DN Debate. Let the healthcare system take responsibility for the addictive disorders

a number of different media have in recent times drawn attention to glaring deficiencies in the management of patients who suffer from addiction and at the same time have other psychiatric problems. ”Mission audit” report in the SVT Sannes suffering and nätmediet KIT's depiction of Isaac's death in an overdose, are two significant examples of how, unfortunately, it can look like in Sweden today.

As beroendeläkare we see far too often, severely ill patients being shifted around between different healthcare providers and samhällsinstanser without anyone taking an overall behandlingsansvar. Even for those of us working in health care, it may be unclear who actually has responsibility for what – how hard is it not for the desperate patients and family?

However, a prerequisite for developing good quality health care where people do not ”fall between the cracks” is that there is a clear framework for who should do what. So, unfortunately, it is not in the day, when the responsibility for beroendevården is divided between the health services and social services.

We can't keep a system where health care denies people the psychiatric help if they use drugs, and categorically refers them to an often nonplussed social services that do not have this expertise.

The solid Missbruksutredningen (SOU 2011:35) stated in 2011 that this fundamental ambiguity leads to major practical problems. No other comparable countries organize their dependency care in this way. The investigation therefore concluded that the system should be reformed so that the responsibility for treatment is transferred to the health services. The proposal has unfortunately not been translated into reality, but in our opinion the arguments for such a reform can only become stronger in recent years.

might be able today can be diagnosed and treated with both medication and psychological approaches, just like other psychiatric diseases. Some patients also need help with such as housing, employment and the economy, and it is, of course, the social efforts is extremely important. But when it comes to diagnostics and specific treatment, there is no reason to give better treatment to patients with addictive disorders in relation to other patient groups. For other ailments, it is a matter of course that these efforts will be administered by certified staff within the health and care system, in accordance with science and proven experience. So it is not for the majority of beroendepatienter.

, namely to see addiction as a health issue, a complex disease, among others, where the individual's beteendeval plays an important role. Studies have also shown that an overwhelming majority of the population would rather seek medical care than social services for dependency problems.

New Swedish research suggests that primary care can make a big positive difference for many beroendepatienter, while more complex cases can be referred to the specialized dependency care. This means that the healthcare industry has greater opportunities to reach patients early and prevent complications.

the Knowledge of how best to help beroendepatienter with psychiatric co-morbidities has increased in recent years. A gratifying development is also that the addition of specific training in addiction for both physicians and psychologists. But the health system must be changed, so that it becomes obvious that beroendepatienter have the right to meet with staff who are trained in this type of diagnosis and treatment.

We can't still have a system where health care denies people the psychiatric help if they use drugs, and categorically refers them to an often nonplussed social services that do not have this expertise. Clinically important examples are patients with addiction, activity and attention (adhd), post-traumatic stress syndrome or bipolar affective disorder. In all these cases, there is effective treatment to offer, which also leads to substansbruket decreases. If such treatment does not come about, however, it is common to beroendeproblemen worsen, increasing the risk of long-term complications, overdose and suicide.

It is equally important to pay attention to physical comorbidity of beroendepatienter, which of course requires medical expertise. A current example is the new, highly efficient drugs against hepatitis C, which means that we within a few years, basically would be able to eliminate the spread of infections among people who inject drugs, if only we had a health care that reached and was able to help these patients over the entire country.

How to become a good a whole is up to each sjukvårdsregion and the municipality to try to resolve locally through so-called agreements. Since we have 290 municipalities in the country, it goes without saying that the system becomes unwieldy. It will also be brittle, since the small municipal units hardly have the resources to maintain a wide and competent range of medical care.

In times of strained municipal economy tends also to reduce the resources available for helping people with addiction, a group that lacks a strong voice in the public sphere and may find it difficult to defend their own rights.

An objection to changing the system is that such a reform in itself requires energy and resources, which could instead be needed in the healthcare system. Initially, it may also be practical difficulties in the transition. This is, however, short-term problems, which can largely be prevented by adequate planning and resource allocation in omställningsfasen. Therefore, they should not prevent us from creating an effective and sustainable structure for beroendevården as a whole. Fortunately, there is now a proposal from the committee on health and welfare that the government should revisit these basic questions of liability. The question is not settled, but hopefully this can lead to a very welcome change of beroendevårdens structure.

the Social services can then focus on their core functions, to assist the most socially vulnerable patients with the action that creates good conditions for the specific treatment, mainly housing and employment. Such a reform would provide the basis for a more knowledge-based dependency care, where more people would feel welcome.