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Treatment demand indicator (TDI)

Overview

Tables present information on the number of people entering treatment for drug use. Data do not include clients in continued treatment from previous years. This data provide insight into general trends in drug use and also offer a perspective on the organisation and uptake of treatment. Treatment demand data come from each country with varying degrees of national coverage, principally from outpatient and inpatient clinics treatment records (Table TDI-1, Table TDI-2).

For 2007 or the most recent year available, 23 European countries and Croatia reported data on around 346 000 outpatient clients (1). Eighteen EU countries, Croatia and Turkey reported data on around 43 000 inpatient clients; 10 countries reported data on 14 000 clients who have entered other types of treatment units (low threshold agencies, treatment units in prison, general practitioners). Not all countries report data on the number of treatment units reporting data and the number of existing treatment units); however according to the available data out of the existing treatment units, those reporting data represent 77 % of existing outpatient and 69 % of inpatient treatment units. Although most countries cover more than 50 % of existing units, country differences in data coverage are relevant both for outpatient (from 24 % to 100 % of units covered) and inpatient (from 25 % to 100 % of units covered) units. The 10 countries reporting data on other types of facility have a units coverage varying from 25 % to 100 %. Very little information is reported on data coverage on the total number of actual clients entering treatment, therefore, the figure is not reported unitl data quality will improve (see Table TDI-7).

Tables TDI-1 to TDI-8 are based on data from all types of treatment centres concerning new clients and all clients; they present the current situation for 2007 data or most recent year available and the trend for the last 10 years (1997 to 2007) where data are available.

Tables TDI-9 to TDI-24 report data on clients’ characteristics and patterns of drug use from outpatient and inpatient treatment centres. In particular, they report data on age and gender, primary drug for entering treatment, age at first use of primary drug, frequency of use of primary drug, educational level, labour and living conditions. Some tables only refer to outpatient treatment clients (Tables TDI-9 on age and gender distribution, TDI-17 on route of administration).

Tables TDI-25 to TDI-33 describe the age distribution, mean age and the age at first use of the primary drug among male and female clients.

Tables TDI-36 to TDI-37 describe drug clients entering treatment for primary use of amphetamines or ecstasy.

Tables TDI-102 to TDI-115 are large tables reporting detailed data by country and by primary drug. In particular:

  • Tables TDI-102 to TDI-109 and Tables TDI-111, TDI-112 present a breakdown by country of the summary Tables TDI-10, TDI-11, TDI-18 on age distribution, age at first use and frequency of use by the primary drug of clients entering treatment;
  • Tables TDI-113 to TDI-115 focus on drug sub-type for opioids (heroin, methadone, other opiates) and cocaine (cocaine HCl and crack).

Figures TDI-1 to TDI-7 are graphics on trends and characteristics of drug treatment clients in Europe.

Summary points

Treatment in profile

Data related to 2007 or most recent year available have been brought together from cooperating agencies in 28 countries. Around 409 000 clients ( 2) entering treatment during the reference year have been reported. Out of them, there were 178 000 new drug clients, which represents almost half of the total number of clients entering treatment in 2007 (Table TDI-7 part (i)).

46 new clients in every 100 000 inhabitants aged 15–64 in the European Union Member States, Croatia and Turkey have entered treatment in 2007. Marked differences are found between countries in the incidence of drug clients: from 3 to 145 per 100 000 inhabitants; those differences are related to countries’ variation in data coverage as well as treatment availability and extent of problematic drug use (Table TDI-6).

Out of the reported data, 86 % of treatment entries are reported from outpatient treatment, 11 % from inpatient treatment and the remaining 3 % from other types of treatment units (low threshold agencies, treatment units in prison, general practitioners and other types of treatment services). It has to be noted that while 24 countries are reporting data from outpatient units, 20 countries are reporting data from inpatient units and 10 countries are reporting data from other types of units. This reflects both a better level of data coverage in outpatient and inpatient centres and the organisation of the treatment system in most European countries (Table TDI-7 part (ii)).

Male drug users predominate among all clients, but with male to female ratios varying greatly between countries and primary drug. Gender ratio among clients in 2007 varies approximately from 2 males for every female in Czech Republic and Finland and to 9 males for every female in Cyprus and 19 in Turkey. There appears also to be a wide variation in primary drug of use by gender: among drug clients entering outpatient treatment for primary cannabis use there are 5.5 male clients for every female, while among clients entering treatment for hypnotics and sedatives there is only 1.4 males for every female. However, figures for hypnotics and sedatives are quite low (Tables TDI-4 part (ii), TDI-21).

