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Please note that the information on this page is based on the EMCDDA Annual report 2011: the state of the drugs problem in Europe. Most statistical data relate to the year 2009 (or the last year available).

 
 

Annual report 2011: the state of the drugs problem in Europe
Responding to drug problems — an overview

Published: 15 November 2011

Treatment

Psychosocial interventions, opioid substitution and detoxification are the main modalities used for the treatment of drug problems in Europe. The relative importance of the different treatment modalities in each country is influenced by several factors, including the organisation of the national health care system. Drug treatment services may be provided in a variety of settings: specialist treatment units, including outpatient and inpatient centres, mental health clinics and hospitals, units in prison, low-threshold agencies and office-based general practitioners.

There is no data set allowing a description of the full population of drug users currently undergoing drug treatment in Europe. However, information on an important subgroup of this population is gathered by the EMCDDA's treatment demand indicator, which collects data on those entering specialist drug treatment services during the calendar year, enabling insights into their characteristics and drug-use profiles (1). In 2009, the indicator registered about 460 000 treatment entrants, 38 % of whom (175 000) were reported to have entered drug treatment for the first time in their life.

Based on a range of different sources, including the treatment demand indicator, it can be estimated that at least 1.1 million people received treatment for illicit drug use in the European Union, Croatia, Turkey and Norway during 2009 (2). While more than half of these clients received opioid substitution treatment, a substantial number received other forms of treatment for problems related to opioids, stimulants, cannabis and other illicit drugs (3). This estimate of drug treatment in the European Union, though still in need of refinement, does suggest a considerable level of provision, at least for opioid users. This is the consequence of a major expansion during the last two decades of specialised outpatient services, with a significant involvement of primary health care, self-help groups, general mental health services, outreach- and low-threshold service providers.

Particularly in western Europe, there appears to be a gradual shift away from a view of drug treatment as the responsibility of a few specialist disciplines providing intensive, short-term interventions, towards a multidisciplinary, integrated and longer-term approach. In part, this is a response to increasing recognition of drug addiction as a chronic condition, with the progress of many clients marked by cycles of remission, relapse, repeated treatments and disability (Dennis and Scott, 2007), a view supported by data collected by the EMCDDA that show that over half of treatment entrants have had a previous treatment episode. Another factor is that western European countries are witnessing a significant ageing of their populations of drug users in treatment, primarily long-term problem users with previous treatment episodes and reporting multiple health and social problems (EMCDDA, 2010).

In response, some national and local drug strategies refer to a continuous care approach, emphasising coordination and integration of interventions between different drug treatment providers (e.g. discharge from residential to outpatient services) and between treatment and the broader spectrum of health and social services. Continuous care builds on regular monitoring of client status, early detection of potential problems, referral between health and social care services, and ongoing client support with no set timeframe. General practitioners can play a key role in this area. A recent French survey among service providers recognised the role of general practitioners in facilitating access to specialist care for opioid users, both for referral to hospitals to initiate methadone treatment and for continuation of treatment upon discharge. In another example, the Dutch government and local authorities of the country's four largest cities have adopted an integrated treatment approach within a broader social support strategy, involving a wide range of agencies.

Continuous care and integrated treatment responses may be aided by the establishment of care protocols, guidelines and management strategies between providers (Haggerty et al., 2003). A 2010 survey among national focal points found that 16 countries have partnership agreements between drug treatment agencies and social services. In six countries (France, Netherlands, Portugal, Romania, United Kingdom, Croatia), structured protocols are the most commonly used mechanisms for interagency coordination, while in the other countries, partnerships rely mainly on informal networks.

Outpatient treatment

In Europe, most drug treatment is provided in outpatient settings. Information is available on about 400 000 drug users entering specialist outpatient treatment during 2009. Half of the treatment entrants (51 %) report opioids, mainly heroin, as their primary drug, while 24 % report cannabis, 18 % cocaine and 4 % stimulants other than cocaine. The most common route to treatment is self-referral (37 %), followed by drug, social and health services (28 %), and referral by the criminal justice system (20 %). The remaining clients are referred through family, friends and informal networks (4).

Those entering outpatient treatment are by far the largest group of drug users for which it is possible to describe personal and social characteristics and drug use profiles. They are predominantly young men, with an average age of 32 years. Males outnumber females by almost four to one, which in part reflects the predominance of males among more problematic drug users. Among clients entering treatment, primary cannabis users are almost ten years younger (25) than primary users of cocaine (33) and opioids (34). On average, the youngest drug clients (25-26) are reported by Poland, Hungary and Slovakia - countries joining the EU since 2004 - and the oldest by Spain, Italy and the Netherlands (34)). Male to female ratios are high for all substances, although varying with drug and country. Gender ratios are generally higher in countries in the south of Europe and lower in countries in the north (5).

