tdi meeting lisbon 23rd and 24th of june 2003 1 stichting informatievoorziening zorg - randhoeve 231...

TDI meeting Lisbon 23rd and 24th of June 2003

1

Stichting Informatievoorziening Zorg - Randhoeve 231 - Postbus 504 - 3990 GH Houten

Treatment Demand Indicator

Working groupon Cannabisprofile


3


Purpose of the working group: Propose some recommendations to the

National Focal Points and the treatment demand experts.

Identify perspectives of work for the short period on analysis with treatment demand data, starting from cannabis.

Develop a model for a profile analyses.


4


Some facts in the EU on cannabis: There is a relevant group of clients

asking treatment for cannabis as primary drug in the European countries

Characteristics of this group seem to be quite similar across countries; this is different from other substances used

The cannabis clients are reported to be very young


5

Some facts in the EU on cannabis:

Gender differences seem to be much lower for the cannabis clients than other groups

A substantial part of the clients reports to use cannabis intensively

The most reported combinations are with alcohol and/or stimulants.



6


Recommendations to the National Focal Points for the 2003 National Report, selected issue on “problematic” cannabis use: Select the population of clients using

cannabis as primary drug. Select among this group of cannabis

users people aged below 20 and people 20 years old and above.


7

Treatment Demand Indicator Variables to start with:

Gender Source of referral Living status Labour status Educational level New/all Frequency of use Age at first use Secondary drugs used in combination with

cannabis


8

These data can be extracted TDI database New/All a Frequency of use a Age at first use a Secondary drugs in combination

cannabis a



9


Variables to use and availability in Treatment Demand Indicator-data`base but not possible to produce by EMCDDA: Gender b Source of referral b Living status b Labour status b Educational level b


10


Give an interpretation providing: context (i.e. legislation/policy) organisation of treatment system cultural background other information that could be useful

to better interpret data


11


Two examples of a profile: An example of a dummy profile of

cannabis clients based on available Treatment Demand Indicator data

An example of a filled in extended profile based on Dutch data


12


Profile example based on Treatment Demand Indicator data only


13

TDI: example of profile Table 1 Demographic profile Young single

cannabis users (<20 yrs.) (N=....)

Older single cannabis users (> 20 yrs.) (N=....)

Cannabis users (with secondary drug) (N=....)

gender (%) male

female age

mean age (sd.) educational level never went to school

primary medium

higher living status

alone with child

other social context marital status

not married married

other labour status

paid not paid

other


14

TDI: example of profile (cont.)

Table 2 Characteristics of cannabisclients Young single

cannabis users (<20 yrs.) (N=....)

Older single cannabis users (> 20 yrs.) (N=....)

Cannabis users (with secondary drug) (N=....)

new clients (%)

source of referral (%)

self-referral healthcare

justice other

secondary problem (%)

alcohol Harddrug

(heroin/cocaine)

gambling other none

frequency of use (%)

occasionally once a week or

less

2-6 times a week

daily

(mean) age at first use


15


Example of a profile based on Treatment Demand Indicator data and some additional national data


16

Treatment demand of cannabis users in The

Netherlands: Which clients? Trends in treatment demand 1994

- 2001 Crossectional comparison of

different subgroups Longitudinal patterns in treatment

demand.


17

Selection: different types of clients

In LADIS primary, secondary and tertiary drugs is registered.

In our profile we developed an additional classification: single and multiple cannabis client.

Single = only cannabis is registered and no other drug or behaviour (i.e. gambling).

Multiple = cannabisproblem (be it primary or secondary) in combination with other drug / behaviour is registered (i.e. alcohol or opiates).


