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Keywords:

  • Alcohol;
  • drugs;
  • Finland;
  • gambling;
  • prevention work;
  • research;
  • tobacco

ABSTRACT

  1. Top of page
  2. ABSTRACT
  3. MERGING HISTORIES
  4. WORKING FOR A SHARED UNDERSTANDING
  5. SYNERGIES AND THEMES FOR FUTURE
  6. Declarations of interest
  7. References

The Department of Alcohol, Drugs and Addiction started operations on 1 January 2009, when the National Institute of Public Health (KTL) and the National Research and Development Centre for Welfare and Health (STAKES) were merged. The newly formed institute, called the National Institute for Health and Welfare (THL), operates under the Finnish Ministry of Social Affairs and Health. The scope of the research and preventive work conducted in the Department covers alcohol, drugs, tobacco and gambling issues. The two main tasks of the Department are (i) to research, produce and disseminate information on alcohol and drugs, substance use, addictions and their social and health-related effects and (ii) to develop prevention and good practices with a view to counteracting the onset and development of alcohol and drug problems and the damaging effects of smoking and other addictions. The number of staff hovers at approximately 60 people. The Department is organized into three units, one specialized in social sciences (the Alcohol and Drug Research Unit), another in laboratory analytics (the Alcohol and Drug Analytics Unit) and the third primarily in preventive work (the Addiction Prevention Unit). These units incorporate a rich variety and long traditions of both research and preventive work. The mixture of different disciplines creates good opportunities for interdisciplinary research projects and collaboration within the Department. Also, the fact that in the same administrative context there are both researchers and people specialized in preventive work opens up interesting possibilities for combining efforts from these two branches. Nationally, the Department is a key player in all its fields of interest. It engages in a great deal of cooperation both nationally and internationally, and among its strengths are the high-quality, regularly collected long-term data sets.


MERGING HISTORIES

  1. Top of page
  2. ABSTRACT
  3. MERGING HISTORIES
  4. WORKING FOR A SHARED UNDERSTANDING
  5. SYNERGIES AND THEMES FOR FUTURE
  6. Declarations of interest
  7. References

Finland has a 60-year-long history of social and biological research on alcohol, first as a part of the state alcohol monopoly Alko until 1995, later as a part of the National Research and Development Centre for Welfare and Health (STAKES) and the National Institute of Public Health (KTL). When these two institutes were merged on 1 January 2009 to form the National Institute for Health and Welfare (THL), substance use-related research stemming from both social and natural sciences, as well as preventive work, were combined under one specialized department, i.e. the Department for Alcohol, Drugs and Addiction (later ‘the Department’). Almost all the research and preventive work that had been dedicated to alcohol, drugs, tobacco or gambling issues in the previous organizations were concentrated into the Department. The only exceptions are some developmental resources connected directly to the service system in social and health care. This means that even if the Department itself is still very young and novel, it includes research approaches and layers of preventive work that have long traditions.

THL operates under the Finnish Ministry of Social Affairs and Health, and is a part of a system of sector/state research institutes. A basic task of the Institute is to produce research-based scientific knowledge to be used when developing social and health policy, as well as practical methods and models to support the system of social and health services. One of the Institute's official tasks is to maintain and develop national statistics, registers and other data resources in the field of social welfare and health. International cooperation is seen as important. THL's total budget for 2010 was some €94 million: 68% coming from the state budget, 27% from outside funding and 5% from chargeable services. THL has a total staff of about 1200.

The two main tasks of the Department are (i) to research, produce and disseminate information on alcohol and drugs, substance use, addictions and their social and health-related effects and (ii) to develop prevention and good practices with a view to counteracting the onset and development of alcohol and drug problems and the damaging effects of smoking and other addictions. The Department's total budget for 2010 is some €4.7 million: 59% coming from the state budget and 41% from external sources. Altogether, 63 people are working in the Department. Permanent and temporary employees account for 76% and 24%, respectively. The Department is led by Adjunct Professor Pekka Hakkarainen, whose research career has been in the field of illicit drugs, with recent interest being mainly in epidemiological issues [1], drug policy [2] and cannabis markets [3]. The Department is organized into three units, one specialized in social science research, another in laboratory analytics and the third primarily in preventive work.

