Models of good practice in drug treatment in Europe. Project group

Transcription

1 Models of good practice in drug treatment in Europe ( moretreat ) Project group Hamburg, London, Rome, Stockholm, Vienna, Warsaw, Zurich Project duration: 17 months from April 2006 August 2008

2 Objectives and Tasks To encourage drug treatment strategies which enable to reach substance users on an earlier stage of their addiction career to improve their integration and health Identify, collect and evaluate models of good practice in drug treatment in Europe Formulation of good practice guidelines for key interventions in drug treatment Carry out an inventory of effectiveness of drug treatment Evidence based recommendations for central drug treatment modalities Improve the quality of drug treatment services in the EU-Member States Exchange of good practices in drug treatment was supported Based on consensus process

3 What has been done European inventory of good practice of drug treatment interventions and their effectiveness based on Scientific reviews of international and European (published in English) evidence Regional search for most relevant studies - realised by the partners resulted in Development of European evidence-based guidelines for good practice with respect to different drug treatment interventions/modalities

4 Evidence-based guidelines for key interventions Dimensions approach, context, duration, staff, client groups, eligibility, inclusion and exclusion criteria, treatment access to service, referral pathways, integrated care pathways Standards management standards, commissioning standards, responsibilities, performance/outcome monitoring, seamless provision of services and support from one setting to the other (e.g. community prisons/hospitals, psychiatry), care coordination, departure planning, monitoring Assessment process-management, phases of treatment, performance/outcome monitoring

5 Guidelines for key interventions in drug treatment Enhancing motivation for change Maintenance treatment Detoxification Cross-cutting issues Treatment for clients with co-occurring disorders Interventions in blood-borne diseases Drug treatment Treatment in criminal justice sys. Treatment for stimulant use disorders Pregnancy and parenting Systemic aspects of treatment Brief interventions therapies Psychosocial interventions

6 Main findings on effectiveness - in brief Motivational Enhancement Therapy Especially good outcomes at early stages of treatment MI seems to increase the effect of another treatment Psychosocial interventions Have an effect on drug dependence - no form of psychosocial treatment works better than another Psychosocial treatment usually improves substitution maintenance treatment outcomes Maintenance treatment Methadone is the best-studied and most effective opioid agonist Treatment outcome is improved with increased dosages and the provision of adequate psychosocial support Detoxification Methadone with equal dose decrease is the standard detoxification Efficacy of buphrenorphine is comparable to methadone

7 Main findings on effectiveness - in brief Brief interventions (one or more sessions to reduce individual harm) High efficacy for cognitive-behavioural therapy, positive effects of family and social therapies Mostly concentrated on problem use of cannabis and stimulants Treatment in criminal justice system All community services can be offered in prison (medical and drug-free treatment as well as harm reduction) Combination of prison-treatment and continuity of care after release is most effective Treatment for co-occurring disorders Three types of interventions are probably effective: Group counselling, contingency management, long-term residential treatment Treatment for stimulant use Limited evidence available shows that most patients can be effectively treated in intensive outpatient programmes There is no evidence for prescribing antidepressants

8 Effectiveness of Harm Reduction Needle and syringe exchange services Strong evidence that availability of NSP contributes to the control of HIV among IDUs May be effective in reducing drug use frequency, transition from i.v. to smoking Drug consumption rooms Positive outcome on health status + risk behavior (reduction of drug-related deaths) Improve enrolment and retention in drug treatment Testing and vaccination No clear evidence for effectiveness of testing for blood-borne diseases Vaccination against hepatitis B is strongly effective in preventing hepatitis B infection HBV vaccination seems to have a positive influence on the hepatitis C serostatus Information and education Only few studies: most effective in combination with other prevention strategies On the short-term in may be effective in raising awareness for risks All interventions are less effective in preventing hepatitis C infection

9 Summary There is a wide range of different drug treatment interventions (concepts, methods, aims) Not all interventions delivered in Europe have shown to be effective Three main types of interventions Pharmacological treatment aim at reduction or cessation of opioid use Maintenance treatment shows better outcome than detoxification Reduction of illicit drug use and crime, decrease of mortality Psychosocial interventions aim at motivation to change drug use and risk behaviour CBT and MI often focused on cocaine/cannabis users or young drug users Coping with risk-situations, reduction of drug use Harm reduction aim at control or reduction of blood-borne diseases NSP programmes, drug consumption rooms, vaccination addressed to IDUs Decrease of sharing of drug use equipment, prevention of overdoses

10 Conclusions situation in Europe Most available literature exists for medical treatment Detoxification and maintenance treatment with different substances (especially methadone, buphrenorphine and heroin) Despite: Out 148 studies only 56 are from Europe (38%) Followed by psychosocial interventions Problem: Many different study designs for different approaches made it difficult to compare the outcomes Out of 102 studies 29 are from Europe (28%) - Most studies are from USA and Australia Harm-reduction Evidence for effectiveness of harm-reduction is in general rather scarce Studies focus on relation between service utilisation and the reduction of blood-borne infections and risk behaviour