Demand for treatment for drug use

Overview of the data | Tables | Graphics | Methods and definitions

Overview of the data

The links above give access to the tables in the bulletin and the associated graphics in the section dealing with TDI (treatment demand indicator), as well as to a description of the methods and definitions used in compiling this data. A brief overview is provided below. See also the side navigation bar for links to all chapters.

The tables present information on the number of people seeking treatment for a drug problem and this provides insight into general trends in problem drug use and also offers a perspective on the organisation and uptake of treatment facilities. Treatment demand data come from each country with varying degrees of national coverage, principally from outpatient clinics' treatment records (Table TDI-1, Table TDI-2 part (iii), Table TDI-2 part (iv)).

About half the countries provide information on the extent of coverage of outpatient treatment facilities, which overall is approximately 75% of number of units (disregarding their size) over the last two years. For other types of facility, there is very limited information from the countries on the coverage. All data presented refer to this reporting base.

The tables distinguish clients starting a treatment for drug use for the first time in their life (new clients) from those starting for the first time in the reporting year, but who may have been treated in previous years (all clients); currently no data are collected on clients continuing a treatment from the year(s) before the reporting year.

Note that data are collected in two forms: summary data on all types of treatment centres (source: EMCDDA Standard Table 3 and Standard Table 4); and more detailed client data by centre type: outpatient treatment centres, inpatient treatment centres, low threshold agencies, general practitioners, treatment units in prison, other types of centres (source: TDI detailed data collection by centre type). In particular, these data permit distinction between clients by primary drug (for which treatment is requested) and secondary drug(s), which are those taken in addition. See the Methods and definitions summary for further information on these points.

Generally tables on socio-demographic characteristics of clients and patterns of drug use (route of administration, frequency of use, age at first use) are based on detailed data mainly from outpatient treatment centres where the coverage is more extensive; tables on trends are generally based on new clients asking for treatment in all types of treatment centres. For every table the source of data is reported, indicating the specific table provided to EMCDDA by the countries reporting.

Table TDI-1 to Table TDI-7 are based on data from all types of treatment centres concerning new clients and all clients; they present the current situation for 2003 data and the trend for the last 8 to 10 years (1993 to 2003) where data are available. (Sources: the EMCDDA standard tables ST.03 and ST.04). In 2003, 22 countries submitted summary data on treatment.

Table TDI-8 to Table TDI-18 are based on detailed data collection by centre type. In 2003 17 countries submitted these data, enabling more detailed descriptions of clients, covering about 40 % of the total reported treatment demands and 55 % of new treatment demands. Table TDI-8 reports data for 6 types of centre (outpatient centres, inpatient centres, low threshold agencies, treatment units in prison, general practitioners providing treatment for drug addiction, other types of centre), and the remaining tables TDI-19 to TDI-26 report on the detailed data for outpatient treatment centres (sources: EMCDDA detailed TDI standard reporting schedules).

Summary points

Treatment in profile

Reports of drug users asking for treatment mainly arise from outpatient treatment centres; in the other treatment centre types the number of reported clients is smaller. This reflects both the organisation of treatment services within a country and the lower coverage of some centre types (Table TDI-8).

Cooperating agencies in 22 countries submitted data in 2003, reporting overall more than 410,000 requests for treatment, excluding clients in treatment continuing from previous years.

Including last available data from the remaining four countries, the 490,000 total treatment requests made comprised 60 % for opiate treatment requests, and over half (54 %) of these opiate clients were known to be injectors, with 10 % more having unknown injecting status. Cocaine treatment comprised about 10 % of all demands, and cannabis about 12 %. These proportions differ widely between countries (Table TDI-5 part (ii)).

Treatment demands from people not previously treated (clients new to treatment) make up only one quarter of this total.

Treatment demands were made by 28.4 new clients in every 100000 inhabitants in the European Member States, Bulgaria and Romania. Marked differences are found between countries in the incidence of new clients: from 4.2 to 58.7 per 100000 inhabitants (both figures relating to Eastern European countries) (Table TDI-19).

Trends

There was a net increase of about 14 % overall in the number of reporting agencies compared with the previous year. Exceptionally in Germany there were 256 more reporting centres; otherwise in all, four Member States reported very small decreases and 11 reported the same or increased numbers of centres (Table TDI-2 part (iii)).

Reported treatment demands increased by about 13 % over the preceding year for Member States reporting both figures (notably this excludes France). This increase is not uniform: six Member States report declines and 15 increases. Most of them report small relative changes, although the 1 % increase in Italian treatment demands represents 1,500 cases. Four Member States report relative increases greater than 10 %, outstandingly the United Kingdom (37 % or 26000 more requests) and Germany (83 % or 17000 more requests) (Table TDI-2 part (ii)).

Clients new to treatment make up 26 % of all treatment demands - approximately 110000 requests, representing a general increase of only 3 % over the preceding year among the countries reporting both years. Notably this excludes the United Kingdom, where the 29000 demands by new clients in 2003 represents an unknown increase over the preceding year. Changes in new treatment demands are more varied across countries than changes in overall demands: nine Member States report decreases and 11 increases (Table TDI-2 part (i)).

New treatment demands remain heavily related to opiates, although overall composition of the new-to-treatment population has changed strongly away from opiates towards cannabis. The relative importance of opiates among new treatment demands has decreased in 14 countries and increased or remained the same in six. By contrast the relative position of cocaine dropped in four countries and increased or remained the same in 15. A similar variety of changes occurred with other stimulants and with cannabis.