The Alcohol and Drug Research Unit

The Alcohol and Drug Research Unit, led by Adjunct Professor Christoffer Tigerstedt, continues a powerful tradition of Finnish social science research on alcohol, initiated in the early 1950s. Compact descriptions of the predecessors of the research community are provided by Mäkelä[4], as well as Hakkarainen & Tigerstedt [5]. Since 2000 and 2007, research has also included drug and gambling issues, respectively. The work of the Unit focuses on four topics: (i) analysing trends in alcohol and drug use and gambling, (ii) analysing consequences of these activities, (iii) studying alcohol, drug and gambling policies and (iv) studying prevention and control of alcohol-, drug- and gambling-related harms. The Unit, together with five to six social scientists working for the Finnish Foundation for Alcohol Studies, constitutes a joint working community. Altogether, this community covers 24 people.

In recent years the Unit has been heavily engaged in analysing the development from a dry to a fairly wet and permissive Finnish drinking culture, total per capita consumption now being 10 litres of pure alcohol compared to 2 litres in 1960 and 6.5 litres in 1975. The basis of this work is a high-quality series of face-to-face collected general population surveys, carried out every 8 years since 1968 [6,7]. The study of change and continuity in the cultural position of drinking is further sharpened by cross-national comparisons and the use of qualitative data [8]. Regarding drug use and attitudes towards drugs, the Unit is responsible for a population survey, conducted every 4 years since 1992 [1].

These studies are paralleled by policy studies, scrutinizing the changing alcohol policy environment both before and particularly after Finland's entrance into the European Union (EU) in 1995 [9,10]. Some studies have concentrated on the growing importance of governing alcohol and drug problems at local and regional levels [11,12]. In a newly started project, experiences from these studies will be used when analysing adolescents' and young adults' drinking, smoking and gambling problems in parallel. Another study in its infancy is one focusing on unfavourable childhood experiences and their transgenerational roots.

Research on gambling has been part of the Unit since 2007 [13]. Accordingly, gambling issues have been integrated into the Unit's regular data collections. Topical research themes are youngsters' gambling and addictive gambling on the web, values held by problem gamblers, health-care professionals' perceptions of young people's problem gambling, as well as the national state-ruled gambling policy system. The Unit also takes part in a nation-wide population survey mapping various gambling activities.

The Unit accommodates approximately five researchers funded by the Finnish Foundation for Alcohol Studies, which grants money to PhD students, among others, for up to 3 years. This provides an opportunity to gain new impulses, fresh ideas and close contacts to academically orientated research. In 2011 and 2012 three studies will be completed, dealing with the drug markets in the city of Helsinki in the 2000s, the role of women in the maintenance and repeal of Prohibition Law (1919–32), as well as the relationship between mind and body in European medical discourse in the late 1700s and early 1800s. Another means of reaching out and nurturing contacts with academically orientated research is provided by the monthly drug research seminar, started in 2001, which collects participants from several universities and other institutions. In 10 years the seminar has generated 14 PhD theses.

The Unit has been strongly engaged in a long-term international collaboration on consumption, harms and policies regarding alcohol [14]. Currently the Unit participates in two large-scale EU studies: Alcohol Measures for Public Health Research Alliance (Amphora; 2009–13) and Addictions and Lifestyles in Contemporary Europe (Alice Rap; 2011–15). Also at the European level, the European School Survey Project on Alcohol and Other Drugs (ESPAD) on school children's drinking and drug use has been part of the research programme since the study was initiated in 1995 [15]. The Unit is engaged strongly in Nordic cooperation in the alcohol and drug field, maintained by the Nordic Centre for Welfare and Social Issues (NVC), as well as the national institutes for alcohol and drug research in Denmark, Norway and Sweden, covering comparative studies and research training courses. An important frame of reference in alcohol research is the international Kettil Bruun Society for Social and Epidemiological Research on Alcohol, while the European Society for Social Drug Research (ESSD) has attracted capable drug researchers.

