Demand for treatment (TDI)

• Methods and definitions

Overview of the data

The tables present information on the number of people seeking treatment for drug use. The data provide insight into general trends in drug use and also offer a perspective on the organisation and uptake of treatment. Treatment demand data from each country contain varying degrees of national coverage, principally from outpatient and inpatient clinics' treatment records (Table TDI-1, Table TDI-2).

In 2005, 21 European countries reported data on 4 121 outpatient units and 315 366 clients; 15 EU countries + Turkey reported data on 930 inpatient units covering 26 502 clients; 8 countries reported data on 4 543 other types of treatment units (low threshold agencies, treatment units in prison, general practitioners) and 11 905 clients. According to the available data on the number of treatment units existing by country, these units cover around 67% of existing outpatient and 53% of inpatient units$fn. For other types of facility there is limited information from the countries on their reporting coverage. It is important to take into consideration that the coverage ratio only refers to countries where data are available both on the number of existing treatment units in the country and on the number of treatment units included in the data collection (16 countries for outpatient units and 11 for inpatient units, see Table TDI-7).

Tables TDI-1 to TDI-8 are based on data from all types of treatment centres concerning new clients and all clients; they present the current situation for 2005 data and the trend for the last 12 years (1994 to 2005) where data are available.

Tables TDI-9 to TDI-24 report data on client characteristics and patterns of drug use from outpatient and inpatient treatment centres. In particular, they report data on age and gender, primary drug for seeking treatment, age at first main drug use, frequency of use of primary drug, educational level, employment and living conditions. Some tables only refer to outpatient treatment clients (Tables TDI-9 on age and gender distribution, TDI-16 on source of referrals, TDI-17 on route of administration and TDI-23 on polydrug use).

Tables TDI-25 to TDI-31 describe age distribution among drug clients and on drug users in treatment aged under 15. This background analysis served for the 2007 Selected issue on drug use and related problems among very young people.

Tables TDI-101 to TDI-125 are large tables reporting detailed data by country and by primary drug. In particular:

• Table TDI-101 presents the trend on gender distribution of drug clients from 1992 to 2005 by country;
• Tables TDI-102 to TDI-109 and Tables TDI-111 and TDI-112 present a breakdown by country of the summary Tables TDI-10, TDI-11 and TDI-18 on age distribution, age at first use and frequency of drug use of treatment clients;
• Table TDI-110 and Tables TDI-113 to TDI-121 focus on drug sub-type for opioid (heroin, methadone, other opioids), cocaine (cocaine HCL and crack) and stimulants other than cocaine (amphetamines, ecstasy and others);
• Tables TDI-122 to TDI-125 focus on under-15 drug clients.

Figures TDI-1 to TDI-14 are graphics on trends and characteristics of drug treatment clients in Europe.

Summary points

Treatment in profile

Cooperating agencies in 21 countries submitted data for 2005, reporting overall 326 184 requests for treatment during the year, excluding clients in treatment continuing from previous years. Out of them, there were 128 997 new demands for drug treatment, which represents around one third of the total number of clients (Table TDI-2 part(i) and TDI-2 part(ii)).

Demands were made by 44.4 new clients in every 100 000 inhabitants aged 15-64 in the European Union Member States and Turkey. Marked differences are found between countries in the incidence of drug clients: from 2 to 111 per 100 000 inhabitants. Differences in incidence are related to countries' variation in data coverage, as well as treatment availability and extent of problematic drug use (Table TDI-6).

Out of the reported data, 89% treatment demands were reported from outpatient treatment centres, 8% from inpatient treatment units and the remaining 3% from other types of treatment centres (low threshold agencies, treatment units in prison, general practitioners and other types of treatment services). It has to be noted that while 21 countries are reporting data from outpatient units, 16 countries are reporting data from inpatient units and only 8 countries are reporting data from other types of units. Therefore, this reflects both a better level of data coverage in outpatient centres and in the organisation of treatment systems in most European countries (Table TDI-7).

