3rd NordAN drug network meeting, June 20, 2023

Mulka Nisic, University of Derby

Presentation focused on the Life in Recovery Survey, a study aimed at enhancing understanding of individuals recovering from substance abuse across various countries, including Sweden, the UK, and the Balkan countries. The webinar highlighted the need for peer-reviewed, evidence-based data in recovery science and emphasized the importance of recovery not only for the individuals but also for the communities they are part of.

The survey found that females were more likely to participate in Sweden, with an overrepresentation in polydrug use and an average drug use onset of 13.5 years. The study also showed high rates of adverse childhood experiences and stigma associated with substance abuse.

The survey revealed that transition to recovery is marked by a significant drop in mental health problems, criminal justice system involvement, and other social issues. However, persistent tobacco use and unresolved mental health issues remained prevalent.

A cross-country comparison showed that Swedish participants were more likely to seek help from residential rehabs and 12-step programs and less likely to engage with peer-based approaches. It was noted that Swedish participants were more likely to succeed at quitting after one or two attempts compared to their UK and Balkan counterparts.

The study revealed that a significant portion of respondents from all countries suffered from anxiety, mood disorders, and chronic pain, often managed with potentially addictive medications. This points to a need for improved engagement with peer-based approaches in Sweden and for further research and interventions addressing chronic pain and mental health comorbidities in those in recovery.

An alarming finding was the high prevalence of domestic humiliation and insult among Swedish participants, with many reporting feeling unloved or coming from a troubled family background, aspects that often persisted into recovery. The data suggested a need for viewing addiction as a family issue rather than an individual's problem and advocating for a healthcare approach that promotes healthier and more supportive family environments.

The key takeaways from the Swedish sample indicated a strong female presence, a preference for residential treatments over community and peer support, and higher rates of criminal justice involvement and family violence during the active addiction phase. Despite the decrease in these rates during recovery, the decline was not as steep as desired.

In summary, the webinar underscored the importance of viewing recovery from substance abuse as a community-wide issue that necessitates a multidisciplinary approach. The findings, though not exhaustive, were groundbreaking and pivotal for policy-making, demonstrating the substantial positive impact that recovery can have on communities.

Takeaway points:

• The Life in Recovery Survey provided vital insight into the experiences of individuals recovering from substance abuse across different countries. It emphasized the importance of recovery not only for the individual but also for the broader community, underscoring the need for evidence-based, peer-reviewed data in recovery science.

• Cross-country differences were apparent, with Swedish participants more likely to seek help from residential rehabs and 12-step programs, and less likely to engage with peer-based approaches. Swedish participants also showed a higher success rate in quitting after one or two attempts compared to participants from the UK and the Balkans.

• A significant concern across all surveyed countries was the high prevalence of anxiety, mood disorders, and chronic pain. This highlights the need for better engagement with peer-based approaches in Sweden and more research into addressing mental health comorbidities and chronic pain in individuals recovering from substance abuse.

• The data revealed concerning levels of domestic humiliation, insult, and family violence among participants, particularly in Sweden. Many respondents reported feeling unloved or coming from troubled family backgrounds. These findings emphasize the importance of viewing addiction as a family issue, requiring healthcare approaches that promote healthier and supportive family environments.

• The study demonstrates the wide-reaching benefits of recovery to the community, including boosting local economies and contributing to the educational landscape. It further stresses the need for policies to view addiction as a community issue, not just an individual's problem. This perspective is essential to support professionals in understanding and facilitating the recovery process more effectively.

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Kim Kannussaari, EHYT ry (Finland)

Kim´s presentation focused on the escalating issue of drug use in Finland, especially in relation to cannabis. In 2021, Finland experienced the highest number of drug-related deaths since 2006, with opioids, benzodiazepines, and alcohol often implicated. Most victims were found to be long-term drug users with associated mental health problems and a low socioeconomic background.

To combat this problem, Finland has formed an expert group, advocating for various interventions. These include improving access to opioid substitution treatments, establishing drug consumption rooms, expanding the needle exchange program, piloting a take-home naloxone program, and encouraging professionals and drug users to stay informed about changes in the drug market. The importance of improving cooperation with the police and reducing the negative stigma associated with drug use was also highlighted.

The prevalence of drug use was found to be high, with cannabis being the most common. It was reported that the casual use of cannabis is quite popular among the Finnish population, while regular use is considerably lower. An interesting trend observed was the increasing acceptance of drug consumption rooms and the decriminalization of cannabis among the Finnish population. However, this sentiment isn't reflected in the government's stance.

Two policy reform initiatives are currently under consideration: one for experimenting with drug consumption rooms and another for legalizing and taxing cannabis. Despite the government's apparent inaction, they have emphasized preventing drug use among young people and reducing drug-related deaths. Notably, the government has shown interest in recovery-focused programs, such as 12-step programs, over harm reduction services.

The topic of CBD products and their legality was also broached, with the selling of THC-free cannabis seeds and flowers beginning in Finnish stores. Despite the legal gray area, the selling of these CBD products is seen as an attempt to advocate for the legalization of cannabis.

Questions raised included the effectiveness of the current healthcare system's contacts in addressing drug misuse, the complexities of establishing drug consumption rooms, and the role of political parties in advocating for drug decriminalization or legalization. A key point was made regarding the potential harm of normalizing cannabis use, especially considering recent studies highlighting its potential harm to fetuses, surpassing that of tobacco and alcohol.

The need for drug prevention efforts in Finland was acknowledged, despite the challenges associated with incorporating the experiences of former drug users into professional strategies. Concerns were raised that the reorganization of Finland's Social and Health sector might lead to a decrease in such preventative activities, mirroring a trend observed in Sweden.

Takeaway points:

• High Drug-Related Deaths in Finland: In 2021, Finland experienced its highest number of drug-related deaths since 2006, largely due to opioids, benzodiazepines, and alcohol. The victims were predominantly long-term drug users, often with co-occurring mental health problems and a low socioeconomic status.

• Increasing Acceptance of Drug Reforms: Despite these issues, public sentiment in Finland is gradually leaning towards accepting drug consumption rooms and the decriminalization of cannabis. However, this view is not yet mirrored by the government.

• Current Policy Reform Initiatives: The government is currently considering two initiatives: experimenting with drug consumption rooms and legalizing and taxing cannabis. Yet, there is a clear focus on preventing drug use among young people and mitigating drug-related deaths, with an emphasis on recovery-focused programs.

• Emergence of CBD Market: In Finland, stores have begun selling THC-free cannabis seeds and flowers, effectively CBD products, in an effort to advocate for the legalization of cannabis. Despite the legal gray area, this shows a significant shift in the cannabis scene.

• Concerns Over Normalizing Cannabis Use: There is an ongoing debate about the potential harm of normalizing cannabis use, especially given recent studies suggesting it might cause more harm to fetuses than tobacco and alcohol. This highlights the importance of considering the wider societal impact when discussing drug reform policies.