Abstract: Angesichts des europaweit steigenden Behandlungsbedarfs für jugendliche Cannabisklienten und der wissenschaftlich belegten Effektivität der Multidimensionalen Familientherapie für jugendliche Drogenklienten wird im Rahmen der europäischen INCANT Studie die in den USA entwickelte Multidimensionale Familientherapie (MDFT) eingeführt und in fünf europäischen Ländern wissenschaftlich evaluiert. Die gleichzeitige Arbeit mit den Jugendlichen, den Eltern, der Familie und anderen relevanten Personen im sozialen Kontext der jugendlichen Klienten ist ein Schwerpunkt des systemischen multidimensionalen Therapieansatzes, der in diesem Beitrag vorgestellt und anhand beispielhafter Therapieverläufe nachvollziehbar gemacht wird. Erste klinische Erfahrungen aus der Studie lassen eine Bestätigung der hohen Wirksamkeit von MDFT erwarten. MDFT is a family based systemic treatment model for adolescent drug abuse and related behavior problems. The model has been tested in several U.S. RCT studies and is developed by Howard Liddle and colleagues at the “Center for Treatment Research on Adolescent Drug Abuse” (CTRADA), University of Miami Medical School. Since 2006 MDFT is being tested in an international multi-site randomized controlled trial (INCANT) in Europe. The work with family members and the extra familiar system in different settings are core pieces of the treat-ment, which will be demonstrated by examples of clinical cases. First experiences with MDFT from the German INCANT site show promising outcomes regarding the effectiveness of MDFT Treatment.

Abstract: AIMS: Effects of differing drug policies are difficult to evaluate, because time trends in the spread of heroin use, the most problematic illicit drug world-wide, are unknown in almost all countries. We aimed to develop a simple method to estimate these dynamics with data that can be gathered from patients in substitution treatment within a single day. DESIGN: We tested the assumption that being in substitution treatment on any day depends solely upon individual time since onset of regular heroin use (following a ’general inclusion function’). We used data from the case register for substitution treatments in the canton of Zurich (1992–2004), comprising 9518 patients, to model a ’general inclusion function’. Applying this function, we calculated 30 incidence curves for heroin dependence, each with data of one of 30 randomly chosen treatment days between 1992 and 2004. FINDINGS: Incidence modelling led to 30 similar curves, and therefore our hypothesis was corroborated. Additionally, our approach also revealed a restricted access to substitution treatment in the early 1990s and a decline in demand due to the introduction of heroin-assisted treatment from 1994 onwards. CONCLUSIONS: In the canton of Zurich, the probability of being in substitution treatment can be described by a ’general inclusion function’, and therefore dynamics of heroin epidemics can be estimated based on data of a single treatment day. Adaptation of our function to areas with a more restricted access to substitution treatment may permit these estimations also in other regions or countries. Thus, our approach facilitates the urgently needed assessment of the effects of different drug policies.

Abstract: Phase I of the Zurich Prometheus Study is a cross-sectional study focusing on an up-to-date serology for HIV and hepatitis B/C and associated risk factors for all clients in four participating clinics offering opiate substitution in Zurich, Switzerland. The mean age of the 603 respondents is 30.7 years (SD=6.2), and 38% of them are women. Seventy-five percent of the respondents have a history of injecting drug use (IDU), and over half have injected within the past six months. Lab-confirmed seroprevalence for HBV (50%) and HCV (57%) is twice that of HIV (24%). There is an 80% risk reduction for all three viral infections among those starting IDU after 1991—when harm reduction efforts were in full swing—compared to those who began before 1988—before clean needles were widely available. These findings suggest a strongly protective effective of harm reduction measures. But while a stabilization in HIV prevalence at 15% can be seen among drug users who started injecting after 1991, prevalence rates for HBV and HCV still remain several times higher. The prevalence data in this study support data showing continued high incidence rates for HBV and HCV, even among new injectors in the harm reduction era.