A Socio-Hygienic Study of Drug Addiction and Alcoholism with the Aim of Developing a Complex of Measures for Their Prevention (on the Example of Sverdlovsk Oblast)

The dissertation is devoted to a comprehensive socio-hygienic study of the problem of drug addiction and alcoholism on the example of Sverdlovsk Oblast and the development of a system of prevention of these diseases at the regional level. The research covers the epidemiological situation regarding the spread of drug addiction and alcoholism in the Middle Urals for the period from 1998 to 2003, including an analysis of factors determining the dynamics of morbidity, as well as an assessment of economic losses resulting from premature mortality of the working-age population. The research proposed and tested a comprehensive system of interagency interaction and preventive measures aimed at reducing the level of drug addiction and alcoholism in a large industrial region.

Relevance of the Problem: The relevance of research on drug addiction and alcoholism is dictated by the significant spread of these diseases, both globally and in the Russian Federation, and the severe medical, social, and economic consequences caused by drugs and alcohol abuse (Reiner Telje, 1999, Starodubov V.I., 1998, Carnwath T., Smith I., 2002, et al.).

At the end of the twentieth — beginning of the twenty-first century, the situation with the spread of drug addiction in Russia became one of the central problems of healthcare. The total number of patients with mental and behavioral disorders associated with the use of drugs, alcohol, and other psychoactive substances in 2003 amounted to 2.4 percent of the total population of the country (Koshkina E.A., Kirjanova V.V., 2004).

The trends in the spread of drug addiction and alcoholism in the Russian Federation have pronounced regional differences (Bogdanov S.I., 2002, Gornyj B.E., Kutumova O.Yu., 2003, Koshkina E.A., Vyshinskij K.V., 2003, et al.). In connection with this, the organization of the fight against and prevention of drug addiction and alcoholism in a specific region, taking into account socio-hygienic, socio-economic, and other regional features, acquires particular importance.

The most terrible consequence of drug addiction and alcoholism is a significant increase in cases of premature mortality among people of working age. Despite the large number of studies of medical and social consequences caused by the consumption of drugs and alcohol, publications analyzing the causes contributing to the spread of these severe social phenomena and assessing the economic damage inflicted on society by drug addiction and alcoholism are insufficient. Meanwhile, only a comprehensive study of all the aforementioned aspects will make it possible to find new approaches to the creation of an effective system of prevention of drug addiction and alcoholism in a region.

Goal of the Work:

On the basis of a comprehensive socio-hygienic study of the spread of drug addiction and alcoholism, their cause-and-effect relationships with the socio-economic factors of the region, to develop and implement a system of comprehensive prevention of drug addiction and alcoholism in a large industrial region.

Tasks of the Research:

1) to conduct a comprehensive assessment of the epidemiological situation associated with the spread of drug addiction and alcoholism in a large industrial region of the Russian Federation for the period from 1998 to 2003;

2) to study the role of socio-economic factors in the spread of drug addiction and alcoholism;

3) to investigate the level and causes of mortality among patients with drug addiction and alcoholism;

4) to conduct an assessment of economic losses resulting from premature death associated with alcoholic and narcological pathology among the working-age population in Sverdlovsk Oblast;

5) to develop and implement a system of comprehensive prevention of drug addiction and alcoholism at the regional level.

Scientific Novelty and Theoretical Significance of the Research

In a large industrial region of Russia:

• the epidemiological situation was studied and a comparative assessment was conducted, including in terms of 50 districts of Sverdlovsk Oblast regarding the use of narcotic drugs;

• the influence of socio-economic factors underlying the spread of abuse of narcotic drugs and alcohol was analyzed;

• an assessment of the socio-economic consequences of drug and alcohol abuse in the subject of the Federation was calculated;

• a scientifically grounded system of interagency and information interaction for the prevention of drug addiction was proposed.

Practical Significance:

• Age-related and trend-specific features of the epidemiological situation regarding alcoholism and drug addiction morbidity in Sverdlovsk Oblast were established, which made it possible to substantiate differentiated measures for their prevention.

• Socio-economic factors contributing to drug addiction and alcoholism morbidity in the region were identified, which found reflection in the formation of the strategy for combating drug addiction in the region.

• An economic assessment of the medical and social consequences of premature mortality from drug addiction and alcoholism was conducted.

• In all cities of Sverdlovsk Oblast, an interagency system of comprehensive prevention of drug addiction and alcoholism based on the principles of program-target planning was implemented.

Validation of the Work:

The results of the work were presented at: 14 scientific-practical conferences and symposia, including the International Conference "New Methods of Treatment and Rehabilitation in Narcology (Substitution Therapy, Psychopharmacotherapy, Psychotherapy)", Kazan (2004), the 2nd European Forum "Prevention of Drug Addiction among Minors", Yekaterinburg (2004), the V All-Russian Scientific-Practical Conference "State of Prospects for Social-Medical Work with Veterans and Participants of Armed Conflicts", Yekaterinburg (2005).

Publications:

22 scientific works were published on the research topic, including 4 monographs.

Implementation:

The results of the work served as the scientific substantiation and methodological basis for the development and implementation of a system of prevention of drug addiction and alcoholism; three informational letters for physicians of the Oblast were developed and approved: "Acute Poisoning by Spirits", "Epidemiology of Acute Poisonings by Opiates and Heroin, Clinical Features, Diagnosis and Treatment at the Pre-Hospital and Hospital Stages", "Express Diagnosis by the "ROFES" Method of Predisposition of Ural Residents to Drug-Dependent Behavior".

The data obtained by the author are used in teaching work at the departments of toxicology and emergency medical care and the department of psychiatry and narcology of the Faculty of Postgraduate Education and Professional Retraining of the Ural State Medical Academy.