fiftj *..-• *» COMVIISSION OF THE EUROPEAN COMVKJNITIES 
COM(90)527 final 
Brussels, 8 November 1990 
REPORT ON NATIONAL PROGRAMMES 
FOR DRUG DEMAND REDUCTION 
IN THE EUROPEAN COMMUNITY 
[COMMUNICATION FROM THE COMMISSION TO THE COUNCIL) 
COMMISSION 
OF THE EUROPEAN 
COMMUNITIES 
REPORT ON NATIONAL PROGRAMMES 
FOR DRUG DEMAND REDUCTION 
IN THE EUROPEAN COMMUNITY 
BACKGROUND 
The European Council on 25 and 26 June 1990 in Dublin invited 
the Commission to present on a regular basis to the Council and 
Ministers for Health a report on work done on drug demand 
reduction in Member States.At its meeting on 19 and 20 July 
1990 in Rome, the CELAD expressed an interest in receiving the 
first of these reports in time for the Rome Summit in December. 
On 30 July 1990, the Commission, following discussions with 
experts from Member States (meeting in Luxembourg on 16th July 
1990), requested, through the Permanent Representations, the 
relevant authorities to forward by mid-September national 
reports on the programmes for the reduction of drug demand, 
giving the following information: 
The introduction should contain details of the scale of 
and trends in drug demand, policies for reducing drug 
demand and whether these are regional or national, and the 
role of central organisations in financing action 
The other sections of the report should cover the 
following points: 
. legal aspects of drug demand, 
. information and instruction, 
. treatment and reduction of risk, 
. social and vocational rehabilitation, 
. education, 
. statistics and epidemiology - population studies, 
public opinion surveys, 
. promotion of research. 
For each of these fields it was considered useful to have 
details of: 
. national, regional and local structures, 
. the level and sources of aid, 
. what action has been taken and the main results to 
date, 
. any future measures planned. 
The reports transmitted by a number of Member States departed 
considerably from the above outline. This overview report, 
which has been prepared in consultation with national experts, 
(meeting in Luxembourg on 2 and 3 October 1990) provides a 
comprehensive synthesis of the situation in the European 
Community regarding drug demand reduction in Member States (A 
summary of the national reports is annexed). 
INTRODUCTION 
The definition of drug policies and the setting up of 
appropriate actions reflect the socio-cultural and political 
context at various levels. In this respect in each Member 
State, national, regional and local levels have their own 
competence in the field of drug demand reduction. Most of the 
Member States involve each level with specific 
responsibilities. 
In most Member States policies and general guidelines for drug 
demand reduction are established at national level, while the 
implementation of actions in prevention, treatment and 
rehabilitation is the responsibility of regional or local 
bodies. There is a trend towards decentralization even in 
Member States where such responsibilities are not clearly 
distributed. 
National support and coordination are often considered 
essential for the establishment of general policies. There is a 
willingness to keep a balance between local innovative 
activities and the necessity to have a minimum coordination of 
policies. 
The sources of funding and their allocation reflect the 
distribution of responsibilities between the national, regional 
and local levels. In some Member States levels of Government 
funding are enhanced by the substantial contribution by the 
non-government sector. In several of them the levels of funding 
have shown a substantial increase in recent years, in a number 
of cases due to the additional threat of AIDS. 
The levels and trends of drug use, when looked at in 
comparative terms, must be considered with caution, since each 
Member State uses different methodologies and definitions for 
data collection. In some cases, trends cannot be ascertained 
within some Member States, since no consistent data collection 
effort has been implemented over a period of time. 
Member States stressed the difficulty of estimating the total 
number of drug users since many do not seek help nor do they 
come into contact with the authorities. On the basis of the 
limited available data on the number of known drug users, many 
Member States have experienced an increase in their number in 
recent years. In some Member States there are reports of a 
stabilization in the overall number of users, in particular for 
heroin. This probably reflects the overall changing pattern of 
supply and demand and the type of drug use. Health based 
indicators on drug users applying for treatment and drug-
related deaths show an increasing trend of drug-related 
problems in most Member States. In a number of Member States, 
there is a clear indication that the average age of the drug-
using population is increasing. Heroin and polydrug use remain 
the main problems; there is evidence in some Member States that 
the use of cocaine and new drugs is increasing; however this is 
not substantiated at present by health data. 
LEGAL ASPECTS 
Regarding the legal framework of drug demand reduction in 
Member States, four aspects are to be pointed out: legal 
provisions regarding drug possession or use, and the 
consequences for drug users; regulations and practices 
concerning compulsory detoxification and treatment; voluntary 
detoxification and treatment, and substitution treatments; and 
special provisions related to the prevention of HIV 
transmission and AIDS. 
There is a constant adaptation of legislation and regulations 
in response to a complex and changing situation. In most 
Member States the legal provisions favour the therapeutic 
approach for drug users. This may be voluntary or compulsory, 
and it is, when compulsory, an alternative to prison. There is, 
however, in certain Member States a tendency to increase the 
penalties for drug possession for personal use. 
h 
More recently, the awareness of the role of intravenous drug 
use as a risk behaviour for HIV infection has emphasized, in 
the legislation of many Member States, the public health 
aspects of drug misuse. Two examples can be mentioned in this 
respect: the substitution treatments on one hand, in particular 
involving methadone, wuich are increasingly approved in some 
Member States for pilot experiments where methadone was not 
available for normal medical treatments; and on the other hand, 
the liberalization of the sales of syringes to take into 
account the new risk of HIV transmission and AIDS. Needle 
exchange programmes still remain limited. 
PREVENTION 
Member States have made numerous efforts to deal with the drug 
abuse problem. As a common factor for most Member States the 
increasing recognition of the need to develop coordinated, 
continuous and structured preventive actions can be highlighted 
responding to a rapidly evolving situation. Guidelines 
mentioned for prevention activities include: 
the importance of a broader framework of prevention 
measures in which various cultural, health and social 
problems are addressed 
the need for a comprehensive approach to drug abuse 
problems, covering a range of different environments 
simultaneously, taking into account risk factors and 
including illicit and licit drugs 
the importance of adapting interventions to local needs 
and circumstances 
the integration of drug education 
education school programmes in general health 
the emphasis on the promotion of a healthy life-style and 
avoiding risk behaviours 
the need for factual, objective, non-dramatized and non-
fear raising information 
the importance of the responsibility 
leading figures as positive role models 
the training of educators, 
professionals of parents and 
youth workers, and health 
There are two approaches concerning the use of mass media in 
information campaigns. Some countries consider them not a very 
effective way to carry out prevention interventions while 
others have recently launched campaigns. 
*> 
TREATMENT AND REHABILITATION 
Most Member States have treatment structures with services 
ranging from hospital and community based medical facilities, 
outpatient centres, and therapeutic communities to self help 
groups. The coverage, diversification and decentralization of 
services varies considerably betweeen them; both formally 
structured institutions with professional staff, and loosely 
organized voluntary assistance provide these services. 
Member States report the need to continue to strive for better, 
more diversified and increased number of treatment 
possibilities. An important factor conditioning treatment 
policies is the role of intravenous drug use as a risk factor 
for HIV transmission. This fact has prompted many Member States 
to have flexible approaches to substitution treatments and 
syringe availability, as well as to try to reach drug users in 
their environments, and to make help available to them without 
the requirement of a drug-free lifestyle as a first goal. 
The balance between health and social services in the 
approaches to the care of drug users is different between the 
Member States; while in some of them the emphasis is on the 
social approach, with the collaboration of health care when 
needed, in others the trend is to include the treatment of 
substance abuse in the general health care system with the 
collaboration of social services. Finally, in some Member 
States the mental health care system also plays an important 
role. Most Member States report a need for better adapted 
services aimed at individuals with specific problems: 
prisoners, AIDS patients and HIV positive persons, drug using 
pregnant women, children of drug users, etc. 
