Outpatient Care for Substance Users and Addicts in the Czech Republic in Health Statistics since 1963

Summary

Outpatient care for alcohol and other addictive substances users in the Czech Republic has a 100--year-old history, with the last 50 years covered in health statistics.

Goal:
To perform descriptive analysis of the historical data gathered, analysed and published by the Institute for Health Information and Statistics on the network of outpatient psychiatric facilities in 1963-2008 (particularly those specialising in the treatment of addictive disorders, e.g. alcohol counselling centres and later AT centres where AT stands for alcoholism and other toxicomanias) as well as on the numbers and characteristics of their patients – users of addictive substances.

Results:
The number of visits to alcohol counselling and AT centres showed an upward trend in 1963–1991, mainly from 1970 to 1988 when a historical peak of 387 thousand visits was recorded. This trend was primarily due to males who constituted the majority of the reported patients and their proportion gradually decreased from 95 % in 1963 to 79 % to 1991. The reporting from the specialised AT centres ended in 1992 to be replaced by the reporting of addictive substances users from all psychiatric outpatient centres. In the period 1993–2008, for which the data by group of addictive substances are available, alcohol users constituted 3/4 of the treated addicts and their annual number decreased by half (from 49 to 25 thousand) – this decrease was also influenced primarily by men, with the male to female ratio declining from approx. 4:1 to 2:1. Since 1995 when age-specific data started to be reported, the age of substance users was increasing, with the exception of non-alcohol drugs users where the proportion of 15–19-year-olds rose in 1995–1997. In 2008, the highest proportion (about two thirds) of alcohol users were aged 40 years and more, while most (nearly 70%) users of non-alcohol drugs were from the age-group 20–39. The number of treated non-alcohol drug users increased more than 3 times between 1993 and 2008. Higher proportions of males were noticed among the users of all non-alcohol drugs but sedatives and hypnotics preferred more often by females (58%). An increase in the number of users was reported for all groups of non-alcohol drugs except volatile substances in 1993–2008: the most common were users of opiates (26 %), followed by users of stimulants other than cocaine (23 %) and poly-drug users (14 %). In 1993–2008, the proportion of injecting drug users decreased from 75% to 50% for opiates and from 70 % to 60 % for stimulants other than cocaine; however, injecting drug use increased in poly-drug users. The trend in the number of clients of sobering-up stations (short‑term detoxification from alcohol and other drugs) follows the trend in the number and capacity of these stations, although a downward trend in their capacity coupled with an upward trend in the number of clients have been observed since 2005.

Conclusion:
Information from the outpatient health care psychiatric facilities is relevant to drug use epidemiology in the Czech Republic, despite the fact that the network of specialised AT centres has not been monitored separately any longer since the early 1990s. Data on drug users in outpatient treatment are in line with the inpatient treatment data and both data sources show some congruent trends. Health statistics remains practically the only data source on the outpatient treatment of alcohol users.

Keywords:
alcohol – drugs – addiction – addictive disorders – out-patient care – AT clinics – sobering-up station – psychiatry.