9th International Symposium on Substance Abuse Treatment

1
Drug clients in Specialised Drug Treatment versus
Traditional Mental Health Care Agencies in
Belgium
similarities and dissimilarities
Kathy Colpaert Wouter Vanderplasschen Guido Van
Hal Eric Broekaert
2
OVERVIEW

• 1. Specialised drug treatment in Belgium history
  
• 2. Specialised versus non-specialised agencies
  current situation, with the province of Antwerp
  as a concrete example
• 3. Conclusion discussion regarding future
  directions

3
1. HISTORY OF SPECIALISED DRUG TREATMENT

• Before 1970s
• Number of drug users demanding treatment limited
  
• Treatment within the traditional mental health
  care system
• 1970s
• Increase in illicit drug use (esp. hallucinogens,
  heroin) associated problems
• The first specialised drug treatment initiatives
  were started up, e.g. the therapeutic communities
  De Sleutel De Kiem. Overall motives
• International influences research findings
  coming from the US
• Anti-psychiatric ideas and rejection of the
  disease-concept
• Traditional mental health care is reluctant to
  admit drug users
• Society (esp. the criminal justice system)
  starts to explicitly target drug users

4
1. HISTORY OF SPECIALISED DRUG TREATMENT

• 1980s - 1990s
• Other types of specialised/exclusive drug
  treatment were
  gradually introduced and developed. Motives
• Increase accessibility (shorter programmes
  outreach)
• Harm reduction approach (substitution treatment)
• Differentiation of the treatment offer

C u r r e n t s p e c i a l i s e d t r e a
t m e n t o f f e r Therapeutic
communities Crisis intervention centres
Short-term therapeutic programmes Day-care
centres Methadone clinics
Well-delineated treatment system Illicit
drug use prerequisite for treatment Same
financing mechanisms conventions
5
1. HISTORY OF SPECIALISED DRUG TREATMENT

• From the mid 1980s onwards
• Renewed or increased interest for the treatment
  
  of drug users from the traditional mental health
  care system
• From the 2000s onwards
• Government stimulates initiatives to
  
  co-ordinate the care and treatment of
  
  drug abusers, this on the level of
  the
  10 Belgian provinces

Outpatient Centres for Mental Health Care
with specific expertise Drug or substance
abuse units in Psychiatric Hospitals Crisis
units for drug abusers in General Hospitals
Often treatment of Alcohol-, Drugs- ánd
Medication-related Problems Also treatment of
other disorders
6
2. CURRENT SITUATION
a. Research questions

• What proportion does the number of treatment
  demands by drug abusers in specialised drug
  agencies bear to that in non-specialised
  traditional mental health agencies?
• What about overlap between specialised and
  non-specialised agencies? Do clients ask
  treatment in both sectors? Are clients referred
  across those two sectors?
• In what way do clients in specialised agencies
  differ from those in non-specialised agencies?

7
2. CURRENT SITUATION
b. Methods

• Secondary data-analysis of a previous study on
  the characteristics and treatment utilization
  patterns of clients in substance abuse treatment,
  in the province of
  Antwerp

8
2. CURRENT SITUATION
b. Methods

• Participation of nearly all inpatient and
  outpatient treatment agencies (specialised drug
  treatment as well as general mental health
  treatment) in the province offering treatment to
  drug users
• ? 15 agencies involved.

9
2. CURRENT SITUATION
b. Methods

• Registration of all new treatment demands of
  substance abusers in a period of 6 months.
• 1,935 treatment demands

Specialised drug treatment agencies 409 treatment
demands of primary drug users zero treatment
demands of primary alcohol abusers
Traditional mental health care agencies 632
treatment demands of primary drug users 872
treatment demands of primary alcohol abusers
10
2. CURRENT SITUATION
b. Methods

• Data collection
• Registration by clinicians
• Standard registration forms on paper
  internet
• Training sessions manual
• Limited set of variables client
  characteristics, substance use, treatment
  history and information on current treatment
  demand(s)

11
2. CURRENT SITUATION
c. Results

• Proportion of treatment demands of drug users in
  specialised versus non-specialised drug treatment
  agencies

Outpatient 48,5 vs 51,5 Inpatient 74,4
vs 25.6
50
50
12
2. CURRENT SITUATION
c. Results

• Overlap between the specialised and
  non-specialised sector
• Some clients were registered in more than one
  treatment agency within the 6-month registration
  period

Antwerp (11.0 n97)
40,2
23,7
36,1
13
2. CURRENT SITUATION
c. Results

• Overlap between the specialised and
  non-specialised sector
• To what extent do clients in one cluster have
  previous treatment experiences in the other?
  data from parallel study in province of
  East-Flanders variable not collected in province
  of Antwerp

Clients registered in traditional mental health
care settings 33.0 has no treatment
history 38.1 has a treatment history within
the specialised cluster 28.8 doesnt have a
treatment history in the specialised cluster

• Clients registered in specialised drug treatment
  agencies
• 25.5 has no treatment history
• 32.6 has a treatment history within the
  traditional cluster
• 41.8 doesnt have a treatment history in the
  traditional cluster

14
2. CURRENT SITUATION
c. Results

• Overlap between the specialised and
  non-specialised sector
• To what extent do treatment agencies from the one
  cluster refer clients to the other one?

• 62 clients registered in traditional mental
  health care settings were referred elsewhere
  after the intake interview (9,8)
• 50 to the specialised cluster

83 clients registered in specialised drug
treatment agencies were referred elsewhere after
the intake interview (20,3) ? 37,7 to the
traditional sector
15
2. CURRENT SITUATION
c. Results

• Similarities and differences in client
  characteristics and substance-related variables
  between the client populations of the specialised
  and non-specialised sector
  (those registered in both were excluded from the
  analyses).

16
2. CURRENT SITUATION
c. Results
Outpatient
CLIENT CHARACTERISTICS
Inpatient
Sign. Diff. on the .01 level (via Chi² or
T-test)
Sign. Diff. on the .01 level (via Chi² or
T-test)
17
2. CURRENT SITUATION
c. Results
Outpatient
SUBSTANCE USE
Inpatient
Sign. Diff. on the .01 level (via Chi² or
T-test)
Sign. Diff. on the .01 level (via Chi² or
T-test)
18
3. CONCLUSION AND DISCUSSION FUTURE

• Specialised drug treatment as well as traditional
  mental health agencies are now both involved in
  the treatment of drug abusers ?? while alcohol
  abusers can only rely on the traditional cluster
  
• Clients seek and find treatment in both clusters
  and also treatment agencies themselves refer
  clients across the two clusters
• Both clusters have a certain shared population,
  but also have an own client population with
  specific characteristics (age, nationality,
  substance use)

19
3. CONCLUSION AND DISCUSSION FUTURE

• Further collaboration between clusters has to be
  encouraged (mapping of the treatment offer
  increased differentiation modulation exchange
  of expertise, e.g. alcohol!), but with respect
  for own historical traditions and views on
  substance abuse.
• Traditional mental health care agencies alcohol
  treatment system evoluating towards substance
  abuse system?