18

Cannabis: outpatient treatment demand 1994 -

2001 1994 2001 % change

Total # of outpatient clients in LADIS (i.e. alcohol+ drugs+ gambling) 49.158 55.072 12,0%

Total # of outpatient clients < 20 yrs. 1.921 1.125 -41,4%

Total # of clients with cannabis as primary problem 5.202 7.496 44,1%

Total # of young (< 20 yrs.) cannabisclients 634 616 -2,8%


19

Single cannabis users 1994 - 2001

(1994 = 100)

0

50

100

150

200

250

1994 1995 1996 1997 1998 1999 2000 2001

year

single cannabis user (1994=100)

single cannabis user young (< 20 yrs.)(1994=100)

single cannabis user old (>= 20 yrs.)(1994=100)


20

Multiple cannabis users 1994 - 2001(1994 = 100)

0

20

40

60

80

100

120

140

160

180

1994 1995 1996 1997 1998 1999 2000 2001

years

%

multiple cannabis user

multiple cannabis user (+alcohol)

multiple cannabis user (+opiates)


21

% of cannabis clients of the total # of outpatient clients in LADIS 1994 -

2001

0%

10%

20%

30%

40%

50%

60%

1994 1995 1996 1997 1998 1999 2000 2001

year

% % cannabisclients

% young cannabisclients(<20 yrs.)


22

% of cannabis clients of the total # of outpatient clients in LADIS according

to type of use (1994-2001)

0%

2%

4%

6%

8%

10%

12%

14%

16%

1994 1995 1996 1997 1998 1999 2000 2001

year

%

% cannabisclients

% single cannabisusers

% multiple cannabisusers


23

Mapping of geographical patterns in treatment demand of cannabis clients:

relative growth (10,000 inh.)

Clientsper 10.000 inhabitants

> 4 clients (3)2 - 4 clients (39)< 2 clients (462)

1994

Clientsper 10.000 inhabitants

> 4 clients (12)2 - 4 clients (90)< 2 clients (402)

2001


24

Table 1

Characteristics of cannabisclients according to type of use

Singletot.

Single (< 20yrs.)

Single(>= 20yrs.)

Multipletot.

Multiple+alcohol

Multiple +opiates

% in treatment in 2001(> 1 contact)

64% 76% 62% 68% 66% 70%

% female 18% 18% 18% 15% 15% 15%

mean age 26,6 16,9 28,8 31,3 32,6 31,2

% > 40 years 7% 9% 20% 24% 19%

Size of municipality (%)<10.000 inhabitants 2% 3% 1% 1% 1% 2%10.000 - 20.000 inhabitants 7% 13% 6% 7% 9% 6%20.000 - 50.000 inhabitants 21% 28% 20% 21% 21% 20%50.000 - 100.000 inhabitants 22% 25% 22% 23% 22% 23%> 100.000 inhabitants 45% 31% 48% 45% 45% 46%

(source: LADIS data 2001)


25

Table 1 (cont.)Characteristics of cannabisclients according to type of use

Singletot.

Single (< 20yrs.)

Single(>= 20yrs.)

Multipletot.

Multiple+alcohol

Multiple +opiates

ReferralClient him/herself 45% 38% 46% 47% 43% 50%Family / Network of client 6% 20% 3% 4% 3% 5%Drug treatment centre 15% 5% 17% 12% 12% 12%Criminal Justice / Probation 11% 11% 11% 19% 19% 20%

Healthcare 11% 9% 11% 9% 11% 7%

Living Statusalone 42% 10% 48% 47% 52% 45%with parents 26% 69% 17% 21% 15% 24%with children 10% 1% 13% 13% 17% 12%

Educational levelnot completed 12% 26% 9% 12% 10% 13%

primary 40% 49% 38% 50% 44% 55%secondary 41% 23% 46% 32% 36% 30%higher 5% 1% 6% 4% 8% 2%

Labour statusRegular employment 48% 34% 49% 38% 41% 35%economically inactive 22% 76% 13% 13% 11% 14%

unemployed 35% 11% 39% 50% 48% 53%

Ethnic backgrounddutch 85% 84% 85% 79% 82% 77%

western hemisphere 3% 6% 2% 5% 5% 6%allochtoon 12% 10% 13% 16% 13% 18%

Frequency of usedaily 78% 60% 81% 72% 76% 72%

2-6 times a week 9% 17% 8% 12% 11% 13%once a week 2% 3% 1% 3% 3% 3%occasional 5% 13% 3% 9% 7% 9%

