Transcript Geen diatitel

Stichting Informatievoorziening Zorg - Randhoeve 231 - Postbus 504 - 3990 GH Houten
TDI meeting Lisbon 23rd and 24th of
June 2003
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Treatment Demand Indicator
Working group
on Cannabisprofile
Treatment Demand Indicator

Purpose of the working group:
Propose some recommendations to the
National Focal Points and the treatment
demand experts.
 Identify perspectives of work for the short
period on analysis with treatment demand data,
starting from cannabis.
 Develop a model for a profile analyses.

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June 2003
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Treatment Demand Indicator

Some facts in the EU on cannabis:
There is a relevant group of clients asking
treatment for cannabis as primary drug in the
European countries
 Characteristics of this group seem to be quite
similar across countries; this is different from
other substances used
 The cannabis clients are reported to be very
young

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June 2003
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Treatment Demand Indicator

Some facts in the EU on cannabis:
Gender differences seem to be much lower
for the cannabis clients than other groups
 A substantial part of the clients reports to use
cannabis intensively
 The most reported combinations are with
alcohol and/or stimulants.

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Treatment Demand Indicator

Recommendations to the National Focal
Points for the 2003 National Report,
selected issue on “problematic” cannabis
use:
Select the population of clients using cannabis
as primary drug.
 Select among this group of cannabis users
people aged below 20 and people 20 years old
and above.

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Treatment Demand Indicator

Variables to start with:

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Gender
Source of referral
Living status
Labour status
Educational level
New/all
Frequency of use
Age at first use
Secondary drugs used in combination with cannabis
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Treatment Demand Indicator

These data can be extracted TDI database
New/All
 Frequency of use
 Age at first use
 Secondary drugs in combination
cannabis
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TDI meeting Lisbon 23rd and 24th of
June 2003
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a
a
a
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Treatment Demand Indicator

Variables to use and availability in Treatment
Demand Indicator-data`base but not
possible to produce by EMCDDA:
Gender
 Source of referral
 Living status
 Labour status
 Educational level

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b
b
b
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Treatment Demand Indicator

Give an interpretation providing:
context (i.e. legislation/policy)
 organisation of treatment system
 cultural background
 other information that could be useful to
better interpret data

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June 2003
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Treatment Demand Indicator

Two examples of a profile:
An example of a dummy profile of cannabis
clients based on available Treatment Demand
Indicator data
 An example of a filled in extended profile
based on Dutch data

TDI meeting Lisbon 23rd and 24th of
June 2003
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Treatment Demand Indicator

Profile example based on Treatment
Demand Indicator data only
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June 2003
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TDI: example of profile
Table 1 Demographic profile
Young single
Older single cannabis
cannabis users (<20 users (> 20 yrs.)
yrs.) (N=....)
(N=....)
Cannabis users
(with secondary drug)
(N=....)
gender (%)
male
female
age
mean age (sd.)
educational level
never went to school
primary
medium
higher
living status
alone
with child
other social context
marital status
not married
married
other
labour status
paid
not paid
other
TDI meeting Lisbon 23rd and 24th of
June 2003
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TDI: example of profile (cont.)
Table 2 Characteristics of cannabisclients
Young single
cannabis users (<20
yrs.) (N=....)
Older single cannabis
users (> 20 yrs.)
(N=....)
Cannabis users
(with secondary drug)
(N=....)
new clients (%)
source of
referral (%)
self-referral
healthcare
justice
other
secondary
problem (%)
alcohol
Harddrug
(heroin/cocaine)
gambling
other
none
frequency of
use (%)
occasionally
once a week or
less
2-6 times a
week
daily
(mean) age at
first use
TDI meeting Lisbon 23rd and 24th of
June 2003
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Treatment Demand Indicator

Example of a profile based on Treatment
Demand Indicator data and some additional
national data
TDI meeting Lisbon 23rd and 24th of
June 2003
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Treatment demand of cannabis
users in The Netherlands:
Which clients?
 Trends in treatment demand 1994 - 2001
 Crossectional comparison of different
subgroups
 Longitudinal patterns in treatment demand.