STATISTICS AND EPIDEMIOLOGY 
As a whole, health based data collection at national level is 
recent, scarce and generally not consistent. The data sources 
at national level most commonly used among Member States are 
treatment-based reporting systems, drug-related deaths and 
school surveys. In some instances national general population 
surveys on drug use, and specific population surveys have been 
carried out using different methodologies. Member States 
mention the need for more systematized, coordinated, comparable 
and in-depth data collection. A number of Member States 
participate in the work of the Pompidou group on health based 
indicators and collection of data in pilot cities. 
& 
At a regional/local level the picture is similar. Most 
countries have carried out isolated regional and local data 
collection efforts, which although very valuable in their 
specific contexts, do not permit trends assessments or the 
establishment of comparisons between regions due to a lack of 
consistent methodology. 
Specific research oriented studies have been carried out at 
local and/or regional levels with a psychosocial/sociological 
/anthropological perspective to provide a more in-depth view of 
different aspects of substance abuse. 
MANPOWER TRAINING 
Most Member States report a recent increase in awareness on 
the urgent need for adequately trained personnel for the 
prevention and treatment of drug use. Up to the moment, the 
most common approach to manpower training has been sporadic 
and/or of short-duration and sometimes outside normal 
structures. Interdisciplinary courses for professionals and, in 
few cases, continuous training has been provided. Some Member 
States have produced resource information/ training materials 
for physicians, pharmacists, teachers and parents. Several 
Member States have structured, regular university and post­
graduate studies for training and specialization in substance 
abuse. 
The need to develop permanent programmes is recognized by a 
number of Member States, and in some instances, the planning 
is well underway. Examples of such plans are: the integration 
of substance abuse training in university curricula of 
teachers, health professionals and psychologists; university 
and postgraduate training on substance abuse; and continuing 
education systems for professionals involved in prevention and 
treatment. 
RESEARCH 
There seems to have been, up to very recently, only minor 
attention given to research, with a lack of coordination at 
national level (mostly isolated research initiatives at some 
universities). This highlights the need for an increase of 
funding and coordination in substance abuse research. Some 
Member States have already started responding to this need by 
creating new research coordinating bodies and/or specific 
funding for substance abuse research. 
CONCLUSIONS 
Member States are deeply aware of the importance of drug demand 
reduction programmes and the need to develop them as an 
essential element in an overall drug policy. The approaches to 
drug demand reduction are continually and often rapidly 
evolving in Member States ; furthermore a large variety of 
approaches is being explored. Member States consider it 
important to introduce and improve evaluation programmes. They 
emphasize the importance of a broader framework of prevention 
measures in which various cultural, health and social problems 
are addressed and for a comprehensive approach to drug abuse 
problems, covering a range of environments simultaneously, 
taking into account risk factors and including illicit and 
licit drugs. Member States stress the need to have available a 
variety of different treatment methods for drug users. They 
consider that there is a clear need for developing comparable 
data collection systems on drug demand reduction. They 
recognize the need for increased support and coordination of 
research efforts. Adequate funding and manpower resources are 
fundamental to ensuring that drug demand reduction (prevention, 
treatment and rehabilitation) is carried out effectively. 
s 
y 
ANNEX 
summary of the national reports 
1 
INTRODUCTION 
1 Definition of drug policies 
1.1 National level 
Belgium 
Everything to do with drug trafficking is a matter for the national authorities (i.e. the 
Ministries of the Interior, Justice and Finance and the Department of Health). As 
regards demand reduction, the Ministry of the Interior is responsible for the crime 
prevention aspect, mainly taking the form of training the police force with a view to 
enhancing their capacity to meet the specific demands issue of such "drugs issue adult 
target groups" as parents, teachers, educators, etc. The legal and criminal aspects of drug 
demand reduction come under the Ministry of Justice, while drugs prescription 
monitoring duties fall to the Health Department's pharmacy inspectorate. 
Denmark 
The national level establishes statutes and other regulations, all control measures and 
general coordination. 
France 
Responsibility for policies regarding prevention, care and rehabilitation and for 
financing special addict care structures lies entirely with the national authorities. There 
is a General Delegation for combating drugs and drug abuse which is responsible for the 
overall coordination of drugs policies. 
Greece 
There is an interministerial body operating since the beginning of 1988 which 
determines national policy against ihe misuse of drugs. The Ministry of Health, Welfare 
and Social Security is currently expanding a network of institutions for prevention, 
treatment and rehabilitation and financially supports a nongovernmental national 
program based on the therapeutic community concept. 
Ireland 
The Department of Health plays a key role at the National level in a concerted effort 
with other Government Departments and Agencies to monitor the position and to 
stimulate corrective action, regarding the abuse of drugs covered by the Misuse of Drugs 
Act. There is a National Co-ordinating Committee on Drug Abuse which is chaired by 
the Minister of State at the Department of Health and is representative of all the 
relevant Government Departments and agencies (i.e. Justice, Education, Foreign 
Affairs, Police, Customs etc.). This Committee is currently drafting a National Plan to 
combat drug abuse. 
Italy 
The new law on drug dependence which entered into force on 26 June 1990 has 
redefined the institutional instruments for the formulation of policies and action 
programmes for the fight against drugs. The President of the Council of Ministers chairs 
the National Coordinating Committee for the Fight against Drugs, which comprises the 
competent ministers (health, defence, internal affairs, education, social affairs, justice 
and external affairs) and is supported by a Committee of Experts and the Permanent 
Observatory for the Drugs Phenomenon (responsible for the collection of data needed 
to prepare action policies). The Permanent Conference on Relations between the State, 
Regions and Autonomous Provinces is responsible for coordination between the central 
and regional governments in respect of programme implementation. 
Luxembourg 
Action to be taken in the fight against drugs is decided at national level by the Ministries 
of Health, Justice, Education, Family Affairs and Youth. A Coordinating Committee 
chaired by a senior official of the Ministry of Justice was set up in 1980 to facilitate 
interministerial cooperation. 
Netherlands 
Drug policy is defined at national level in close cooperation between the ministry for 
Justice and the ministry for Welfare, Health and Cultural Affairs. 
Portugal 
There is an interministerial and intcrinstitutional integrated plan against drugs, called 
"Project Life", in effect since March 1987, coordinated in each specific area by the 
following Ministries: Internal Affairs, Justice, Education, Health, Employment and 
Social Security, Youth and Adjunct Minister Cabinet. Their aim is to decentralize the 
response to drugs and reinforce community initiatives. The areas covered are: 
information, treatment, rehabilitation, social reinsertion and supply reduction. 
Spain 
There is a National Plan on Drugs since 1985. It coordinates all governmental and non­
governmental organisations, as well as citizens in general on actions against drugs. This 
Plan is implemented through two bodies: an Interministerial Group, which coordinates 
the Central Administration (Health and Consumer Affairs; Employment and Social 
vSecurity; Justice; Interior; Education and Science; and Social Affairs) and a Sectorial 
Conference, with representations from the Autonomous Communities (regions). They 
take decisions and actions related both to offer and demand reduction. The NGO 
National Assembly acts as a consultative body. The fight against drugs demand is seen 
as a collective, participative and integrative task, based on specific and unspecific 
prevention, treatment, rehabilitation and training of professionals. The basic objective 
is to normalize the social perception and response to the problem, therefore providing 
care through the general health and social resources and minimizing specific resources. 
/?,/ 
United Kingdom 
Responsibility for implementing the Government's strategy rests with a number of 
Departments. Their activities are coordinated by Ministers. An Advisory Council on the 
Misuse of Drugs has also been established. 
The UK drug demand reduction strategy has two main components. One is a 
programme of publicity and education aimed at discouraging people, in particular young 
people, from trying drugs. The other is to bring existing misusers into contact with a 
range of services intended to facilitate their adoption of less dangerous habits of misuse 
and, ultimately, to lead to total abstinence from drugs. 
1.2 Regional and local levels 
Belgium 
Drug demand reduction, including prevention and treatment, is essentially a matter for 
the three regional (i.e. Flemish, French and German-speaking) communities. Some 
provinces have their own structure for organizing the coordination and development of 
specific programmes in conjunction with the national authorities and the regional 
communities. 
Denmark 
The regional level is responsible for treatment matters, regional coordination and expert 
counselling; the local level is responsible for prevention and early intervention. 
