Drug Abuse in the Global Village

Drug Abuse in Western Europe

                                        TREATMENT AND REHABILITATION

AUSTRIA
Treatment and rehabilitation in Austria aim at drug abstinence. Counselling and treatment are voluntary, confidential and free of charge.

            In 1991 there were 61 out-patient counselling centres, 7 in-patient short-term detoxification centres, 2 medium-term and 5 long-term treatment and rehabilitation centres. In 1989, approximately 5,000 drug addicts were undergoing treatment and rehabilitation, most for opiate dependence of multiple drug addiction (Austria 1991).

            Methadone maintenance. Since 1987 a pharmacological substitution treatment programme (mostly using methadone) has been implemented. Almost 900 patients were treated in 1989. Conditions for entering the programme include being aged over 18, previous unsuccessful drug free treatment and/or HIV seropositivity (Austria 1991).

BELGIUM
Mobile mental health services consisting of specialist and non specialists are in operation. Treatment services are available in residential or semi-residential therapeutic communities and rehabilitation centres. "Substitution" programmes are operating on an experimental basis in large towns. Several psychiatric hospitals provide specialized services for alcoholics and drug abusers. Further, rehabilitation is carried out either in out-patient services, in day care centres or in-patient therapeutic communities (U.N. 1992).

FRANCE
In the early 1970s, a special scheme was implemented for the treatment and rehabilitation of drug abusers which aimed at catering for each case on an individual basis. As a result, treatment is very divers in France and comprises:

- care centers (145 in 1990) for outpatient detoxification, psychotherapeutic follow up, preventive action and rehabilitation;
- special hospital units for the reception and detoxification of drug abusers (5 in 1990);
- post-cure accommodation centres for ex-addicts to prepare them for reintegration (58 centres, 678 beds in 1990) and,
- 218 host families (U.N. 1990).

            Since 1989 over the counter sale of syringes is legal and, in certain specialized centres, needle exchange programmes have been introduced (WHO 1991).
Two Paris hospitals ran pilot programmes of methadone substitution in 1990. The treatment is not aimed at maintenance but at drug discontinuance (France 1991).
Another programme gives the opportunity to first time drug trafficking offenders to have their sentence suspended in favor of treatment (France 1991).

GERMANY
The National Programme on Drug Abuse Control promotes abstinence in a drug free society. Abstinence is, therefore, a prerequisite for out-patient and in-patient therapies and all programmes are drug free. Drug substitution therapy is permissible only in special cases under strict medical supervision and in conjunction with psycho-social care. (National Programme on Drug Abuse Control 1990).

            A total of 1,000 counselling centres and 3,000 specialized inpatient treatment centres operate nationwide. Federal pilot programmes include 14 outreach programmes for long term addicts, 38 in-patient crisis intervention facilities (caring for 39 per cent of all therapy patients), 12 special care housing centres, 12 outpatient treatment centres, 12 care and counselling centres which also includes AIDS immediate help programmes, AIDS and Children programmes and AIDS and Women programmes. Low-threshold services to reach as many dependent persons as possible are also in operation in areas most affected in cities. They provide short term shelter, meals, but also sterile syringes and condoms. Fifteen long term addicts are also spending a year with farming families (Germany 1992).

LUXEMBOURG
Luxembourg has one therapeutic community caring for 51 patients in 1992, most of which are males (40), one psychiatric hospital providing treatment to drug abusers and 2 mobile counselling and detoxification centres treating 409 patients (275 males). Of the 55 patients in the therapeutic community in 1992, 40 per cent had relapsed one year after the treatment (U.N. 1992).

             A pilot methadone maintenance programme began in 1989 to prevent AIDS and care for pregnant drug abusers. Strict admission criteria apply. Results of a 1991 evaluation of the programme is pending.

             Drug addicts in prisons. Approximately 10 per cent of the prison population in 1992 were drug abusers (9 males to 1 females). All prisons provide general medical care, drug counselling, drug related disease counselling, social reintegration, general education and after care. Detoxification in prison is not available (U.N. 1992).

NETHERLANDS
Primary care facilities are increasingly utilized in lieu of specialized treatment in order to increase accessibility and reduce stigmatisation of drug abusers. Treatment start with outreach harm reduction programmes, intake in primary care facilities, drug maintenance (mainly methadone) when deemed necessary and then socio-economic support and social reintegration if needed (Ministry of Welfare et al. 1991). It is estimated that about 70 to 80 per cent of drug addicts are in contact with treatment agencies (Ministry of Welfare et al. 1991).

            The Consultation Bureaus for Alcohol and Drug Problems (CADs) form a nationwide network of non governmental organizations, consisting of 17 main branches, 44 subsidiaries and 45 consulting rooms. CADs provide non-residential mental health care and social work services including psychotherapy, counselling, material assistance, family therapy, prevention and AIDS prevention (Ministry of Welfare et al. 1991).

            Residential drug free treatment facilities provide services to alcohol and other drugs addicts throughout the country. There are 1,000 beds in independent clinics, therapeutic communities or specialized units in psychiatric hospitals (Ministry of Welfare et al. 1991).

            Methadone substitution programmes. Methadone is supplied to approximately 75 per cent of all addicts in approximately 60 municipalities, or 37 per cent (16,000) of CAD's 1989 case load (Ministry of Welfare et al. 1991).

SAN MARINO
Treatment is tailored according to the drug abused. For "soft drugs", treatment is carried out in San Marino, but for "heavy drugs" it is done abroad (there are 7 therapeutic communities and one specialized hospital outside San Marino for such treatment) (U.N. 1992).

SWITZERLAND
Switzerland's policy regarding treatment calls for harm minimization. Accordingly, the harm of AIDS and hepatitis is reduced through needle exchange programmes and vaccination campaigns for hepatitis.

            Treatment approaches, including psychotherapy, behavioral therapy, and family and social therapy aim for abstinence. Increased attention is given to improving drug abusers quality of life through the provision of street kitchens, working opportunities, health care centres, residential centres and "stations" where injecting may be done under surveillance (Fixerrהum, now operating in Bגle and Berne).