Lenka Miovská’s scientific contributions

The chapter is divided into groups by different types of addictive substances withparticular respect to specific features pertaining to the potential risks of the developmentof cognitive deficits associated with the use thereof. Considerably greater attention ispaid to some of the substances, as the users of such substances and the consequences ofusing them are encountered more frequently in practice. For example, this emphasis wasapplied for cannabis and MDMA ("ecstasy"), as these are substances that have becomevery popular among adolescents and young adults, and there are no signs of any majorreversal of this tendency. Significant attention was also paid to the group of stimulantswhose risk in terms of cognitive deficits is unfortunately often underestimated in practice,as opposed to the risk associated with opioid use, which, conversely, is overestimated. Aseparate area of concern involves volatile substances whose significant risks, includingthose to cognitive functions, are well known-the professional community has beenpointing this issue out-but these facts are not adequately reflected in writings publishedin professional journals, nor in other messages. Finally, the concluding section of thechapter deals with assessment methods and recommended procedures for theidentification and proposal of treatment and rehabilitation interventions aimed ataddressing cognitive deficits caused by addictive substance use.

BACKROUND: The EUDAP 2 Project took place in Czech basic schools during the years 2007/2008. The main goal of this project was to test the applicability and effectiveness of the Unplugged primary prevention programme in the selected Czech schools. Because of the effectiveness study, another analysis was carried out in schools. This analysis was focused on the description of all the primary prevention activities which were pursued during the EUDAP 2 project but which were not related to the project. The results of this analysis are the subject of this article. AIMS: The main goal of the analysis was to provide a detailed description of the prevention programmes delivered by the schools involved in the EUDAP 2 project. METHODS: The data were collected using questionnaires. The main focus was on the description of the primary prevention programmes and the way in which they were delivered. Experimental and control groups were compared. SAMPLE: The sample consisted of 70 basic schools from the entire Czech Republic; 33 were involved in the project as the control group, 37 were involved in the project as the experimental group. The questionnaires were completed by the school prevention workers. RESULTS: The most frequent primary prevention activity was one-off activity. The schools mostly carried out their programme by themselves. In the control group, only 21% of the primary prevention programmes covered the prevention of drug use, while in the experimental group, comprehensive primary prevention programmes took place in all (100%) cases. CONCLUSIONS: The teachers responsible for primary prevention were most likely to organise the programmes by themselves. Most of the programmes are just occasional lectures.

Školní metodici prevence si často zajišťují programy prevence sami. Málokdy se přitom preventivní program prevence skládá z více lekcí a využívá více prvků než jen prostou edukaci nebo diskuzi.

After alcohol and tobacco, cannabis is the third most frequently used drug in the Czech Republic. In 2003 the lifelong prevalence of cannabis use in the adult population reached 21.1 %. Accordingly, it has become crucial to assess the impacts of the use of this substance and, first and foremost, make long-term predictions of such effects in terms of public health and mental health epidemiology. The authors conducted a comprehensive assessment of the current state of research into the potential impact of cannabis use on cognitive functions. Using studies based on electroencephalography (EEG), magnetic resonance imaging (MRI), functional magnetic tesonance imaging (fMRI), single photon emission computed tomography (SPECT), positron emission tomography (PET) and computed axial tomography (CAT), they draw a comparison with earlier studies, as well as those carried out applying different methods. In addition, the authors point out that it is essential to distinguish between the effects of acute drug intoxication, the influence of drug residues within 12-24 hours following acute intoxication, and the long-term toxic effects on the central nervous system, which may even persist after all the residues have been excreted from the body. Some effects may persist for as long as 28 days after the dtug was last taken. After one month of abstinence no detected cannabis-induced deficits are demonstrable, which suggests, as is also indicated by the current evidence, that they may be reversible. Electrophysiological and neuropsychological studies show that cannabis has an influence on attention, psychomotor pace, and short-term memory within 12 to 24 hours after being used. Nevertheless, there is insufficient evidence either to support or disprove the long-term effects of cannabis residues or irreversible toxic impact on the CNS. Similarly, the studies demonstrating major structural brain damage in heavy users have not been confirmed by better-controlled studies using more state-of-the-art methods.

This Annual Report summarises information about the situation in the field of drug use and its consequences, in the fields of legislation, strategies, and drug policy coordination, and about interventions, especially in the areas of drug demand reduction, drug crime, and drug markets in Czech Republic in 2007, as well as trends in the abomentioned fields.

In 2005 the new discipline of addictology came into existence. It is based on a so-called multidisciplinary approach to substance use and its causes, context and impact. Addictive substances pose significant health, social, legal and economic risks for both society and individuals. Since 1989 many changes in substance use have occurred. The consumption of legal addictive substances (such as alcohol and tobacco) has shown a continuously increasing tendency. The drug scene involving illicit substances has seen dramatic changes which have resulted in the virtual extinction of its previous nature and the rise of a drug scene operating on a commercial basis, which is a pattern we know from the Western European countries. The authors of this paper summarize current basic data reflecting the use of both types of addictive substances and point out that the so-called recreational users are the group which is the least covered by research although, statistically, it is the largest group of users. A major proportion of this group never becomes directly engaged with treatment programmes or serves a prison sentence, and, in terms of public health, insufficient attention has been paid to this group.

The Czech National Monitoring Centre for Drugs and Drug Addiction carried out a survey focused on the out-patient psychiatric treatment provision to drug users in 2003. The survey was realised in 2004. The aim of the study was to find out how many out-patient treatment centres are primarily oriented on drug users, i.e. how many so called "AT ambulances" do exist in the Czech Republic. Altogether 195 out-patient psychiatric centres participated in the study, out of them 35 centres had no drug user in treatment in 2003. Therefore 160 out-patient treatment centres were focused on treatment of drug users. 128 out-patient psychiatric centres provide treatment to alcohol users, 33 to tobacco users and 70 to illicit drug users. In these 160 centres, 43 201 patients were treated in 2003 (67% alcohol users, 15.5% tobacco users and 15% illicit drug users). The most frequent illicit drugs used were pervitin (methamphetamine) and marijuana. These centres co-operate mostly with inpatient psychiatric clinics and departments, as well as with general practitioners. Collaboration with non-governmental organisations in the field of drug treatment and after-care is assessed as insufficient.

The objective of this study was to establish the prevalence of psychiatric comorbidity among patients admitted in 2003 to mental institutions and hospitals' psychiatric departments in the Czech Republic for drug-related problems. The data used to carry out the analysis were supplied by the Institute of Health Information and Statistics (UZIS) and cover the year 2003. They provide information on patients admitted to mental institutions and hospitals' psychiatric departments with an F10-F19 diagnosis as their principal or secondary and additional psychiatric disorder. According to UZIS, in 2003 a total of 15,118 patients were admitted to hospitals for disorders induced by drug use (F10-F19). 2,489 patients (68.9% men, 31.1% women) with F10-F19 as their principal or secondary diagnosis were also diagnosed for other psychiatric disorders. A total of 920 patients were admitted to hospitals for disorders induced by drug use and they were also diagnosed for other mental illnesses. These cases included multiple drug use, personality disorders and neurotic disorders. In the year 2003 1,569 individuals were also admitted to in-patient establishments with a principal diagnosis outside the range of disorders induced by drug use; those were indicated as one of the secondary diagnoses. The most frequently used substances included alcohol, sedatives or hypnotics, and cannabis. Multiple substance use was also frequent.