The Alcohol and Drug Analytics Unit

For many decades the Alcohol and Drug Analytics Unit, led by Adjunct Professor Kimmo Kuoppasalmi, has concentrated on developing and exploiting alcohol and drug analyses in research. The work of the Unit focuses on five topics: (i) performing alcohol and drug analyses, (ii) producing research data on the role of alcohol and drugs in traffic and traffic accidents, (iii) conducting research into doping agents and new drugs, (iv) assessing and developing practices and laboratory methods for alcohol and drug testing and (v) offering expert advice and education on alcohol and drugs and related testing.

The staff at the Unit consists of chemists, physicians, researchers, laboratory technicians, laboratory assistants and a secretary for the Unit: in all, 22 people. In addition to research and expert tasks, the Unit also provides paid services to some authorities within the criminal justice and health-care systems.

Several methods for analysing multiple drugs in the same laboratory run have been developed [16,17]. To conduct research into doping agents and new drugs, the interaction between amphetamine and anabolic steroids has been studied [18]. Several studies have been carried out to study drunken and drugged drivers [19–21]. The Unit has also conducted studies on the life-time prevalence of psychotic, bipolar I and alcohol-induced psychotic disorder and delirium in the general population [22,23], as well as the treatment of amphetamine dependence with methylphenidate [24].

The Unit is strongly engaged in cooperation with expert tasks in the United Nations, in the EU and in Nordic cooperation. Several researchers have completed their theses within the Unit and many are still ongoing. In the near future a drug analysis on waste water will be performed and the results will be compared with other forms of follow-up studies of drug abuse. In addition the Unit will produce research data on the role of alcohol and drugs in traffic and traffic accidents. The founding of a new forensic centre, that will include forensic chemistry, is planned for the year 2020.

The Addiction Prevention Unit

The Addiction Prevention Unit, led by Research Professor Kalervo Kiianmaa, aims at the prevention and treatment of medical and social problems arising from smoking, alcohol and drug abuse as well as problem gambling. It has good national and international network connections, including the World Health Organization (WHO)-Euro, EU and advisory work based on bilateral agreements with some non-European countries. The staff consists of 18 people. Training opportunities for students at undergraduate and graduate levels are also provided.

The Unit investigates and offers expert advice on tobacco control policy, measures to prevent and reduce tobacco use and smoking cessation. The main research activities in the prevention of tobacco use include initiation of smoking among young people, the impact of the national Tobacco Act and the benefits of smoke-free environments. The Unit is also involved in developmental work as a result of its statutory functions. These include monitoring the effects of the Finnish Tobacco Act [25] and retail cigarette prices on the national smoking prevalence. Another area of responsibility, shared with regional authorities and non-governmental organizations (NGOs), is organizing national and regional health promotion work to prevent and reduce tobacco use among youth and adults, as well as promoting smoking cessation. For example, a project was established to plan and organize pre- and postgraduate smoking cessation education for health-care professionals. The Unit acts as an advisory group for the Ministry of Social Affairs and Health on questions related to smoking prevention.

Another focus is on the development of effective prevention measures and minimizing harm arising from problem gambling. A central task is to strengthen and support the knowledge and skills of professionals working in health and social welfare services. A website is maintained as a part of these activities (http://www.thl.fi/pelihaitat) and printed material on the issue is published. The Unit is also responsible for coordinating the prevention of gambling problems and treatment development on a national level, under a mandate from the Ministry of Social Affairs and Health. It has played a key role in the establishment of a Gambling Clinic, with a service unit located in Helsinki, as part of a collaborative project among the local municipalities, non-governmental organizations and the Institute.

