WORK PACKAGE WORK PACKAGE TREATMENT CHALLENGESTREATMENT CHALLENGES

Dr.Thomas LeglDr.Thomas Legl Member of Executive Committee EURO –TC Director Member of Executive Committee EURO –TC Director Kur- und Gesundheitszentrum Knappenhof/AustriaKur- und Gesundheitszentrum Knappenhof/AustriaICAA,, Vienna NGO Committe on Narcotic DrugsICAA,, Vienna NGO Committe on Narcotic Drugs

DEMOCRACY CITIES AND DRUGS II

Kick-off Seminar

Paris, 20-21 June 2008

OBJECTIVESOBJECTIVES

To identify actual challenges in treatment To identify actual challenges in treatment To find responses to local specifities and To find responses to local specifities and

actual consumption patternsactual consumption patterns To develop best strategy for the local city To develop best strategy for the local city

levellevel To promote exchange to other To promote exchange to other

stakeholdersstakeholders To make treatment easier accessible and To make treatment easier accessible and

more attractive to the persons in need more attractive to the persons in need

PLATFORM LEADER - EURO-TCPLATFORM LEADER - EURO-TC

Network of addiction treatment centersNetwork of addiction treatment centers Covers 9 european countriesCovers 9 european countries Special promotion of: Special promotion of:

Flexible therapeutic programmes fitting the Flexible therapeutic programmes fitting the patients needspatients needs

Integrated treatment programmes for special Integrated treatment programmes for special target groupstarget groups

Exchange on the scientific level as well as Exchange on the scientific level as well as on the level of clients activitieson the level of clients activities

WORK AGENDAWORK AGENDA

Implementation seminar Bucharest / Implementation seminar Bucharest / establishment of scientific group and work planestablishment of scientific group and work plan

Development of a questionnaire to evaluate a Development of a questionnaire to evaluate a status quostatus quo

Analyze the questionnaire Analyze the questionnaire 2 workshops organized by the scientific group2 workshops organized by the scientific group 5 refinement meetings 5 refinement meetings Development of guidelinesDevelopment of guidelines

BACKGROUND/GENERAL BACKGROUND/GENERAL GUIDELINES WITHIN THE EUGUIDELINES WITHIN THE EU

Integrative ApproachIntegrative Approach Different Problems – Different StrategiesDifferent Problems – Different Strategies Punishment for Trafficking & Treatment Punishment for Trafficking & Treatment

for Dependant Persons for Dependant Persons Counseling ConsumersCounseling Consumers Decriminalization vs. LegalizationDecriminalization vs. Legalization

SITUATIONSITUATION

Rapid Development of Substitution Rapid Development of Substitution ProgrammesProgrammes

Traditional Abstinent Treatment / Need for Traditional Abstinent Treatment / Need for flexible interventionsflexible interventions

Co-Morbidity - Flow PatternCo-Morbidity - Flow Pattern

Psychiatric Hospital

OutpatientFacility

TCSubstitutionProgramme

High Co-Morbitity Low Co-Morbitity

High Co-Morbitity

Low Co-Morbitity

SUBSTIUTION TREATMENTSUBSTIUTION TREATMENT Italy 27-29%Italy 27-29% Spain 41-86%Spain 41-86% 90% Methadone – 300.000 Methadone patients 90% Methadone – 300.000 Methadone patients

in Europein Europe

BEST PRACTICEBEST PRACTICE Long term basis and effective dosageLong term basis and effective dosage Psychosocial treatmentPsychosocial treatment Excellent experience in combination with Excellent experience in combination with

residential treatment residential treatment

Substitution drugsSubstitution drugs

Very different legal situation within European Very different legal situation within European countriescountries

Methadone – BuprenorphineMethadone – Buprenorphine

Heroine maintenance – “perfect Heroine maintenance – “perfect administration”administration”

Matching treatment towards clients needs Matching treatment towards clients needs special target groups / Vienna experiencespecial target groups / Vienna experience

MATCHING TREATMENT TO THE PATIENTS MATCHING TREATMENT TO THE PATIENTS NEEDSNEEDS

SPECIAL PROGRAMMESSPECIAL PROGRAMMES

Parents and ChildrenParents and Children

Dual DiagnosisDual Diagnosis

AdolescentsAdolescents

Gender Oriented TreatmentGender Oriented Treatment

Ethnic ApproachEthnic Approach

Geriatric CommunitiesGeriatric Communities

CHANGE IN CONSUMPTION CHANGE IN CONSUMPTION PATTERNSPATTERNS

WHAT IST THE ANSWER TO WHAT IST THE ANSWER TO

Increasing consumption of cocaineIncreasing consumption of cocaine Increasing consumption of Increasing consumption of

methamphetaminesmethamphetamines Parallel -consumption of alcohol and Parallel -consumption of alcohol and

stimulants in substitution programsstimulants in substitution programs

NECESSITIESNECESSITIES

Different settings for different types Different settings for different types

Anonymity essentialAnonymity essential

Time factor needs focusing on behavioral Time factor needs focusing on behavioral aspectsaspects

CHALLENGESCHALLENGES

ADAPTING TREATMENT TO PATIENTS ADAPTING TREATMENT TO PATIENTS NEEDSNEEDS

Needs emerge during therapy Needs emerge during therapy

Matching needs as they emergeMatching needs as they emerge

Treatment not limited to a single inpatient Treatment not limited to a single inpatient intervention intervention very clear for non-addiction very clear for non-addiction diagnosesdiagnoses

Making treatment attractiveMaking treatment attractive

THANK YOU THANK YOU FOR YOUR FOR YOUR ATTENTIONATTENTION