Male drug users predominate among all clients, but with male to female ratios varying greatly between countries and between primary drug of use. Gender ratio among new clients in 2005 varies from 1.8 males for every female in Sweden to 6.3 males for every female in Italy and between 6 men clients for every woman among primary cannabis users to less than 1 man for every woman among clients entering treatment for hypnotics and sedatives (even if figures are quite low in the latter case) (Tables TDI-4 part(i), TDI-5 part(i), TDI-21 and TDI-101).

Most clients are aged 20 to 30, with a mean age varying between 24.2 in Bulgaria and 32.4 in Sweden. New clients are on average 2 to 4 years younger than all clients (Tables TDI-4 part(i), TDI-5 part(i)).

In 2005, the treatment requests from 21 countries comprised 48% for heroin treatment requests, 13% for cocaine and 20% for cannabis. These proportions differ widely between countries. Among new demands for drug treatment in 22 countries, 35% were due to heroin, 29% to cannabis, 22% to cocaine and 6% to stimulants other than cocaine (Tables TDI-3, TDI-4 part(ii), TDI-5 part(ii), Figure TDI-2).

Trends in reported treatment demands

The number of reporting agencies increased from approximately 2 200 in 1996 to 50% more in 2005, with a slight decrease in 2004 and 2005 (Table TDI-2 part(iii)).

Total reported treatment demands increased by around 17% compared with the preceding year for Member States reporting both figures; notably this excludes France and Spain; Italy is also excluded because of a change in the case definition in 2005. This trend is not uniform across countries (Table TDI-2 part(ii)).

In 2005, requests from clients new to treatment represent a general increase of around 13% over the preceding year among countries reporting both years. Changes in new treatment demands are similar to changes in overall demands, but variations are reported between countries (Table TDI-2 part(i),and part(ii)).

Looking at the trend of new clients according to the main drug of use as the reason for entering treatment, data over a seven-year trend are analysed across 20 EU countries (Figure TDI-1) and it is possible here to detect a total fall of about 33% in absolute numbers of new heroin treatment demands; this strongly contrasts with those for cocaine over the same period (showing a13% increase) and even more so for cannabis demands (which have risen by 18%). (Table TDI-3 part(i), part(ii), part(iii)).

New treatment demands are still principally for heroin treatment, even though the relative importance of heroin amongst new treatment demands has decreased in most countries. By contrast, the relative position of cocaine and cannabis has increased in several countries.

Socio-demographic profile of drug treatment clients from outpatient and inpatient treatment centres

Differences in socio-demographic characteristics of drug treatment patients are found according to individual country and main drug of consumption. Variations may be due to differences in the organisation of treatment facilities, in the profile of problematic drug users and in other elements to be clarified. Overall, the following characteristics of drug clients in outpatient and inpatient treatment centres can be summarised:

• most drug clients live in stable accommodation, and a smaller group (correspondingly 7% and 13% of all outpatient and inpatient clients) live in unstable accommodation (the majority are homeless); 8% (outpatient) and 10% (inpatient) of all clients live in social institutions (Table 15 part(ii), part(iv));
• Around 40% of all clients live with their parents and around 15% of all outpatient clients and 7% of all inpatient clients are living with children, either alone or with a partner (Table 14 part(ii), part(iv));
• Around 10% of all outpatient and inpatient clients have neither been to school nor finished primary level education and only around 4% have reached a higher level of education (Table TDI-12 part(ii), part(iv));
• The proportion of drug clients without a regular employment is high, especially when compared with the general population. Unemployment rates are 45% among all outpatient clients and 76% among all inpatient clients against 7.3% in the general population (Table TDI-20 part(ii), part(iv); Table 13 part(ii), part(iv));

Treatment for opioids

Opioid use is still the main reason for entering treatment in Europe accounting for 48% of all treatment demands in 2005 and for 35% of new demands (Figure TDI-2); strong differences are reported between countries (Table TDI-5 part(ii)). In most countries, the proportion of opioid users is lower among new treatment demands (Table TDI-4 part(ii)).