The Unit supports the implementation of substance abuse prevention, such as early intervention, both at local and regional levels in collaboration with different national and regional networks, administrative sectors and non-governmental organizations. To prevent alcohol and drug-related harm, national and international information and expertise is collected, produced, adapted and provided. One of its functions is coordination of the National Alcohol Programme 2008–15 for reducing harm from alcohol use. It guides local authorities in the implementation of the programme and participates in the coordination of national drug policy. The quality of prevention methods is improved and their impact is evaluated. As part of this work, there is an extensive website, Neuvoa-antavat[the Adviser], offering information and tools for planning, executing and assessing substance abuse prevention work. A database on organizations providing treatment services is also maintained.

Research on the aetiology and prevention of alcohol and drug addiction and related health problems is conducted. This function represents the vestiges of the Biomedical Alcohol Research Centre at the National Public Health Institute (previously known as the Biomedical Department at Alko Ltd) [26]. The studies take advantage of the long-standing collaboration on neurobiology of alcohol and drug addiction among scientists in Finland and other countries, e.g. in Canada, Germany, Sweden and the United States. The addiction research focuses on the neurobiological processes leading to alcohol and drug dependence, and provides information for the development of new prevention and treatment methods that are based on the underlying biological mechanisms. The projects address the role of specific neuronal and neuroadaptive mechanisms in the development of addiction to alcohol and other drugs. Current research is into clarifying the role of central opioidergic systems in the development of addiction to alcohol using the animal model of alcohol-preferring AA (Alko Alcohol) and alcohol-avoiding ANA (Alko Non-Alcohol) lines of rats selected for differential alcohol intake, developed more than 50 years ago [27–29]. Another goal is to develop a valid biomarker that can detect alcohol misuse, and may be used in clinical work in the prevention and treatment alcohol-related harm. In current research, proteomic analysis of biological samples is used for the identification of a protein profile that enables detection of alcohol misuse.

WORKING FOR A SHARED UNDERSTANDING

  1. Top of page
  2. ABSTRACT
  3. MERGING HISTORIES
  4. WORKING FOR A SHARED UNDERSTANDING
  5. SYNERGIES AND THEMES FOR FUTURE
  6. Declarations of interest
  7. References

The great variety of different disciplines in the Department creates good opportunities for interdisciplinary research projects. Also, the fact that in the same administrative context we have both researchers and people specialized in preventive work opens up interesting possibilities for combining efforts from these two branches. All this, however, requires close cooperation and continuous work for a common understanding. Diverse scientific traditions with different theories, concepts and methods may cause problems in finding a shared language and understanding of a certain subject of study. Similarly, there are disparities between researchers and prevention professionals in their methods of working: while researchers spend a great deal of time to prove the validity of their results, prevention people strive to bring new ideas and thoughts of a researcher immediately into the field in order to determine if they work in practice. Conversely, at its best a dialogue between diverse perspectives can challenge routine ways of thinking and thus encourage creativity and produce new solutions. Furthermore, creativity is encouraged by running informal and voluntary study circles around crucial classical or topical texts.

Administration and other common issues are dealt with on a weekly basis in the management group of the Department formed by the Heads of the three units and the Head and Assistant Secretary of the Department. This board promotes a common culture at the Departmental level by also arranging joint mini-seminars where a given topic (e.g. ‘tobacco’, ‘youth and substances’, ‘substance use and pregnancy’, ‘cannabis’) is examined and debated from the points of view of different disciplines and research traditions. Once or twice a year the office is left behind for a day of joint recreation, play and familiarization. A common institutional culture and identity are also promoted by the Department's own intra- and internet sites.

Until now we have been able to utilize interdisciplinary potentialities mainly in practical tasks, such as in producing information about use, users and properties of some designer drugs such as methylenedioxypyrovalerone (MDPV), which raised considerable concern in spring 2010 in Finland. However, collaboration across the Department is also carried out in a newly initiated research project on intoxicants' role in accidents. Another project includes a cross-problem approach while studying the functioning of age-limit controls in alcohol sales, tobacco sales and gambling. When new research angles arise, researchers are sometimes encouraged to rearrange resources and established cooperative constellations. Occasionally, in the case of bigger projects, external funding is applied, as in the case of the project ‘Changes in cultural position of drinking’, proceeded in collaboration with the Universities of Stockholm and Torino [8].The website Neuvoa-antavat, maintained by the Addiction Prevention Unit, is used for collaboration between researchers and prevention people at the Department.

