1. TDI meeting Lisbon 23rd and 24th of June 2003 1 Stichting Informatievoorziening Zorg - Randhoeve 231 - Postbus 504 - 3990 GH Houten

2. Treatment Demand Indicator Working group on Cannabisprofile

3. TDI meeting Lisbon 23rd and 24th of June 2003 3 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.

4. TDI meeting Lisbon 23rd and 24th of June 2003 4 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

5. TDI meeting Lisbon 23rd and 24th of June 2003 5 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

6. TDI meeting Lisbon 23rd and 24th of June 2003 6 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.

7. TDI meeting Lisbon 23rd and 24th of June 2003 7 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

8. TDI meeting Lisbon 23rd and 24th of June 2003 8 These data can be extracted TDI database New/Alla Frequency of usea Age at first usea Secondary drugs in combination cannabisa Treatment Demand Indicator

9. TDI meeting Lisbon 23rd and 24th of June 2003 9 Treatment Demand Indicator Variables to use and availability in Treatment Demand Indicator-data`base but not possible to produce by EMCDDA: Genderb Source of referralb Living statusb Labour statusb Educational levelb

10. TDI meeting Lisbon 23rd and 24th of June 2003 10 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

11. TDI meeting Lisbon 23rd and 24th of June 2003 11 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

12. TDI meeting Lisbon 23rd and 24th of June 2003 12 Treatment Demand Indicator Profile example based on Treatment Demand Indicator data only

13. TDI meeting Lisbon 23rd and 24th of June 2003 13 TDI: example of profile

14. TDI meeting Lisbon 23rd and 24th of June 2003 14 TDI: example of profile (cont.)

15. TDI meeting Lisbon 23rd and 24th of June 2003 15 Treatment Demand Indicator Example of a profile based on Treatment Demand Indicator data and some additional national data

16. TDI meeting Lisbon 23rd and 24th of June 2003 16 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.

17. TDI meeting Lisbon 23rd and 24th of June 2003 17 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).

18. TDI meeting Lisbon 23rd and 24th of June 2003 18 Cannabis: outpatient treatment demand 1994 - 2001

19. TDI meeting Lisbon 23rd and 24th of June 2003 19 Single cannabis users 1994 - 2001 (1994 = 100) 0 50 100 150 200 250 19941995199619971998199920002001 year single cannabis user (1994=100) single cannabis user young (< 20 yrs.) (1994=100) single cannabis user old (>= 20 yrs.) (1994=100)

20. TDI meeting Lisbon 23rd and 24th of June 2003 20 Multiple cannabis users 1994 - 2001 (1994 = 100) 0 20 40 60 80 100 120 140 160 180 19941995199619971998199920002001 years % multiple cannabis user multiple cannabis user (+alcohol) multiple cannabis user (+opiates)

21. TDI meeting Lisbon 23rd and 24th of June 2003 21 % of cannabis clients of the total # of outpatient clients in LADIS 1994 - 2001 0% 10% 20% 30% 40% 50% 60% 19941995199619971998199920002001 year % % cannabisclients % young cannabisclients(<20 yrs.)

22. TDI meeting Lisbon 23rd and 24th of June 2003 22 % 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% 19941995199619971998199920002001 year % % cannabisclients % single cannabisusers % multiple cannabisusers

23. TDI meeting Lisbon 23rd and 24th of June 2003 23 Mapping of geographical patterns in treatment demand of cannabis clients: relative growth (10,000 inh.) Clients per 10.000 inhabitants > 4 clients (3) 2 - 4 clients (39) < 2 clients (462) 1994 Clients per 10.000 inhabitants > 4 clients (12) 2 - 4 clients (90) < 2 clients (402) 2001

24. TDI meeting Lisbon 23rd and 24th of June 2003 24 Table 1 Characteristics of cannabisclients according to type of use Single tot. Single (< 20 yrs.) Single (>= 20 yrs.) Multiple tot. Multiple +alcohol Multiple + opiates % in treatment in 2001 (> 1 contact) 64%76%62%68%66%70% % female18% 15% mean age26,616,928,831,332,631,2 % > 40 years7%9%20%24%19% Size of municipality (%) <10.000 inhabitants2%3%1% 2% 10.000 - 20.000 inhabitants7%13%6%7%9%6% 20.000 - 50.000 inhabitants21%28%20%21% 20% 50.000 - 100.000 inhabitants22%25%22%23%22%23% > 100.000 inhabitants45%31%48%45% 46% ( source: LADIS data 2001)

25. TDI meeting Lisbon 23rd and 24th of June 2003 25 Table 1 (cont.) ( source: LADIS data 2001)

26. TDI meeting Lisbon 23rd and 24th of June 2003 26 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

27. TDI meeting Lisbon 23rd and 24th of June 2003 27 Social situation of cannabis clients (LADIS data 2001) 0% 10% 20% 30% 40% 50% 60% 70% 80% single cannabis usermultiple cannabis user single cannabis user young (< 20 yrs.) single cannabis user old (=> 20 yrs.) multiple cannabis user (+ alcohol) multiple cannabis user (+ opiates) type of client % alone with parents with children

28. TDI meeting Lisbon 23rd and 24th of June 2003 28 Ethnic background of three groups of cannabis clients (LADIS data 2001) 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% single cannabis usermultiple cannabis user single cannabis user young (< 20 yrs.) single cannabis user old (=> 20 yrs.) multiple cannabis user (+ alcohol) multiple cannabis user (+ opiates) type of cannabis client % % dutch % western world % allochtoneus

29. TDI meeting Lisbon 23rd and 24th of June 2003 29 Type of professional help for various categories of cannabis clients (LADIS data 2001) 0% 10% 20% 30% 40% 50% 60% 70% single cannabis user multiple cannabis user single cannabis user young (< 20 yrs.) single cannabis user old (=> 20 yrs.) multiple cannabis user (+ alcohol) multiple cannabis user (+ opiates) type of cannabisclient % social worker psychologist psychiatrist medical doctor nurse psychiatric nurse other

30. TDI meeting Lisbon 23rd and 24th of June 2003 30 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 cannabis user multiple cannabis user single cannabis user young (< 20 yrs.) single cannabis user old (=> 20 yrs.) multiple cannabis user (+ alcohol) multiple cannabis user (+ opiates) type of cannabis client mean # of contacts 0 50 100 150 200 250 300 350 mean # days in treatment mean # contacts / month mean # days in treatment

31. TDI meeting Lisbon 23rd and 24th of June 2003 31 Cumulative and annual returnrate of different types of cannabis clients discharged in 1994 0% 10% 20% 30% 40% 50% 60% cumulative returnrate '95-01 % returned in 1995% returned in 1996% returned in 1997% returned in 1998% returned in 1999 % returned in 2000 % returned in 2001 % single + multiple users young single users multiple users

32. TDI meeting Lisbon 23rd and 24th of June 2003 32 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

33. TDI meeting Lisbon 23rd and 24th of June 2003 33 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.

34. TDI meeting Lisbon 23rd and 24th of June 2003 34 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.

35. TDI meeting Lisbon 23rd and 24th of June 2003 35 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.