WORK PACKAGE TREATMENT CHALLENGES

WORK PACKAGE WORK PACKAGE TREATMENT CHALLENGESTREATMENT CHALLENGES

Dr.Thomas LeglDr.Thomas Legl Member of Executive Committee EURO –TC Director Member of Executive Committee EURO –TC Director Kur- und Gesundheitszentrum Knappenhof/AustriaKur- und Gesundheitszentrum Knappenhof/AustriaICAA,, Vienna NGO Committe on Narcotic DrugsICAA,, Vienna NGO Committe on Narcotic Drugs

DEMOCRACY CITIES AND DRUGS II

Implementation Seminar

Bucharest, 22-23 January 2009

OBJECTIVESOBJECTIVES To identify actual challenges in treatment To identify actual challenges in treatment To find responses to local specifities and To find responses to local specifities and

actual consumption patternsactual consumption patterns To develop best strategy for the local city To develop best strategy for the local city

levellevel To promote exchange to other To promote exchange to other

stakeholdersstakeholders To make treatment easier accessible and To make treatment easier accessible and

more attractive to the persons in need more attractive to the persons in need

PLATFORM LEADER - EURO-TCPLATFORM LEADER - EURO-TC

Network of addiction treatment centersNetwork of addiction treatment centers Covers 9 european countriesCovers 9 european countries Special promotion of: Special promotion of:

Flexible therapeutic programmes fitting the Flexible therapeutic programmes fitting the patients needspatients needs

Integrated treatment programmes for special Integrated treatment programmes for special target groupstarget groups

Exchange on the scientific level as well as Exchange on the scientific level as well as on the level of clients activitieson the level of clients activities

WORK AGENDAWORK AGENDA Implementation seminar Bucharest / Implementation seminar Bucharest /

establishment of scientific group and work planestablishment of scientific group and work plan Development of a questionnaire to evaluate a Development of a questionnaire to evaluate a

status quostatus quo Analyze the questionnaire Analyze the questionnaire 2 workshops organized by the scientific group2 workshops organized by the scientific group 5 refinement meetings 5 refinement meetings Development of guidelinesDevelopment of guidelines

BACKGROUND/GENERAL BACKGROUND/GENERAL GUIDELINES WITHIN THE EUGUIDELINES WITHIN THE EU

Integrative ApproachIntegrative Approach Different Problems – Different StrategiesDifferent Problems – Different Strategies Punishment for Trafficking & Treatment Punishment for Trafficking & Treatment

for Dependant Persons for Dependant Persons Counseling ConsumersCounseling Consumers Decriminalization vs. LegalizationDecriminalization vs. Legalization

SITUATIONSITUATION

Rapid Development of Substitution Rapid Development of Substitution ProgrammesProgrammes

Traditional Abstinent Treatment / Need for Traditional Abstinent Treatment / Need for flexible interventionsflexible interventions

Co-Morbidity - Flow PatternCo-Morbidity - Flow Pattern

Psychiatric Hospital

OutpatientFacility

TCSubstitutionProgramme

High Co-Morbitity Low Co-Morbitity

High Co-Morbitity

Low Co-Morbitity

SUBSTIUTION TREATMENTSUBSTIUTION TREATMENT Italy 27-29%Italy 27-29% Spain 41-86%Spain 41-86% 90% Methadone – 300.000 Methadone patients 90% Methadone – 300.000 Methadone patients

in Europein Europe

BEST PRACTICEBEST PRACTICE Long term basis and effective dosageLong term basis and effective dosage Psychosocial treatmentPsychosocial treatment Excellent experience in combination with Excellent experience in combination with

residential treatment residential treatment

Substitution drugsSubstitution drugs Very different legal situation within European Very different legal situation within European

countriescountries

Methadone – BuprenorphineMethadone – Buprenorphine

Heroine maintenance – “perfect Heroine maintenance – “perfect administration”administration”

Matching treatment towards clients needs Matching treatment towards clients needs special target groups / Vienna experiencespecial target groups / Vienna experience

MATCHING TREATMENT TO THE PATIENTS MATCHING TREATMENT TO THE PATIENTS NEEDSNEEDS

SPECIAL PROGRAMMESSPECIAL PROGRAMMES Parents and ChildrenParents and Children Dual DiagnosisDual Diagnosis AdolescentsAdolescents Gender Oriented TreatmentGender Oriented Treatment Ethnic ApproachEthnic Approach Geriatric CommunitiesGeriatric Communities

