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Ill Effects
of The Separation of Psychiatric and Substance Abuse Treatment Services
in the City of Norilsk (Russian Federation)
Dr. Makarov Michael L., Dr. Makarova Tanya F.
Municipal institution “Psychoneurological dispensary” of the City of Norilsk; Zavenyagin
Street 2-100, City of NORILSK, Krasnoyarsk Region, 663300, Russian Federation.
There is a substance use pandemic in the biggest northern-most industrial town in the
world. There is also an extraordinary high morbidity and prevalence of HIV/AIDS and
drug use. The City of Norilsk may become an example of the most expressed ill effects
following irrational organization of psychiatric and substance abuse treatment services,
which are separated in the institution by office walls and written official power for specialists. Absolutely uncomfortable for vital activity climate particularities and environmental
pollution are contributing to unhealthy and pernicious inhabitants’ customs.
Key words: public health, alcohol and tobacco use, drug and other substance use, pandemic, separation of treatment services, Norilsk, monograph
The biggest northern-most industrial town in the world
The City of Norilsk is the biggest northern-most industrial town in the world. It
includes the central district – Norilsk proper (founded in 1935) and its two satellites – Talnah (1960) and Kayerkan (1943). The whole quantity of townspeople is about 240000.
Norilsk is known in the world thanks industrial activities of the enterprise Mining&Metallurgical Company "Norilsk Nickel", JSC. The amount of employees is 71000
(29,6% of the whole quantity of townspeople) in 2001. Details about climate and production in Norilsk may be found on the site http://psychonarcolog.narod.ru.
Official statistics
1. Harmful consequences of alcohol use are presented by personal disorders as a
result of alcohol use; alcohol abuse; chronic alcoholism of the 1 stage (psychological dependence), 2 (physical dependence) and 3 (organic irreversible process in functioning of
internal, including affection of liver and brain); alcoholic psychosis, alcoholic dementia
and liver cirrhosis. During the 1 and the 2 stages occur periodical short term disability,
from the 3 stage - permanent steady disability.
There is in 1,5-2 times alcohol dependence morbidity higher in Norilsk than on the
average in Russia, at that there is a trend to equalization of this figures (against a background growth of mean indexes in Russia, this figures are decreasing in Norilsk). During
the last 5 years on the average this index in Norilsk is exceeding the mean Russian one in
1,4 times; in Norilsk it decreased in 1,1 (almost invariable) and in Russia it increased in
about 1,4 times.
The amount of alcohol psychosis is being kept on an extremely high level in
Norilsk, it exceeds mean Russian figures in about 3 times. During 5 years on the average it
exceeds mean Russian figures in 2,3 times. During the last 5 years the amount of alcohol
psychosis has increased in 1,9 times in Norilsk as well as in Russia. This is indicating malignant course of chronic alcoholism in Russia as a whole.
2. Harmful consequences of drug use
There is in 2,6-6,5 times drug dependence morbidity higher in Norilsk than on the
average in Russia, at that there is a trend to equalization of this figures (against a background decrease of mean indexes in Russia, this figures are decreasing in Norilsk). During
the last 5 years on the average this index in Norilsk is exceeding the mean Russian one in
4,7 times; in Norilsk it decreased in 1,1 (almost invariable) and in Russia it decreased in
about 1,7 times.
During the last 5 years drug dependence morbidity is increased in 3,7 times in
Norilsk, but in 2,1 times on the average in Russia. In that way the mean quantity of drug
dependent patients is growing almost in 2 times faster than on the average in Russia.
3. Connected to drug use and alcoholism harmful consequences
The quantity of registered HIV/AIDS patients has been 2225 in Norilsk at the end
of 2003, most of them were drug dependent. On the Norilsk scale it’s about 1% of all
townspeople.
The figures of HIV/AIDS dissemination in Norilsk are exceeding ones in Russia in
about 7 times. It could be compared to drug use morbidity in Norilsk that is exceeding the
Russian indexes in 4,7 times during the last 5 years (with its maximum in 1999 – 6,5
times). Alcoholism morbidity and alcohol use in Norilsk could be compared to it too.
In such ill conditions HBsAg and HIV/AIDS circulation is predictable because
substance use puts ill effects on mental options that carry to common safety norms slighting. In the same way a drunk driver drives a vehicle having wrong confidence in absence
of inadmissible high risk for his own life and community safety.
The source of officially confirmed substance use harmful consequences are the
substance using inhabitants without any harmful consequences. This is why we may discuss an equalization of clinical conceptions of substance use and abuse.
