Norwegian Alcohol and Drug Abusers – Health Problems and Health Services in Relation to General Supervision. An Evaluation of Central References

In this report, a review of central references about the health status of alcohol and drug abusers, the health services received by these people, and the availability of health services for them, is presented. The main emphasis is on alcohol and drug abusers with serious addiction. One aim of the report was to evaluate whether available references in this area give an adequate knowledge base for continuous surveillance of the area by the supervision authorities. Another aim has been to evaluate whether there are areas with a large risk of deficiency in provision of health services, according to health policy aims or requirements from the authorities in this area.

The Administrative alcohol and drug treatment reform was implemented on 1 January 2004. The reform transferred responsibility for treatment of alcohol and drug abusers from the county councils to the regional health authorities on behalf of the state. The regional health authorities’ new responsibility is defined as “interdisciplinary, specialised treatment of alcohol and drug abuse”. It forms part of the specialised health services on a par with the somatic and psychiatric services. The overriding objective of the reform is that alcohol and drug abusers with complex problems shall receive improved and more coordinated services, and that the results of treatment should be better. The changes have been made in order to make it easier for alcohol and drug abusers to receive the specialist health services that they need to improve their somatic and mental health. The reform has not entailed any changes in the responsibilities and tasks of the municipal authorities. The social services retain overall responsibility for provision and coordination of measures to help alcohol and drug abusers.

An important future task for the supervision authorities is to monitor whether the intentions of the alcohol and drug treatment reform are fulfilled, and whether the legislation is followed.

The review of available knowledge in this area has shown that statistics from surveys, registers and other sources are inadequate for the purpose of carrying out continuous monitoring of the alcohol and drug field. The general databases on municipal and specialist health services are organised in such a way that it is difficult to identify alcohol and drug abusers as a separate group. In addition, the national documentation systems in the alcohol and drug field have little data on patient flow, treatment methods and treatment results.

The information gained from central and regional supervision, from research reports, publications, studies etc., cannot be regarded as satisfactory to meet the needs of the supervisory authorities for evaluation of alcohol and drug abusers’ health status and their use of available health services.

However, the main impression gained from the available data and information is that many alcohol and drug users do not receive the services they require. In particular, the health problems, the level of physical and mental illness and the high mortality among alcohol and drug abusers with serious addiction give special cause for concern. However, the threshold for receiving help from the specialist health services is often high. Supply of specialist health services, both acute medical help and long-term treatment, is often inadequate. But in addition, general health services, such as regular general medical practitioner services, dental services, nursing and care services and health services in prisons, often function inadequately for alcohol and drug abusers. Lack of coordination between different levels, such as between health and social services, often acts as a barrier to achieving the aims of the treatment programme.

Based on the knowledge that has been collected, the conclusion is that there are clear indications that many alcohol and drug abusers do not receive their right to be provided with essential health care. In planning supervision of the alcohol and drug field in 2006 on a country-wide basis, the Norwegian Board of Health will take into account the areas identified in this report where there is a risk that deficiencies in provision of health services can occur. When monitoring the alcohol and drug field in the future, we will particularly focus on availability of services, professional standards, cooperation between and within treatment levels, and how services are organized to ensure adequate patient participation, information and consent.