Drug treatment service procurement: A systematic review of models, goals, and outcomes.

Aim: To explore the goals and outcomes of public procurement of drug treatment services in OECD countries. The study explores how these complex services are procured and delivered. Methods and data: A systematic review of the literature (1990-2020) identified four partly overlapping models of drug treatment service procurement that are here labelled traditional, value-based, outcome-based, and innovative. Results: Even though different forms of drug treatment services procurement are common, only 12 empirical studies that focused on procurement were found. The four models differ in their approaches to design and performance specifications and the role of competition and collaboration in the co-creation of value. Conclusions: Competition and incentives improve neither the efficiency nor the quality or the outcomes of complex drug treatment services. Whereas many studies focus on payment mechanisms, there are important research gaps that relate to the co-creation of value with and for the service-users and other stakeholders.

Comparison of data sources on alcohol problems: An exploratory exercise using surveys vs. national healthcare registers.

Aims: Both survey and healthcare register data struggle as data sources to capture the phenomenon of alcohol problems. We study a large group of people for whom survey data and two types of register data are available, and examine the overlaps of similar or related measures in the different data sources to learn about potential weaknesses in each. We also examine how register-based data on the prevalence of alcohol problems change depending on which register data are used. Design: We use data from the Regional Health and Wellbeing Study (ATH) of the adult Finnish population collected in 2013 and 2014 (n = 69,441), individually linked with data on two national healthcare registers (Care Register for Health Care; Register of Primary Health Care visits) for the survey year and previous year. Results: The prevalence of substance-abuse-related healthcare was almost two-fold if data on outpatient primary care visits were included in addition to hospitalisations. Forty-six per cent of the survey respondents self-reporting substance-abuse-related healthcare service use were identified in the registers, and 22% of all respondents with such service use according to registers reported this in the survey. Records of substance-abuse-related healthcare service use, controlled for self-reported alcohol use and self-reported substance-abuse-related service use, were found more often for men, the middle-aged, people with basic education only, and the non-employed. Conclusions: The results are suggestive of underreporting in both data sources. There is an evident need to develop recording practices in the healthcare registers regarding substance use disorders.

Mortality and causes of death among people suspected of driving under the influence and testing positive for multiple substances.

Aims: Understanding the mortality of drug users using multiple substances is helpful in preventing the harmful effects of polydrug use. We examined overall and cause-specific mortality and differences in mortality based on social background among people suspected of driving under the influence and testing positive for multiple substances (DUIMS) compared with the general Finnish population. Methods: Register data from 785 DUIMS during 2003-2006 were studied, with a reference population (n = 25,381) drawn from the general Finnish population. The effect of DUIMS on all-cause and cause-specific mortality was estimated using a Poisson regression model. Results: DUIMS had an increased risk of death compared with the general population (MRR 5.3, 95% CI 4.2-6.6). The most common causes of death in DUIMS were poisonings (37.9%) and suicides (13.6%), whereas in the reference population these were cardiovascular diseases (30.8%) and cancer (26.6%). The cause-specific risk of death among DUIMS was higher in all observed causes of death, except for cancer. The effect of DUIMS on mortality was modified by age, employment status and marital status; DUIMS was associated with an elevated risk of death especially in younger age groups and in singles. Conclusions: DUIMS indicates higher mortality, and DUIMS' profiles in causes of death differ from the general population. Elevated risk for, for instance, suicidal, accidental and violent death among those using multiple substances highlights the need to also pay attention to causes of death other than poisoning/overdose.

Mental health problems among clients with substance use problems: a nationwide time-trend study.

PURPOSE: Mental health and substance use disorders are notable contributors to the global total burden of disease. On a population level, co-occurring mental health and substance use problems are estimated to account for 2-4%. In clinical samples, estimate is even higher. The aim of this study was to examine changes in recognized mental health problems (MHPs) and in the substance use profiles among clients with substance use problems in Finland. METHODS: Data concerning individuals with substance use entering Finnish social and health care services during 1 day were collected nationwide at three time-points in 2007, 2011, and 2015. Cross-tabulations and logistic regression were used for statistical analysis. RESULTS: Co-occurring MHPs and substance use problems were common: 56-60% of the clients with substance use problems were reported to have had MHPs between the years 2007 and 2015. The proportion of MHPs remained rather stable among them. Substance use profiles have changed: the proportion of illicit drug use among those who had MHPs has increased in health care services, social services, and substance use problem services. CONCLUSION: Co-occurring substance use and MHPs among clients with substance use problems are common, and substance use profile is shifting from using alcohol only towards illicit drug use. This may even bring along more challenges for the treatment system and should be considered in future service planning.

