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

125713702339

16972135

301321162532

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 Moscow

Department in the Moscow government

responsible for cooperation with security

bodies

Moscow Office of the Federal Drug Control

Service

Moscow Department of

the Interior

Moscow Office of the Federal

Security Service

Department of Health

Department of Education

Department of Social Support City Centre ‘Street

Children’

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

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

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 of

patients 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!