Adequacy in Drug Abuse Treatment and Care in Europe (ADAT)
Total Page:16
File Type:pdf, Size:1020Kb
Adequacy in Drug Abuse Treatment and Care in Europe (ADAT) Part II: Treatment and Sup- port Needs of Drug Addicts Country Reports and Assessment Procedures Lisa Guggenbühl, Ambros Uchtenhagen, Denise Paris A project of WHO European Office sponsored by the Swiss Federal Office of Public Health and the Euro- pean Commission Research Report from the Addiction Research Institute Zurich 2000 Editors: Ambros Uchtenhagen, Lisa Guggenbühl With collaboration of: Prof. Anders Bergmark, Stockholm; Prof. Wim van den Brink, Amsterdam; Dr. Maurizio Coletti, Rome; Prof. Jørgen Jepsen, Aarhus; Prof. Michael Krausz, Ham- burg; Dr. Jacek Moskalewicz, Warsaw; Ms. Monique Nieuwenhuijs, Amsterdam; Ms. Valeria Pomini, Ath- ens; Mr. Josef Radimecky, Prague; Mr Ulrich Simmel, Berne; Mr. Josep M. Suelves, Barcelona. Addiction Research Institute, Zurich December 2000 2 Content 1. Introduction _________________________________________6 2. Country Reports______________________________________9 2.1. The Czech Republic______________________________________________ 9 2.1.1. Current Developments in the Assessment of Needs and Services___________ 9 2.1.2. Study on Unmet Support and Treatment Needs in the City of Ústí nad Labem _ 11 2.2. Denmark ______________________________________________________ 14 2.2.1. Current Developments in the Area of Service Improvement and the Assessment of Needs ___________________________________________________ 14 2.2.2. Evaluating the Impact of State Grants on the Improvement in Services for Drug Abusers____________________________________________________ 16 2.2.3. Considering Adequacy in Treatment and Care ________________________ 19 2.3. Germany ______________________________________________________ 21 2.3.1. Analyses of Needs as a Precondition for Planning and Control_____________ 21 2.3.2. Studies on treatment-relevant questions ____________________________ 22 2.3.3. Quality assurance system of the pension funding institutions in addiction treatment ___________________________________________________ 23 2.3.4. Documentation Systems and Monitoring as Systematic Evaluation Documentation_______________________________________________ 25 2.4. Greece________________________________________________________ 33 2.4.1. Epidemiological studies_________________________________________ 33 2.4.2. Clients Studies_______________________________________________ 34 2.4.3. Studies focused on specific groups and issues________________________ 35 2.4.4. Clients and Staff Satisfaction _____________________________________ 37 2.5. Italy__________________________________________________________ 39 2.6. The Netherlands________________________________________________ 40 2.6.1. Dutch Registration Systems______________________________________ 40 2.6.2. Studies on qualitative support and treatment needs ____________________ 42 2.6.3. Studies on Size and Needs of the Hidden Population___________________ 43 2.6.4. Quality Management___________________________________________ 44 2.7. Poland________________________________________________________ 47 2.7.1. Studies on qualitative support and treatment needs ____________________ 47 2.7.2. Studies on Hidden Populations___________________________________ 48 2.7.3. Comprehensive Adequacy Assessment through Experts ________________ 49 3 2.8. Spain _________________________________________________________ 52 2.8.1. Focusing on Health Needs of Opiate Users___________________________ 52 2.8.2. Unmet needs of high-risk drug users and "new" patterns of use____________ 53 2.8.3. Empirical Studies on Health Needs_________________________________ 53 2.8.4. Studies on Size of the Hidden Population ___________________________ 57 2.9. Sweden_______________________________________________________ 59 2.9.1. The Swedish Perspective on the Needs of Drug Abusers ________________ 59 2.9.2. Reports on Aspects of Adequacy in the System of Treatment and Care ______ 60 2.10. Switzerland__________________________________________________ 63 2.10.1. Current Development Trends: Consumers, Substances, Forms of Consumption63 2.10.2. Statistics, Monitoring, Evaluations, Registration Procedures ______________ 64 2.10.3. Inclusion of the Needs of Different Client Groups ______________________ 68 2.10.4. Target Groups with Special Treatment Needs _________________________ 69 2.10.5. The Hidden Population_________________________________________ 71 2.10.6. Referral of Clients to Suitable Treatment Services______________________ 72 3. Summary and Discussion _____________________________75 3.1. Approaches in the Assessment of Met and Unmet Needs in Addiction Treatment and Care ____________________________________________ 76 3.1.1. Empirical investigation of the needs from the drug