Treatment Services For Drug Users Research Articles

Estimating the Prevalence of Crack Dependence Using Capture-Recapture With Institutional and Field Data: A Three-City Study in the Netherlands

The aim of this study was to estimate the prevalence of crack dependence in the three largest Dutch cities (Amsterdam, Rotterdam, The Hague), stratified by gender and age. Three-sample capture-recapture, using data (collected between 2009 and 2011) from low threshold substitution treatment (n = 1,764), user rooms (n = 546), and a respondent-driven sample (n = 549), and applying log-linear modeling (covariates: gender, age, and city), provided a prevalence rate of 0.51% (95% CI: 0.46%–0.60%) for the population aged 15–64 years, with similar estimates for the three cities. Females (23.0% of total estimate) and younger crack users (12.8% aged <35 years) might be underrepresented in drug user treatment services.

Evaluation of Consumer Participation Demonstration Projects in Five Australian Drug User Treatment Facilities: The Impact of Individual Versus Organizational Stability in Determining Project Progress

This project evaluated consumer participation projects in five drug user treatment services in metropolitan and regional areas in three Australian states. Qualitative interviews were conducted with staff and consumers at two time points between from 2010 (n = 108). At baseline staff and some consumers focused on the stability of consumers to undertake representative roles. At postimplementation, the focus was on the stability of the organization, as frequent staffing changes and lack of adequate handover affected the progress of the projects. These issues combined with the perceived “noncore” status of consumer participation resulted in none of the projects achieving all of their agreed goals.

Challenges in Providing Drug User Treatment Services in Russia: Providers' Views

The estimated number of opiate users in Russia is 2,000,000 and heroin consumption is continuing to increase. The Russian government is discussing the initiation of compulsory treatment to bring illegal drug users to the treatment services. At the same time, there is no access to the evidence-based treatment for opiate addiction such as methadone and buprenorphine maintenance programs. Qualitative interviews were conducted with drug user treatment service providers (N = 35) in Barnaul, Volgograd, and Yekaterinburg, Russia, in 2003–2004 to examine their views on drug user treatment services in Russia. The framework approach was used in data collection and analysis. Study participants identified major challenges in service provision for drug using population, including lack of resources, rehabilitation programs, and social support. It also depicted ambivalent attitudes toward compulsory treatment and clients' registration. The Russian drug user treatment system desperately needs resources allocation to provide quality care and diversify in its services in order to achieve long-term recovery. At this stage, it seems unreasonable to initiate compulsory treatment as is advocated by some government officials.

Development of a Brief Treatment Instrument for Routine Clinical Use with Methadone Maintenance Treatment Clients: The Methadone Treatment Index

Routine measurement of treatment outcome between clinician and client in alcohol and drug user treatment services is an important quality improvement initiative. It is particularly important for clients receiving long-term treatment such as methadone maintenance treatment, as fluctuations in substance use, functioning, and health are to be expected. Although there are a number of standardized alcohol and drug user treatment outcome instruments available for research and clinical use, a key challenge is to develop clinical instruments that will actually be used routinely in busy practice settings by a range of staff. Such instruments need to be brief, acceptable to staff and clients, easy to use, provide immediate feedback, and meet adequate psychometric requirements. This report describes development work undertaken in three studies of the Methadone Treatment Index (MTI). The MTI is a brief instrument comprising measures of recent substance use, aspects of social and behavioral functioning, and physical and psychological health. The MTI was designed in consultation with clinicians and clients for use in monitoring treatment progress with clients receiving methadone maintenance treatment. Key findings were that the MTI was acceptable to clients, produced clinically relevant information, and has satisfactory psychometric properties, although it was not used to measure change in this study. Further evaluation of the MTI on a longitudinal basis is supported.

Do Treatment Services for Drug Users in Outpatient Drug-Free Treatment Programs Affect Employment and Crime?

Using the 1992–1995 National Treatment Improvement Evaluation Study data, we employ principal components analysis to create treatment service factors based on both patient self-reports and treatment record extracts. We included these factors in multivariate models for 1,136 outpatient drug-free treatment patients to estimate the relationship between services and post-treatment employment and crime. Although our models indicated some significant predictors of employment and crime, the overall effects of services were generally insignificant. We conclude that either services are unrelated to outcomes or if they are related then we are not measuring the key aspects of service provision that may be important. The study's limitations are noted.