Most clients entering treatment are aged 20 to 30, with a mean age varying between 26 in Bulgaria, Czech Republic, Latvia, Hungary and 33 in Spain, Italy, Sweden. Clients entering treatment for the first time are usually 1–2 years younger (Tables TDI-4 part (iii), TDI-4 part (iv)). For 2007 or the most recent year available, the treatment entries from 25 countries were due to primary heroin use for 49 %, cocaine for 17 % and cannabis (20 %). These proportions differ widely between countries (Figure TDI-2, Tables TDI-5 part (i), TDI-5 part (ii)).

Trends in reported treatment demands

The number of reporting agencies increased from 2 658 in 1997 to 6 541 in 2007, with a slight decrease in 2004 and 2005 and a stabilisation between 2006 and 2007 (Table TDI-2 part (iii)).

In 2007, total reported treatment demands seems to be stable (–1 %), compared with the preceding year for member states reporting both figures and not registering changes in the reporting system; notably this excludes Spain, Malta and Poland (on the basis of the first argument) and Germany and Hungary (on the basis of the second argument). This trend is not uniform across countries (Table TDI-2 part (ii)).

Adopting the same rationale for calculations, in 2007, requests from clients new to treatment represent a general increase of around 4 % over the preceding year. Changes in new treatment demands are similar to changes in overall demands, but variations are reported between countries (Table TDI-2 part (i), part (ii)).

Looking at the trend of new clients according to the main drug of use, as reason for entering treatment, (only for the clients for which the primary drug is known and for the most important primary drugs), data over the period 2002 to 2007 are analysed across 18 countries for people who have entered treatment during those years and across 19 countries for new treatment entries (Figure TDI-1 and Figure TDI-3). Such analysis has made use of an estimation process to make up for data gaps. According to the reconstructed time series, the number of clients entering treatment for primary heroin use went from 108 000 in 2002 (63 % of all treatment entries) to 129 000 in 2007 (52 %); those who have entered treatment for primary cocaine use went from 22 000 (13 %) to 47 000 (19 %); for cannabis from 27 000 (16 %) to 50 000 (20 %) and for stimulants other than cocaine from 15 000 (9 %) to 20 000 (8 %). Among the new treatment entries, the corresponding figures are the following: heroin from 36 000 (48 %) in 2002 to 38 000 (34 %) in 2007; cocaine from 13 000 (17 %) to 28 000 (25 %); cannabis from 18 829 (25 %) to 34 312 (31 %); stimulants other than cocaine from 8 000 (10 %) to 10 000 (9 %) (Table TDI-3 part (i), part (ii), part (iii)).

New treatment entries are still principally for heroin treatment, even though the relative importance of heroin has decreased in most of the countries. By contrast the relative position of cocaine and cannabis has increased in several countries. Since 2004, the relative decrease of heroin treatment demand seems to be stabilising.

Socio-demographic profile of drug treatment clients from outpatient and inpatient treatment centres

Differences in socio-demographic characteristics of drug treatment patients are found according to individual reporting country and main drug of consumption. Variations may be due to differences in the organisation of treatment facilities, in the profile of problematic drug users and in other elements to be clarified. Overall, the following characteristics of drug clients in outpatient and inpatient treatment centres can be summarised:

  • most of the drug clients live in a stable accommodation, and a smaller group (correspondingly 8 % and 13 % of all outpatient and inpatient clients) live in an unstable accommodation, mainly homeless; 9 % (outpatient) and 15 % (inpatient) of all clients live in institutions (prison, clinic) (Table TDI-15 part (ii), part (iv));
  • 42 % of outpatient and 51 % of inpatient drug clients were living with their parents before entering treatment; around 15 % of all outpatient clients and 6 % of all inpatient clients are living with children, either alone or with a partner (Table TDI-14 part (ii), part (iv));
  • 6 % of all outpatient and 4 % of all inpatient clients have never been to school or have never finished a primary level of education and 7 % of outpatient and 5 % of inpatient clients have reached a higher level of education (Table TDI-12 part (ii), part (iv));
  • the proportion of drug clients without a regular employment is high (35 % of all outpatient clients and 56 % of all inpatient clients) (Table TDI-13 part (ii), part (iv)).