France 
The "départements" are responsible for adolescent maladjustment matters and to this 
end run and finance clubs and drug advisory units active in this area, which is clearly 
linked with drug dependency. The prevention of delinquency is a matter for the local 
mayors under their overall responsibility for the maintenance of public order, and it is in 
this light and in the context of urban social development policies that local authorities 
are concerning themselves increasingly with matters relating to drug addiction, 
particularly in the fields of prevention and rehabilitation (before and after the event). 
The General Delegation has the task of developing activities involving the various levels 
of jurisdiction and financing, as well as central government. 
Germany 
Public health, including the care of drug addicts, is the responsibility of individual 
Lander. 
Greece 
Several regional and local consulting and therapeutic centres are currently in operation 
or will operate shortly. The centers are under the auspices of the public or the private 
sectors, the local authorities or the church. 
Ireland 
Details of the organisations providing services for drug abusers are set out in the 
Department of Health's publication "Directory of organisations dealing with Substance 
Abuse" The Health Promotion Unit of the Department of Health seeks to encourage 
community - based responses to local drug problems. Co-ordination of regional services 
is the responsibility of the eight Regional Health Boards. 
Italy 
The law makes the regions and autonomous provinces responsible for drawing up (on 
the basis of guidelines issued by the Ministry of Health) and implementing plans of 
action relating to prevention, health treatment and social rehabilitation of drug addicts. 
The local and mountain-community authorities take action to prevent social deprivation 
and facilitate educational, occupational and social reintegration of addicts. 
Netherlands 
The major 23 municipalities are responsible for the development of ambulatory 
treatment and prevention policy. The 12 provinces are responsible for hospital-based 
treatment services (residential addiction clinics). 
Portugal 
Regional and local initiatives have recently been encouraged in order to develop and 
coordinate local partners. 
Spain 
There is a progressive development of Autonomous Plans on Drugs (17 Autonomous 
Communities). These plans implement prevention, treatment and rehabilitation in each 
Community, setting in the National Plan on Drugs. 
LLK 
Regional Health Authorities (RHA) are responsible, with the help of their Drug 
Advisory Committee and Regional Drug Problem Team, for developing and 
coordinating local drug misuse treatment services. 
Local services for drug misusers are provided by a diverse range of statutory and 
voluntary services, general practitioners (GPs) and health authorities themselves. Proper 
coordination of service delivery should be provided by District Drug Advisory 
Committees, whose members should include representatives of the health service, social 
services, the police, the probation service, the local education authority and the 
voluntary sector (including parents and self-help groups). Their role is to monitor the 
prevalence of drug misuse, to assess the effectiveness of local services and make 
proposals for their improvement, and to coordinate, at working level, the efforts of 
different agencies involved in preventive measures and in service provision. 
2 Level and sources of funding 
Belgium 
The system of demand reduction - ranging from prevention to care and treatment - is 
financed in whole or in part by the regional authorities (institutions resulting from 
public or private, governmental or non governmental initiatives). One exception here 
concerning some primary prevention educational projects consists of very fragmentary 
sponsoring of such projects by private commercial institutions. The Ministry of the 
Interior finances its own prevention activities. The current level of prevention financing 
- especially primary prevention - is on the whole inadequate to meet the needs of the 
regional communities. 
Denmark 
Has distinguished the respective parts of fundings from municipalities, counties and 
national Authorities; for instance, treatment expenses are provided both by 
municipalities (50%) and counties (50%); social assistance support, by municipalities 
(50%) and the State (50%); reception centres and shelters, by counties (25%) and the 
State (75%). 
France 
Over recent years, central government has substantially increased its financial 
involvement. Taking a look just at the Ministry of Solidarity, Health and Social 
Protection, expenditure on addiction prevention and the care of addicts in special 
centres, hospitals and the social system increased from FF235 million (33.6 million ecus) 
in 1984 to FF428 million (61 million ecus) in 1990. In addition, an annual allocation of 
FF250 million (35.7 million ecus) has, for a number of years, been divised by the 
General Delegation among the various ministries, with some FF150 million (21.4 
million ecus) allocated for demand reduction work to the Ministries of Education, 
Solidarity and Health, Justice, Youth and Sport. 
Germany 
Has pointed out that the national Authorities have increased their funding by DM 
11 million (5.3 million ecus), from DM 1,8 million (870,000 ecus) to 12,8 million (6.2 
million ecus). 
Greece 
The Ministry of Health, Welfare and Social Security has allocated 582 million drs. (2.9 
million ecus) for the public sector and 450 million drs. (2.2 million ecus) for the 
nongovernmental program of therapeutic communities for the year 1990. For the year 
1991 the respective sums are 2,000 million drs. (10 million ecus) for the public and 450 
million drs. (2.2 million ecus) for the nongovernmental sectors. 
Ireland 
Over£ 1 million (1.3 million ecus) has been allocated from National Lottery Funds to a 
number of statutory and voluntary agencies dealing with intravenous drug abusers, who 
are at risk of contracting and transmitting HIV. The National Drug Treatment and 
Advisory Centre is funded by the State at a cost of £ 1 million per annum (approx.) 
The new drugs law and other recent legislation provide for the funding of the following 
activities over the period 1990-1992 : 
360 million lire (230,000 ecus) per annum for the creation and operation of the 
Central Service for Alcohol, Narcotic and Psychotropic Substance Dependence 
attached to the Health Ministry; 
6.05 billion lire (3.9 million ecus) per annum from 1991 for the employment of 
200 social assistants within the Ministry for Internal Affairs; 
4 billion lire (2.6 million ecus) per annum for the operation of Ministry of Public 
Education committees whose main task is to prevent drug addiction in schools; 
176,040 billion lire (114 million ecus) for 1990 including 30 billion lire (20 million 
ecus) for expanding the state drug addiction services, and 180 billion lire (120 
million ecus) per annum for 1991 to finance anti-drug projects presented by the 
ministries, regions and local authorities; 
150 billion lire (97 million ecus) per annum to finance help for drug-addicted and 
AIDS-infected prisoners; 
10 billion lire (6.5 million ecus) for the marketing of non-reusable ("self-
blocking") syringes; 
20 billion lire (13 million ecus) for 1990 and 38 billion lire (25 million ecus) from 
1991 for employment of state services staff to work on the prevention of AIDS 
among drug addicts. 
Netherlands 
All aid and treatment facilities - except for the methadone programmes of some 
municipal Health Services - are autonomous non-governmental institutions. The 
medical consultation bureaus for alcohol and drug problems (CAD) with a 
multidisciplinary orientation has a total budget Fl 79 million (34 million ecus) for 1990; 
the budget for social welfare services directed to drug users is of Fl 55 million (23.6 
million ecus) in 1990, the budget of the methadone programmes of municipal health 
services is +/- Fl. 7 million (3 million ecus). Approximately 95% of the funds is 
depending on the Ministry of Welfare, Health and Cultural Affairs that distributes these 
funds among the major municipalities. Residential treatment facilities are financed by 
the public health insurance funds (Fl. 100 million i.e 43 million ecus). Furthermore the 
Ministry of Welfare, Health and Cultural Affairs provides Fl. 6 million (2.5 million ecus) 
for AIDS prevention among drug users and Fl. 4 million (1.7 million ecus) for 
specialised national residential treatment facilities and experimental projects. The total 
cost of addiction treatment and prevention are +/ Fl 250 million (107 million ecus). 
These costs include the treatments for alcohol dependency. 
*> 
U.K 
The Government has allocated specific funds since 1986/87 to all Regional Health 
Authorities loi the expansion ol"setvices lot diuj.', misusers; luithei additional funds have 
been allocated since 1987/88 to help prevent the spread of HIV among and lioiu 
injecting drug users; in 1990/91 this funding totalled over £ 15,5 million (22.6 million 
ecus), and this money is distributed on the basis of the proportion of the population 
between the ages of 15 and 34 within each Region. 
3 Levels and trends of drug use 
Belgium 
Estimates put the number of users and addicts at between 10,000 and 20,000, half of 
whom are regarded as problem cases. These figures are for the whole of the country. It 
is not possible to give reliable and significant figures given that nothing is known of the 
number of users outside the specialized care and treatment network. 
