1. Alcoholism in Finland By Simon Kaklugin and Johanna Lehtinen

2. Leading killer in Finland, above heart disease and cancer. (responsible for 17% of all deaths among men of 15-65 years old) (responsible for death of 10.5% of adult women, along side breast cancer)

3. Reasons The Finnish are said to be typically quiet and shy people. Alko, state owned and only store in finland which retails alcohol (finland’s alcohol monopoly), established in 1937 2004, 40% slash of alcohol tax to prevent cheap private import from neighboring countries.

5. 6 months after tax cut, there was a 10% increase in binge drinking in 17 year olds. 14% increase in alcohol consumption since tax cut. 2006, 1 in 4 people involved in a car accident were found to be drunk. 2005 - # non drinkers, men = 22%, women = 47%. 2007- # non drinkers, men = 11%, women = 14%. 1 in 3 15-16 year olds admit to being drunk within the last month. 4% of population (150,000) are alcoholics.

6. Complications Cost to treat alcohol related illnesses has increased 14% since 2003. Early retirement and longer sick leave. Depression Alcoholics are 5080 times more likely to commit suicide than the general public, (due to unemployment, economic status and social status).

8. Physical Effects liver cirrhosis pancreatitis epilepsy polyneuropathy alcoholic dementia heart disease predisposition to cancer nutritional deficiencies sexual dysfunction

9. Mental Effects – 25% of alcoholics present with psychiatric disturbances, which worsen during withdrawal (depression, anxiety, panic disorder, bulimia, schizophrenia) Social Effects -loss of employment causing financial problems and loss of home. -drink driving -public disorder -marital conflict -divorce -domestic violence

10. Preventative Measures Increased tax on alcohol (but has lead to increased private import by travellers) supermarkets cannot sell beer with greater alcohol content than 4.7%. Alko cannot have a window display Drinks with an alcohol content of higher than 22% cannot be advertised.

11. Current evidence indicates that alcohol dependence is: 50-60% genetically determined. 40-50% determined by environmental factors. About 10 genes have been linked with predisposition to alcoholism. (e.g. 1 of these genes includes a mutation of the dopamine receptor, which predisposes people to addiction of opiates and endorphin releasing drugs such as alcohol).

12. Primary effect of alcohol is stimulation of GABA receptor, causing CNS depression. Repeated consumption causes desensitisation of receptors and decreased number. This causes tolerance and dependence. If alcohol intake is stopped abruptly it results in uncontrolled synapse firing in the CNS (anxiety, life threatening seizures) Therefore alcohol withdrawal must be carefully managed.

13. Therapy Many factors encourage drinking which must be addressed to prevent relapse. Detoxification – drugs are given which mimic the effects of alcohol to prevent withdrawal symptoms. Medication: - Antabuse, prevents acetaldehyde release, which extends duration of hangover acting as a deterrent for drinking. - Naltrexone, competes with opioid receptor, preventing endorphin function, therefore no satisfaction from alcohol and no craving. - Topiramate, reduces level of dopamine, therefore no pleasure from consuming alcohol. Group therapy and psychotherapy are used to tackle underlying psychological issues and provide relapse prevention skills.

14. Sources WHO http://news.bbc.co.uk/2/hi/europe/6106570.stm wikipeia http://alcalc.oxfordjournals.org/cgi/content/full/34 /3/320 http://alcalc.oxfordjournals.org/cgi/content/full/34 /3/320 www.suomenafh.fi www.utuonline.fi www.uufisuomi.fi