Client characteristics and treatment needs (CARED-Project)* Dilek Sonntag 1st REITOX Academy 2007 Berlin, March 29-30, 2007 *Funded by the Federal Ministry of Health and Social Security Source: Simon, Sonntag, Bühringer & Kraus (2005). CARED-Project. BMGS. To be download.

Method 52 out-patient facilities all over Germany. clients with a primary cannabis related problem (ICD-10; F12.1, F12.2) 2002-2004 Survey 1 (clients-questionnaire), retrospectively (N=223), response rate= 40% Survey 2 (CIDI), clients currently undergoing therapy (N=51) Survey 3 (staff-questionnaire) (N=183)

Socio-demographic characteristics Typical client in out-patient centre: Male (86%) Between 18-24 years (M=22, sd=5) Lives with parents (40%) Single with unsteady partners 55% in education (school/work) 23% unemployed Onset of cannabis use with 15 years

Prevalence of use

Heterogeneity Low-risk Moderate-risk High-risk Days of use No. in the last 30 days 1,0 14,1 28,7 Frequency /day 3,4 7,0 10,8 Heavy use (lifetime) Yes 53,4 59,6 78,1 Number 1,17 5,0 7,33 Duration (months) 17,4 13,9 15,2 Diagnosis Misuse 14,4 27,6 4,1 Dependence 56,7 63,8 87,7 Total 40,9 26,4 32,7

Comorbidity 64% single cannabis diagnosis 21% with alcohol 12% with amphetamines + ecstasy 11% with psychotic disorders 39% with affective disorders 15% with anxiety disorders

Self- and external motivation for counselling

Counselling and goals

Change motivation (in percent) Low-risk Moderate-risk High-risk Phases Precontemplation 31 22 11 Contemplation 46 62 70 Action 16 19 Total 90 58 72

Summary 85% a ICD-10 diagnosis 15% sub-threshold problems 64% single cannabis diagnosis Majority of clients has comorbid substance use and psychological disorders 3 client clusters: low (41%), moderate (26%) and high-risk (33%) differ in problems, characteristics of use and treatment needed, but not socio-economic sit. Voluntary help seeking and because of parents Goals: reduction, abstinence and dealing with other problems Satisfied with counselling, high-risk clients more critical 21/21

Conclusion Improved diagnostic phase (development of screening instruments) Tailored treatment approach Low-risk: information, referral, in social or school system Moderate-risk: motivation to change, controlled use, work with parents and peers High-risk: training of staff to specialize to individual cannabis oriented problems, abstinence-oriented Re-orientation of out-patient facilities Younger clients Parents‘ work Peer access