Assessing need and organizing services for drug misuse problems

John Marsden, Colin Bradbury and John Strang

in New Oxford Textbook of Psychiatry

Second edition

Published on behalf of Oxford University Press

Published in print February 2012 | ISBN: 9780199696758
Published online October 2012 | e-ISBN: 9780191743221 | DOI:
Assessing need and organizing services for drug misuse problems

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In the present decade, there has been substantial investment in drug misuse treatment thereby expanding the workforce, the capacity of the treatment system and leading to reduced waiting times and better integration of local services. In 2006–07, an in-treatment population of approximately 200 000 individuals were recorded by the National Drug Treatment Monitoring System (NDTMS). Capture-recapture estimates suggest that there are approximately 327 000 users of opioids and/or crack cocaine. About two-thirds of adults entering drug misuse treatment services are dependent on illicit heroin—a clinical presentation complicated by between 20 per cent to 50 per cent of admissions by concurrent dependence on cocaine and other substances such as the misuse of pharmaceutical medications (such as benzodiazepines). Cannabis is reported as the main problem drug for younger patients under 18 years of age. Overall, treatment services for clients of all ages are able to assess and provide interventions across all illicit drugs including amphetamine-type stimulants, sedative/hypnotics, cannabis, hallucinogens and volatile substances (solvents and inhalants). Hazardous and harmful alcohol use characterizes a significant, but priority group of drug misuse treatment seekers. In 2006, a revised national drug misuse treatment effectiveness strategy stressed the need for better local partnerships to commission and organize local services and promote reintegration of treated patients into the community. A core component of the strategy was the creation of Criminal Justice Integrated Teams (CJITS) who were given the role of treatment case coordi-nation for individuals involved in the justice system with identified drug misuse. Nevertheless, improvements to the reach, operation, and effectiveness of treatments remains a priority—particularly tackling high-risk behaviours linked to the acquisition and transmission of blood-borne infections and ensuring that all service users receive good quality assessment and care coordination.

Chapter.  5347 words. 

Subjects: Psychiatry ; Addiction Medicine

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