1. Senior Drug Users A European-wide problem November 18th 2009 Glasgow Nina Kuplewatzky University of Applied Sciences, Frankfurt, Germany Institute of Addiction Research Nina Kuplewatzky, Institute of Addiction Research, Frankfurt, Germany

2. Participants in the study  Germany: Institute of Addiction Research; Institut für Soziale Infrastruktur  Austria: European Centre for Social Welfare and Research; Schweizer Haus Hadersdorf  Scotland: Scottish Drugs Forum  Poland: Institute of Psychiatry and Neurology, Warsaw Nina Kuplewatzky, Institute of Addiction Research, Frankfurt, Germany

3. Aims of the study Phase 1 and 2:  Providing data –re-analyses of national and local data sets  Providing legal and financial frameworks for support and care of senior drug users in the 4 countries. Phase 3 and 4:  Interviews with target group on:  living situation, their health status and their future.  Interviews with key ‘experts’ on:  current and future needs of this population.  Developing European guidelines to support and care for elderly drug dependents. Nina Kuplewatzky, Institute of Addiction Research, Frankfurt, Germany

4. Restrictions  Focus on heroin use/dependence (ICD F11) and multiple substance use (ICD F19)  Cut-off points of age groups in the study: -34 and younger, -35 and older. (Background: very small numbers of problematic drug users 40+ in Austria) Nina Kuplewatzky, Institute of Addiction Research, Frankfurt, Germany

5. Problems on an international perspective Difficult to do comparisons between countries due to:  variations in national data files,  definitions of clients (cf. new clients versus all clients, estimates on sdu’s versus clients in treatment etc.)  differences in diagnostics Nina Kuplewatzky, Institute of Addiction Research, Frankfurt, Germany

6. Drug dependents 35 years and older 2000/01 – 2006/7 Relative increase of senior (problem) drug users (35+) known to authorities (treatment facilities) in the 4 countries Austria Germany Scotland Poland 2000/0128%20%14%16% 2006/0733%38%29%23% Nina Kuplewatzky, Institute of Addiction Research, Frankfurt, Germany

7. Percentage of senior female problematic drug users (35+) in treatment in the 4 countries 2006/07 Austria Germany Scotland Poland 2006/0721%31%24%33% Nina Kuplewatzky, Institute of Addiction Research, Frankfurt, Germany

8. Preliminary results  Between 2000 and 2006, in all four countries the absolute and relative percentage of sdu’s (35+) registered in psychosocial and medical treatment increased.  The percentage of senior female problematic drug users (35+) varies to some extent between the 4 countries. Nina Kuplewatzky, Institute of Addiction Research, Frankfurt, Germany

9. Preliminary results  The are indications across the four countries that polydrug use within this population has increased  In all 4 countries there is a change in recorded diagnoses. Since 2000/01, F11 diagnoses (opiate misuse/ dependence) has decreased while F19 diagnoses (polydrug misuse/ dependence) increased. Nina Kuplewatzky, Institute of Addiction Research, Frankfurt, Germany

10. Legal and financial frameworks  The legal and financial frameworks differ between countries.  Those of Austria, Germany and Scotland have a lot in common, especially welfare support such as minimum financial support including housing (and heating), health care and disability care for illicit drug users who are jobless or need professional help or care (unlimited time span).  In these 3 countries, sdu’s have free access to (all kinds of) psychosocial and medical treatment. However, going on (inpatient) abstinence therapy may be more difficult for sdu’s than for younger ones. Nina Kuplewatzky, Institute of Addiction Research, Frankfurt, Germany

11. Legal and financial frameworks  Poland differs because of differences regarding the level of welfare support to all citizens.  Those who have been in the workforce may apply for unemployment benefits which – if it is granted – is paid for 6 month only.  Unemployed problematic drug users may apply for disability pensions, but bureaucratic procedures are painful and payment is small and also limited (up to 5 years only). Nina Kuplewatzky, Institute of Addiction Research, Frankfurt, Germany

12. Legal and financial frameworks  In Poland social welfare benefits require an active attitude of those who apply for it (collaboration with social workers, willingness to sign a contract and to go on abstinence treatment etc.) and time of payment is once again restricted.  The restrictions for sdu’s to get unemployment or welfare benefits or qualify for disability pensions are difficult to overcome. Consequently, sdu’s have to look for other support systems. Nina Kuplewatzky, Institute of Addiction Research, Frankfurt, Germany

13. Legal and financial frameworks Polish sdu’s who are known to drug treatment clinics depend strongly on their family networks, shown in many areas like:  Housing: ca. 70% live with their family  Financial support: many of those who live with their family are also financially supported by family members.  Sdu’s who are not supported by family networks or by unemployment or welfare benefits have to look for other income sources, e.g. criminal activities (dealing with drugs, shoplifting etc.). Nina Kuplewatzky, Institute of Addiction Research, Frankfurt, Germany

14. Interviews with sdu’s preliminary results  Despite a rather poor health situation report, most sdu’s judge their health status as good.  Many of the sdu’s report experiencing discrimination, marginalization and isolation. Nina Kuplewatzky, Institute of Addiction Research, Frankfurt, Germany

15. Interviews with sdu’s preliminary results A rather high number of sdu’s say that they long for a drug free life in the future, but have also problems to pursue this because  becoming drug free may go along with losing ones drug-using friends.  social circumstances makes maintaining a drug free life difficult to achieve over the long-term. Reports on living arrangements in the future and in need of help are fragmented, sometimes even contradictory, and vary by subgroups Nina Kuplewatzky, Institute of Addiction Research, Frankfurt, Germany

16. Interviews with experts preliminary results Isolation of sdu’s was a common theme in all of the interviews with experts. Sdu’s seem not to have much contact with family members, other persons in every day life or with other drug-using seniors. They often rely on professionals, for instance social workers or GPs whom they idealize. Furthermore, experts are very much aware of the health risks of sdu’s which seem likely to become acute in the near future. Nina Kuplewatzky, Institute of Addiction Research, Frankfurt, Germany

17. Summary Data on senior problematic drug users in the 4 countries is available but has many limitations. It is therefore difficult to present reliable absolute and relative data on sdu’s in the 4 countries. Even so, there is overwhelming evidence that the target group of our study – problematic senior drug users – has increased since 2000 across the four countries. In Germany and Scotland, the rate of the seniors doubled between 2000 and 2006/07, in Austria and Poland it increased at least by 5%. Nina Kuplewatzky, Institute of Addiction Research, Frankfurt, Germany

18. Summary In all 4 countries sdu’s who are engaged in the drug scene mostly live in poverty and at the margins of society – even when they live with their families as in Poland. The situation is getting worse with age and sdu’s experience social exclusion in every day life. As a consequence they often retreat into the drug scene which lowers once more their chances to get in touch with people who have no drug problems. They are caught in a vicious circle. Nina Kuplewatzky, Institute of Addiction Research, Frankfurt, Germany

19. Summary In summary, countries and cities with large numbers of problematic drug users in their 40s and 50s have to prepare to take care of this group of - often – physically impaired and often with mental health problems of varying severity. Nina Kuplewatzky, Institute of Addiction Research, Frankfurt, Germany

20. Thank you for your attention Nina Kuplewatzky Institute of Addiction Research kuplewa2@fb4.fh-frankfurt.de www.sddcare.eu Nina Kuplewatzky, Institute of Addiction Research, Frankfurt, Germany