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Selection: different types of
clients

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
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In LADIS primary, secondary and tertiary drugs is
registered.
In our profile we developed an additional
classification: single and multiple cannabis client.
Single = only cannabis is registered and no other
drug or behaviour (i.e. gambling).
Multiple = cannabisproblem (be it primary or
secondary) in combination with other drug /
behaviour is registered (i.e. alcohol or opiates).
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June 2003
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Cannabis: outpatient treatment
demand 1994 - 2001
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Single cannabis users 1994 - 2001
(1994 = 100)
250
200
150
single cannabis user (1994=100)
single cannabis user young (< 20 yrs.)
(1994=100)
single cannabis user old (>= 20 yrs.)
(1994=100)
100
50
0
1994
1995
1996
1997
1998
1999
2000
2001
year
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meeting Lisbon 23rd and 24th of
June 2003
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Multiple cannabis users 1994 - 2001
(1994 = 100)
180
160
140
120
100
%
multiple cannabis user
multiple cannabis user (+alcohol)
80
multiple cannabis user (+opiates)
60
40
20
0
1994
1995
1996
1997
1998
1999
2000
years
TDI meeting
Lisbon 23rd and 24th of
June 2003
2001
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% of cannabis clients of the total # of
outpatient clients in LADIS 1994 - 2001
60%
50%
%
40%
% cannabisclients
% young cannabisclients(<20 yrs.)
30%
20%
10%
0%
1994
1995
1996
1997
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year
June 2003
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% of cannabis clients of the total # of
outpatient clients in LADIS according to type
of use (1994-2001)
16%
14%
12%
10%
%
% cannabisclients
8%
% single cannabisusers
% multiple cannabisusers
6%
4%
2%
0%
1994
1995
1996
1997
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1998
1999 23rd
2000
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meeting
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June 2003
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Mapping of geographical patterns in treatment
demand of cannabis clients: relative growth
(10,000 inh.)
1994
2001
Clients
per 10.000 inhabitants
> 4 clients
(3)
2 - 4 clients (39)
< 2 clients (462)
Clients
per 10.000 inhabitants
TDI meeting Lisbon 23rd and 24th
June 2003
> 4 clients
(12)
2 - 4 clients
(90)
of< 2 clients (402)
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Table 1
Characteristics of cannabisclients according to type of use
Single Single (< 20 Single
Multiple Multiple Multiple +
tot.
yrs.) (>= 20
tot. +alcohol
opiates
yrs.)
64%
76%
62%
68%
66%
70%
% in treatment in 2001
(> 1 contact)
% female
18%
18%
18%
15%
15%
15%
mean age
26,6
16,9
28,8
31,3
32,6
31,2
9%
20%
24%
19%
1%
6%
20%
22%
48%
1%
7%
21%
23%
45%
1%
9%
21%
22%
45%
2%
6%
20%
23%
46%
% > 40 years
7%
Size of municipality (%)
<10.000 inhabitants
10.000 - 20.000 inhabitants
20.000 - 50.000 inhabitants
50.000 - 100.000 inhabitants
> 100.000 inhabitants
2%
7%
21%
22%
45%
3%
13%
28%
25%
31%
(source: LADIS data 2001)
TDI meeting Lisbon 23rd and 24th of
June 2003
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Table 1 (cont.)
Characteristics of cannabisclients according to type of use
Single
tot.
Single (< 20 Single
yrs.) (>= 20
yrs.)
Multiple
Multiple
tot. +alcohol
Multiple +
opiates
Referral
Client him/herself
Family / Network of client
Drug treatment centre
Criminal Justice / Probation
Healthcare
45%
6%
15%
11%
11%
38%
20%
5%
11%
9%
46%
3%
17%
11%
11%
47%
4%
12%
19%
9%
43%
3%
12%
19%
11%
50%
5%
12%
20%
7%
Living Status
alone
with parents
with children
42%
26%
10%
10%
69%
1%
48%
17%
13%
47%
21%
13%
52%
15%
17%
45%
24%
12%
Educational level
not completed
primary
secondary
higher
12%
40%
41%
5%
26%
49%
23%
1%
9%
38%
46%
6%
12%
50%
32%
4%
10%
44%
36%
8%
13%
55%
30%
2%
Labour status
Regular employment
economically inactive
unemployed
48%
22%
35%
34%
76%
11%
49%
13%
39%
38%
13%
50%
41%
11%
48%
35%
14%
53%
Ethnic background
dutch
western hemisphere
allochtoon
85%
3%
12%
84%
6%
10%
85%
2%
13%
79%
5%
16%
82%
5%
13%
77%
6%
18%
76%
11%
3%
7%
72%
13%
3%
9%
Frequency of use
daily
2-6 times a week
once a week
occasional
(source: LADIS data 2001)
78%
9%
TDI
2%
5%
60%
81%
17%
8%
meeting3%
Lisbon 23rd
1%
June 2003
13%
3%
72%
and12%
24th
3%
9%
of
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Age in categories of single and multiple
cannabis users (LADIS data 2001)
50%
45%
40%
35%
%
30%
single cannabis user
25%
multiple cannabis user
20%
15%
10%
5%
0%
15-19 yrs.
age category
20-29 yrs.
30-39 yrs.
TDI meeting Lisbon 23rd and 24th of
June 2003
40 yrs. or older
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Social situation of cannabis clients
(LADIS data 2001)
80%
70%
60%
50%
%
alone
40%
with parents
30%
with children
20%
10%
0%
single cannabis user
multiple cannabis single cannabis user single cannabis user multiple cannabis
user
young (< 20 yrs.)
old (=> 20 yrs.)
user (+ alcohol)
of client
TDI meetingtype
Lisbon
23rd and 24th of
June 2003
multiple cannabis
user (+ opiates)
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Ethnic background of three groups of
cannabis clients (LADIS data 2001)
90%
80%
70%
60%
50%
%
% dutch
% western world
% allochtoneus
40%
30%
20%
10%
0%
single cannabis user multiple cannabis single cannabis user single cannabis user multiple cannabis
user
youngmeeting
(< 20 yrs.) Lisbon
old (=>23rd
20 yrs.)
user (+of
alcohol)
TDI
and 24th
type of cannabis
client
June 2003
multiple cannabis
user (+ opiates)
28
70%
Type of professional help for various
categories of cannabis clients
(LADIS data 2001)
60%
50%
social worker
psychologist
40%
%
psychiatrist
medical doctor
30%
nurse
psychiatric nurse
20%
other
10%
0%
single cannabis multiple
single cannabissingle cannabis multiple
multiple
user
cannabis user user young (<user old (=> 20
cannabis user cannabis
(+
user (+
20 yrs.)TDI meeting
yrs.)
alcohol)
opiates)
Lisbon 23rd and 24th of
type of cannabisclient
June 2003
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Time in treatment and mean # of contacts
per month of different type of cannabis
clients (LADIS data 2001)
2,5
350
300
250
1,5
200
mean # days
in treatment
mean # of contacts
2
150
1
100
0,5
mean # contacts / month
50
mean # days in treatment
0
0
single cannabis multiple single cannabissingle cannabis multiple
multiple
user
cannabis user user young (<user old (=> 20cannabis user cannabis user
20 yrs.)
yrs.) Lisbon
(+ alcohol)
opiates)
TDI meeting
23rd and(+24th
of
type of cannabis client
June 2003
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Cumulative and annual returnrate of
different types of cannabis clients discharged
in 1994
60%
50%
%
40%
single + multiple users
young single users
multiple users
30%
20%
10%
0%
TDI meeting Lisbon 23rd and 24th of
June 2003
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Primary problem on readmission (in the
period ‘94-’03) of young single and multiple
use cannabis clients discharged in 1994
50%
45%
40%
35%
%
30%
young single users
multiple users
25%
20%
15%
10%
5%
0%
% alcohol
% opiates
% cocain
% cannabis
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Juneproblem
2003
% other
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Conclusions