The first scientific investigation
From June to December 2004, during medical occupational consultations made for
stuff of the enterprise Mining&Metallurgical Company "Norilsk Nickel", JSC, we drew,
organized and conducted an epidemiological investigation on alcohol and tobacco use dissemination in capable of working Norilsk inhabitants. This investigation has involved
more than 5000 workers. Such medical epidemiological investigation on substance use
hasn’t ever been conducted in Norilsk; there is only official statistics that is partly presented above. The outcomes were arranged as a monograph ‘Pandemic and Prevention of Alcohol- and Tobacco Use To Norilsk, Talnah and Kayerkan’ that was published in 20 specimens. The whole text of the monograph in Russian can be downloaded from this location
in Internet: http://psychonarcolog.narod.ru/pandemia.pdf (the size is about 2,1 MB).
Notice. There is no official figures to tobacco and alcohol use dissemination and
tobacco harmful health consequences in Norilsk as well as in Russia.
Resume to the outcomes and monograph
Sobriety and lack of any dependency is fashionable in the progressive industrialized
world with developed economy. Unhealthy customs are being noted by employers announcing a vacancy, because they care about prosperity of their enterprises and about
well-being of workers.
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In Russia as a whole and in the Norilsk Industrial Region (NIR) in particular there is
an epidemic of tobacco and alcohol use. Deduction about pandemic in NIR has been is
made on the base of a first epidemiological investigation of able-bodied inhabitants.
The main achievement of this study is showing indication for primary and secondary
prevention of alcohol and tobacco use have about 66,7% of NIR inhabitants, that makes ca
160 thousand people. The secondary prevention only in consequence of tobacco use have
ca 171 thousand people, of alcohol use – ca 215 thousand people. The primary prevention
is necessary only for 5,8% of all NIR inhabitants, that is 14 thousand people. So the object
of preventive activity are to be all the NIR inhabitants without exceptions (240000), every
man and every woman of any age, of any NIR life and work longitude, of all education
stages and marital status.
In this book are included made first in Russia translations into Russian of background
papers for WHO report Priority Medicines for Europe and the World “A Public Health
Approach to Innovation”, written by Warren Kaplan – “Alcohol Use Disorders: Alcoholic
Liver Diseases and Alcohol Dependency” (7, October 2004) and “Tobacco Use Cessation:
Importance and Implications” (12, October 2004). As an example of used in the Center of
Mental Health’s social activity is included a translation of a booklet “Parenting Skills: 21
Tips & Ideas to Help You Make a Difference”, that is issued by Office of National Drug
Control Policy (USA).
This monograph can be of interest for public health specialists, managers of pharmaceutical industry, sociologists, educational specialists, employers, politologists, policy
makers and unrestricted group of readers in NIR and other regions in Russia and the
world.
The monograph is being a first part of a fundamental original research that has a
working name “Morbus Norilski”.
The monograph contains 160 pages; 10 graphs, 30 tables; 1 scheme; 200 literature
references, including 44 in Russian and 156 in foreign languages; foreword, 4 parts, afterword; a yellow cover with a photograph.
Conclusion
Substance use pandemic and related psychiatric diseases prevalence are obvious in
the City of Norilsk. Statistical figures show 60% (about 150000 inhabitants) of able to
work people smoke (they use tobacco), 90% (about 216000 inhabitants) use alcohol beverages. So big are the risk groups for substance use, psychiatric, cancer, heart and other
chronic diseases. Healthy life styles have only 5,8% of all Norilsk inhabitants that is
14000.
Unhealthy behavioral diseases pandemic is an ill consequence of a health care system inertia on informing people about substance use harmful results. Irrational organization of psychiatric and substance abuse treatment services that are separated in an institution by office walls and written official power for specialists have contributed to this pandemic. Substance users get psychiatric treatment only on the terminal stages of diseases
when they get weak-headed. Then psychiatric help consists of social and medical protection for permanent and steady disable people.
Acknowledgements
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The authors thank the management of the Municipal institution “Psychoneurological dispensary” of the City of Norilsk for giving an opportunity to conduct medical occupational consultations and to prepare and implement reflected above investigation.
We thank our colleagues psychiatrists and experts in narcology that have accepted
us for their collective and promoted conditions for effective and confident work.
We’re also thankful to our relatives that live in Norilsk for their psycho-emotional
and financial support during intensive investigational work.
We thank Mr. Warren Kaplan, Ph.D., JD, MPH, for his “Alcohol Use Disorders:
Alcoholic Liver Diseases and Alcohol Dependency” and Dr. Samira Asma (Centers for
Disease Control, USA) for his and of Mr. Kaplan “Tobacco Use Cessation: Importance
and Implications”, whose outcomes we use to show really harmful results of substance use
in the monograph.
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