Evaluation of substance dependence and ability to drive
As stated in the Finnish Road Traffic Act, the police grant the right to drive to applicants who meet the health requirements laid down in the relevant decree and who are not considered to create a traffic hazard due to their abuse of alcohol or other narcotic substances. The 1996 EU directive on driving licenses pays special attention to substance use in the evaluation of applicants’ fitness to drive. Since then, the regulations have been amended and specified to make the evaluation process more reliable. The requirements laid down for fitness to drive are not met if the applicant has a substance addiction that significantly weakens their ability to drive a vehicle or if they create a traffic hazard due to their long-term abuse of alcohol or other narcotic substances. In addition, doctors have a responsibility to report to the police if their clients are permanently or relatively permanently incapable to drive due to their substance dependence.
The police may ask a doctor to assess a driver’s substance use and possible substance dependence if they have been found driving under the influence repeatedly, if they have been taken into police custody due to intoxication, or if the police come to know other substance-related incidences. In the case of narcotic substances, the police often ask for a doctor’s assessment after the first recorded incident. The client must take note of the time limit within which the doctor’s certificate is to be produced to the police. The time limit is stated in the written request issued by the police, and it is two to three months, at minimum. If the doctor’s certificate is not produced in time, the client may lose their right to drive. Further details on individual cases involving a doctor’s assessment can be inquired at the permit office at your local police station.
The assessment is carried out in accordance with guidelines set by the Ministry of Social Affairs and Health. The assessment can be conducted in primary health care, in substance abuse service units (such as an A-Clinic), or at a private clinic. The doctor may refer the client to a specialist in addiction medicine. In the case of clients abusing narcotic drugs or medication as well as professional drivers, the driving license monitoring is recommended to be carried out in a unit specialized in substance abuse services. The assessment is conducted in cooperation between a doctor and a nurse who are both specialized in substance use services.
A reliable assessment requires several visits to the health care unit, which also ensures the client’s legal protection. Usually the client visits the unit a total of three times, once every three or four weeks. The reasons warranting the assessment are stated in the written police order given to the client. The assessment of substance dependence is defined by the criteria of ICD-10 classification of diseases. During the visits, the aim is to examine the client’s history and current state of substance use, the reasons leading to the assessment, and the client’s mental wellbeing and medication, among other topics. The client’s alcohol use is mapped with tests such as the AUDIT, OCDS, and Drinkl surveys, which consist of multiple-choice questions regarding the client’s alcohol use. The client’s blood alcohol level is measures with breathalyzer tests. The substance anamnesis is confirmed with laboratory tests in order to increase the reliability of the assessment. The laboratory tests include a basic blood count (especially E-MCV, that is, the average size of red blood cells), liver function tests (S-GT, Asat, Alat), as well as tests on the biomarker S-CDT, which suggests high alcohol consumption. In addition, urine samples are collected in order to examine the client’s use of medication and narcotic drugs. Together, all these tests give a reliable account of the client’s substance use.
In the discussions during the assessment, the doctor provides the client with information relating to substances and tries to influence the client’s substance use and traffic behavior. The doctor is obligated to recommend substance treatment whenever the holder of a diving license is found to be dependent on substances. An early, small-scale intervention is highly important when the risk of substance dependence is clear even before it becomes a full-blown addiction. However, the assessment period focuses on the examination of possible substance dependence and should be separated from actual treatment.
In the last visit of the assessment period, the doctor gathers all the acquired information, including the blood test and screening results. The certificate issued by the doctor may be valid for an undefined or a specified period, or it may be refused. A refused certificate means that according to the doctor’s assessment, the client does not meet the requirements for fitness to drive during the assessment period. A new assessment can be carried out in approximately six months, if the client’s situation is significantly improved in that time. If the certificate is issued for a specified period, the client must follow the directions given by the doctor in order to receive a favorable certificate after the set time period. The doctor may also suggest demoting the client’s driving license from the professional driving category 2 to category 1.
Psychotherapist, specialized nurse
The A-Clinic Foundation