Denmark 
It is estimated that the total number of drug abusers is about 10,000, with a substantial 
increase of drug abusers in methadone substitution treatment in recent years; 
France 
The number of drug users is put at some 100,000, a figure which has remained stable 
since 1980. 
Germany 
The number of regular hard drug users is estimated at 60 to 80,000, with a shift towards 
older age groups; 
Greece 
The number of regular hard drug users as judged by the commonly used indicators is 
currently estimated to between 9,000 and 13,000 users. 
Ireland 
The number of patients who attended the Dublin drug advisory and treatment centre 
was 1,052 in 1988, decreasing steadily from 1,514 in 1983, as compared with the number 
of persons charged with drug offences - 1,422 in 1989 and regularly increasing. There is 
an evidence to suggest however that polydrug use in particular and new drug use is 
increasing. 
Italy 
The information available at present is not sufficient to allow an estimate of the total 
number of users of illegal substances. Figures are available for the number of persons 
who turn to the state help services and social rehabilitation structures. The Ministry of 
Health has estimated the number of drug addicts who at least started treatment under 
the state health services during the twelve months of 1989 at around 6,000, and increase 
of almost 18% over the previous year. On 30 June 1990, according to data compiled by 
the "Observatory" operated by the Ministry of Internal Affairs, some 38,000 persons 
were currently being treated on that specific day by the state structures, plus 11,000 in 
residential therapy communities. The average age of new users is increasing. 30-40 % of 
persons receiving treatment were found to be HIV-seropositive. Almost 90% of new 
subjects starting treatment over the past two years have been addicted to heroin as the 
primary substance, with 5-6% addicted to cannabinoids. 
Luxembourg 
Department of Toxicological and Pharmaceutical Chemistry statistics show that 1,799 
analyses were carried out on samples from drug addicts in 1989. These figures reflect of 
the level of activity of the service rather than trends in drug addiction in Luxembourg. 
Out of the 1,799 analyses requested in 1989, around 700 samples had been collected 
under the new methadone maintenance treatment programme (two compulsory urine 
analyses per week for each person participating in the programme). 
Netherlands 
Reliable estimates for 1989 put the number of heroin addicts in the country as a whole 
at approximately 20,000, with stabilisation of the overall problems but increase in socio-
economically disadvantaged populations. The mean age and the age of first use of 
heroin users are rising. Multiple drug use among heroin addicts is common. There are 
no indications that the use of cocaine has increased in recent years and has presented 
problems comparable to the nature and size of heroin problems. According to some 
local reports the pattern of the misuse of other drugs, such as benzodiazepines and 
MDMA (Extacy), changes rapidly. 
Portugal 
The estimate of the total number of addicts in Portugal is 40-50,000, 1/3 of them 
concentrated in the greater Lisboa area. There are around 3,000 first treatment 
admissions every year, mostly because of intravenous heroin use. It is estimated that 
there are 4,000 addicts in treatment and 350 in methadone substitution. Users seeking 
treatment are getting younger and there are indications that heroin is increasing on the 
streets. Cocaine use is low but increasing, frequently combined with heroin. Polydrug 
use is also increasing. 
Spain 
In the last three years, there has been an increase in offer indicators, as well as an 
increase in acute deaths and treatment admissions; this seems to indicate an increase of 
drug use associated problems. There is also an age increase among addicts in treatment 
centres, emergency rooms and acute deaths. Problems are concentrated around heroin, 
although an increase of cocaine consumption is pointed out. 
/-
10 
Uj i ! led _Kj ngdo 111 
It is difficult to measure the extent of an illegal activity such as drug-taking. One 
indicator is the number of addicts formally notified to the Home Office by doctors. This 
shows an increase in notifications of some 30% a year between 1980 and 1985, a fall 
between 1985 and 1987, and a renewed rise from 1987. However, this does not represent 
a complete picture of the scale of drug misuse. It has been estimated that the Addict's 
index underestimates Addicts of notifiable drugs by a factor of at least 5, though these 
proportions, too, may be changing as a result of efforts to attract clients to drug services. 
There are also perhaps as many misusers of non-notifiable drugs, excluding those who 
use cannabis. Other indicators of the changing scale of the drug misuse problem are 
statistics for the seizure of drugs and for persons involved in drug-related offences. This 
corroborates the evidence from the Home Office Addicts' Index of a respite in the 
increase in numbers of misusers during the mid-1980s, although changes in statistics for 
seizures can, of course, be influenced by a range of other factors. The figures for drug-
related offences show a similar correlation with the general trend. 
LEGAL ASPECTS 
Belgium 
The problem of drug abuse is generally covered by laws relating to public order and the 
protection of young people. However, there are a number of measures in certain 
districts at the instigation of public prosecutors seeking an alternative to the penal 
sanctioning of illicit drug taking and requiring the drug abuser to consult a mental health 
service run by the aid network or to seek aid under a methadone programme. 
Denmark 
Treatment programmes for drug abuse are authorized under the Social Assistance Act, 
and treatment has always been voluntary. As regards the prevention of HIV 
transmission, specific recommendations have been added as amendments to treatment 
programmes. 
France 
The law of 31 December 1970 authorizes compulsory treatment of drug users on the 
basis of a court decision. It also allows the public prosecutor to suspend legal 
proceedings if the addict agrees to undergo treatment. 3,800 addicts benefited from this 
provision in 1988. The 1970 law also encourages spontaneous requests for treatment by 
making such treatment anonymous and free of charge. In order to prevent the spread of 
AIDS, legislation was introduced in 1988 to liberalize the sale of syringes. Pilot needle 
exchange programmes were set up, though without specific legal provisions. 
11 
Germany 
There is disagreement in the Federal Republic of Germany as to the form drug 
substitution treatment should take, as reflected in the resolution passed by the special 
conference of the Lander of 30 March 1990. The current situation is that the Lander 
apply different criteria (medical and otherwise). A decision clarifying the legality of 
substitute drug treatment was taken by the Bundesrat (second chamber) on 11 May 
1990. The Government endorses the position adopted by the chamber of Physicians on 
9 February 1990, setting out the various circumstances in which L-Polamidon can be 
dispensed to drug addicts. The Chamber of Physicians' view is that substitute drugs 
should be made available to addicts only in very specific (medically determined) cases 
under strict medical supervision and in conjunction with intensive psychosocial care. 
Drug substitution treatment should take place only in special institutions. 
Greece 
Arrested drug users are separated into two categories: non dependent users arrested for 
personal use are obliged to follow a counselling programme, and they are imprisoned if 
recidivists in detoxification units; dependent users arrrested for personal use follow 
either a voluntary detoxification programme or a compulsory confinement in a prison 
detoxification unit for therapy without any penalty; if these dependent users are arrested 
for drug trafficking, penalties are reduced with the same two above options (voluntary 
detoxification or compulsory confinement). Extensive modifications or the current law 
are being advanced for approval by the Greek Parliament. These modifications provide 
for extended authorities for the interministerial policy-making body and institute 
measures for the rapid materialization of the public sector program. They also provide 
alternate solutions to punishment to encourage convicted drug users to attend treatment 
and rehabilitation programs. 
Ireland 
The previous Regulations (1979) relating in particular to the possession of controlled 
drugs have been up-dated by the new Misuse of Drugs Regulations (1988) and the 
Minister for Health has established an out-patient drug treatment centre in the city 
centre of Dublin which has statutory responsibility for organizing and administering out­
patient drug treatment services. 
Italy 
The law confirms the illicitness of the personal use of illegal substances, but punishes 
only possession. Possession of a quantity of an illegal substance below the average daily 
dose, fixed by the Health Ministry, is punishable by administrative penalties, with 
criminal penalties commensurate with the offence of drug-pushing for larger quantities. 
Both administrative and criminal penalties may be suspended if the subject agrees to 
undergo treatment. Persons requesting voluntary treatment are guaranteed anonymity. 