Estimating the Needs of Substance Problem Use Services: An Exercise in Seven Finnish Municipalities Using Nationally Collected, Municipal-Level Survey and Register Data†.

OBJECTIVE: The needs of substance problem use services (SPUSs) should ideally be assessed locally to support the provision of appropriate, cost-effective services for the population. In this article we present a model for estimating the adult population's potential needs for and actual use of SPUSs. We used Finnish survey and register data as material for a qualitative assessment. The purpose of our article is to contribute to a discussion on the dimensions of assessment of the need for SPUSs at a local level. METHOD: Seven Finnish municipalities were chosen as examples. The need for SPUSs was assessed by freely available register and survey data of the use of services, substance use and problem use, side effects of use, and lack of social support. Babor et al.'s (2008) description of links between the use of services and need for treatment, in terms of substance use and general social conditions, and Ritter's (2014a) set of methods for assessing the need for treatment are used as theoretical background. RESULTS: The number of people using SPUSs varied from one municipality to the next. The local service system policy and the general well-being of the population have a remarkable role in the use of SPUSs. CONCLUSIONS: Estimations of need and demand with indicators can be useful for local treatment system policy but must be interpreted with thorough knowledge of the local treatment and social handling resources and general social situation. Comparisons between different local areas should be made with caution.

Measuring Concurrent Polydrug Use in General Populations: A Critical Assessment.

BACKGROUND/AIMS: Polydrug use is a complicated phenomenon that is measured in a wide variety of different ways. Using Finland as an example, we aimed to demonstrate how the prevalence and prevalence trends of concurrent polydrug use (CPU) varied in the general population based on the different measurements used. METHODS: Population-based Drug Surveys conducted every 4 years during 1998-2014 were used. CPU was measured with different measurements: strict, medial and loose definition of CPU, which were based on different combinations of alcohol, illicit drugs, pharmaceutical drugs and cigarettes used during the last 12 months/30 days. Logistic regression was used to estimate the p values for assessing trends. RESULTS: Depending on the measurements used, the prevalence of CPU in 2014 varied between 2.0 and 18.7%. Different definitions also produced contradictory trends of CPU: there was a modest increase in prevalence if it was measured with a medial (p < 0.001) or strict (p = 0.054) definition, but when measured with the loose definition (only measure that included smoking), there was a decrease in prevalence (p < 0.001). CONCLUSIONS: The prevalence of CPU varies greatly depending on the measurement used, as does the course of the prevalence trends. The concept of simultaneous polydrug use may capture the phenomenon better compared to the concept of CPU.

Co-occurrence of substance use related and mental health problems in the Finnish social and health care system.

AIM: Many studies have noted that substance abuse and mental health problems often occur simultaneously. The aim of the work reported here was to study the co-occurrence of mental health problems and problems related to substance use in a sample of clients visiting the Finnish social and health care services for issues related to substance use. We collected background information on the clients and considered the parts of the treatment system in which these clients were treated. DATA AND METHODS: Survey data on intoxicant-related cases in the Finnish health care and social services were gathered on a single day in 2011. During the 24 hours of data collection, all intoxicant-related cases were reported and data were obtained for 11,738 intoxicant-related cases. In this analysis we took into account the clients' background variables, mental health variables, information on the treatment type and the main reasons for the client being in treatment. The χ(2) test, Fisher's exact test and binary logistic regression analysis were used. RESULTS: Half of the visiting clients had both substance use related and mental health problems. The strongest factors associated with the co-occurrence of substance use related and mental health problems were female sex, younger age and single marital status. Clients with co-occurring problems were more often treated in the health care services, whereas clients with only substance use related problems were primarily treated in specialized services for the treatment of substance abuse. CONCLUSIONS: It is important to identify clients with co-occurring substance use related and mental health problems. In this study, half of the clients presenting to the Finnish social and health care treatment system had both these problems.