Substances

Despite differences in treatment policies and recording practices, it is possible to identify both common and divergent trends across Europe.

As in previous years, for 2001 all countries report an increase in the overall number of people treated for drug problems. According to the national reports, there are several reasons for this: improved methods of registration (more persons treated are reported), increased availability of treatment facilities (especially substitution treatments and low-threshold services), differentiation of programmes (there are now specialised services for specific target groups and different substances used in substitution programmes, such as buprenorphine as well as methadone), increasing treatment duration of existing clients and an increase in the number of persons being treated in rural/non-urban areas (National reports, 2002).

Drug users mainly demand treatment spontaneously or because family members exert pressure on them to do so; other sources account for only a small proportion of referrals (Figure 3 OL). Referrals to drug-treatment centres vary from country to country, for several reasons: differences in distribution of use of abused substances; differences in the national organisation of health, social and judicial services; and social or cultural differences. For example, the proportion of clients referred by the courts, police or other judicial services is highest in Germany, possibly because of the high proportion of cannabis users there (11). In contrast, in Sweden, which has a highly structured welfare system, social services play an important role in referring drug users to specialised services. In Greece, the family is a central institution in society and plays an important role as a source of referral (National report, 2002) (Figure 4 OL).



Figure 7

All clients admitted to treatment – presented by main drug

item Opiates | item Cocaine | item Cannabis | item Amphetamines | item Ecstasy | item Hallucinogens | item Others

Notes

n = 300 414.

(1) 1999 data. (2) 2000 data.

Sources: Reitox national reports (2002). See also Statistical Table 6: Characteristics of persons treated for drug problems in the EU.

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Opiates (especially heroin) remain the main substances of abuse among all clients seeking treatment in most countries (Figure 7). In most EU countries, between 50 % and 70 % of clients requesting treatment are heroin users, but the figure varies widely. It is possible to categorise EU Member States into four groups depending on the extent to which opiates abuse accounts for referrals to drug-treatment centres:

It seems that attendees of outpatient treatment centres tend to be more differentiated than users of other treatment services (Figure 5 OL) either because outpatient clinics specialise in specific drug-related problems or because such clinics have developed in response to demand for treatment of different types of drug abuse (such as cannabis or cocaine abuse) (Molinae et al., 2002).

In many countries, heroin is followed by cannabis in terms of the number of users seeking treatment, and the figure is highest among new clients (24.7 % of the total number of new admissions are cannabis users) (Figure 6 OL); clients requesting treatment for cannabis use mainly attend outpatient and inpatient clinics (Figure 5 OL). Often, cannabis is used in association with other substances and is used as a secondary drug (Figure 7 OL). The proportion of people seeking treatment for cannabis use varies greatly between countries: from 7.3 % in Greece to 27.2 % in Germany (Figure 7).



Spain (19 %) and the Netherlands (29.9 %) remain the countries with the highest percentages of clients seeking treatment for cocaine as their main drug. Rates in other countries are lower – from 0.8 % in Greece to 7 % in Luxembourg. A specific study of treatment data conducted in the Netherlands found that the two largest groups of people requesting treatment for cocaine use in the last years were cocaine base/crack users and those using cocaine in combination with heroin or methadone. Base/crack users may be particularly challenging for treatment services as crack cocaine is associated with a high level of dependence and problems and those who use it, either alone or in combination with heroin, are often poorly integrated socially (Mol and van Vlaanderen, 2002).

The drug group for which demand for treatment shows the widest disparity between countries is amphetamines, with the proportion of demand accounted for by amphetamine users being 3 % in Denmark, 8.7 % in Germany, 1.5 % in the Netherlands, 31.1 % in Finland, 29 % in Sweden, 2.7 % in the United Kingdom and less than 1 % in the other countries.

Polydrug use is increasingly apparent in treatment data. In all countries, over 50 % of all clients use at least one other drug in addition to their first drug, mainly cannabis (18.4 %) or cocaine (19 %). The most frequently reported combinations of substances are heroin with cocaine or cannabis, and cocaine with alcohol or cannabis (National reports, 2002).


(11) For various reasons (including, for example, the imposition of administrative sanctions such as a driving ban) the proportion of users referred by the criminal justice system does not necessarily correspond to the proportion of offenders.

(12) See Statistical Table 6: Characteristics of persons treated for drug problems in the EU; and Statistical Table 7: Characteristics of persons treated for drug problems in the EU for the first time.