Within the Institute, the Department collaborates especially with the Department of Mental Health and Substance Abuse Services, as well as with the Information Department producing statistics and registers, which is also responsible for tasks of the national focal point of the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA).

Contacts with universities are most important to the Department. In fact, many of the senior researchers of the Department have been appointed as adjunct professors at a university and are thereby participating in lecturing and supervising students in their areas of interest. This kind of collaboration is shown to be very valuable when recruiting new staff to the Department. Correspondingly, contacts with NGOs and other actors of the civil society are most significant to the preventive work. The national coordination and guidance of professionals working in the field of prevention is defined as a central task of the preventive work at the Department. Collaboration with the parent Ministry of Social Affairs and Health and other parts of the state administration is quite frequent, especially in the area of preventive work. These kinds of tasks offer direct opportunities for social and political influencing.

International collaboration is deeply rooted in the different research traditions of the three units. Participation in the international scientific community is seen as a necessary measure to improve the quality of the research we are conducting. Nordic cooperation has been a particularly important arena for young researchers. International collaboration in prevention issues is directed more towards international organizations such as the Nordic Council of Ministers, EU, WHO and United Nations (UN).

SYNERGIES AND THEMES FOR FUTURE

  1. Top of page
  2. ABSTRACT
  3. MERGING HISTORIES
  4. WORKING FOR A SHARED UNDERSTANDING
  5. SYNERGIES AND THEMES FOR FUTURE
  6. Declarations of interest
  7. References

Basically, the working agenda of the Department is formed through autonomous discussions within the units and in the management group of the Department. The plans of the Department are presented to the General Director of the Institute and are thereby included into the working programme of the Institute. The Institute also negotiates a working contract with the Ministry that includes the tasks regarded as most important by the Ministry. In recent contracts the Ministry has directed the Institute to develop an information service system for decision-makers and other interested agents on the harms of alcohol, drugs, tobacco and gambling problems at national, regional and local levels.

A central foundation of the future plans of the Department is built around regularly collected data sets of high quality that cover long time-spans, such as the Finnish Drinking Habit Survey (every 8 years), the Drug Survey (every 4 years), ESPAD (every 4 years), the Gambling Survey (every 4 years) and Drunk Driving Statistics. These data sets are valuable both for scientific and practical reasons. However, with the general downward trend in response rates for surveys, a stronger investment in qualitative and register-based research may become more important in the future. New options for receiving EU funding (e.g. projects such as Amphora and Alice Rap) and the traditions of Nordic and international collaboration will be explored and continued, respectively. The Institute has also started negotiations with the WHO towards being appointed a collaborating centre on alcohol.

Furthermore, the Department will continue to exploit its interdisciplinary structure and possibilities for a cross-problem approach. Developmental trends in different topical areas offer continuous challenges for the Department to nurture creativity. For example, tobacco policy has been moving consistently towards stricter restrictions, while in recent decades the development in alcohol policy has been led mainly by liberal attitudes, and in drug policy the strict efforts of law enforcement have been forced to cooperate with more lenient lines of thinking that promote different kinds of harm reduction measures. An interesting point of departure for comparing different problems is also offered by the fact that in Finland we have state monopoly systems both in alcohol retail sales (of beverages containing more than 4.7% alcohol by volume) and in the gambling industry. To conclude, even if the shrinking public sector and the ideology of New Public Management employed in the state administration are currently producing some insecurity, we believe that as those social and public health problems that we are dealing with are certainly not going to disappear any time soon, society will need good-quality research-based knowledge on alcohol, drugs and addictions well into the future.

References

  1. Top of page
  2. ABSTRACT
  3. MERGING HISTORIES
  4. WORKING FOR A SHARED UNDERSTANDING
  5. SYNERGIES AND THEMES FOR FUTURE
  6. Declarations of interest
  7. References
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