Data from outpatient and inpatient treatment centres show the following profile of opioid clients on gender, age distribution and patterns of drug use:

• the male to female ratio among opioid users is 3-4 males to 1 female client for outpatient and inpatient clients. Marked variations are reported between countries in gender ratios which drop to near equality and reach 5 or more in some populations (Table TDI-21 part(ii), part(iv));
• the mean age of opioid clients is 32 years in outpatient centres and 30 in inpatient centres; among new demands for opioid treatment the mean age is one year lower (Table TDI-10 part(i), part(iii), part(v), part(vii));
• most clients experience their first opioid use before the age of 25, mainly between 15 and 19 years (Table TDI-11 part(i), part(iii), part(v), part(vii));
• around 61% of outpatient and inpatient opioid clients report using the drug on a daily basis; among new opioid clients the proportion of daily users is higher (67% among outpatient clients and 75% among inpatient clients) (Table TDI-18);
• in outpatient centres, 45% of all clients and 38% of new clients report injection as their main route of drug administration; and correspondingly 37% and 48% of them smoke it (Table TDI-17 part(i), part(v));
• many outpatient clients use opioids with another drug - in combination or in sequence - 23% of them use cocaine as secondary drug, 17% cannabis and 11% alcohol;35% of all opioid clients use it with another opioid (Table 23 part(i), part(ii));
• opioids are used as a secondary drug by 6% of outpatient clients and 12% of inpatient clients with a non-opioid primary drug (Table TDI-22).

Treatment for cocaine

In 2005, cocaine is the primary drug for 13% of all treatment demands and 22% of new treatment demands (Figure TDI-2). Marked country variations are reported; since several years Spain and The Netherlands have the highest proportion of cocaine users in drug treatment (in 2005 correspondingly 40.5% and 35.3% of all clients). In most countries, the percentage of cocaine clients is higher among new demands for drug treatments (Table TDI-3 part(ii), Table TDI-4 part(ii), Table TDI-5 part(ii)).

Data from outpatient and inpatient treatment centres show the following profile of cocaine clients on gender, age distribution and patterns of drug use:

• the gender ratio among cocaine clients is around 5 males for every female cocaine client; among new outpatient clients the gender ratio is higher (5.8 to 1) (Table TDI-21 part(i), part(ii), part(iv));
• the mean age of all cocaine clients is 31 years; new clients are around 1 year younger on average (Table TDI-10 part(i), part(iii), part(v), part(vii));
• most cocaine clients start their drug use before the age of 25 (Table TDI-11 part(i); part(iii), part(v), part(vii));
• outpatient cocaine clients can be divided in two groups according to their frequency of cocaine use: in the month before entering treatment around half of new (42.5%) and all (49.5%) cocaine clients have used cocaine occasionally or have not used it at all, presumably because some form of treatment or service contact had already begun; the other half of cocaine clients have used it daily or several times a week (57.5% of new clients and 50.5% of all clients). (Table TDI-18);
• around half of cocaine outpatient clients sniff the drug and another 34% smoke or inhale it; 9% of cocaine clients inject the drug (5% if they are new to treatment (Table TDI-17 part(ii), part(vi)); among crack cocaine users smoking/inhaling is the most frequent route of administration (Table TDI-17 part(ii), part(vi) and Table TDI-110 part(ii), part(iv));
• cocaine is often used in combination with another substance: 28% of outpatient clients use cocaine with cannabis, 23% with alcohol and 16% with opioids (Table TDI-23 part(i)). In outpatient treatment centres, 38% of crack cocaine users take cocaine in combination with opioid, in contrast with 15% of clients using cocaine HCL and opioid (Table TDI-118 part(i)). Cocaine is also reported as secondary drug by 15% of outpatient clients and by 9% of inpatient clients (Table TDI-22).

Treatment for amphetamines and ecstasy

Stimulants other than cocaine are infrequently reported as the primary reason for attending drug treatment. Among clients entering treatment for stimulants other than cocaine, 81% report using amphetamines, 16% ecstasy and the remainder stimulants other than cocaine, amphetamines or ecstasy. (Table TDI-8 part(i)). Marked differences are reported between countries: some Member States (Czech Republic, Latvia, Slovakia, Finland and Sweden) report amphetamines and methamphetamines as accounting for between around a quarter and more than half of all primary treatment demands. Only a few countries report some clients in treatment for primary ecstasy use (Table TDI-4 part(ii), Table TDI-5 part(ii)).

