1. WORK PACKAGE TREATMENT CHALLENGES Dr.Thomas Legl Member of Executive Committee EURO –TC Director Kur- und Gesundheitszentrum Knappenhof/Austria ICAA,, Vienna NGO Committe on Narcotic Drugs DEMOCRACY CITIES AND DRUGS II Implementation Seminar Bucharest, 22-23 January 2009

2. OBJECTIVES  To identify actual challenges in treatment  To find responses to local specifities and actual consumption patterns  To develop best strategy for the local city level  To promote exchange to other stakeholders  To make treatment easier accessible and more attractive to the persons in need

3. PLATFORM LEADER - EURO-TC  Network of addiction treatment centers  Covers 9 european countries  Special promotion of: Flexible therapeutic programmes fitting the patients needs Flexible therapeutic programmes fitting the patients needs Integrated treatment programmes for special target groups Integrated treatment programmes for special target groups  Exchange on the scientific level as well as on the level of clients activities

4. WORK AGENDA  Implementation seminar Bucharest / establishment of scientific group and work plan  Development of a questionnaire to evaluate a status quo  Analyze the questionnaire  2 workshops organized by the scientific group  5 refinement meetings  Development of guidelines

5. BACKGROUND/GENERAL GUIDELINES WITHIN THE EU  Integrative Approach  Different Problems – Different Strategies  Punishment for Trafficking & Treatment for Dependant Persons  Counseling Consumers  Decriminalization vs. Legalization

6. SITUATION  Rapid Development of Substitution Programmes  Traditional Abstinent Treatment / Need for flexible interventions

7. Co-Morbidity - Flow Pattern Psychiatric Hospital Outpatient Facility TC Substitution Programme High Co-Morbitity Low Co-Morbitity High Co-Morbitity Low Co-Morbitity

8. SUBSTIUTION TREATMENT  Italy 27-29%  Spain 41-86%  90% Methadone – 300.000 Methadone patients in Europe BEST PRACTICE  Long term basis and effective dosage  Psychosocial treatment  Excellent experience in combination with residential treatment

9. Substitution drugs  Very different legal situation within European countries  Methadone – Buprenorphine  Heroine maintenance – “perfect administration”  Matching treatment towards clients needs  special target groups / Vienna experience

10. MATCHING TREATMENT TO THE PATIENTS NEEDS SPECIAL PROGRAMMES  Parents and Children  Dual Diagnosis  Adolescents  Gender Oriented Treatment  Ethnic Approach  Geriatric Communities

11. CHANGE IN CONSUMPTION PATTERNS WHAT IST THE ANSWER TO  Increasing consumption of cocaine  Increasing consumption of methamphetamines  Parallel -consumption of alcohol and stimulants in substitution programs

12. NECESSITIES  Different settings for different types  Anonymity essential  Time factor needs focusing on behavioral aspects

13. CHALLENGES  ADAPTING TREATMENT TO PATIENTS NEEDS  Needs emerge during therapy  Matching needs as they emerge  Treatment not limited to a single inpatient intervention  very clear for non-addiction diagnoses  Making treatment attractive

14. The cities‘ individual challenges: 1. Liège  Main Topics: ▪ Cocaine treatment ▪ Long-term treatment  Challenges / needs to be done: ▪ Implementation of heroin assisted treatment ▪ adequate residential treatment and aftercare ▪ implementation of a consumption place ▪ increase cooperation to reorganisation

15. 2. Vienna  Main topics: ▪ treatment of addicted pregnant women & young mothers ▪ treatment of children with a familial addiction background ▪ treatment of older people, as well as other people dependent on other‘s help

16. Vienna  Challenges / needs to be done: ▪ implementation of case management ▪ work for a higher tolerance within the population ▪ Addicts in and after treatment need an ordered day structure ▪ especially young people need a more positive prospect, unemployment situation should be discussed in treatment and prevention programmes

17. 3. Leipzig  Main topics: ▪ development of appropriate activities and preoccupation for work as well as leisure ▪ improvement of an easier/better access to target groups ▪ early intervention in somatic treatment facilities

18. Leipzig  Challenges / needs to be done: ▪ provide sufficient psycho-social support for addicts on substitutes ▪ prevent premature prescription of medication which delay an early treatment of addiction ▪ intensify work focused on women and families

19. 4. Central Bohemia Region (Czech Rep.)  Main Topics: ▪ high percentage of very young drug users ▪ higher drug use with Roma people and other ethnic minorities ▪ too few substitution treatment programmes offered by the towns

20. Central Bohemia Region  Challenges / needs to be done: ▪ provide more staff specialised/trained in issues of drug treatment/therapy ▪ provide short- and middle-term treatment, as well as sufficient aftercare ▪ increase interest of politicians and raise financial contributions ▪ set up a network of regional NGO‘s dealing with these issues

21. THANK YOU FOR YOUR ATTENTION