The concept of National guidelines for treatment of alcohol and drug problems/ dependence in Sweden 2007

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1 The concept of National guidelines for treatment of alcohol and drug problems/ dependence in Sweden 2007 Ulf Malmström coordinator, PhD National Board of Health and Welfare Cyprus May 2009

2 Why establish norms and guidelines? 1. Changes in structure and content 2. Diminution in quality 3. Competence problems 4. Poor general knowledge and accumulation of knowledge 5. Regional differences 6. Increased number of heavy misusers

3 How to organize the development of guidelines? 1. Seminars with experts, representatives of occupational groups, authorities and client and patient organizations 2. Internal project group and executive group 3. Reference group 4. Expert groups

4 Substance use disorder care system; a brief introduction Treatment of substance use disorders main responsibility: Local Social Authority -detoxification: Health Care System -dual diagnosis: Psychiatric Health Services & Local Social Authority -hazardous drinking: Health Care System & (identification, intervention) Local Social Authority Special. in-outpatient.: Addiction Centres

5 Expert group 1 Psychosocial treatment and medicinal treatment of drug misuse and addiction, including care Expert group 2 Psychosocial treatment and medicinal treatment of alcohol misuse and addiction, including care Expert group 3 Discovery and preventive activity Expert group 4 Markers, diagnostic instruments and systematic of patients and clients as well as documentation Expert group 5 Treatment of pregnant misusers

6 Target groups and Intervention/ remedial action Effect and the reliability and performance of the test 12 Cost of the test (form etc.) 2005 Accessibility Persons in the risk zone or with already identified alcohol problems. Identification of alcohol problems (at-risk consumption, harmful consumption and addiction). The instrument is free of charge Electronic version available on the Internet AUDIT (questionnaire) AUDIT is well tested and quality assured for identification Swedish manual exists

7 Target groups and Intervention/ remedial action Effect and the reliability and performance of the test Cost of the test (form etc.) 2005 Accessibility Persons in the risk zone or with already identified alcohol problems. Assessment of severity of problem and assistance needs as well as follow-up respectively of action and clients and patients with alcohol and drug problems. Training and system costs Both instruments are easily accessible ASI or DOK ( instrument) Validity and reliability of the ASI-interview are satisfactory. Corresponding test of validity and reliability has not been made for DOK

8 Target groups and Intervention/ remedial action Effect for effect Economic Patients in primary care and emergency care that have been identified with at-risk alcohol consumption Brief counselling Reduced alcohol consumption level 1 Reduced expenditure for among others health services, social services and the judicial system. Scientific foundation.

9 Target groups and Intervention/remedial action Effect for effect Economic Comment Clients and patients misusing or addicted to drugs Psychosocial treatment in the form of: Cognitive behaviour therapy focussed on misuse. Brief intervention /Motivational Interviewing (MI). CRA-treatment. Dynamic therapy. Family therapy focussed on misuse and addiction. Reduced use of drugs, improved social situation Remain in treatment longer level 1 Not capable of See chapter 5. Common to the methods showing effects is that treatment is characterised by Clear structure Focus on misuse and addiction Well-defined remedial action Detailed guidelines (manual)

10 Target groups and Intervention/remedial action Effect for effect Economic Comment Clients and patients misusing or addicted to alcohol Psychosocial treatment in the form of: 12 Step programme Sobriety Reduced consumption and fewer days of misuse. level 1 Not capable of See chapter 6. Common to the methods showing effects is that treatment is characterised by Cognitive behaviour therapy focussed on misuse. Motivation enhancing treatment. CRA-treatment. Brief intervention. Improved quality of life. Clear structure Focus on misuse and addiction Well-defined remedial action Detailed guidelines (manual) Interactional therapy Dynamic therapy Family therapy focussed on misuse and addiction.

11 Target groups and Intervention/ remedial action Effect for effect Economic Comment Patients addicted to alcohol. Treatment with akamprosat (Campral ) Reduced risk of relapse. Reduced need of alcohol. More fully sober days. level 2 Not capable of See chapter 6. The product may be used in the treatment of alcohol addiction generally within health care in combination with care that includes medical counselling, support and careful follow-up. Patients addicted to alcohol. Treatment with naltrexon (Revia ) Reduced risk of relapse. Reduced need of alcohol. More fully sober days. level 2 Not capable of See chapter 6. See the comment above for Campral. Patients misusing or addicted to alcohol. The medicine disulfiram (Antabus ) to be given under supervision. Sobriety. Fewer days spent in misuse. level 1 Not capable of Chapter 6. Intake should take place in the presence of, for example, personnel or a workmate. Regular control of liver function ( ref. Medical Products Agency)

12 Target groups and Intervention/remedial action Effect for effect Economic Comment Pregnant women with alcohol and drug problems in need of treatment. Sobriety and freedom from drugs Reduced level of misuse and addiction problems and thereby reduced danger of injury to foetus Test of experienc e Not capable of See chapter 7. Different alternative treatments with high evidence levels exist. (see previous recommendations) Treatment is designed - considering the health of the foetus - to involve the partner if the woman wishes it - to investigate and deal with the need of social support

13 Target groups and Intervention/action Effect for effect Economic Clients and patients with alcohol or drug problems and suspected mental or somatic illness seeking assistance from the social services. Improved mental or somatic health as well as reduced misuse or addiction Test of experience Not capable of Immediate contact is to be taken with an operational unit within the health service competent to assess mental or somatic illness.

14 Target groups and Intervention/action Effect for effect Economic Clients and patients with a mental illness or disorder misusing or addicted to drugs. Improved mental health as well as reduced misuse or addiction level 2 Reduced expenditure for treatment, health care, social service and for the judicial system. Scientific foundation. After emergency measures, treatment is to be coordinated. Treatment of one of the conditions may not be delayed while waiting for the other condition to improve.

15 Implementation of guidelines Lectures at conferences, seminars Refer for consideration Pamphlet and a guide for implementation Publication and distribution Government grants and economical support for local implementation Evaluation

16 Results A new standard for treatment of alcohol and drug dependence in both municipalities (social work) and county councils (health care) is established Great interest in changing methods towards evidence-based knowledge

17 Revision A new document or platform with information about: how to organize the work procedure for reviews of literature the role of experts which type of data should be included how the guidelines should be implemented

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