Substance Misuse in Primary Care: A multidisciplinary approach

With the rapid growth in substance misuse treatment services in the UK and shared care services in general practice, this new publication is a useful addition to the library. Edited by Rosie Winyard, a nurse practitioner in Oxford, the book examines how a multidisciplinary team can provide effective treatment services for drug users in primary care.

Prevalence and correlates of drug use disorders in Mexico

To describe the prevalence of drug use disorders, the correlates of drug use, and the utilization of specialized treatment services for drug users among the Mexican urban population 18-65 years old. The data were collected in 2001 and 2002 in the Mexican National Comorbidity Survey. The sample design was stratified probabilistically for six geographical areas of the country in a multistage process for census count areas, city blocks, groups of households, and individuals. The data were weighted, taking into account the probability of selection and the response rate. The information was collected using a computerized version of the World Mental Health Survey edition of the Composite International Diagnostic Interview. The weighted response rate for individuals was 76.6%. Overall, 2.3% of the population reported any illicit use of drugs in the preceding 12 months; marijuana and cocaine were the substances most often used. Low levels of education were significantly associated with use, abuse, and dependence. Use of any drug was significantly more common among those who were in the youngest age group (18-29 years), were male, or were living in the Northwest region of the country. Overall, 1.4% had a lifetime history of drug abuse or dependence, with this being much more common for men (2.9%) than for women (0.2%). The 12-month prevalence of drug abuse or dependence was 0.4% overall (0.9% for men, and 0.0% for women). The rate of treatment during the preceding 12 months for those with the 12-month criteria for abuse or dependence was 17.1%; 14.8% were seen in specialized treatment centers; 2.8% reported having attended self-help groups. A noticeable number of Mexicans have a drug use disorder, but demand for treatment is limited, in part due to stigma. Our results indicate that there is an urgent need to organize the specialized services for persons with a substance abuse disorder according to the prevalence of dependence on different substances and the variation in prevalence in the different regions of the country.

AFRICAN-AMERICAN INJECTION DRUG USERS: TENSIONS AND BARRIERS IN HIV/AIDS PREVENTION

This exploratory study utilized a focus group methodology to explore tensions and barriers in HIV/AIDS prevention among African-American injection drug users. Participants discussed HIV infection risks, national/community HIV prevention effectiveness, prevention barriers, ideas on barrier removal, and the tensions which exist between users and the larger African-American community. Recognizing the inevitability of continued drug use for many injectors, participants requested basic harm-reduction supplies including condoms, needle exchange programs, additional drug user treatment services, and the use of culturally- and gender-matched peer-led prevention and treatment outreach. Preliminary recommendations are made for consideration in HIV/AIDS prevention among African-American IDUs. [Translations are provided in the International s Section of this issue.]

GENDER DIFFERENCES IN THE PERCEPTION OF DRUG USER TREATMENT: ASSESSING DRUG USER TREATMENT FOR YOUTHFUL OFFENDERS

The present study sought to determine whether gender-specific differences existed in the perception of drug user treatment services delivered at a residential substance misuse treatment program operated by a large youth correctional agency in the western United States. Hypothesized gender differences in perceptions of treatment services and treatment-related needs were confirmed in a number of areas such as treatment engagement, counseling needs, and post-release concerns. Findings of this exploratory study underscore the need to consider gender-specific issues in correctional substance misuse treatment for young offenders.

A Natural Response to Drug Misuse Problems: A Review of Drug-User Treatment Services of Bangladesh

This paper reviews and describes the natural processes through which the people of a Third World country, Bangladesh, have been trying to provide treatment to drug misusers. As the demand for medical help increases, different organizations develop to cater to the needs. Bangladesh has followed the age-old ashram model and the contemporary medical hospital model to provide services to its addicts. In reality the drug misuse treatment providers are still evolving through different learning stages about the biopsychosocial manifestations of addiction. According to the authors, the stages of learning can be divided into three phases: 1) the early period of confusion and enthusiasm, 2) the period of truism, and 3) the period of pragmatism. The people who have gained experience in running treatment centers in the last decade need to form alliances to share their experiences in order to develop rational models for drug treatment programs in Bangladesh. It is also important that they develop methods to monitor providers' activities and to protect clients' safety and interests.