abusers perspective ______ 76 3.1.2. Empirical investigation of the needs of drug abusers based on epidemiological data _______________________________________________________ 77 3.1.3. Assessing the satisfaction of clients________________________________ 78 3.1.4. Comprehensive assessment of service adequacy______________________ 79 3.1.5. Inventory of treatment and care services offered_______________________ 80 3.1.6. Detection of new development trends ______________________________ 80 3.1.7. Assessing the needs of the hidden population________________________ 81 3.1.8. Needs of professionals, relatives of drug addicts, and local communities______ 82 3.2. Met and Unmet Needs of Drug Abusers ___________________________ 83 3.2.1. Needs of Drug Abusers_________________________________________ 83 3.2.2. Needs of Professionals and System Adequacy________________________ 86 3.2.3. Conclusion__________________________________________________ 87 4. Assessment Procedures and Instruments _________________88 4.1. Criteria for the classification of survey procedures _________________ 89 4.2. Needs-led service planning on the basis of epidemiological studies __ 90 4.2.1. Introduction _________________________________________________ 90 4 4.2.2. Assessing the prevalence of drug use in the general population ___________ 91 4.2.3. Estimation techniques__________________________________________ 93 4.2.4. Treatment monitoring and reporting systems _________________________ 97 4.2.5. Drug-related deaths and mortality of drug users_______________________ 102 4.2.6. Drug-related infectious diseases and other health problems _____________ 103 4.2.7. Systems for the detection of new trends____________________________ 105 4.3. Identification of unmet needs from the drug abusers’ perspective___ 112 4.3.1. Evaluation of client satisfaction___________________________________ 112 4.3.2. Inclusion of users’ and carers’ organisations in quality assurance and service planning___________________________________________________ 122 4.3.3. Needs-led treatment planning ___________________________________ 123 4.3.4. Identifying unmet needs within and outside the treatment system _________ 129 4.3.5. Needs of specific target groups __________________________________ 134 4.4. Needs of other customer groups ________________________________ 136 4.4.1. Exemplary list of possible customers of a therapeutic facility______________ 136 4.4.2. Needs of professionals ________________________________________ 137 4.4.3. Relatives of drug addicts _______________________________________ 141 4.4.4. Local communities ___________________________________________ 142 4.5. Survey and description of the service ___________________________ 143 4.5.1. Treatment Unit Form (TUF)______________________________________ 143 4.5.2. Monitoring Area and Phase Unit Description Form (MAP-unit) ____________ 144 4.5.3. Modular Instrument for the Description of Addiction Treatment (MIDES) _____ 145 4.6. Comparison of the service and need_____________________________ 147 4.6.1. Individually appropriate treatment and care of clients ___________________ 147 4.6.2. Adequacy of facilities’ services for the needs of identified target groups_____ 148 4.6.3. Adequacy of services for needs at the level of entire treatment regions _____ 149 4.6.3.2. Checklist for recommended services for the treatment and care of substance abusers ______________________________________ 151 4.6.3.3. Interviewing experts on their assessment of the adequacy in meeting needs _________________________________________ 154 References_________________________________________________________ 157 Annex _____________________________________________________________ 158 Annex I: Results of a survey on needs and investments in drug abuse treament and care in Denmark _____________________________________ 163 Annex II: Questionnaire to Danish Counties (Social Welfare Section) on Social Assistance Offers in the drug abuse field ______________________ 164 5 1. Introduction There is adequate professional treatment and care of drug abusers if, amongst other things, the services - both individual and the entire care system as a whole - best meet the needs of the service recipients. As service recipients of the care system in the broader sense we mean in par- ticular the drug abusers themselves, and indeed regardless as to whether they are currently making use of the services offered. However, people close to drug abusers, specialists working in addiction care, allocators, as well as the neigh- bourhood of treatment and care facilities, are also in the broader sense clientele of the addiction care system. In order to be able to determine and assess the adequacy of treatment modali- ties, establishments and care systems as defined above, it is necessary to specify what we mean