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Methods and definitions: demand for treatment

Information on the number of people seeking treatment for a drug problem 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.

The objective of the TDI project is to extend the detailed data collection to a full coverage on all the treatment centres, in order to have a better picture of the European clients demanding treatment for their drug use. The collection system classifies clients by primary and secondary drugs used: primary drug is the drug reported as the drug that causes the client the most problems. It can be based on problems as defined by clients or on short diagnoses, based on the ICD-10. The main drug is also the main reason for asking for treatment; the secondary drugs are the drugs taken in addition to the primary drug; up to four different drugs can be recorded for every client.

Data are collected in two forms: summary data on all types of treatment centres (Sources: Standard Table 03 — see below) and detailed data by centre type (outpatient treatment centres, inpatient treatment centres, low threshold agencies, general practitioners, treatment units in prison, and any other types of centres) (Sources: TDI detailed data collection by centre type — see below).

The treatment demand indicator measures the yearly uptake of treatment facilities by the overall numbers entering treatment for drug use and by the numbers among these of people entering for the first time (treatment incidence). Currently, no data are collected on clients continuing a treatment from the year(s) before the reporting year; but a pilot project started in 2005 with a group of nine countries has now finished the first phase and the first extensive pilot data collection on treatment prevalence on all countries will start in September 2008, producing the first comprehensive results in 2009.

The EU Member States, the candidate countries and Norway collect the data on people starting a treatment for their drug use according to an established European protocol (the TDI protocol): the Joint Pompidou Group-EMCDDA Treatment Demand Indicator Protocol version 2.0, along with a more detailed Technical Annex. This protocol is the result of the developmental work undertaken by the Pompidou Group, the study of national experiences and specific projects run by the EMCDDA.

The EMCDDA’s treatment demand indicator (TDI) provides a uniform structure for reporting on the number and the characteristics of clients referred to drug treatment facilities. The TDI protocol is based on 20 items concerning the type of treatment provided and the characteristics of clients: socio-demographic data and drugs information.

The item list of 20 variables which should be collected by EU countries, is reported below. Currently, the item list was revised and only 18 out of 20 items are collected, adapting to an updated situation.

A revision of the TDI protocol, which will include the new data collection and the updates in the current version of the protocol as well as substantial changes in the drug clients conditions (e.g. polydrug use) and in the treatment system will be carried out in the following period.

For further details, see the TDI protocol. The protocol provides a classification of treatment centres, defines which clients they should notify, and gives guidelines on methods of data collection, analysis and reporting.

There are some limitations related to the differences in data collection and reporting methods by each Member State. The number of missing cases for each data item is another limitation.

The results presented in the tables reflect that treatment information is not available from all the Member States. Differences in coverage among Member States affect data comparability. Some countries lack information on treatment units and the definitions used are not always 100% compatible with the TDI protocol. Most countries have different kinds of treatment facilities and, moreover, the differences in the availability and use of drug treatment services could bias the results. The network of drug treatment centres has changed in the last decade; for example, methadone programmes have expanded. These changes in treatment services could have influenced treatment figures over time. A last problem concerns the network of treatment centres and whether it is extensive enough to meet all treatment demands. Because of those methodological limitations, a project on data coverage has been carried out in 2007, providing a general assessment of the level of representativeness and validity of data presented through the treatment demand indicator. The project gives some recommendations for extending the level of coverage in the treatment system and for interpreting treatment demand data, taking into account the variability and limitations in data coverage.

Specific analyses based on treatment demand data are reported in the web page, detailing client profiles.