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This document outlines the objectives and discussions from the implementation seminar held in Bucharest on January 22-23, 2009, addressing the current challenges in addiction treatment across Europe. Focused on local specifications and consumption patterns, the seminar aimed to develop strategies for effective urban treatment programs and promote collaboration among stakeholders. Key topics included the adaptation of treatment to emerging patient needs, the promotion of diverse therapeutic approaches, and the importance of addressing specific demographic challenges in cities like Vienna, Leipzig, and Central Bohemia.
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WORK PACKAGE TREATMENT CHALLENGES Dr.Thomas Legl Member of Executive Committee EURO –TC Director Kur- und Gesundheitszentrum Knappenhof/Austria ICAA,, Vienna NGO Committe on Narcotic Drugs DEMOCRACY CITIES AND DRUGS II Implementation Seminar Bucharest, 22-23 January 2009
OBJECTIVES • To identify actual challenges in treatment • To find responses to local specifities and actual consumption patterns • To develop best strategy for the local city level • To promote exchange to other stakeholders • To make treatment easier accessible and more attractive to the persons in need
PLATFORM LEADER - EURO-TC • Network of addiction treatment centers • Covers 9 european countries • Special promotion of: • Flexible therapeutic programmes fitting the patients needs • Integrated treatment programmes for special target groups • Exchange on the scientific level as well as on the level of clients activities
WORK AGENDA • Implementation seminar Bucharest / establishment of scientific group and work plan • Development of a questionnaire to evaluate a status quo • Analyze the questionnaire • 2 workshops organized by the scientific group • 5 refinement meetings • Development of guidelines
BACKGROUND/GENERAL GUIDELINES WITHIN THE EU • Integrative Approach • Different Problems – Different Strategies • Punishment for Trafficking & Treatment for Dependant Persons • Counseling Consumers • Decriminalization vs. Legalization
SITUATION • Rapid Development of Substitution Programmes • Traditional Abstinent Treatment / Need for flexible interventions
Co-Morbidity - Flow Pattern Outpatient Facility Psychiatric Hospital High Co-Morbitity Low Co-Morbitity TC High Co-Morbitity Substitution Programme Low Co-Morbitity
SUBSTIUTION TREATMENT • Italy 27-29% • Spain 41-86% • 90% Methadone – 300.000 Methadone patients in Europe BEST PRACTICE • Long term basis and effective dosage • Psychosocial treatment • Excellent experience in combination with residential treatment
Substitution drugs • Very different legal situation within European countries • Methadone – Buprenorphine • Heroine maintenance – “perfect administration” • Matching treatment towards clients needs special target groups / Vienna experience
MATCHING TREATMENT TO THE PATIENTS NEEDS SPECIAL PROGRAMMES • Parents and Children • Dual Diagnosis • Adolescents • Gender Oriented Treatment • Ethnic Approach • Geriatric Communities
CHANGE IN CONSUMPTION PATTERNS WHAT IST THE ANSWER TO • Increasing consumption of cocaine • Increasing consumption of methamphetamines • Parallel -consumption of alcohol and stimulants in substitution programs
NECESSITIES • Different settings for different types • Anonymity essential • Time factor needs focusing on behavioral aspects
CHALLENGES • ADAPTING TREATMENT TO PATIENTS NEEDS • Needs emerge during therapy • Matching needs as they emerge • Treatment not limited to a single inpatient intervention very clear for non-addiction diagnoses • Making treatment attractive
The cities‘ individual challenges: 1. Liège • Main Topics: ▪ Cocaine treatment ▪ Long-term treatment • Challenges / needs to be done: ▪ Implementation of heroin assisted treatment ▪ adequate residential treatment and aftercare ▪ implementation of a consumption place ▪ increase cooperation to reorganisation
2. Vienna • Main topics: ▪ treatment of addicted pregnant women & young mothers ▪ treatment of children with a familial addiction background ▪ treatment of older people, as well as other people dependent on other‘s help
Vienna • Challenges / needs to be done: ▪ implementation of case management ▪ work for a higher tolerance within the population ▪ Addicts in and after treatment need an ordered day structure ▪ especially young people need a more positive prospect, unemployment situation should be discussed in treatment and prevention programmes
3. Leipzig • Main topics: ▪ development of appropriate activities and preoccupation for work as well as leisure ▪ improvement of an easier/better access to target groups ▪ early intervention in somatic treatment facilities
Leipzig • Challenges / needs to be done: ▪ provide sufficient psycho-social support for addicts on substitutes ▪ prevent premature prescription of medication which delay an early treatment of addiction ▪ intensify work focused on women and families
4. Central Bohemia Region (Czech Rep.) • Main Topics: ▪ high percentage of very young drug users ▪ higher drug use with Roma people and other ethnic minorities ▪ too few substitution treatment programmes offered by the towns
Central Bohemia Region • Challenges / needs to be done: ▪ provide more staff specialised/trained in issues of drug treatment/therapy ▪ provide short- and middle-term treatment, as well as sufficient aftercare ▪ increase interest of politicians and raise financial contributions ▪ set up a network of regional NGO‘s dealing with these issues