Merchant, priest and humble engineer: Observations from Rotterdam's drug scenes

The object of the study is the drug scene and the administration of drug-related services in Rotterdam. The focus is on the relationship between drug users and the drug control system. The study draws upon observations and documents, and numerous interviews with civil servants, treatment staff, and drug users. The Dutch view on the nature of the problem and appropriate ways to treat drug users is different from what is common elsewhere. No legal sanctions relate to smoking of cannabis or to possession of small amounts, whereas large-scale trade, smuggling, and commercial cultivation are criminal activities. Neither is the use of hard drugs or possession for personal use criminalized. The core of the drug problem is seen to be on one hand the nuisance caused by those addicted hard drug users, and on the other hand the threat to the economy and politics of the country created by criminal drug organizations. In dealing with drug-related nuisance the aim is harm reduction. The central idea is the normalization of the drug problem. This means that efforts are made to keep drug users in contact with society, instead of pushing them outside by pursuing repressive policies. The threshold to health and social services and to treatment is kept as low as possible. At the same time addicts are held responsible for their behavior, and they are required to follow the regulations of the institutions providing support and treatment. Two remarkable aspects of the administration of drug-related affairs are a close co-operation between health authorities and the police, and an emphasis on Japanese-style neighborhood policing. The support and treatment services for drug users are run by private foundations that are fully financed by the government and the city. The extensive system of municipal services is supplemented by voluntary aid mainly provided by the churches and religious organizations. The Dutch way of dealing with the drug problem derives from the traditions of governance and political culture in Dutch society. These are crystallized in three character masks: those of the pragmatic and prudent merchant, more concerned with practical problems than lofty ideals, the charitable and paternalistic priest, and the humble engineer who in his age-long fight against floods has learned that nature can be controlled but never fully tamed.

The merchant, the priest, and the humble engineer. Observations on the Rotterdam drug scene

The Dutch policy on drugs has often been criticized in other countries. It has been claimed that the Netherlands has given up the fight against drugs and does not fulfill its international responsibilities. The purpose of this article is to show that the drug problem is taken seriously in the Netherlands, and plenty of resources are used to deal with it. The Dutch view on the nature of the problem and appropriate ways to treat drug users, however, is different from what is common elsewhere. The object of the study is the drug scene and the administration of drug-related services in Rotterdam. The focus in this article is on the relationship between drug users and the drug control system. The study draws upon observations and documents, and numerous interviews with civil servants, treatment staff, and drug users during a three-week visit in Rotterdam. In Rotterdam there are separate markets for cannabis and hard drugs. About 150 cafes are permitted to sell cannabis products provided they follow the rules: no sales to minors under 18 years of age, no alcohol, no hard drugs, no advertising. Hard drugs are sold illegally in 300-400 apartments located in the older parts of the city. The number of hard drug users is estimated to be 2500 - 4000, and the majority of them are registered in the Rotterdam Drug Information System (RODIS), which makes them eligible to use the services provided by the city for addicted drug users, gamblers, and alcoholics. No legal sanctions relate to smoking of cannabis or to possession of small amounts, whereas large-scale trade, smuggling, and commercial cultivation are criminal activities. Neither is the use of hard drugs or possession for personal use criminalized. The core of the drug problem is seen to be on the one hand the nuisance caused by those addicted hard-drug users who resort to petty crime and threaten the safety of other people, leading to the deterioration of the urban environment, and on the other hand the threat to the economy and politics of the country created by criminal drug organizations. In dealing with drug-related nuisance the aim is harm reduction. The central idea is the normalization of the drug problem. This means that efforts are made to keep drug users in contact with society, instead of pushing them outside by pursuing repressive policies. The threshold to health and social services and to treatment is kept as low as possible. At the same time addicts are held responsible for their behavior, and they are required to follow the regulations of the institutions providing support and treatment. Decisions concerning drug policies in Rotterdam are made at the top level, by the mayor, the public prosecutor, and the chief of police. They are assisted by the aldermen responsible for health, social affairs, and public order, and by commissions set up by the city council. Two remarkable aspects of the administration of drug-related affairs are a close cooperation between health authorities and the police, and an emphasis on Japanese-style neighborhood policing. The support and treatment services for drug users are run by private foundations that are fully financed by the government and the city. The extent and the variety of available services is impressive, ranging from consultation bureaus and daycare centers to intensive care units and a methadone dispensing program for 1 200 daily customers. The extensive system of municipal services is supplemented by voluntary aid mainly provided by churches and religious organizations. The Dutch way of dealing with the drug problem thus combines tolerance for drug use with a comprehensive network of services for drug users and a strict and carefully designed administration. Such an approach derives from the traditions of governance and political culture in Dutch society. These are crystallized in three character masks: those of the pragmatic and prudent merchant who is more concerned with practical problems than lofty ideals, the charitable and paternalistic priest, and the humble engineer who in his age-long fight against floods has learned that nature can be controlled but never fully tamed.