"For example, during my last shift a few days ago, 100 percent of the patients' conditions were related in some way to intoxication. It really stands out, also during shift handovers," said Paadik.

"The profile ranges from teenagers to the elderly. When we discuss this among colleagues, we agree that changes are happening over time, and this is occurring more frequently than in the past," she added.

Andres Lehtmets, director of the psychiatric clinic, stressed that while alcohol consumption tends to increase in summer, there is never a time when the emergency department is completely free from this type of problem.

The doctor said there is always a shortage of resources in emergency medical care. There are times when demand spikes and times when it declines again. Flexibility is essential, he said.

"The fact that people in Estonia drink a lot of alcohol is well known, and unfortunately, the health problems caused by alcohol are a part of everyday life," the director said.

"For us, the problem is similar to what regular emergency departments face – people in a state of intoxication, which alcohol intoxication certainly is. They do need some form of medical assessment, or at the very least to be evaluated by a healthcare worker, to determine whether there might be a more serious health issue beneath it. But that doesn't always mean these individuals need to sober up in a hospital setting, which is unfortunately often what's expected," Lehtmets explained.

"Police or ambulance services bring them to the emergency department or to the psychiatric clinic intake, and then there is an expectation that we will admit them for an extended period. Once they sober up and regain their senses, they go home peacefully. But we simply do not have the resources for that," he said.

Dr. Lehtmets emphasized that the psychiatric emergency department accepts and admits patients requiring special care, such as if they are in a psychotic state, including delirium, or experiencing serious suicidal thoughts.

Many addicts not interested in treatment or help

It is a waste of resources for psychiatrists to assess intoxicated people, Dr. Paadik believes.

"Considering the current shortage of doctors and the high workload, this is clearly a waste of a specialist's time. We talk about people not getting enough access to doctors, and yet we are using specialists around the clock for tasks that do not require medical expertise."

Paadik also commented on a recent controversial article by East Tallinn Central Hospital physician Toivo Tänavsuu, who wrote that alcoholics overburden emergency department staff.

She acknowledged that addiction develops over a long process and that the issues involved are never black-and-white.

"At any point in our work, we might encounter a patient at a different stage of that process. I think what Toivo Tänavsuu said reflected a physician's perspective, specifically that of an ER doctor, based on what he deals with. It expressed a sense of helplessness in that situation. A family member sees it from their perspective, and a psychiatrist certainly has theirs. The fact remains: addiction treatment is voluntary, and many addicts are simply not interested in getting help or treatment," Paadik said.

If a person is motivated to treat their addiction, they can go to a separate addiction treatment department in Tartu, she emphasized. The doctor also noted that hospitalization there is not involuntary, meaning the person must seek help on their own initiative.

"Intoxication affects their behavior and thinking. After all, these are neurotoxic substances," the doctor explained. "So it is very difficult to assess whether there might also be another psychiatric condition present. The usual procedure is that if a person is severely intoxicated, we refer them to the sobering-up facility and ask them to return later if symptoms persist," said Paadik.

Both Dr. Lehtmets and Paadik acknowledged that the situation is extremely complex, but something must change. The most logical step would be to direct intoxicated patients straight to the emergency department, as other hospitals do. According to Lehtmets, however, this is currently restricted by law.

Paadik added that another option would be to make sobering-up facilities more medically competent so they could better assess the patient's condition and level of intoxication.

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