TDI meeting Lisbon 23rd and 24th of June 2003
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Stichting Informatievoorziening Zorg - Randhoeve 231 - Postbus 504 - 3990 GH Houten
Treatment Demand Indicator
Working groupon Cannabisprofile
TDI meeting Lisbon 23rd and 24th of June 2003
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Treatment Demand Indicator
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.
TDI meeting Lisbon 23rd and 24th of June 2003
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Treatment Demand Indicator
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
TDI meeting Lisbon 23rd and 24th of June 2003
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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.
Treatment Demand Indicator
TDI meeting Lisbon 23rd and 24th of June 2003
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Treatment Demand Indicator
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.
TDI meeting Lisbon 23rd and 24th of June 2003
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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
TDI meeting Lisbon 23rd and 24th of June 2003
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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
Treatment Demand Indicator
TDI meeting Lisbon 23rd and 24th of June 2003
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Treatment Demand Indicator
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
TDI meeting Lisbon 23rd and 24th of June 2003
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Treatment Demand Indicator
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
TDI meeting Lisbon 23rd and 24th of June 2003
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Treatment Demand Indicator
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
TDI meeting Lisbon 23rd and 24th of June 2003
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Treatment Demand Indicator
Profile example based on Treatment Demand Indicator data only
TDI meeting Lisbon 23rd and 24th of June 2003
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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
TDI meeting Lisbon 23rd and 24th of June 2003
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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
TDI meeting Lisbon 23rd and 24th of June 2003
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Treatment Demand Indicator
Example of a profile based on Treatment Demand Indicator data and some additional national data
TDI meeting Lisbon 23rd and 24th of June 2003
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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.
TDI meeting Lisbon 23rd and 24th of June 2003
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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).
TDI meeting Lisbon 23rd and 24th of June 2003
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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%
TDI meeting Lisbon 23rd and 24th of June 2003
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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)
TDI meeting Lisbon 23rd and 24th of June 2003
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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)
TDI meeting Lisbon 23rd and 24th of June 2003
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% 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.)
TDI meeting Lisbon 23rd and 24th of June 2003
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% 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
TDI meeting Lisbon 23rd and 24th of June 2003
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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
TDI meeting Lisbon 23rd and 24th of June 2003
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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)
TDI meeting Lisbon 23rd and 24th of June 2003
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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)
TDI meeting Lisbon 23rd and 24th of June 2003
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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
TDI meeting Lisbon 23rd and 24th of June 2003
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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
TDI meeting Lisbon 23rd and 24th of June 2003
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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
TDI meeting Lisbon 23rd and 24th of June 2003
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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
TDI meeting Lisbon 23rd and 24th of June 2003
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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
multiplecannabis user
single cannabisuser young (<
20 yrs.)
single cannabisuser old (=> 20
yrs.)
multiplecannabis user
(+ alcohol)
multiplecannabis user
(+ 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
TDI meeting Lisbon 23rd and 24th of June 2003
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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
TDI meeting Lisbon 23rd and 24th of June 2003
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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
TDI meeting Lisbon 23rd and 24th of June 2003
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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.
TDI meeting Lisbon 23rd and 24th of June 2003
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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.
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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.