Abstract: The report on the state of the drugs problem in Europe presents the EMCDDA’s yearly overview of the drug phenomenon. This is an essential reference book for policy-makers, specialists and practitioners in the drugs field or indeed anyone seeking the latest findings on drugs in Europe. Published every autumn, the report contains non-confidential data supported by an extensive range of figures.

Abstract: Recent estimates suggest that, each year, over 1 million Europeans receive treatment for problems related to the use of illicit drugs (EMCDDA, 2010). Of these, more than half receive opioid substitution treatment for problems related to opioid drugs, primarily heroin. The current levels of provision of drug treatment services in the European Union are the result of an expansion of services that has taken place during the last two decades. For much of that time, services expanded against a background of a growing drug problem, and one in which economic conditions were largely favourable. Now, however, in an era of cuts in government expenditure, managing the costs of treatment and ensuring the highest quality and best outcomes for the lowest possible cost are priorities. While measuring and improving drug treatment outcomes have been relatively high on the research agenda in recent years, the cost of treatment has received far less research attention. Addressing this information gap is likely to have a number of benefi ts for both decision-makers and treatment providers. On the one hand, service providers need accurate information on the costs of service provision in order to plan the allocation of resources. On the other, decision-makers and funders can use such information as a means of cost control, for example, by comparing costs of similar services or those of alternative providers of similar services. Finally, as a part of a fuller economic analysis, information on service costs is needed to determine the cost-effectiveness of interventions and treatment programmes. The cost of drug treatment in Europe is looked at from two main angles in this Selected issue. First, it presents an overview of the main sources of drug treatment funding and the financing mechanisms that are employed in European countries. The available data are presented on who is paying for drug treatment, how funding is organised, and how funding is distributed among different treatment modalities. This is followed by an analysis of the unit costs of different types of drug treatment. Costs related to opioid substitution treatment including the costs of substitution medication for a number of European countries are presented here. This publication keeps a tight focus on the cost of drug treatment and does not attempt to undertake a broader economic analysis of the healthcare and social costs relating to illicit drugs. This Selected issue represents a fi rst attempt to provide a European overview of drug treatment costs, and individual countries are brought into focus to illustrate specifi c aspects of the analysis. This subject is both topical and methodologically challenging. The varying availability of information as well as the complexity of funding arrangements mean that, at best, only very incomplete estimates can be made of the costs of (or expenditure on) drug treatment in Europe.

Abstract: The last two decades have witnessed an increase in the development of treatment guidelines in the European drugs field. This has largely built on a body of evidence on the treatment of drug dependence that has developed since the 1980s, alongside a growing interest in, and understanding of, the eff ectiveness of interventions. A range of tools became available to translate evidence into satisfactory and sustainable results, among them : guidelines and standards, education and training, implementation and assessment, monitoring, and accreditation systems based on quality standards. The focus of this Selected issue is drug dependence treatment guidelines – one of the main measures used to improve and guarantee the quality of drug treatment provision. The focus on drug dependence treatment is timely and appropriate, as current estimates suggest that at least 1.1 million people were treated for illicit drug use in the European Union, Croatia, Turkey and Norway during 2009 (1). This is the consequence of a major expansion of specialised outpatient services during the last twenty years, with the significant inclusion of primary healthcare, self-help groups, general mental health services, and outreach and low-threshold service providers. While more than half of clients received opioid substitution treatment, a substantial number received other forms of treatment for problems related to opioids, stimulants, cannabis and other illicit drugs. The main modalities used for the treatment of drug problems in Europe are opioid substitution, detoxification and psychosocial interventions. Drug dependence treatment services are provided in a variety of settings: specialised treatment units (including outpatient and inpatient centres), mental health clinics and hospitals, units in prison, lowthreshold agencies and by offi ce-based general practitioners. Particularly in western Europe, there appears to have been a gradual shift away from a view of drug dependence treatment as the responsibility of a few specialist disciplines providing intensive, short-term interventions towards a multidisciplinary, integrated and longer-term approach. Evidence suggests that continuous care and integrated treatment responses may be aided by the development and use of guidelines, care protocols and case management by all the relevant service providers (Haggerty et al., 2003). This publication sets out to introduce the topic of treatment quality improvement by the development of guidelines (and other documents), and to provide an overview of the existing national guidelines for the treatment of drug dependence in Europe.

Abstract: Les addictions sont souvent associées à la précarité, à l’errance et à l’absence de travail. Le plan gouvernemental a voulu agir sur les facteurs pouvant concourir à l’insertion ou la réinsertion sociale des personnes présentant une addiction, notamment par l’établissement de bonnes pratiques destinées aux professionnels de l’addiction et aux intervenants auprès de publics précaires. Une première étape de cette action, portée par l’association “Drogues et Société”, a abouti à l’élaboration du document intitulé “Insertion par l’emploi des usagers de drogues”. Cet ouvrage, réalisé également avec le soutien du Fond Social Européen, présente des pistes de réflexion à partir d’actions et de réponses existantes.