A range of interventions are used for the treatment of drug problems in Europe, including psychosocial interventions, opioid substitution and detoxification. The relative importance of the dfferent treatment modalities in each country is influenced by several factors, including the organisation of the national health care system and the nature of the drug problems in each country. Drug treatment services may be provided in a variety of outpatient and inpatient settings: specialist treatment units; primary health care and mental health clinics; low-threshold agencies; hospital-based residential units and specialist residential centres; and units in prison.
Most drug treatment in Europe is provided in outpatient settings and the two main modalities of outpatient treatment in Europe are opioid substitution treatment and psychosocial interventions.
Substitution treatment is the predominant intervention 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 prisons. In addition, office-based general practitioners play an important role, often in shared-care arrangements with specialist addiction treatment centres, in about a third of all EU Member States.
Psychosocial interventions include counselling, motivational interviewing, cognitive behavioural therapy, case management, group and family therapy, and relapse prevention. ese interventions support users to manage and overcome drug problems. ey are the main form of treatment provided to users of stimulant drugs, such as cocaine and amphetamines. ey are also provided to opioid users in combination with opioid substitution treatment. In many countries, responsibility for outpatient psychosocial treatment is shared between public institutions and non-governmental organisations. Commercial providers generally play a minor role in the provision of psychosocial interventions in Europe.
A smaller proportion of drug treatment in Europe is provided in inpatient settings. Inpatient or residential treatment, whether hospital-based or non hospital-based, requires clients to live in the treatment facility for several weeks to several months, with a view to enabling clients to abstain from drug use. The provision of opioid maintenance treatment in inpatient settings is rare, but exists for selected client groups with high levels of morbidity. A prerequisite for entry may be detoxification, a short-term, medically supervised intervention aimed at the reduction and cessation of substance use, with support provided to alleviate withdrawal symptoms or other negative effects. 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 individually structured psychosocial treatments and take part in activities to rehabilitate and reintegrate them into society. A therapeutic community approach is often used. Inpatient treatment may also be provided in psychiatric hospitals for those with comorbid mental health problems. Public institutions, the private sector and non-governmental organisations are all involved in the provision of inpatient care in Europe, with the main providers varying between countries.
Increasingly, a wide range of drug prevention and treatment interventions are provided online. Internet-based interventions have the potential to extend the reach and geographical coverage of treatment programmes to people experiencing drug use problems who may not otherwise access specialist drug services.