The two main modalities of outpatient treatment in Europe are psychosocial interventions and opioid substitution treatment. Psychosocial interventions include counselling, motivational interviewing, cognitive-behavioural therapy, case management, group and family therapy and relapse prevention. They are mostly provided, depending on the country, by public institutions or by non-governmental organisations. Psychosocial interventions offer support to users as they attempt to manage and overcome their drug problems, and they are the main form of treatment for users of stimulant drugs, such as cocaine and amphetamines. They are also provided for opioid users, often in combination with substitution treatment. According to a 2008 survey of national experts, most European countries report the availability of outpatient psychosocial treatment to those who seek it. While there is considerable variation across Europe, most countries reported average waiting times of less than a month.

Substitution treatment is the predominant treatment option for opioid users in Europe. It is generally provided in specialist outpatient settings, though in some countries it is also available in inpatient settings, and is increasingly provided in prisons (6). Also, office-based general practitioners, often in shared-care arrangements with specialist centres, increasingly play a role. Opioid substitution is available in all EU Member States, as well as Croatia and Norway. In Turkey, substitution treatment in the form of the combination buprenorphine-naloxone was introduced in 2010. Overall, it is estimated that there were about 700 000 substitution treatments in Europe in 2009 (see Chapter 6) (7).

Inpatient treatment

Data are available for about 44 000 drug users who have entered drug treatment in inpatient settings in Europe during 2009 (8). The primary drug reported by half of these clients were opioids (53 %), followed by cannabis (16 %), cocaine (8 %) and non-cocaine stimulants (12 %). Inpatient clients are mainly young men, with a mean age of 31 years and about three males to every female (9).

Inpatient or residential treatment requires clients to stay overnight for a duration of several weeks to several months. In many cases, these programmes aim to enable clients to abstain from drug use, and do not allow substitution treatment. Drug detoxification, a short-term, medically supervised intervention aimed at resolving the withdrawal symptoms associated with cessation of chronic drug use, is sometimes a prerequisite for starting long-term, abstinence-based inpatient treatment. Detoxification is usually provided as an inpatient intervention in hospitals, specialised treatment centres or residential facilities with medical or psychiatric wards.

In inpatient settings, clients receive accommodation and individually structured psychosocial treatments, and take part in activities geared towards rehabilitating and reintegrating them into society. A therapeutic community approach is often used in this context. Inpatient drug treatment is also provided by psychiatric hospitals, notably for clients with co-morbid psychiatric disorders.

According to a 2008 survey of national experts, most European countries report the availability of inpatient psychosocial treatment and detoxification services for those who seek it. Estimates of national waiting times for access to inpatient psychosocial treatment, provided by experts from 16 countries, vary across Europe. Average waiting times were reported to be less than one month in 14 countries, a few months in Hungary and 25 weeks in Norway.

Footnotes

(1) The treatment demand indicator received data for specialist drug treatment centres from 29 countries. Most countries provided data for more than 60 % of their units, though for some countries the proportion of units covered is unknown (see Table TDI-7 in the 2011 statistical bulletin).

(2) See Table HSR-10 in the 2011 statistical bulletin.

(3) More detailed information on specific types of treatment for the different substances, and their effectiveness, quality and evidence are available in the respective chapters.

(4) See Tables TDI-16 and TDI-19 in the 2011 statistical bulletin.

(5) See Tables TDI-9 (part iv), TDI-21 and TDI-103 in the 2011 statistical bulletin. For information on treatment clients according to primary substance, see the respective chapters.

(6) See 'Assistance to drug users in prison'.

(7) See Tables HSR-1, HSR-2 and HSR-3 in the 2011 statistical bulletin.

(8) This figure should be interpreted with caution as it does not include all users who temporarily enter inpatient care as part of a more complex treatment process.

(9) See Tables TDI-7, TDI-10, TDI-19 and TDI-21 in the 2011 statistical bulletin.

Bibliographic references

Dennis, M. and Scott, C.K. (2007), 'Managing addiction as a chronic condition', Addiction Science and Clinical Practice 4(1), pp. 45-55.

EMCDDA (2010), Treatment and care for older drug users, Selected issue, Publications Office of the European Union, Luxembourg.

Haggerty, J.L., Reid, R.J., Freeman, G.K., Starfield, B.H., Adair, C.E. and McKendry, R. (2003), 'Continuity of care: a multidisciplinary review', BMJ 327, pp. 1 219-21.

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The European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) is the reference point on drugs and drug addiction information in Europe. Inaugurated in Lisbon in 1995, it is one of the EU's decentralised agencies. Read more >>

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Page last updated: Friday, 28 October 2011