Data from outpatient and inpatient treatment centres show the following profile of clients using stimulants other than cocaine on gender, age distribution and patterns of drug use:

• the male to female ratio among users of stimulants other than cocaine is the lowest compared to other drug users; there are 2 males for every female in drug treatment for stimulants use, but country variations should be considered (Table TDI-21);
• the mean age of amphetamines and ecstasy clients is 27 years among outpatient clients and 29 among inpatient clients; clients entering treatment for the first time in their life are usually younger (Table TDI-10 part(i), part(iii), part(v), part(vii));
• the mean age at onset of drug use for most clients entering treatment for the use of stimulants other than cocaine is before 25, with most of them starting their drug use before the age of 20 (Table TDI-11 part(i); part(iii), part(v), part(vii));
• around half of outpatient clients in treatment for stimulants other than cocaine use them only occasionally or have not used them in the month prior to treatment; around one third use them daily or several times a week. Among inpatient clients, the proportion of regular users (daily or several times a week) is higher (60% among new patients and 39% among all patients), but figures reported are quite low and caution should be used wheninterpreting the data (Table TDI-18);
• more than half of outpatient clients in treatment for use of stimulants other than cocaine take them orally; drug injection is used by 14% of drug clients (11% among new clients); marked variations are reported between countries, namely in the Czech Republic, where most drug clients are in treatment for methamphetamine use and 73% inject it (Table TDI-17 part(iii), part(vii));
• many outpatient clients use stimulants – amphetamines and ecstasy - with another drug, mainly other stimulants (34%) or alcohol (26%) (Table 23part(i));
• stimulants other than cocaine are used as a secondary drug by 7% of outpatient clients and by 9% of inpatient clients (those with other primary drugs) (Table TDI-22).

Treatment for cannabis

Overall, cannabis is the second most reported primary drug among treatment demands and counts for 20% of all treatment demands and 29% of new demands (Figure TDI-2). There are marked differences between countries in the proportion of clients requesting treatment for cannabis as a primary drug (Table TDI-4 part(ii), Table TDI-5 part(ii)). According to available data, most cannabis clients enter treatment in outpatient centres and only few countries report a non trivial proportion of cannabis clients in inpatient treatment (Table TDI-24).

Data from outpatient treatment centres on gender, age distribution and patterns of drug use show the following profile of cannabis clients:

• male to female ratio for clients in treatment for cannabis is the highest among all drug types (5.3 males to 1 female among all clients and 6 males to 1 female among new clients) (Table 21 part(i), part(ii));
• cannabis users have a mean age of around 24 years, being the youngest clients in drug treatment after clients in treatment for use of volatile/inhalant substances (but figures for the latter are very low) (Table TDI-10 part(i), part(iii)). Among younger clients, 80% of under 15s and 67% of 15- to 19-year-olds are in treatment for primary cannabis use (Table TDI-10 part(ii));
• virtually all cannabis clients start their drug use before the age of 20 (Table TDI-11 (part(i), part(iii));
• in the month before entering treatment, 34% of all clients report using cannabis only occasionally or not at all (as with other drugs, presumably because some service or judicial contact had already been made earlier) and around 40% report using it on a daily basis (Table TDI-18 part(ii)). Marked differences exist between countries, with countries reporting around half of clients with occasional or no use in the 30 days prior to treatment and countries with 60% or more daily cannabis users (Table TDI-111 part(iv));
• cannabis is sometimes reported as primary drug used in combination (or sequence) with another substance; when cannabis use is reported with another substance, it is usually combined with alcohol (37%) or stimulants other than cocaine (28%) or cocaine (15%) (Table TDI-23 part(i)). Overall, 26% of all clients report the use of cannabis as secondary drug (Table TDI-22 part(i)).

Page last updated: Tuesday, 20 March 2012