Treatment for opioids

Opioid use is still the main reason for entering treatment in Europe. Of the around 400 000 treatment entries reported in 2007, heroin was the principal drug reported in 49 % of cases for which the primary drug is known and 37 % of new treatment entries (Figure TDI-2); although there are strong differences reported between countries (Table TDI-5 part(ii)). In most countries, the proportion of opioid users is lower among new treatment demands (Table TDI-5 part (i)). In some countries opioids other than heroin are reported as primary reason for entering treatment: Finland and France reported 51 % and 7 % for buprenorphine use respectively; Denmark refer to 20.6 % of clients entering treatment for primary methadone misuse; Czech Republic, Austria, Latvia and Sweden reported between 5 % and 15 % of clients entering treatment for use of opioids other than heroin (Table TDI-113)

Data from outpatient and inpatient treatment centres reported show the following profile of opioid clients on gender, age distribution and patterns of drug use:

  • the males to females ratio among opioid users is 3–4 males to 1 female client for outpatient and inpatient clients. Marked variations are reported between countries in gender ratios which drip to near equality and extend to 5 or more in some populations (Table TDI-21 part (ii), part (iv));
  • the mean age of opioid clients is 33 years in outpatient centres and 31 in inpatient centres; among new demands for opioid treatment the mean age is approximately one year lower (Table TDI-10 part (i), part (iii), part (v), part (vii));
  • More than 3 out of 4 clients start using opioids before the age of 25. The most prevalent age group was represented by clients ranging from 15 to 19 years old (Table TDI-11 part (i), part (iii), part (v), part (vii));
  • 61 % of outpatient and 72 % of inpatient clients reported using opioids as a primary drug on a daily basis; among new clients the proportion of daily users is even higher (69 % among outpatient clients and 80 % among inpatient clients) (Table TDI-18);
  • in outpatient centres 44 % of all clients and 42 % of new clients consuming opioids as the primary drug reported injection as their main route of drug administration; and correspondingly 35 % and 36 % of them smoked it (Table TDI-17 part (i), part (v));
  • 59 % of clients who have entered treatment in 14 countries participating a a pilot data analysis on polydrug use opioids as primary drug use and another drugs, mainly cocaine (28 %), cannabis (14 %), alcohol (7 %) and, to a less extent, other drugs (3).

Treatment for cocaine

In 2007, cocaine is the primary drug for 17 % of all treatment demands and 22 % of new treatment entries (Figure TDI-2); marked country variations are reported; since several years, Spain, the Netherlands and since 2006, Italy has the highest proportion of cocaine users in drug treatment (correspondingly, 45 % , 32 % and 23 % of all clients. In most countries, the percentage of cocaine clients is higher among the new than among all clients (Table TDI-3 part (ii), Table TDI-4 part (ii), Table TDI-5 part (ii)).

Data from outpatient and inpatient treatment centres show the following profile of cocaine clients on gender, age distribution and patterns of drug use:

  • the gender ratio among cocaine clients is 5 males for every female cocaine client in outpatient centres and inpatient centres (Table TDI-21 part (i), part (ii), part (iv));
  • the mean age of all cocaine clients is 32 years; new clients are slightly younger, both in outpatient and inpatient settings (Table TDI-10 part (i), part (iii), part (v), part (vii));
  • most cocaine clients start their drug use before the age of 25 (Table TDI-11 part (i), part (iii), part (v), part (vii));
  • outpatient cocaine clients can be divided into two groups, according to their frequency of cocaine use: cocaine clients using it once a week or less or having not used it at all in the month before entering treatment (38 % of new and 40 % of all clients) and clients using cocaine daily or several times a week (62 % of new and 60 % of all clients) (Table TDI-18);
  • more than half of cocaine outpatient clients (55 %) sniff the drug and another 32 % smoke or inhale it; 6 % of cocaine clients inject the drug (3 % if they are new to treatment (Table TDI-17 part (ii), part (vi));
  • 63 % of primary cocaine users who have entered treatment in 2007 in 14 countries participating in a pilot data analysis on polydrug use takes cocaine with another drug (at the same time or in different moments). The other drugs combined with cocaine are mainly alcohol (42 %), cannabis (28 %) and heroin (16 %) (3).

Treatment for amphetamines and ecstasy

Stimulants other than cocaine are infrequently reported as a primary reason for attending drug treatment: about 9 % among all clients and 6 % among new clients (Figure TDI 2). Among clients entering treatment for stimulants other than cocaine, 86 % report using amphetamines, 12 % ecstasy and 2 %, the remainder stimulants other than cocaine, amphetamines or ecstasy (Table TDI-8 part (i)). Marked differences are reported between countries: some Member States (Czech Republic, Sweden, Finland, Slovakia, Latvia and Hungary) report amphetamines and methamphetamines as accounting for between 10 % and 61 % of all primary treatment entries. Only a few countries report some clients in treatment for primary ecstasy use (Table TDI-5 part (i), part (ii)).