The use of methadone is subject to ministerial regulations and must be available at state 
help centres. The sale of syringes by pharmacies has been liberalized. 
>v 
12 
Luxembourg 
The law of 19 February 1973 on the sale of medicinal substances and the fight against 
drug addiction offers addicts the option of withdrawal treatment in a specialized 
establishment. 
Netherlands 
There is a clear-cut distinction between drug users and traffickers, in order to avoid 
classifying the possession of drugs by users as a serious crime, and to allow easy access to 
prevention and voluntary interventions. As a consequence of prosecution policy, no 
special action is taken by the police to detect offences involving possession or drugs for 
personal use except in practice in the course of finding evidence against drug dealers, or 
in cases of public order disturbances. The selling or possessing up to 30 grams of hemp 
products is illegal, but has lowest priority in prosecution policy, except in cases where 
minors are involved or (illegal) advertising takes place. There are no legal restrictions of 
the distribution of methadone in addiction treatment or the sales and free distribution of 
syringes in AIDS prevention. All medical treatment of addicts takes place within the 
framework of the ordinary legislation concerning medical practice. For drug addicts 
who commit drug-related crimes the Penal Code provides for different measures to 
divert the suspects or convict from the criminal justice system to the treatment system. 
Portugal 
Both traffic and use are punished with prison and/or fines. In care of addicts, prison can 
be commuted for treatment. The sale of syringes is free, but there are no exchange 
programmes or availability for free. Methadone is not commercially available. 
Spain 
The use of drugs has never been penalized in Spain. Possession for personal use is not 
penalized, but there is an open clause which allows to consider an offence the invitation 
to use or the donation for use. A regulation on public use is under study, which foresees 
administrative sanctions (not penal). In 1990 a new law made substitutive treatments 
more flexible and less restrictive, due to the risk of HIV transmission. The sale of 
syringes has always been free in Spain. To what concerns the workplace, there is a lack 
of legislation to allow drugs intake detection among employees. 
O 
13 
U.K 
The principal legislation concerned with the control of drugs in the UK is the Misuse of 
Drugs Act 1971 and the various regulations made under it. The Act defines illegal drugs, 
placing them in three categories according to their degree of harmfulness. It is designed 
to be flexible, allowing new drugs to be added to the lists of illegal substances by 
secondary legislation. The Act prohibits the import and export, production and supply 
and possession of controlled drugs and sets out a range of penalties relating to its 
infringement. The Act also established the Advisory Council on the Misuse of Drugs. 
Other relevant legislation includes the Medicines Act 1968 which provides for the 
control of medicinical products and certain other substances and articles, for example 
syringes and sterile water for injecting, through a system of product licences and clinical 
trial certificates, licences for manufacturers, and, where appropriate, restrictions on 
methods of sale. The Customs and Excise Management Act 1979 and the Drug 
Trafficking Offences Act 1986 broadened the range of drug-related offences and set out 
penalties. 
PREVENTION 
Belgium 
The French and German-speaking regional communities place the emphasis on 
coordinated and global approaches with fieldworkers, organized by the "Coordinating 
Committee on AJcohol and others Drugs" in the French-speaking community and the 
"Working Party for the Prevention of Drug Addiction and Coping with Life" in the 
German-speaking community. These approaches are centred on such centre-of-interest 
groupings as the family, the school, the working environment, the local communities, etc. 
They cover training for people with a "relay" function and the organization of ongoing 
activity programmes addressed to young people and adults. In the Flemish-speaking 
community, information and education responsibilities lie with the "Association for 
Alcohol and other Drug-related Problems", whose prevention staff work to strengthen 
the existing cooperation within and between such groupings as education, young people, 
adult education, health care and law enforcement agencies. 
Denmark 
Denmark bases its prevention interventions on two main paths: general social 
preventive measures to provide good conditions of life, and specific information given 
through two-way communication activities rather than mass media. Their emphasis is on 
harm-reduction rather than abstinence. 
The implementation is based on national delineation of basic principles together with 
the publication of resource materials and a local planning and implementation of 
specific prevention interventions. 
France 
In 1990, France set up a major prevention programme based on three lines of attack : 
mass communication largely based on the media; the school and the family as role-
leaders for young people; local initiatives bringing together a wide variety of people and 
organizations in towns and neighbourhoods. 
14 
Germany 
Germany puts an emphasis on the concept of vulnerability and the need of protecting 
those at risk, as well as of including secondary prevention. Its aim is to develop targeted 
information campaigns to make people aware of the dangers and legal implications of 
drug abuse, pointing towards total abstinence. Its plan of action encompasses a broad-
based range of interventions aimed at reaching multiple target groups: publicity 
campaigns using the mass media for the general public work with media representatives, 
community figures and staff in schools; youth in their natural environments and 
institutional group situations (military and civilian national servicemen); young adults 
and parents. 
Greece 
There are no systematic primary prevention programmes, but several actions oriented 
towards secondary prevention: a network of consulting and drop-in centres, and groups 
of immediate intervention with high risk populations. A national program based on the 
"Health Careers" concept is under approval for immediate implementation. 
Ireland 
Has actions mostly oriented towards the information and training of professionals: 
teachers, workers in local communities, doctors, pharmacists, and specialists in drug 
abuse. 
Ital 
A publicity campaign to prevent drug abuse, aimed primarily at young people aged 
between 12 and 16, is currently being carried out through the mass media, parallel to the 
AIDS campaign. The Ministry of Health has promoted the expansion of educational 
initiatives which have proved effective (school team approach) and is to support 
initiatives of other agencies (the UNICRI's "STOP DROGA" programme), which will be 
coordinated with the measures implemented by the Ministry of Public Education. The 
Ministry of Defence has introduced an information programme for military service 
conscripts. 
Luxembourg 
Efforts are concentrated on supplying information to the population, parents, teachers 
and youth. The police participates in these information activities. Another focus is the 
promotion of alternative activities. 
Netherlands 
Drug prevention is part of general health education in schools as well as prevention 
programmes in the field of youth, mental health and social welfare. Specific drug 
information campaigns are found to be effective only with specific at-risk groups; 
therefore mass media campaigns are not found to be appropriate. On the basis of local 
risk assessments (in a Community, a school, a youth service etc.) emphasis is given to 
substance abuse in general, specific licit or illicit substances, primary or secondary 
prevention. On a national level special funds are made available for prevention-workers 
and the development of technical support. However, priority is given to alcohol, 
smoking, and AIDS prevention among drug users. 
Qn 
15 
Portugal 
Uses in its prevention efforts, an array of initiatives, through a variety of channels: 
information and awareness campaigns to motivate social groups to become involved in 
prevention; production and distribution of informative materials for specific target 
groups, mass media campaigns and collaboration with the media; a telephone help line; 
information and education programmes for specific groups (school environment, parent 
to parent, youth-to-youth, professionals); and leisure-time activities with the 
collaboration of NGOs. 
Spain 
In recent years there has been a progressive increase of resources allocated to 
prevention by the Autonomous Communities in relation to the total budget allocated to 
drug abuse control (from 14% in 1986 to 28.6% in 1989). The three main areas of 
intervention for prevention are: schools, communities and the workplace. A school 
prevention programme was launched by the Education Ministry in 1987-1988. It created 
the figure of provincial coordinators and entails teacher's training, creation of resource 
materials, the incorporation of school health education in curricula and training for 
parents associations. Pilot projects are planned to evaluate the integrated curriculum. 
According to the priorities set-up in community prevention special support is given to 
programmes dealing with: high risk youth, the improvement of the social image of drug 
abusers, the support of community social and health services, a technical information 
network, on-going prevention programmes "IDEA-prevencion", and the training of local 
professionals. These community programmes are based on the knowledge of the 
current situation regarding drug abuse situation in each municipality in which they are to 
be implemented, and are drawn up with the coordinated participation of representatives 
from the various levels of power and the community sectors concerned. Pilot 
programmes at the workplace are starting to develop in Spain some of them with the 
support of the main trade unions. 
