Transcript Best Practice in Treatment of Dependencies - euro-tc

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:
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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
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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
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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
flexible interventions
Treatment / Need for
Co-Morbidity - Flow Pattern
Psychiatric
Hospital
Outpatient
Facility
High Co-Morbitity
Low Co-Morbitity
TC
High Co-Morbitity
Substitution
Low Co-Morbitity Programme
SUBSTIUTION TREATMENT
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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
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Very different legal situation within European
countries
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Methadone – Buprenorphine
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Heroine maintenance – “perfect
administration”
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Matching treatment towards clients needs
special target groups / Vienna experience
MATCHING TREATMENT TO THE PATIENTS
NEEDS
SPECIAL PROGRAMMES
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Parents and Children
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Dual Diagnosis
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Adolescents
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Gender Oriented Treatment
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Ethnic Approach
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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
 Time
essential
factor needs focusing on behavioral
aspects
CHALLENGES
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ADAPTING TREATMENT TO PATIENTS
NEEDS
 Needs emerge during therapy
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Matching needs as they emerge
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Treatment not limited to a single inpatient
intervention very clear for non-addiction
diagnoses
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Making treatment attractive
The cities‘ individual challenges:
1. Liège
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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
THANK YOU
FOR YOUR
ATTENTION