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If broken down according to age (<-> 20 yrs.) or/and
multiple or single use meaningful data can be presented.
The total treatment demand for cannabis is growing: about
44% in the period 1994-2001.
The multiple cannabis client is the growth factor;
specifically the client co-using alcohol. Combined use of
cannabis seems to be the prevalent type of use.
The cannabis client is growing older as with other clients
groups.
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June 2003
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Conclusions (cont.)

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The young single cannabis client (< 20 yrs.) is a relatively
small group, but overrepresented under young clients
(55%).
Young single clients markedly differ on type of referral,
living situation, care pattern (i.e. intensity) and returnrate.
About 65% of the single young cannabis clients do not
return to outpatient treatment.
When young single users return, about half of them
applies for help for cannabis; about 20% returns to apply
for help for problems with cocain.
TDI meeting Lisbon 23rd and 24th of
June 2003
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LADIS clients profiles;
current developments


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Evolving to a fixed format with information on:
- trends
- longitudinal patterns (for example readmission)
- cross-sectional comparisons
Additional surveys (“quick scans”) are done to gather
contextual information about treatment programs.
Every outpatient drug treatment centre receives a
benchmark in which the data on the national profile is
compared to the profile of the service itself.
TDI meeting Lisbon 23rd and 24th of
June 2003
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