United Kingdom 
The twin-pronged strategy of seeking to discourage people from using drugs in the first 
place and bringing those who use drugs into touch with a range of services reflects the 
Governments' overriding priority of eliminating completely the misuse of drugs. But it 
also recognises the important role of risk minimisation among people who continue to 
misuse drugs. This emphasis is in large measure the product of recognition of drug 
misuser's role as a channel by which the HIV virus can spread into the general 
population. 
In 1985 the Government launched a major health education and information campaign 
to discourage drug misuse. The campaign was developed in the wider context of 
Government action, begun in 1983, to improve treatment facilities, encourage 
professional interest and improve training. It was also a preliminary step in the fuller 
development of other preventative measures, which are now under way, such as advice 
and counselling services for parents and young people and educational material for use 
in schools. AJI extention of the Government's strategy on prevention was the 
introduction of needle exchange schemes in 1987. 
16 
TREATMENT AND REHABILITATION 
Belgium 
In the French-speaking community, there is a special network of outpatient, reception 
and residential facilities in addition to the conventional hospital and psychiatric services. 
The German-speaking community uses addiction-treatment professionals operating 
within the mental health care system. There is a scheme (in the French-speaking 
community) in day centres for rehabilitation and for helping people to readjust to 
working life, while the Flemish-speaking community also has a substantial network of 
addict-aid associations. 
Over recent years, there has been a definite trend towards making evaluation of the 
types of treatment available and their results more uniform. This applies too to the 
other regional communities, who are trying to move in the same direction. The various 
self-help groups also have a specific role to play in the rehabilitation system throughout 
the country. 
Denmark 
Reports an important revision of aims and methods in the last five years. The 
importance of offering different treatment options, including low-threshold ones in 
order to meet the needs of individual abusers is stressed. There is an emphasis on 
outpatient treatment, rather than in-patient; an increasing use of reception and shelter 
centres and a decreasing use of psychiatric hospitals. The majority of professional staff 
are social pedagogues and social workers. Prescription of methadone should be only a 
part of the treatment, accompanying continued control and assistance in the different 
areas;the improvement of methadone prescription practices by general practitioners is 
stressed. There are insufficient programmes, and their geographical distribution is 
irregular, not always covering the needs of the different types of abusers. There are 
special services for pregnant women and abusers with children. Special HIV/AIDS 
prevention interventions have been developed: information, easy access to needles and 
syringes and distribution of condoms. A clinic for HIV + drug abusers has been set up, 
and the collaboration between treatment centres and hospitals promoted. 
France 
A system specifically designed for drug addicts was set up in the 1970s, characterized by 
a wide range of schemes: reception centres (including outpatient, psychotherapy, 
prevention and reintegration services), special hospital units, after-care centres and 
foster families. The aim here is to provide an optimum response to the wide range of 
individual needs, leaving plenty of leeway for multiple therapeutic models. The role of 
general health services is growing in importance and general practitioners have received 
training in drug abuse since 1988. In the main prisons, specific services have been set up 
to prepare prisoners for release, putting them in touch with sources of aid. Steps have 
been taken to limit the risk of transmission of infectious diseases, particularly HIV, with 
the deregulation of syringe sales and a syringe échange programme. These are seen as 
an important source of prevention work thanks to the information on HIV transmission 
and contact with addicts who are not registered with a care centre. Improved job access 
is also a part of the overall reintegration programme for young people. 
^ L 
17 
Germany 
Has set up some prerequisites for treatment: accessibility, availability and diversification 
to cater for specific needs, long-term addicts being one main target group. They stress 
the need to supplement treatment with a lull integrated range of follow-up services and, 
within treatment, to provide for many stages (although it may entail a risk to prolong 
addiction). There is controversy about drug substitution, without uniformity between 
Lander. The Federal position is to administer it in special cases, under medical and 
psychosocial supervision. There is a comprehensive system which, nevertheless, needs to 
be extended in quantitative and qualitative terms, specially to rural areas; outreach 
work; confidence-building facilities (to reach more addicts); provision of special 
accomodations; women and addicts with children; easy-access hospital detoxification; 
and in some Lander, drug substitution. 
Greece 
There is network of services operating within the National Health System (public sector) 
and a variety of services operating within the private sector which include a national 
program based on the therapeutic community concept. Both sectors are being 
substantially financed by the Ministry of Health, Welfare and Social Security and are 
currently expanding their services. The services available are several counselling and 
evaluation centres, a physical detoxification centre, a drug therapy unit within a hospital 
psychiatric section, therapeutic communities, day hospital, a hot line for emergencies 
and mobile units for action in the Community. The therapeutic communities include a 
rehabilitation and social reintegration programme as well as a programme for 
vocational training. 
Ireland 
Has an outpatient treatment centre which coordinates comprehensive services: out­
patient treatment; toxicology laboratory service; referral for in-patient treatment; 
counselling services; ante-natal and post-natal advice and methadone maintenance. 
There is also a drop-in centre for IVDU, offering counselling, medical services, needle 
exchange services, methadone maintenance, welfare advice and link with housing. 
Statutory and voluntary agencies are funded to facilitate the expansion of special 
services and AIDS prevention programmes, in particular outreach research and services, 
and a community based information programme. 
Italy 
In the various regions of Italy there are 517 state help centres for drug addicts, which 
operate as part of the State Health service. Addicts may also be admitted into hospitals 
providing detoxification treatment. There are around 11,000 drug addicts in the 433 
residential therapy communities, almost all of which are run by voluntary non­
governmental organizations, though financed by the state or regions. The 
interdisciplinary teams of the state help services practise programmes of treatment with 
substitute products, psychotherapy and social rehabilitation programmes. They also 
cooperate with the AIDS Unit to care for HIV-seropositive subjects. 
18 
Luxembourg 
There is a system of decentralized reception and information centres, including 
psychology guidance departments in schools and street workers networks. The 
therapeutic facilities include out-patient treatment centres, specialized psychiatric 
services, in-patient detoxification, therapeutic community and a post-treatment centre. 
The AIDS and drugs programme aims at reaching as many addicts as possible, and 
includes a network of street workers (including visits to hospitals and prisons), a pilot 
project on methadone substitution, a pilot project in the prison, and the preparation of a 
system for syringe exchange and free distribution of condoms. 
Netherlands 
Has the following principles for treatment and rehabilitation of addicts: a 
multifunctional network of medical and social services built up at local or regional level; 
easily accessible aid; the maximum use of unspecific services and the promotion of social 
rehabilitation of present and former drug abusers. The regional networks include non­
residential services (field work, social counselling, therapy, methadone supply and 
rehabilitation); semi-residential services (day/night centres, day-care treatment, 
employment and recreation); and residential services (crises and detoxification drug 
dependence units and therapeutic communities). 
In this network there are forms of assistance not primarily intended to end addiction, 
but to "harm-reduction": field work, initial reception, supply of substitute drugs, material 
support and opportunities for social rehabilitation. The AIDS prevention measures 
provide information on safe sex and safe drug use, offer new for old syringes exchange 
programmes and distribute condoms. These networks are based on various types of 
centres: medical consultation bureaus for alcohol and drug problems; municipal 
methadone programmes; social welfare services and residential facilities. The 
consultation bureaus also have a probation task in relation to the criminal justice 
system. 
Portugal 
There are insufficient treatment (outpatient, methadone substitution, theraputic 
community) facilities, and the existing ones are concentrated on the coast. More 
cooperation with social services is needed. The government coordinates 8 outpatient 
centres and two therapeutic communities. Methadone is administered in only one 
centre in Porto. One centre attached to Project Life (Taipas) is a specialized unit with 
an array of services (outpatient, inpatient detoxification, emergency service and day care 
centre). NGOs have an important role in the implementation of treatment and 
rehabilitation. There are plans to create penitentiary units. There is an agreement with 
a maternity clinic for the care of pregnant addicts, although insufficient. Care of addicts 
with AIDS is assumed from drug abuse treatment centres. 
