohol and drugs play a part
    7 days post discharge
    ScottishdrugsForum
  • Global drug use
  • Illicit drug use at the global level
    Globally, UNODC estimates that between 155 and 250
    million people (3.5 to 5.7% of the population aged15-64)used illicit substances at least once in 2008.
    Number of "problem drug users“ aged 15-64 years : 16-38 million persons (UNODC 2010)
    Number of people who inject drugs aged 15-64 years : 11-21 million persons (UNODC 2010)
    ScottishdrugsForum
  • UNODC 2010 world drug report
    In 2008, 12% - 30% of problem drug users had received treatment in the past year
    which means that between 11 and 33.5 million problem drug users did not receive treatment that year
    ScottishdrugsForum
  • Drugs across Europe
    Report from the commission- 2010 progress review of the EU Drugs Action Plan (2009-2012)
    25 to 30 million adults — aged 15 to 64 — have taken some type of illicit drug in the last year
    Between 1.2 and 1.5 million adults are problem opioidusers.
    European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), 2009 Annual Report on the State of the Drugs Problem in Europe.
    Combined estimates include 22.5 million cannabis users and 4 million cocaine users.
    ScottishdrugsForum
  • Just to mention......
    Every year, 6 500 to 7 000 people die in the EU from a drug
    overdose. (ECMDDA 2010)
    ScottishdrugsForum
  • Scottish Drug use
    55000-60000 opiate/benzo users (ISD 2009)
    ~ 1.7% of population age 15-64
    Examples
    GGC A&A Tayside
    2.53%(95% CI 2.46 - 2.66%) 1.96%(95% CI 1.86-2.10%) 1.96%(95% CI 1.86-2.10%)
    ISD Drug Misuse Stats 2010-http://www.drugmisuse.isdscotland.org/publications/09dmss/09dmss.pdf
    ScottishdrugsForum
  • The substances formerly known as ‘legal highs’
    Newly emerging substances and research chemicals?
    ScottishdrugsForum
  • “If you are looking at drugs you are looking at people depressed. You cannot see a
    drug addict out there that is not depressed, that is not stressed out..”
    Mental Health Foundation Research 2003
  • primary mental health disorder may lead to substance misuse
    • substance misuse may worsen mental health disorder
    • substance misuse (intoxication/dependence) may lead to mental health problems
    • withdrawal from substance use often leads to mental health problems
    • substance misuse and mental health problems may develop concurrently.
  • Co morbidity General population studies
    Dutch NEMESIS study (7076)
    UK National
    Co morbidity Study
    Finnish (245)
    Lifetime - 43% males;
    15% females : mood and
    substance misuse
    (DeGraaf 2003)
    12% males 6% females
    drug dependence and
    neurotic disorders
    (Coulthard 2002)
    39% one month
    prevalence (Aalto-Setala 2001)
    ScottishdrugsForum
  • Psychiatric disorder in substance misuse population
    Cumulative 15%-93%!
    Psychotic disorders (20%)
    Affective disorder (30%-55%)
    Personality disorders (65%-85%)
    ScottishdrugsForum
  • ‘Vulnerable’ groups
    Adolescents in detoxification
    Glasgow homeless
    Dutch homeless
    Prisoners in remand
    Street workers/prostitutes
    75% Hannesdottir (2001)
    22% Kershaw (2000)
    27% Reinking (2001)
    81 % Singleton (1998)
    70% Gilchrist (2004)
    ScottishdrugsForum
  • So what do we know......
    Alcohol dependence, opiate and benzodiazepine dependence, and mixed drug dependence have all been related independently to an increased risk of suicide(Miles 1977; Pokorny 1983; Harris & Barraclough1997; Borges et al. 2000)
    ScottishdrugsForum
  • Global research- risk of suicide in those using opiates
    Females were significantly more likely than males to have attempted suicide (50% vs. 31%) Darke & Ross 2000
    223 participants 40% reported at least one suicide attempt. Darke & Ross 2000
    Overall, heroin users are 14 times more likely than peers to die from suicide Darke & Ross 2002
    Recent suicidal behaviour is a major clinical problem for heroin users, and for females and Residentital Rehabilitation entrants in particular. Darke et al 2004
    ScottishdrugsForum
  • Scotland and Lanarkshire
    Delivering for mental health mental health and substance misuse 2007
    ScottishdrugsForum
  • Lanarkshire
  • Lanarkshire
    Psychiatric conditions were mentioned more frequently than medical conditions, and over half of the drug deaths were recorded as having depression (55%) and/ or anxiety (35%)
    Within Lanarkshire, 8.6% of North Lanarkshire patients and 8.7% of South Lanarkshire patients are prescribed drugs for anxiety, depression or psychosis compared to 8.1% in Scotland overall (North and South Lanarkshire Health and Well Being Profiles, 2008).
    ScottishdrugsForum
  • Scottish Research and subsequent responses to research
    Risk & Protective Factors (Platt 2008)- Substance misuse
    HEAT targets NHS Scotland , HEAT 5
    Commitment 13
    Chooselife 2002 20% decrease in suicide by 2013,
    Drug Related Death Review Group (local and national)
    Road to Recovery
    http://www.scotland.gov.uk/Publications/2008/05/22161610/0
  • Challenges
    Stigma/societal/cultural considerations
    Assessment
    Service capacity
    Skills required for working with clients experiencing Co morbid MH conditions
    Substance use during treatment?
    Economics
    Pragmatic Solutions
    ScottishdrugsForum
  • Solutions?
    Awareness of Context
    Collaborative advertising
    ScottishdrugsForum
  • Solutions?
    Not sitting in a silo
    Regular assessment of suicide
    Joint training
    Working together
    Integrated, not sequential or serial pathways
    ScottishdrugsForum
  • Good Practice
    Joint training for staff in suicide intervention skills, overdose awareness and for some Naloxone training.
    Outcomes from local DRD groups being fedback to GP’s, staff, peers
    Working to attend GP “Protected Learning Time” PLT
    Involvement of operational staff on DRD
    COMMUNICATION
    ScottishdrugsForum
  • Communication
  • Summary and opening up for questions
    Q. Those of you who work with people with alcohol problems do you highlight the risk of topping up with methadone?
    Q. How many of you are involved with Commitment 13 in your area?
    ScottishdrugsForum