Transcript Scottish Drugs Forum Glasgow 30th June 2005 Residential Drug

Residential Drug Services –
Where do they fit on the
treatment map?
The situation in Switzerland
Nicolas Heller
Gilgamesch House
Basle, CH
Tel: 0041 79 291 32 03
e-mail: [email protected]
Comparison Switzerland Scotland
•
Area:
•
Population:
•
IDU:
(15-49 years old)
15,940 sq mi
78,782 sq mi
7,450,867
5,054,800
30,000
0,9%
50,000
?%
Language(s)
•
German 60%
• French 30%
• Italian
10%
• Romansh
Political divisions

26 cantons
(responsible for
health services)
 2,904 communes

26 “different” drug
policies
Switzerland's drug policy
•
1980s:



HIV-AIDS epidemic
“Open drug scenes”
Miserable state of drug addicts becomes
visible to everybody (public pressure to act)
 Needle
exchange programmes
 Hepatitis vaccinations
New approach: Harm reduction
•
1990s:
Fourfold approach (4 pillars):

1.
2.
3.
4.

Prevention
Law enforcement
Treatment
Harm reduction
300 projects/programs supported by 6,5
millions Pounds/year
Heroin assisted treatment HAT

Severely dependent heroin addicts, who had
failed at other treatment programmes, “treatment
non-responders”
•
Restricted clinical trials
•
Strict scientific evaluation
Begin 1994 – End 1996
Evaluation report (1997)

Increase of physical and/or psychic health
 Increase of quality of life (housing, work etc.)
 Decrease of illegal use of heroin/cocaine
 Decrease of prostitution and criminality
•
Economy benefits

Since 1999 HAT recognized type of therapy
Treatment

Objectives:
• Breaking drug addicts of their habit
• Social reintegration
• Better physical an mental health
-
2004:
1,280
14,588
486
51
medically prescribed heroin
medically prescribed methadone (1979: 728)
medically prescribed buprenorphin
medically prescribed morphin
Residential drug services
•
1999:
100 institutions – 1,750 spaces

Thunderclouds:
- Lower demand
- Standard Quality Management System
- 80% occupancy at least claimed

2005:
80 institutions – 1,000 spaces
Costs
•
Residential rehabilitation:
150 Pounds/day
Social welfare
•
Residential detoxification:
300 Pounds/day
Health insurance
•
Methadone programmes:
20 Pounds/day
Health insurance
•
Heroin assisted
treatment:
20 Pounds/day
Health insurance
o
Welfare outpatients:
+ 40 Pounds/day
Drug-abstinence
 Methadone
programme (2 years): 42,4%
 Abstinence
based therapy (1 year): 50%
Traditional residential services
Aims:
• withdrawal / abstinence / reintegration
Duration:
• short / medium / long
Interventions:
• clinical detoxification / psychosocial support /
counselling / group therapy / employability
training
Main treatment goal
Empowering to lead a life

1.
as independent as possible
2.
as satisfying as possible
•
•
for themselves
and their social environment
Combination of residential and
substitution benefits
•
2 residential rehabilitation services
specialized for addicts in methadone
programme and/or heroin assisted
therapy:
1.
House Gilgamesch, Basle (since 1995)
7-12 beds
Saurenhorn Community, Berne (since
1998) 10 beds
2.
Challenges
Concomitant cocaine and crack cocaine
consumption

•
Resulting relapses for substituted patients
Psychiatric co-morbidity

•
•
Flexible, made-to-measure setting
Training for the staff
Thank you