19 
Spain 
In 1989 there were in Spain more than 300 out-patient treatment centres, 120 
therapeutic communities and more than 200 hospital beds for detoxification. Most out­
patient services and half of the therapeutic communities are funded with public 
resources. The general services of health, in special primary care, have progressively 
more active participation in drug users' attention. Although there has been an 
important increase of resources in recent years, there are still waiting lists. There is a 
special programme for care of drug abusers in prison. Special risk-reduction activities 
have been developed to combat HIV transmission (including education programmes for 
high risk groups and methadone maintenance). The priorities are the following: 
increase coverage; diversification of treatment services; 
improvement of care programmes for drug abusers having legal problems; and 
programmes evaluation. Rehabilitation efforts are concentrated around the promotion 
of the reinsertion in the socio-laboral environment. The participation of general social 
services in this process is potentiated. Occupational promotion is sought through 
training and support for youth cooperatives initiatives, and general promotion of 
employment alternatives. 
U.K. 
Government guidelines state that all DHAs should have access to the following services 
advice and counselling; 
in-patient and out-patient facilities for detoxification; 
short-term residential rehabilitation facilities, including re-entry houses; 
hostel or other housing provision 
In addition to developing, coordinating and monitoring the provision of drug treatment 
services locally, RHAs provide at least one specialist drug service; an expert Regional 
Drug Problem Team (RDPT) made up of professional medical, nursing and social care 
staff 
They are based at a Drug Dependency Unit, with full in-patient and laboratory 
facilitites. 
The RDPT also gives experts advice, support and training for district services. 
In Scotland and Wales detailed arrangements differ to take account of the different 
organisational and administrative structure to the national Health Service and local 
government; but overall policy relating to the provision of drug misuse services is the 
same as in England. Primary responsibility for the planning and provision of services 
with Health Boards and local authorities in consultation with the voluntary sector. Inter­
agency Drug Liaison Committees have been established in all mainland Health Board 
areas to co-ordinate local action. In addition to their general allocations, some £2.2m 
per annum is currently being made available to Health Boards in Scotland specifically 
for the support and development of drug misuse services. A wide range of services for 
drug misusers has developed from a low base over the last six years, but some gaps 
remain, particularly in relation to residential crisis intervention and rehabilitation 
facilities. 
?> 
20 
STATISTICS AND EPIDEMIOLOGY 
Belgium 
A variety of regional studies, mostly among schoolchildren and other target populations, 
have been conducted over the past 10 years. With such a variety of survey methods, it is 
impossible to make any comparison at present between times and regions. No estimate 
has been made of the total number of addicts or drug users. A one-day prevalence 
survey was carried out in 1986, 1987 and 1988 in all treatment institutions in all three 
regional communities. An inter-community coordinating committe has been set up, 
along with a permanent observation unit on drug and alcohol-related problems. 
A summary report for the three communities is now being drawn up, including national 
data from the various departments concerned, the German-speaking community has set 
up a "permanent measuring instrument", while the Flemish-speaking has an 
epidemiology working party. The three units are organized differently in the three 
regional communities, but work together with the Hygiene and the Epidemiology 
Institute nationally. 
Denmark 
Has annual reports from the counties based on drug abusers in treatment, as well as 
estimates of the prevalence of drug abuse and the characteristics of drug abusers in 
contact with service providers. The National Board of Health collects information on 
methadone prescriptions and the Institute of Psychiatry on drug-related admissions to 
hospitals. School surveys have been conducted in local areas, but there are no long-term 
observations. A project underway is a National Substance Abuse Profile, which will 
provide more complete nation-wide information. 
France 
France conducts an annual national statistical survey (by the Ministry for Solidarity and 
Health) at special consultation and treatment centres, and an epidemiological survey on 
drug addiction in prisons (conducted by INSERM - the National Institute of Health and 
Medical Research). At regional level, there is a monitoring network which collects and 
analyses indicators on drug abuse. Demographic studies are mostly related to licit 
drugs, but since 1978, other surveys have been carried out (by the INSERM) in schools 
on illicit drugs. Several sociological and anthropological, as well as evaluation, studies 
have been carried out. A permanent drug and drug addiction observatory is now being 
set up by the general delegation and all the ministries concerned. 
Germany 
Under the "Establishment-Based Information System" (EBIS), information is collected 
on addicts in some 300 outpatient centres. A survey is conducted every three years by 
the Centre for Youth Education on susceptibility to drugs among young people. Other 
studies have been conducted, e.g. extensive interviewing and HIV testing of drug 
addicts. The Ministry of Youth, the Family, Women and Health has for many years now 
conducted representative surveys of the nature and extent of drug use in particular age-
groups. The survey currently in progress uses a sample of 19,000 people aged between 
12 and 39, and for the first time includes what used to be the territory of the GDR. In-
depth analysis of the survey results should bring out what factors operate on individuals 
in triggering and stabilizing drug abuse. 
21 
Greece 
The department of psychiatry of Athens University, in connection with the Department 
of Youth has conducted several nation-wide and local studies: retrospective study of 
recorded drug addicts (73-83); a nation-wide general population survey (84); a nation­
wide high school student survey (84); other high school surveys in Athens and in other 
major cities; and psychosocial studies on drug addicts. 
Ireland 
Ireland collects treatment-based data 
Italy 
Help centres and doctors send information on subjects receiving treatment to the 
Regional Epidemiological Observatories. The data are processed on a central basis by 
the Ministry of Health and cover the following aspects: 
Number of subjects taken into care through the year; 
Substances to which they are addicted ; 
Type of treatment (in 1989 33,000 subjects were treated with substitute drugs, 
around half of them with methadone; a total of 55% of subjects received 
substitute drug treatment, whilst 45% received only psychosocial treatment); 
Age and sex of persons receiving treatment. 
These data are published (also in English) in the Ministry of Health's "Bollettino per le 
Farmacodipendenze". 
The Permanent Observatory for the Drug Phenomenon, which is an instrument of the 
National Coordinating Committee for the Fight against Drugs and operates under the 
Ministry for Internal Affairs, carries out regular systematic surveys covering the whole 
country, in collaboration with state and local authorities. These surveys involve the 
collection of epidemological data on social and health aspects and the prevention and 
suppression of illicit drug traffic. 
The main data published by the "Observatory" are as follows: 
the number, distribution and characteristics of drug addicts who have turned to 
the state health structures and residential therapy communities (situation on four 
specific days of the year). 
the number, distribution and characteristics of the state services and social 
rehabilitation structures. 
Luxembourg 
Luxembourg has statistics from the toxicological and pharmaceutical chemical division 
on forensic toxicology. 
Lj 
22 
Netherlands 
Has a reporting sytem based on drug treatment services, which, at this point, includes 
the Ambulatory Consultation Bureau for Alcohol and Drugs and the residential 
addiction clinics; and in 1991 it will be expanded to municipal methadone programmes 
and local rehabilitation services. The Central Bureau of Statistics reports on drug deaths 
and AIDS data are also collected. A study on "Acute death after misuse" was conducted 
in Amsterdam (90). Surveys have been carried out both at national (National School 
Survey 88) and regional/local level (Household Survey city of Amsterdam 89-90), 
several sociological (qualitative/descriptive) studies have been conducted. After positive 
experiences with anthropological techniques in several local studies on drug abuse, a 
continuous nationwide drug abuse monitoring programme is now under consideration. 
The Netherlands participate in the epidemiology programmes of the Pompidou group, 
directed to school surveys and city-based studies. 
Portugal 
The development of a systematic drug abuse data collection network is underway. This 
network is to be integrated in the European network called for in Resolution 89/C 
185/01 of the Council of Health (EEC). 
Spain 
Spain has an on-going reporting system based on three indicators: outpatient treatment 
admissions, acute deaths, and non-fatal emergency room episodes (State Information 
System on Toxicomanies: SEIT). This system provides information on opiate and 
cocaine use at national and regional levels. 
A retrospective study on drug related deaths was conducted in 6 Spanish cities (83-89). 
Several surveys, mostly regional, have been conducted between 84 and 89, but, since 
there was no standardized multiwave survey, trend assessment is not possible. Indirect 
indicators regarding drugs offer, are also available. 
U.K 
In Wales and all Regional Health Authorities in England have been asked to set up a 
database which collects anonymous data about clients attending both voluntary and 
statutory services and will enable Regions to monitor trends in drug misuse and the use 
of drug misuse services in their own Region and to plan future services. 
