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Abstract |
In Germany, the risky consumption of legal and illegal substances causes a great deal of social and psychological harm to the individual and to society. It is a key objective of health policy to prevent or substantially reduce risky consumption, harmful use and dependence on addictive substances by every possible means. Consequently, drug prevention is of outstanding importance. In addition, it is important to recognise addictive developments at an early stage and offer assistance in good time, so that addiction can be prevented or a way out of addiction found. Addiction is an illness requiring treatment. The aim is to make the existing treatment options available to addicts as soon, and as comprehensively, as possible. Addicts in Germany have a legal claim to assistance. The providers of social security benefits are obliged to finance this assistance. Together with the service providers and self-help groups they have, in recent decades, established a wide range of drug dependence and addict support services. In the last 30 years, a high-quality, differentiated treatment system has been developed in the addict support sector in Germany, encompassing outreach and low-threshold support, non-residential counselling and treatment offers, qualified withdrawal, residential withdrawal treatment with a subsequent adaptation phase and continuing, post-residential support services in the framework of integration (e.g. non-residential rehabilitation, assisted living, vocational rehabilitation projects, aftercare and self-help groups). In addition, there is a medication-assisted, non-residential treatment system, especially for opiate addicts. Substitution treatment for opiate addicts has been quantitatively expanded and qualitatively improved in recent years. It has become a pillar of the support available for opiate addicts. The efficacy of this counselling and treatment system has been widely confirmed. Co-operation between office-based doctors and the addict support system should be promoted in order to improve the interfaces in the field of acute medicine. There is a need for patients suffering from chronic multiple addiction, and thus presenting unfavourable starting conditions, also to be given the possibility of taking up the offer of withdrawal treatment. The resources available for the treatment of pathological dependence are also to guarantee need-based, high-quality care in the future. However, too few people with addiction problems are still being reached, and often too late. For this reason, improving access to addicts and people at risk of addiction is a central objective of health policy. The different measures of treatment – i.e. case management as an effective tool – will be presented. Quality assurance procedures will be also discussed. Quality assurance (QA) is implemented by the pension and health insurance funds which finance the treatment of drug addiction in Germany. QA as part of quality management aims to offer a high level of quality in drug aid. QA focuses on the effectiveness and efficiency of the services. A process of continuous improvement of treatment results is implemented. Systematic QA in in-patient institutions (esp. in medical rehabilitation centres) is stipulated by the service provider and strictly carried out. Case management has been shown to be effective in a pilot project to reach hard-to-reach addicts. The assistance planning procedures were difficult to implement (low reliability of clients, inadequate stability, cognitive limitations). Nevertheless, case management supervision was terminated successfully. The overall situation of clients improved. The vast majority of clients had been (very) satisfied with this intervention. Generally, satisfaction grew with the intensity of co-operation. Support structures were expanded in many pilot regions. Conceptual pre-requisites will be discussed. |
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