CHANGE IN CONSUMPTION CHANGE IN CONSUMPTION PATTERNSPATTERNS

WHAT IST THE ANSWER TO WHAT IST THE ANSWER TO

Increasing consumption of cocaineIncreasing consumption of cocaine Increasing consumption of Increasing consumption of

methamphetaminesmethamphetamines Parallel -consumption of alcohol and Parallel -consumption of alcohol and

stimulants in substitution programsstimulants in substitution programs

NECESSITIESNECESSITIES

Different settings for different types Different settings for different types

Anonymity essentialAnonymity essential

Time factor needs focusing on behavioral Time factor needs focusing on behavioral aspectsaspects

CHALLENGESCHALLENGES ADAPTING TREATMENT TO PATIENTS ADAPTING TREATMENT TO PATIENTS

NEEDSNEEDS Needs emerge during therapy Needs emerge during therapy

Matching needs as they emergeMatching needs as they emerge

Treatment not limited to a single inpatient Treatment not limited to a single inpatient intervention intervention very clear for non-addiction very clear for non-addiction diagnosesdiagnoses

Making treatment attractiveMaking treatment attractive

The cities‘ individual challenges: The cities‘ individual challenges: 1. Liège1. Liège

Main Topics:Main Topics:▪ ▪ Cocaine treatmentCocaine treatment▪ ▪ Long-term treatmentLong-term treatment Challenges / needs to be done:Challenges / needs to be done:▪ ▪ Implementation of heroin assisted treatmentImplementation of heroin assisted treatment▪ ▪ adequate residential treatment and aftercareadequate residential treatment and aftercare▪ ▪ implementation of a consumption placeimplementation of a consumption place▪ ▪ increase cooperation to reorganisationincrease cooperation to reorganisation

2. Vienna2. Vienna

Main topicsMain topics::▪ ▪ treatment of addicted pregnant women & treatment of addicted pregnant women &

young mothersyoung mothers▪ ▪ treatment of children with a familial treatment of children with a familial

addiction backgroundaddiction background▪ ▪ treatment of older people, as well as other treatment of older people, as well as other

people dependent on other‘s helppeople dependent on other‘s help

ViennaVienna

Challenges / needs to be doneChallenges / needs to be done::▪ ▪ implementation of case managementimplementation of case management▪ ▪ work for a higher tolerance within the populationwork for a higher tolerance within the population▪ ▪ Addicts in and after treatment need an ordered Addicts in and after treatment need an ordered

day structureday structure▪ ▪ especially young people need a more positive especially young people need a more positive

prospect, unemployment situation should be prospect, unemployment situation should be discussed in treatment and prevention discussed in treatment and prevention programmesprogrammes

3. Leipzig3. Leipzig

Main topicsMain topics::▪ ▪ development of appropriate activities and development of appropriate activities and

preoccupation for work as well as leisurepreoccupation for work as well as leisure▪ ▪ improvement of an easier/better access to improvement of an easier/better access to

target groupstarget groups▪ ▪ early intervention in somatic treatment early intervention in somatic treatment

facilitiesfacilities

LeipzigLeipzig

Challenges / needs to be done:Challenges / needs to be done:▪ ▪ provide sufficient psycho-social support for provide sufficient psycho-social support for

addicts on substitutesaddicts on substitutes▪ ▪ prevent premature prescription of prevent premature prescription of

medication which delay an early treatment medication which delay an early treatment of addictionof addiction

▪ ▪ intensify work focused on women and intensify work focused on women and familiesfamilies

4. Central Bohemia Region (Czech 4. Central Bohemia Region (Czech Rep.)Rep.)

Main TopicsMain Topics: : ▪ ▪ high percentage of very young drug usershigh percentage of very young drug users▪ ▪ higher drug use with Roma people and higher drug use with Roma people and

other ethnic minoritiesother ethnic minorities▪ ▪ too few substitution treatment programmes too few substitution treatment programmes

offered by the townsoffered by the towns

Central Bohemia RegionCentral Bohemia Region

Challenges / needs to be doneChallenges / needs to be done::▪ ▪ provide more staff specialised/trained in issues of provide more staff specialised/trained in issues of

drug treatment/therapydrug treatment/therapy▪ ▪ provide short- and middle-term treatment, as well provide short- and middle-term treatment, as well

as sufficient aftercareas sufficient aftercare▪ ▪ increase interest of politicians and raise financial increase interest of politicians and raise financial

contributionscontributions▪ ▪ set up a network of regional NGO‘s dealing with set up a network of regional NGO‘s dealing with

these issuesthese issues

THANK YOU THANK YOU FOR YOUR FOR YOUR ATTENTIONATTENTION