Articles

FAQ

Drugs and the brain

Published: 18.06.2007

Welfare services for intoxicant abusers in the 2000’s

Harms caused by intoxicants are linked to many societal, communal and individual factors and their inter-related interactions. These factors can be influenced by treatment only to a limited extent. Still, many intoxicant use related harms can be prevented by professional care and peer group activities. 

The law on social welfare from 1982 and the legislation on health care form the basis for the welfare services for intoxicant abusers. The main legislative foundation for the versatile Finnish welfare service system for intoxicant abusers is based on the Act on Welfare for Substance Abusers that came into force in 1987. According to the law, the general aim of welfare services for intoxicant abusers is to prevent and reduce the problematic use of intoxicants and the relating social and health problems by promoting one’s abilities and increasing the safety of problem users and their family members. It is the responsibility of the social and health care authorities in each municipality to make sure that enough services are provided.

Services are mainly general social and health care services, with special services available for problem users. The core of the special services in outpatient care consists of A-clinics and youth centres in larger towns and, in inpatient care, of detoxification units and rehabilitation centres maintained by several co-operating municipalities or owned by organisations. In addition there are versatile housing and day centre services for problem users without permanent lodgings. Professionals working in special services are mainly social workers, nurses, doctors and advisors.

The law does not differentiate between users of different intoxicants so the services are usually equally available to alcoholics, drug users and mixed users. All people with intoxicant problems have equal rights to support and treatment under the law. In the spirit of the law, low-threshold welfare services for intoxicant users should be available to everyone according to their needs. This means that a municipality has to organise the services so that they reach the total population of problem users in need of care and support. Services are provided voluntarily, confidentially and allowing the users to discuss the place of treatment with local health authorities.

Outpatient care services are free but the coverage of inpatient care fees is agreed on together with the social and health care authorities of the municipality. Usually the municipality takes care of the fees, but at times the patient may have to pay for the treatment himself. The goals of the treatment vary case by case, from versatile crisis support and improvement of the patient’s life situation to detoxification treatment and abstinence from alcohol. It is very important to realise that lessening of suffering and giving the patient’s family time to relax are in themselves sufficient goals of treatment and make it worthwhile. Their adequacy can be justified both from the patient’s point of view and from the viewpoint of his immediate communities. In accordance with the spirit of the law, the services form a whole where physical, mental and social harms of intoxicant abuse are all taken into consideration.

The Act on Welfare for Substance Abusers also makes involuntary treatment possible based on health hazard or violence. A decision to treat the patient without their consent based on health hazard is made by the head of the local medical authority and leads to treatment period of up to 5 days. If the basis for the decision is the patient’s violent behaviour, the treatment period can last up to 30 days. The decision requires a proposition by the head of the social services of the community and the acceptance of the proposition by the county administrative board. Health hazard refers to an immediate danger to the patient’s life or serious risks to health. Violent behaviour can only be used as a basis for treatment if it is caused by the use of intoxicants. For “special reasons” the violence criteria can be applied also to adolescents aged 15 - 17, but apart from this exception the law only applies to people over 18 years of age. The possibility of involuntary treatment has not been used widely in Finland. There have only been a few instances per year.

Approximately 60 000 - 80 000 intoxicant users or their family members seek voluntarily help from the welfare services yearly. Despite drastic cuts to these services in the 1990’s, the Finnish service system for intoxicant users can be considered versatile and of high quality even in international terms.

You can find out more about the services offered from your municipality’s social services, health centres, A-clinics and/or the treatment centre register maintained by Stakes. A telephone helpline offering information on treatment centres operates in various municipalities.

Docent Lasse Murto
Managing Director, A-Clinic Foundation

More information on treatment units:

• Treatment centres - contact information
• The A-Clinic Foundation web site (www.a-klinikka.fi)
• A Finnish-language database, maintained by Stakes, on treatment, rehabilitation and aftercare units in the field of intoxicant services (http://www.stakes.fi/neuvoa-antavat/), see under Kuntataso