Transcript ICAA conference Estoril 2009 - Euro-TC

TREATMENT CHALLENGES
Dr.Thomas Legl
President EURO –TC
Director Kur- und Gesundheitszentrum
Knappenhof/Austria
Shaping the Future – A Multisectoral Challenge
52nd ICAA CONFERENCE
ESTORIL, October 11th-16th 2009
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
EVIDENCE BASED RESEARCH
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Level A: Consistent randomised controlled
clinical trial cohort study, clinical decision rule
validated in different populations.
 Level B: Consistent retrospective cohort,
exploratory cohort, ecological study, outcomes
research, case control study .
 Level C: Case series study .
 Level D: Expert opinion without explicit critical
appraisal, bench research or first principles
FINDINGS AND REALITIES
 Time
Factor most essential/cost cuttings
 Treatment to be ready available/reality of
long waiting lists
 No single treatment appropriate for
everyone /programmes predominately not
flexible
 Focus on multiple needs-co morbiditysocial factor/ come-go-come back” effect
 Continuous assessment/rare existence
Co-Morbidity - Flow Pattern
Psychiatric
Hospital
Outpatient
Facility
High Co-Morbitity
Low Co-Morbitity
Specialised
Residential
Treatment
High Co-Morbitity
Substitution
Low Co-Morbitity Programme
SUBSTIUTION TREATMENT
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Around 600 000 patients receive treatment in
Europe
 Predominant option for opiod users
 Methadone still most common with
Buprenorphine coming up
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
TYPES OF CONSUMERS
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DROP OUT TYPE – long term use and social
problems
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SENSITIVE TYPE – female, successful
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OBSESSIVE TYPE – male, frustrated with everyday
live
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SOCIALIZING TYPE – male, seeking social inclusion
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LIFESTYLE TYPE - fun oriented party consumer
Maik Just, Magdeburg 2006
IMPACT ON TREATMENT
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Traditional Treatment setting, oriented towards
opioid users only fits needs of small number of
persons from first user group
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Other types have no identification with treatment
system, detest counseling and treatment together
with opioid users mainly because of different social
situation
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As consequence often do not receive other
treatment than individual therapy with private
psychotherapists
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Evidence based treatment principles highly ignored
Evidence based intervention and
local necessities and strategies
2 –Democracy City and Drugs
/European Project
 Treatment challenges on local basis
 Necessity to develop common guidelines
on the European basis
 Gap between knowledge ,local necessities
and political realities
 High motivation for common solutions
 DCD
Liège
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Main Topics:
Increasing cocaine use
Increasing number of pregnant women using drugs
Illegal drug users do not use possibilities for treatment
Boarder region with high drug trafficking
Challenges / needs to be done:
Implementation of heroin assisted treatment
Adequate residential treatment and aftercare
Implementation of a consumption place
Increase cooperation to reorganisation
Vienna
 Main
topics:
▪ treatment of addicted pregnant women &
young mothers
▪ early treatment intervention of children with
addiction background in the family
▪ 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
▪ Provide addicted persons during and after
treatment (substitution) with a productive
structure
▪ Special feature on education and job promotion
for young persons
Solutions for growing unemployment rate with
early intervention system
3. Leipzig
 Main
topics:
▪ Appropriate structure and possibilities for
working activities as well as for leisure
time rarely exist during outpatient
treatment
▪ Insufficiant access to target groups
▪ Early intervention in general/somatic
treatment facilities
Leipzig
 Challenges
/ needs to be done:
▪ Provide sufficient psycho-social support for
addicts in substitution treatment
▪ Optimise prescribing regulations for
substitution drugs/train prescribers
▪ intensify work focused on women and
families
4. Central Bohemia Region (Czech
Rep.)
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Main Topics:
▪ High percentage of very young drug users
▪ Ethnic dimension-high prevalence of drug use in
Roma community and other ethnic minorities
▪ Inadequate substitution treatment programmes
offered by the towns-not practicable regulations
(3 doctors cover population of 3000 adicts)
High prevalence of pregnant drug using women
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
Stuttgart
 Main
Topics:
 Not enough cooperation with primary
health care
 A rather well-working system for outpatient
treatmet, but long waiting times
 Many alcoholics can not be reached;
substitution programs are missing their
point
Stuttgart
 Challenges
 Better
/ needs to be done:
Networking between
stakeholders
 Supporting early intervention, early
warning systems also in terms of cost
effectivness
TREATMENT MOTIVATION
 Addiction
treatment still has low
retention rate – negative
cost/outcome effects
 Client participation in
development of guidelines and
planning of strategies
 Unpleasant environment
ARE ISOLATED SETTINGS
FOR DRUG/ALCOHOL
ABUSERS
STILL APPROPRIATE?
NEW STRATEGIES
to Primary Care Sytem –
special education (general practicioners
and substitution)
 Common settings with other
psychosomatic diseases /focus from
symptom to wider perspective of
psychosocial status
 Attachment
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 extended to different interventions at
different times /relapse not failure
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Making treatment attractive
KUR UND GESUNDHEITSZENTRUM
KNAPPENHOF
THANK YOU FOR
YOUR ATTENTION