Accessibility and Affordability of Alcohol Dependency Medical Care in Serbia

CONTEMPORARY HOT ISSUES ON ALCOHOL DEPENDENCY IN SERBIA Alcoholic beverages are traditional to the Balkans region since the Antiquity. Consumption of domestic honey-made spirits and wine was wide spread among the Serbs even in the early medieval history before spreading of Christianity (1). Today, it remains a deeply rooted custom while prevalence of full scale dependency and associated disorders in Serbia are slightly less frequent than European average (3.4 vs. 4.0% and 5.2 vs. 7.5%, respectively) Alcohol dependence in cited WHO sources was confirmed according to ICD-10 criteria. (2). Although hosting one of the oldest medical societies across European region, Serbia still lacks systematic morbidity and mortality registries for a variety of leading prosperity diseases including alcoholrelated disorders (3). Nevertheless some national estimates on standardized death rates attributed to alcohol-related causes and alcohol consumption are available thus allowing the insight into trends of change since late 1990s. Likewise, elsewhere in the European community, traffic accidents caused by alcohol consumption posed a substantial challenge to the road safety (4). Undisputed relationship between alcohol blood concentration and severity of acquired traffic injuries was proven in national forensic studies on cases with fatal outcome (5). Afterward, national policies have been adopted with more severe legislation framework and punitive measures compared to previous real socialism legacy (6). Unfortunately, like many other public health strategies, this one actually had quite limited effect to alcohol attributed traffic accident mortality in consecutive years (7). According to the forensic observation of a local sample of deceased with mortal injuries, craniocerebral trauma remains the most typical clinical pattern (8). Among direct alcohol effects on mortality are classified as mental disorders with suicidal tendency (9) as well as poisoning with ethanol, methanol, and unspecified alcoholic compounds, which were attributed a total of 248 fatal outcomes in 2012. Indirect alcohol effects on mortality present far more extensive burden for the health system. Diseases such as alcoholcaused degeneration of nervous system, alcoholic cardiomyopathy, alcoholic liver disease, and alcohol-induced chronic pancreatitis caused a total of 430 deaths in 2012 according to latest official release (10). Observing the landscape of age-stratified direct alcohol-related deaths due to overdoses, one could notice heavy domination of 45–79 years age group. According to the criminal justice procedure in Serbia, there are some 106 beds of Special Prison Hospital in Belgrade reserved for mandatory treatment of offenders who committed crimes in alcoholic condition. Such treatments are either been conducted in the penitentiary institution itself or elsewhere, in a specialized medical facility. Quite a peculiar issue is non-fatal alcohol overdoses whose treatment lies within responsibility of the National Poison Control Center of the Military Medical Academy being the reference institution in the country for diagnostics and treatment of intoxications. This facility reported 2078 patients admitted because of acute ethylalcohol intoxications or almost 50% of all cases in 2012 (11). Broad portion of similar clinical cases, with or without suicidal intention, are being admitted to the emergency wards of other tertiary university clinics across the countries. So far illicit psychoactive substances cause several fold less overdoses than alcohol although drugscaused mortality belongs to far younger adolescent age group (12). One promising trend among the youth is slightly decreasing prevalence of those who have ever used alcohol from 75.6% in 2008 to 64.3% level in 2012 (13). Risky attitudes of adolescents toward the alcohol use contributed substantially to the current morbidity (14). Recent pan-European trends expose binge drinking habits and co-assumption of diverse novel psychoactive substances, which contribute to the challenging nature of alcohol addiction treatment (15).