A similar database has been established in Scotland. This information will be submitted 
to the Department of Health at six monthly intervals and used to monitor and evaluate 
the expenditure by Health Authorities and Boards of earmarked monies and to develop 
future policies. The database will also provide information required by the Home Office 
for the Addicts Index. 
•-> <c-
23 
MANPOWER TRAINING 
Belgium 
There is no specific curriculum at university level on drug abuse. A number of 
universities have developed training modules for health, social work and education 
professionals to provide knowledge on treatment and prevention. One of them now 
offers a full second-level course, while even more recently, a new, more intensive 
programme (160 hours) has been organized by the provincial authorities, aimed at 
graduates in paramedical and social studies. 
Denmark 
Manpower training had a low priority at a national level until recently. In July 90 a 
model training programme was established. This programme is addressed at 
postgraduate training of staff dealing with substance abusers, with the long term aim to 
reform local treatment in general. 
France 
France has continuous national drug misuse training for general practitioners, organized 
by the Ministry of Solidarity, Health and Social Protection; practical organization is up 
to the regional authorities. There is also a national training scheme for professionals in 
after-care centres on problems related to HIV and a programme for pharmacists similar 
to the one for physicians. An information brochure for pharmacists has been published, 
to be followed shortly by another for local politicians. 
Germany 
Reports a need of general improvement in manpower training. This improvement 
means the extension of the range of multidisciplinary further training courses available 
(including judges, public prosecutors, and social services connected to the courts and the 
police). 
Greece 
A few sporadic actions have been carried out up to now. Meetings and short training 
programmes for health workers have been conducted with the aim to form small expert 
groups in the different regions. 
Ireland 
There is a programme for interdisciplinary training for people working in local 
communities which seeks to encourage community based responses. 
One college offers a diploma course on addiction studies which provides specialized 
training for workers in direct contact with drug abusers and their families. Information 
resources such as a document for doctors and pharmacists with recommendations on the 
prescribing and dispensing of controlled drugs, and an information booklet on substance 
abuse have been produced. 
24 
Italy 
At the moment there are no post-university training courses for doctors and 
psychologists working with drug addicts. Occasional initiatives by individual universities 
are limited to short, non-permanent courses. Staff training is currently entrusted to the 
regional authorities. Non-governement agencies provides for a national staff training 
plan specific to the needs of health service personnel and therapy community staff, 
together with permanent training structures. Special training programmes are also 
planned for staff involved in prevention. These will form part of a series of training 
actions promoted by the Ministry of Health through its recent financing of around 50 
courses at national level to be organized according to guidelines drawn up by the 
Ministry itself for the following programmes: attitude training, training for staff 
involved in preventing the spread of AIDS among drug addicts, training for drugs 
workers and counsellors etc. 
Netherlands 
Several projects have been funded in order to stimulate manpower training in 
universities and professional education, post-graduate training and in-service training. 
These projects were meant for addiction treatment personnel and for personnel in 
general health care and social work facilities. The Netherlands Institute on Alcohol and 
Drugs provides many training programmes, which cover the whole range of treatment 
and prevention modalities. 
Portugal 
At this point, generalists start getting some specific information on drug abuse. It is 
considered to be of great importance and need to integrate training on drug abuse 
within medicine, psychology and nursing schools. 
Spain 
In 1987 the National Plan funded postgraduate university studies on drug abuse in five 
Spanish universities. Nowadays three Spanish universities offer a Masters in Drug 
Abuse. Other higher education institutions have included drug abuse education for 
their students. Schools of Public Health at the Autonomous Communities offer 
specialized training. Training packs are being produced to support courses for health 
professionals, teachers and parents. The Ministry of Education promotes training of 
teachers and parents. 
United Kingdom 
The Advisory Council on the Misuse of Drugs (ACMD) made a number of 
recommendations regarding the Training of professional staff who (may) work with drug 
misusers, but also of health care staff, teachers, youthworkers, health service managers 
and residential care staff. The Government has itself initiated a range of activities and 
supported others to help meet the financing needs identified in the ACMD's report. 
Teachers play a crucial role in making young people aware of the risks involved in drug 
taking. The Government also provides funds for a number of training activities. For 
example, it has provided pump-priming money for training courses run by the English 
National Board for nurses, and by the National Association for the Care and 
Resettlement of Offenders. 
3 v. 
25 
RESEARCH 
Belgium 
A number of universities have ongoing research covering different aspects of drug abuse 
(prevention, treatment and training) looked at from different angles : psychiatry, social 
psychology, medical sociology, hygiene and pedagogics, legal aspects, etc. Generally 
speaking, these projects tend to be isolated, apart from two coordinated projects 
involving a number of universities in the two main regional communities, centring on 
use habits and activities undertaken in the two communities. The inter-community 
coordinating committee and its ad hoc working party on epidemiology want to start work 
in 1991 on epidemiological research using a standard method throughout Belgium. 
Denmark 
A review on research from 1986 reported the existence of few integrated environments 
for substance abuse research, mostly by medical doctors, few by social scientists, and 
virtually none by humanists. There is a need for increased priority to be given to 
substance abuse research, specially aspects of prevention and control policy. In 1988, 
and for a trial period of five years an organisation and funding project to promote 
substance abuse research was initiated. It intends to promote educational possibilities 
for young researchers and the establishment of integrated environments for substance 
abuse research. 
France 
Research into drug addiction has always had an important place in France. The main 
areas covered are basic neuroscientific research, epidemiological, ethnographic and 
psychosocial research and, to a lesser degree, historical and legal research. 
Germany 
There are problems in research, since substance abuse professionals don't have, in 
general, adequate research training, and researchers in universities, on the other hand, 
haven't given enough attention to the subject. The areas needing improvement are: basic 
biological research, medicament development, interlinking available data systems, 
family background and drug use and different prevention aspects. 
There is a need for coordination between the federal government and other bodies, as 
well as more committment from research institutions and their collaboration with 
treatment centres. At a national level an analysis of research requirements and 
potentials is under way. 
Greece 
Several epidemiological research studies have been carried out primarily by the 
University of Athens. In addition, Greece is participating in the development of 
methodology for reporting and survey systems in connection with the Pompidou Group. 
(2.2 million ecus). 
2 G 
Ireland 
Ireland is participating in the setting up of a drug reporting system under the aegis of the 
Pompidou Group. 
Italy 
A considerable amount of drug dependence research is financed by the various 
ministries (health, internal affairs, universities, etc) and the regional authorities. The 
new drugs law includes provisions on coordination between the research promoted by 
the mentioned industries. Increased funding is needed if more in-depth research and 
monitoring of the phenomenon are to be made possible. 
Netherlands 
Has different lines of research: epidemiological studies (including methodology 
development for surveys and reporting systems in connection with the Pompidou 
Group), treatment evaluation studies, qualitative and descriptive sociological studies. 
There is promotion of research through funds from the Ministry of Welfare, Health and 
Cultural Affairs, the Ministry of Justice and the Ministry of Education and Science, also 
non governmental funds are involved. 
Portugal 
Research carried out up to the moment is very insufficient and with no specific support, 
although there is scientific potential to develop it. Some epidemiology studies in the 
school environment have been carried out in connection with the Pompidou group. 
Spain 
There has been an important increase in funding for research on fields associated with 
drug use. A specific line of funding for drug abuse research within the main Spanish 
research agency in the area of health is to be created. There have been some 
epidemiological and sociological studies and other research initiatives funded by the 
National and Autonomic Plans on Drugs. There is a need to define priority areas for 
research in the field of drugs. An information and Documentation and Centre was 
created in 1987 at the National Plan on drugs. Its documentary found (over 7,000 titles) 
constitutes a database named ELEUSIS that is fully computerized. 
United Kingdom 
The Department of Health and the Scottish Office have funded or commissioned a 
number of research projects and other studies relevant to the prevention of misuse, and 
the treatment and rehabilitation fo misusers. Research is carried out by a variety of 
people or bodies - independent researchers, university departments, and specialist units. 
u, 
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