Addiction And Co Morbidity


Published on

Published in: Health & Medicine
1 Like
  • Be the first to comment

No Downloads
Total views
On SlideShare
From Embeds
Number of Embeds
Embeds 0
No embeds

No notes for slide

Addiction And Co Morbidity

  1. 1. Drugs, Co-morbidity and Suicide 2011<br />Greg Burgess SAMH<br />Stephen Malloy SDF<br />ScottishdrugsForum<br />
  2. 2. What will be covered<br />Prevalence of Suicide and drug use Globally/European/Scotland<br />Challenges/barriers that exist <br />Examples of good practice<br />Questions<br />ScottishdrugsForum<br />
  3. 3. Global suicide WHO <br />Every year, nearly one million people die from suicide. For every suicide 6 people on average are affected (WHO)<br />Risk factors<br />Mental illness-primarily depression and alcohol use disorders, <br />Prevention<br />identification persons suffering from mental and substance use disorders, <br /><br />
  4. 4. Suicide and Scotland<br />746 deaths in 2009<br />2 a day in Scotland<br />Confidential enquiry into Homicide and Suicide (Manchester Uni 2008) <br />Twice as likely in Scotland to die by suicide - alcohol and drugs play a part<br />7 days post discharge<br />ScottishdrugsForum<br />
  5. 5. Global drug use<br />
  6. 6. Illicit drug use at the global level<br />Globally, UNODC estimates that between 155 and 250<br />million people (3.5 to 5.7% of the population aged15-64)used illicit substances at least once in 2008.<br />Number of "problem drug users“ aged 15-64 years : 16-38 million persons (UNODC 2010) <br />Number of people who inject drugs aged 15-64 years : 11-21 million persons (UNODC 2010)<br />ScottishdrugsForum<br />
  7. 7. UNODC 2010 world drug report<br />In 2008, 12% - 30% of problem drug users had received treatment in the past year <br />which means that between 11 and 33.5 million problem drug users did not receive treatment that year<br />ScottishdrugsForum<br />
  8. 8. Drugs across Europe<br />Report from the commission- 2010 progress review of the EU Drugs Action Plan (2009-2012) <br />25 to 30 million adults — aged 15 to 64 — have taken some type of illicit drug in the last year<br />Between 1.2 and 1.5 million adults are problem opioidusers.<br />European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), 2009 Annual Report on the State of the Drugs Problem in Europe. <br />Combined estimates include 22.5 million cannabis users and 4 million cocaine users.<br />ScottishdrugsForum<br />
  9. 9. Just to mention......<br />Every year, 6 500 to 7 000 people die in the EU from a drug<br />overdose. (ECMDDA 2010)<br />ScottishdrugsForum<br />
  10. 10. Scottish Drug use <br />55000-60000 opiate/benzo users (ISD 2009)<br />~ 1.7% of population age 15-64<br />Examples<br />GGC A&A Tayside<br />2.53%(95% CI 2.46 - 2.66%) 1.96%(95% CI 1.86-2.10%) 1.96%(95% CI 1.86-2.10%)<br />ISD Drug Misuse Stats 2010-<br />ScottishdrugsForum<br />
  11. 11. The substances formerly known as ‘legal highs’<br />Newly emerging substances and research chemicals?<br />ScottishdrugsForum<br />
  12. 12. “If you are looking at drugs you are looking at people depressed. You cannot see a<br />drug addict out there that is not depressed, that is not stressed out..”<br />Mental Health Foundation Research 2003<br />
  13. 13. primary mental health disorder may lead to substance misuse<br />• substance misuse may worsen mental health disorder<br />• substance misuse (intoxication/dependence) may lead to mental health problems<br />• withdrawal from substance use often leads to mental health problems<br />• substance misuse and mental health problems may develop concurrently.<br />
  14. 14. Co morbidity General population studies<br />Dutch NEMESIS study (7076) <br />UK National <br />Co morbidity Study<br />Finnish (245)<br />Lifetime - 43% males;<br />15% females : mood and<br />substance misuse <br />(DeGraaf 2003)<br />12% males 6% females<br />drug dependence and<br />neurotic disorders <br />(Coulthard 2002)<br />39% one month<br />prevalence (Aalto-Setala 2001)<br />ScottishdrugsForum<br />
  15. 15. Psychiatric disorder in substance misuse population <br />Cumulative 15%-93%!<br />Psychotic disorders (20%)<br />Affective disorder (30%-55%)<br />Personality disorders (65%-85%)<br />ScottishdrugsForum<br />
  16. 16. ‘Vulnerable’ groups<br />Adolescents in detoxification<br />Glasgow homeless<br />Dutch homeless<br />Prisoners in remand <br />Street workers/prostitutes<br />75% Hannesdottir (2001)<br />22% Kershaw (2000)<br />27% Reinking (2001)<br />81 % Singleton (1998)<br />70% Gilchrist (2004) <br />ScottishdrugsForum<br />
  17. 17. So what do we know......<br />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)<br />ScottishdrugsForum<br />
  18. 18. Global research- risk of suicide in those using opiates<br />Females were significantly more likely than males to have attempted suicide (50% vs. 31%) Darke & Ross 2000<br />223 participants 40% reported at least one suicide attempt. Darke & Ross 2000<br />Overall, heroin users are 14 times more likely than peers to die from suicide Darke & Ross 2002<br />Recent suicidal behaviour is a major clinical problem for heroin users, and for females and Residentital Rehabilitation entrants in particular. Darke et al 2004<br />ScottishdrugsForum<br />
  19. 19. Scotland and Lanarkshire<br />Delivering for mental health mental health and substance misuse 2007<br />ScottishdrugsForum<br />
  20. 20. Lanarkshire<br />
  21. 21. Lanarkshire<br />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%)<br />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).<br />ScottishdrugsForum<br />
  22. 22. Scottish Research and subsequent responses to research <br />Risk & Protective Factors (Platt 2008)- Substance misuse<br />HEAT targets NHS Scotland , HEAT 5<br />Commitment 13<br />Chooselife 2002 20% decrease in suicide by 2013, <br />Drug Related Death Review Group (local and national)<br />Road to Recovery <br /><br />
  23. 23. Challenges<br />Stigma/societal/cultural considerations<br />Assessment<br />Service capacity<br />Skills required for working with clients experiencing Co morbid MH conditions<br />Substance use during treatment?<br />Economics<br />Pragmatic Solutions <br />ScottishdrugsForum<br />
  24. 24. Solutions?<br />Awareness of Context<br />Collaborative advertising<br />ScottishdrugsForum<br />
  25. 25.
  26. 26.
  27. 27. Solutions?<br />Not sitting in a silo <br />Regular assessment of suicide <br />Joint training<br />Working together<br />Integrated, not sequential or serial pathways<br />ScottishdrugsForum<br />
  28. 28. Good Practice<br />Joint training for staff in suicide intervention skills, overdose awareness and for some Naloxone training. <br />Outcomes from local DRD groups being fedback to GP’s, staff, peers<br />Working to attend GP “Protected Learning Time” PLT<br />Involvement of operational staff on DRD<br />COMMUNICATION<br />ScottishdrugsForum<br />
  29. 29. Communication<br />
  30. 30. Summary and opening up for questions <br />Q. Those of you who work with people with alcohol problems do you highlight the risk of topping up with methadone?<br />Q. How many of you are involved with Commitment 13 in your area?<br />ScottishdrugsForum<br />