Data from outpatient and inpatient treatment centres show the following profile of clients using stimulants other than cocaine on gender, age distribution and patterns of drug use:

  • the males to females ratio among users of stimulants other than cocaine is the lowest compared to other drug users, after the clients reporting use of hypnotics and sedatives as a primary drug (but figures are very low in that case); there are 2 males for every female in drug treatment for stimulants use, but countries variations should be considered (Table TDI-21);
  • the mean age of amphetamines and ecstasy clients is 28 years, both among outpatient and inpatient clients; clients entering treatment for the first time in their life are usually younger (Table TDI-10 part (i), part (iii), part (v), part (vii));
  • the mean age at onset of drug use for most clients entering treatment for the use of stimulants other than cocaine is lower than 25, with most of them starting their drug use before the age of 20 (Table Table TDI-11 part (i); part (iii), part (v), part (vii));
  • around 21 % of outpatient clients in treatment for stimulants other than cocaine use them daily (36 % in the case of inpatient clients), around 27 % several times a week (31 % in the case of inpatient clients) and the remaining occasionally (Table TDI-18);
  • half of outpatient clients in treatment for use of stimulants other than cocaine take them orally; drug injection is used by 14 % of drug clients (10 % among new clients); marked variations are reported between countries, namely in Czech Republic, where most drug clients are in treatment for methamphetamine use and 72 % inject it (Table TDI-17 part (iii), part (vii); Table TDI-4 part (ii)).

Treatment for cannabis

Overall, cannabis is the second most reported primary drug among treatment demands and counts for 20 % of all treatment demands and 28 % of new demands (Figure TDI-2). There are marked differences between countries in the proportion of clients demanding treatment for cannabis as a primary drug (Table TDI-4 part (ii), Table TDI-5 part (ii)). According to available data, most cannabis clients enter treatment in outpatient centres and only a few countries report a non-trivial proportion of cannabis clients in inpatient treatment (Table TDI-24).

Data from outpatient treatment centres on gender, age, distribution and patterns of drug use show the following profile of cannabis clients:

  • together with gender ratio among primary cocaine users, the males to females ratio for clients in treatment for cannabis is the highest among all drug types (5.5 males to 1 female) (Table TDI-21 part (i), part (ii));
  • cannabis users have a mean age of around 24 years, being the youngest clients in drug treatment after clients in treatment for use of volatile/inhalant substances (but figures in that last case are very low) (Table TDI-10 part (i), part (iii)). Among the younger clients, 78 % of under 15 year olds and 67 % of 15–19 year olds are in treatment for primary cannabis use (Table TDI-10 part (ii));
  • virtually all cannabis clients start their drug use before the age of 20 (Table TDI-11 part (i), part (iii));
  • in the month before entering treatment, 24 % of all clients report using cannabis only occasionally or not at all, 29 % have used it once or more times a week and 47 % report using it on a daily basis (Table TDI-18 part (ii)). Marked differences are reported between countries, with countries reporting around half of clients with occasional or no use in the 30 days prior to treatment and countries with 50 % or more daily cannabis users (Table TDI-111 part (iv));
  • clients entering outpatient centres often report secondary drugs use. On the basis of 14 countries participating in an ad-hoc analysis on polydrug use, the proportion of new clients taking cannabis with another drug was 85 %. They mainly use cannabis with alcohol (65 %), cocaine (13 %) or with both substances (alcohol and cocaine) (12 %) ( 3).

( 1) Figures refer to all clients entering outpatient treatment  Data from Portugal and Latvia, which only only reported data for new clients entering outpatient treatment (around 6 000 clients), might be added to the total to get an overall estimation of 351 000. Malta, Netherlands, Spain and Hungary submitted aggregated data (outpatient centres along with other kinds of treatment centre). However, for computational purposes, such data have been classified as outpatient-related, the reason being that outpatient clients represent, even at national level, the majority of  all clients.

(2) Data from Portugal and Latvia, which only only reported data for new clients entering outpatient treatment (around 6 000 clients) have been considered here.

(3 More information and specific reference on this study will be provided in the context of a forthcoming Selected issue publication on polydrug use.

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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: Monday, 16 November 2009