Over an 8 year trend across the 11 EU countries that provided long-term data (see Figure TDI-1 part (i) and Figure TDI-1 part (ii) for details) it is possible to detect a total fall of about 13 % in absolute numbers of opiate new treatment demands; this strongly contrasts with those for cocaine over the same period (risen about 40 %) and more so cannabis demands (risen about 80 %, including 20 % from 2002 to 2003). Caution is required in interpreting this as the total EU picture since these countries contribute only about 50 % of the new treatment clients in 2003 (Table TDI-3 part (i), Table TDI-3 part (ii), Table TDI-3 part (iii), Table TDI-3 part (iv)).

Current treatment patterns

Male drug users predominate among all clients, as outpatients and as new treatment clients in all European countries, but with male to female ratios varying greatly between 9 to 1 and 1.6 to 1 (Table TDI-5 part (i), Table TDI-9, Table TDI-20).

The mean age of all clients is usually two to three years older (from 23 to 33) than new clients, which varies between 22 and 30 (Table TDI-9, Table TDI-5 part (i)).

The most common age groups for new opiates outpatient clients are 20 to 30; although almost 40 % are aged more than 30 (Table TDI-10 part (ii)).

A number of countries do not report outpatient socio-demographic data, including some major treatment populations, but among those that do, representing about half this treatment population, marked differences are found between countries, depending on the main drug distribution, the organisation of treatment facilities and the socio-demographic situation. Overall, summarising those countries that reported data:

About 15 % of all outpatient clients live in social institutions or in an unstable accommodation (Table TDI-15).
Around 13 % of all outpatient clients are living with children, either alone or with a partner (Table TDI-14).
Almost 20 % of new outpatients did not complete a primary level of education and almost half the clients (45 %) completed only this primary level (data based on only 17000 clients) (Table TDI-12).
The proportion of new outpatient clients without a regular employment is high, especially when compared with the general population; but there is no strong correspondence between level of unemployment in the general population and level of unemployment among drug clients (Table TDI-13, Table TDI-21).

Detailed information on differences between types of clients according to their primary drug of treatment and data on source of referral for clients are usually only available for outpatients reported through the TDI schedule.

Treatment for opiates

The males to females ratio among opiates users is 2.8 to 1. Marked variations are reported between countries in gender ratios, which drop to near equality and extend to 4 or more in some populations (Table TDI-22).

Most opiates clients have started using opiates before age 25 and 50 % before age 20 (Table TDI-11 part (i)).

Overall about one third (ranging from 20 % to 90 %) of new outpatient opiates clients report using the drug on a daily basis (Table TDI-18 part (i)).

Of new outpatient clients, 43 % report injection as their route of opiate administration and 41 % smoke it (Table TDI-17 part (i)).

Many of these clients use opiates with another drug or in combination or in sequence; for 53% of them cannabis is the secondary drug and for 28 % it is alcohol (Table TDI-25 part (ii) Among new outpatients, 9 % of clients report opiates as a secondary drug of use (Table TDI-24).

Treatment for cocaine

Cocaine related treatment demands are higher among new clients than all clients (Table TDI-3 part (ii), Table TDI-4 part (ii), Table TDI-5 part (ii)).

Among new outpatient treatment demands for cocaine use:

The gender ratio is 3.7 males for each female (Table TDI-22).
Mean age is around 30 years and most clients are in the age group 20 to 34 (Table TDI-10 part (iv)).
Half the clients first start cocaine use when they are between 15 and 19 years and one third between 20 and 24 (Table TDI-11 part (iv)).
Half of the clients sniff cocaine and another 45 % smoke or inhale it (Table TDI-17 part (ii)).

Cocaine is often used in combination with another drug: for 49 % of clients with cannabis and for 45 % with alcohol (Table TDI-25 part (i), Table TDI-25 part (iii)). Cocaine is reported as secondary drug by 13 % of clients (Table TDI-24).

Treatment for amphetamines and ecstasy

Stimulants other than cocaine, specifically amphetamines and ecstasy, are infrequently reported as primary reason for attending drug treatment. Some countries are exceptions to this and report them as accounting for between a quarter and more than half of all primary treatment demands (Table TDI-4 part (ii), Table TDI-5 part (ii), Table TDI-3 part (iii)).

Among new outpatient clients for stimulants other than cocaine,

84 % report using amphetamines and 16 % MDMA (ecstasy) (Table TDI-23).
Almost one third of clients are aged between 15 and 19 years and another third between 20 and 24 (Table TDI-10 part (v)).
The large majority of users of stimulants (other than cocaine) among clients first start use between 15 and 19 years (Table TDI-11 part (v)).

Treatment for cannabis

Overall, cannabis is the second most reported primary drug among treatment demands. There are marked differences between countries in the proportion of new clients demanding treatment for cannabis as primary drug: between 2 and 3% in some Eastern European countries and more than 20 % in some older EU Member States. Proportions among new clients are higher, ranging to over 50 % with only a few countries reporting below 10 % (Table TDI-4 part (ii), Table TDI-5 part (ii)).

In the detailed reports received from outpatient clinics, cannabis is often reported as a primary drug without reporting the use of other drugs; when reported with other substances, it is usually combined with alcohol or stimulants other than cocaine (Table TDI-25 part (iv)). Overall 22.5% of new clients report the use of cannabis as secondary drug (Table TDI-24).

Males to females ratio for new client treatment demands for cannabis use is higher than for opiates, cocaine or other stimulants (4.8 to 1) (Table TDI-22).
Almost all new cannabis clients are younger than 30; 39 % are aged between 15 and 19 years (Table TDI-10 part (i)).
In the month prior to entering treatment 30 % of new clients report using cannabis only occasionally or not at all and 36 % report using it on a daily basis (Table TDI-18 part (iv)).

Source of referral

Among the countries that are able to supply data, the main referral source reported for new outpatients (36 %) is self-referral followed by the criminal justice system (17 %) and then by general practitioners (15 %); the other sources of referrals have much less impact (Table TDI-16).