Iceland research has highlighted success in dealing with addiction issues though a multi-agency public health approach. Ian McKenzie and Dr Murray Patton, of Mental Health and Addiction Services at Northland DHB, contacted the two key agencies in Iceland and organised their own two-day “match” as part of the 2018 IIMHL Leadership Exchange.

The Icelandic approach is premised on the assumption that substance (alcohol and other drug) use disorders are chronic but treatable brain diseases that require medical and psychological intervention, not moral judgment or criminalisation.

With this approach, understanding the transformation in the brain is critical to understanding why addiction is a health condition, not a moral failing or character flaw.

    Agencies visited

    The two key agencies visited in the Leadership Exchange were SÁÁ and Directorate of Health.

    SÁÁ

    SÁÁ provides all services across the drug spectrum and ages. All staff are health professionals.

    SÁÁ's main objective is to counteract prejudice and ignorance of substance (alcohol and other drug) use disorders and offer the best treatment and services available.

    Directorate of Health

    The Directorate of Health drives the public health approach in Iceland.

    The Directorate's main objective is to reduce or eliminate harm that the consumption of substances has on individuals, families and society. Special emphasis is placed on preventing or delaying young people from committing to legal and/or illegal substance use.

    Quick facts about Iceland

    Iceland has:

    • a population of 350,000
    • universal health care and tertiary education for its citizens
    • high rates of economic, political and social stability and equality
    • state-controlled alcohol sales and marketing 
    • strong family structures
    • a homogenous and very highly educated population
    • low unemployment
    • a high level of access to inpatient treatment
    • an age of consent of 18 years for consuming alcohol (changed from 16)
    • liquor regulation including pricing, marketing and availability (sale outlets).

    A population approach

    The population approach comprises coherent and multi-year action plans with stakeholder agencies and groups (including police, local bodies/councils, schools, health services, sports groups, violence prevention services, communities and parents).

    Parents and parents' groups are actively involved in the action plans regarding their own families.

    The small population has a single main provider of addiction treatment, which means that people's engagement with services is easily tracked over time, and now a third generation of families is seeking treatment.

    Treatment involves parents, siblings and children.

    Treatment in Iceland is similar to treatment in New Zealand (eg detoxification, group work, motivational interviewing).

    There are also 12-step fellowships such as Alcoholics Anonymous (AA) and Narcotics Anonymous (NA).

    Iceland has a far greater emphasis on hospital and residential treatment services compared to New Zealand.

    Population-based research from Iceland has shown:

    • there is a general understanding of the disease of addiction
    • there is a general belief that treatment works
    • people come freely for treatment
    • people come early for treatment
    • highly functioning people also seek help.

    At the end of 2017, the proportion of living Icelanders that had accessed treatment was 7.5%.

    The following successful outcomes have been recorded:

    • 13.5% of people will choose treatment in their lifetime
    • alcohol, tobacco and drug use by youth has decreased markedly
    • time spent with parents has increased
    • there are higher rates of 16-20 year olds who have never been drunk
    • drugs and alcohol have become socially unacceptable in schools.

    Actions from the visit

    Ian and Murray have presented the information to the Northland DHB Governance Board and the MHAS Clinical Governance Group.

    While noting the differences in populations, the plan is to pursue the translation of the concept and methodology to the local environment.

    Ian and Murray hope to develop and agree on a public health-oriented plan across multiple stakeholders to respond to addiction issues in Northland.