Treatment challenges
Download
1 / 27

TREATMENT CHALLENGES - PowerPoint PPT Presentation


  • 44 Views
  • Uploaded on

TREATMENT CHALLENGES. Dr.Thomas Legl President EURO –TC Director Kur- und Gesundheitszentrum Knappenhof/Austria. Shaping the Future – A Multisectoral Challenge 52nd ICAA CONFERENCE ESTORIL, October 11th-16th 2009. BACKGROUND/GENERAL GUIDELINES WITHIN THE EU. Integrative Approach

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about ' TREATMENT CHALLENGES' - noe


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
Treatment challenges

TREATMENT CHALLENGES

Dr.Thomas Legl

President EURO –TC

Director Kur- und Gesundheitszentrum Knappenhof/Austria

Shaping the Future – A Multisectoral Challenge

52nd ICAA CONFERENCE

ESTORIL, October 11th-16th 2009


Background general guidelines within the eu
BACKGROUND/GENERAL GUIDELINES WITHIN THE EU

  • Integrative Approach

  • Different Problems – Different Strategies

  • Punishment for Trafficking & Treatment for Dependant Persons

  • Counseling Consumers

  • Decriminalization vs. Legalization


Evidence based research
EVIDENCE BASED RESEARCH

  • Level A: Consistent randomised controlled clinical trial cohort study, clinical decision rule validated in different populations.

  • Level B: Consistent retrospective cohort, exploratory cohort, ecological study, outcomes research, case control study .

  • Level C: Case series study .

  • Level D: Expert opinion without explicit critical appraisal, bench research or first principles


Findings and realities
FINDINGS AND REALITIES

  • Time Factor most essential/cost cuttings

  • Treatment to be ready available/reality of long waiting lists

  • No single treatment appropriate for everyone /programmes predominately not flexible

  • Focus on multiple needs-co morbidity-social factor/ come-go-come back” effect

  • Continuous assessment/rare existence


Co morbidity flow pattern
Co-Morbidity - Flow Pattern

Outpatient

Facility

Psychiatric

Hospital

High Co-Morbitity

Low Co-Morbitity

Specialised

Residential

Treatment

High Co-Morbitity

Substitution

Programme

Low Co-Morbitity


Substiution treatment
SUBSTIUTION TREATMENT

  • Around 600 000 patients receive treatment in Europe

  • Predominant option for opiod users

  • Methadone still most common with Buprenorphine coming up

    BEST PRACTICE

  • Long term basis and effective dosage

  • Psychosocial treatment

  • Excellent experience in combination with residential treatment


Substitution drugs
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


Matching treatment to the patients needs
MATCHING TREATMENT TO THE PATIENTS NEEDS

SPECIAL PROGRAMMES

  • Parents and Children

  • Dual Diagnosis

  • Adolescents

  • Gender Oriented Treatment

  • Ethnic Approach

  • Geriatric Communities


Change in consumption patterns
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


Types of consumers
TYPES OF CONSUMERS

  • DROP OUT TYPE – long term use and social problems

  • SENSITIVE TYPE – female, successful

  • OBSESSIVE TYPE – male, frustrated with everyday live

  • SOCIALIZING TYPE – male, seeking social inclusion

  • LIFESTYLE TYPE - fun oriented party consumer

    Maik Just, Magdeburg 2006


Impact on treatment
IMPACT ON TREATMENT

  • Traditional Treatment setting, oriented towards opioid users only fits needs of small number of persons from first user group

  • Other types have no identification with treatment system, detest counseling and treatment together with opioid users mainly because of different social situation

  • As consequence often do not receive other treatment than individual therapy with private psychotherapists

  • Evidence based treatment principles highly ignored


Evidence based intervention and local necessities and strategies
Evidence based intervention and local necessities and strategies

  • DCD 2 –Democracy City and Drugs /European Project

  • Treatment challenges on local basis

  • Necessity to develop common guidelines on the European basis

  • Gap between knowledge ,local necessities and political realities

  • High motivation for common solutions


Li ge
Liège strategies

  • Main Topics:

    ▪ Increasing cocaine use

    ▪ Increasing number of pregnant women using drugs

  • Illegal drug users do not use possibilities for treatment

  • Boarder region with high drug trafficking

  • Challenges / needs to be done:

    ▪ Implementation of heroin assisted treatment

    ▪ Adequate residential treatment and aftercare

    ▪ Implementation of a consumption place

    ▪ Increase cooperation to reorganisation


Vienna
Vienna strategies

  • Main topics:

    ▪ treatment of addicted pregnant women & young mothers

    ▪ early treatment intervention of children with addiction background in the family

    ▪ treatment of older people, as well as other people dependent on other‘s help


Vienna1
Vienna strategies

  • Challenges / needs to be done:

    ▪ implementation of case management

    ▪ work for a higher tolerance within the population

    ▪ Provide addicted persons during and after treatment (substitution) with a productive structure

    ▪ Special feature on education and job promotion for young persons

    Solutions for growing unemployment rate with early intervention system


3 leipzig
3. Leipzig strategies

  • Main topics:

    ▪ Appropriate structure and possibilities for working activities as well as for leisure time rarely exist during outpatient treatment

    ▪ Insufficiant access to target groups

    ▪ Early intervention in general/somatic treatment facilities


Leipzig
Leipzig strategies

  • Challenges / needs to be done:

    ▪ Provide sufficient psycho-social support for addicts in substitution treatment

    ▪ Optimise prescribing regulations for substitution drugs/train prescribers

    ▪ intensify work focused on women and families


4 central bohemia region czech rep
4. Central Bohemia Region (Czech Rep.) strategies

  • Main Topics:

    ▪ High percentage of very young drug users

    ▪ Ethnic dimension-high prevalence of drug use in Roma community and other ethnic minorities

    ▪ Inadequate substitution treatment programmes offered by the towns-not practicable regulations (3 doctors cover population of 3000 adicts)

    High prevalence of pregnant drug using women


Central bohemia region
Central Bohemia Region strategies

  • 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


Stuttgart
Stuttgart strategies

  • Main Topics:

  • Not enough cooperation with primary health care

  • A rather well-working system for outpatient treatmet, but long waiting times

  • Many alcoholics can not be reached; substitution programs are missing their point


Stuttgart1
Stuttgart strategies

  • Challenges / needs to be done:

  • Better Networking between stakeholders

  • Supporting early intervention, early warning systems also in terms of cost effectivness


Treatment motivation
TREATMENT MOTIVATION strategies

  • Addiction treatment still has low retention rate – negative cost/outcome effects

  • Client participation in development of guidelines and planning of strategies

  • Unpleasant environment


ARE ISOLATED SETTINGS FOR DRUG/ALCOHOL ABUSERS strategies

STILL APPROPRIATE?


New strategies
NEW STRATEGIES strategies

  • Attachment to Primary Care Sytem –special education (general practicioners and substitution)

  • Common settings with other psychosomatic diseases /focus from symptom to wider perspective of psychosocial status


Challenges
CHALLENGES strategies

  • ADAPTING TREATMENT TO PATIENTS NEEDS

  • Needs emerge during therapy

  • Matching needs as they emerge

  • Treatment extended to different interventions at different times /relapse not failure

  • Making treatment attractive



Thank you for your attention

THANK YOU FOR YOUR strategiesATTENTION


ad