( source: LADIS data 2001)


26

Age in categories of single and multiple cannabis users (LADIS

data 2001)

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

15-19 yrs. 20-29 yrs. 30-39 yrs. 40 yrs. or older

age category

% single cannabis user

multiple cannabis user


27

Social situation of cannabis clients (LADIS data 2001)

0%

10%

20%

30%

40%

50%

60%

70%

80%

single cannabis user multiple cannabisuser

single cannabis user young (< 20 yrs.)

single cannabis userold (=> 20 yrs.)

multiple cannabisuser (+ alcohol)

multiple cannabisuser (+ opiates)

type of client

%

alone

with parents

with children


28

Ethnic background of three groups of cannabis clients (LADIS data 2001)

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

single cannabis user multiple cannabisuser

single cannabis useryoung (< 20 yrs.)

single cannabis userold (=> 20 yrs.)

multiple cannabisuser (+ alcohol)

multiple cannabisuser (+ opiates)

type of cannabis client

%

% dutch

% western world

% allochtoneus


29

Type of professional help for various categories of cannabis clients

(LADIS data 2001)

0%

10%

20%

30%

40%

50%

60%

70%

single cannabisuser

multiplecannabis user

single cannabisuser young (<

20 yrs.)

single cannabisuser old (=> 20

yrs.)

multiplecannabis user (+

alcohol)

multiplecannabis user (+

opiates)

type of cannabisclient

%

social worker

psychologist

psychiatrist

medical doctor

nurse

psychiatric nurse

other


30

Time in treatment and mean # of contacts per month of different type of cannabis clients (LADIS data 2001)

0

0,5

1

1,5

2

2,5

single cannabisuser


single cannabisuser young (<

20 yrs.)

single cannabisuser old (=> 20

yrs.)


(+ alcohol)


(+ opiates)

type of cannabis client

me

an

# o

f c

on

tac

ts

0

50

100

150

200

250

300

350m

ea

n #

da

ys

in

trea

tme

nt

mean # contacts / month

mean # days in treatment


31

Cumulative and annual returnrate of different types of cannabis clients

discharged in 1994

0%

10%

20%

30%

40%

50%

60%

cumulativ

e returnra

te '95-0

1

% re

turned in

1995

% re

turned in

1996

% re

turned in

1997

% re

turned in

1998

% re

turned in

1999

% re

turned in

2000

% re

turned in

2001

%

single + multiple users

young single users

multiple users


32

Primary problem on readmission (in the period ‘94-’03) of young single and multiple use cannabis clients

discharged in 1994

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

% alcohol % opiates % cocain % cannabis % other

primary problem

% young single users

multiple users


33

Conclusions

If broken down according to age (<-> 20 yrs.) or/and multiple or single use meaningful data can be presented.

The total treatment demand for cannabis is growing: about 44% in the period 1994-2001.

The multiple cannabis client is the growth factor; specifically the client co-using alcohol. Combined use of cannabis seems to be the prevalent type of use.

The cannabis client is growing older as with other clients groups.


34

Conclusions (cont.)

The young single cannabis client (< 20 yrs.) is a relatively small group, but overrepresented under young clients (55%).

Young single clients markedly differ on type of referral, living situation, care pattern (i.e. intensity) and returnrate.

About 65% of the single young cannabis clients do not return to outpatient treatment.

When young single users return, about half of them applies for help for cannabis; about 20% returns to apply for help for problems with cocain.


35

LADIS clients profiles; current developments

Evolving to a fixed format with information on:- trends- longitudinal patterns (for example readmission)- cross-sectional comparisons

Additional surveys (“quick scans”) are done to gather contextual information about treatment programs.

Every outpatient drug treatment centre receives a benchmark in which the data on the national profile is compared to the profile of the service itself.

tdi meeting lisbon 23rd and 24th of june 2003 1 stichting informatievoorziening zorg - randhoeve 231...

Documents

cannabis slide

treatment demand data

outpatient treatment

treatment demand experts

example of profile slide

young slide

multiple cannabis users

single cannabis users