ATLAS on substance use (2010) Resources for the prevention and treatment of substance use disorders

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1 INTRODUCTION Dimensins f psychactive substance use and dependence The use f alchl and ther psychactive substances alters bth the functin and, ultimately, the structure f the brain by the altered stimulatin f particular pathways in the central nervus system. Md, perceptin and cnsciusness are affected by the use f psychactive substances, which can influence the capacity f persns t exert cntrl ver their drug use. The result can lead t physical and psychlgical dependence, cercing the persn t cntinue taking the drug despite adverse cnsequences. Besides prfund impairment and lss f physical health, peple with alchl and drug use disrders may suffer severely frm psychlgical and psychscial prblems, interpersnal prblems, lss f emplyment, difficulty in participating in educatin, and legal prblems. Given the cmplexity f substance use disrders and their effects n the health and scial aspects f the persn, treatment and preventin f alchl and drug use disrders may invlve a range f treatment and preventin mdalities which may be delivered in a variety f settings. Treatment mdalities may invlve pharmaclgical treatment but may als include ther cmpnents f health care, such as psychlgical supprt and cunselling, as well as rehabilitatin t respnd t the stage f the illness and t the different needs f the persn with the substance use disrder. Delivery f adequate care and treatment fr persns with alchl and drug use disrders requires a well functining treatment and preventin system that has the capacity t respnd t the needs f these persns. What cnstitutes resurces fr the treatment and preventin f substance use disrders? The effective preventin and treatment f substance use disrders requires the availability f a range f resurces at the natinal r subnatinal level. Resurces therefre cmprise financial capital f natinal authrities t fund treatment and preventin services fr substance use disrders, but als include human and institutinalized resurces such as the availability f health care staff and nngvernmental rganizatins (NGOs) assisting in the delivery f care and treatment fr the ppulatin in need. Within the health care setting, clinical management f substance use disrders may invlve a variety f services and treatment appraches; treatment may als be differentiated by the use f different classes f pharmaclgical drugs used fr detxificatin r fr the treatment f alchl and drug dependence. Other resurces include the knwledge f natinal authrities abut the epidemilgical situatin in the cuntry regarding substance use disrders, and data n natinal service delivery data and assciated treatment service infrmatin. The knw-hw f health prfessinals and the use f natinal standards f care fr health prfessinals als cmprise resurces, as d guidelines, plicy dcuments and special legislative prvisins regulating the cntext in which treatment is prvided. Why mnitring f resurces is essential Glbally, there is an impressin that there is a large treatment gap fr substance use disrders i.e. that nly a small prprtin f thse peple in need f treatment, r thse wh wuld benefit frm preventin measures, are receiving treatment r preventin measures. The ATLAS n Substance Use (ATLAS-SU) attempts bth t explre the size f the treatment gap and t examine the underlying reasns fr that gap. Any 1

2 ATLAS n substance use (2010) Resurces fr the preventin and treatment f substance use disrders significant preventin and treatment gap suggests a shrtage f resurces fr the treatment and preventin f substance use disrders. Given the cmpetitin fr scarce health resurces, bth lw-incme and high-incme cuntries can benefit frm a mre detailed awareness f what resurces are being made available fr the treatment f substance use disrders, s that this can be cmpared t ther health pririties r ther mdels f resurce distributin (as may be used in ther cuntries, fr instance). In view f this, the ATLAS-SU prject seeks t map thse resurces at natinal, reginal and glbal levels t highlight the specific resurces available fr treatment and preventin f substance use disrders. As such, it represents an essential tl fr natinal authrities, health prfessinals and plicy-makers in helping t assess the pririty f needs, and in increasing the quality f care fr peple with substance use disrders. Fr the first time, infrmatin abut the resurces available fr the treatment and preventin f substance use disrders in all WHO regins has been cllected and analysed, making natinal, reginal and glbal cmparisns pssible. A structured descriptin f available preventin and treatment resurces fr substance use disrders is als a prerequisite fr a mre detailed assessment f treatment systems, and fr imprving treatment and preventin systems fr substance use disrders at natinal, reginal and glbal levels. The bjective f the ATLAS-SU prject and the structure f the reprt The bjective f the ATLAS-SU prject was t cllect, cmpile, analyse and disseminate basic infrmatin frm WHO Member States n the fllwing resurces and assets required fr substance use treatment and preventin: administrative and financial resurces such as the presence f gvernment units, funding and ways f financing treatment and preventin services in cuntries; health service resurces such as the availability and cverage f different treatment services, the presence f pharmaclgical treatment, and the number f beds and length f stay fr treatment; human resurces such as the invlvement f health prfessinals fr the treatment f substance use disrders, and the presence f ther institutinalized and nninstitutinalized grups prviding care fr persns with substance use disrders; plicy and legislative resurces such as the presence f different plicies and legislative prvisins fr preventin and treatment f substance use disrders; resurces fr preventin f substance use disrders, such as availability and cverage f different preventin services, implementatin f screening and brief interventins in primary care, and presence f harm reductin prgrammes; infrmatin resurces such as knwledge f epidemilgical aspects f substance use in the cuntry, and knwledge f treatment service delivery. In accrdance with the infrmatin cllected frm natinal authrities and experts in the field, the ATLAS-SU reprt is divided int six chapters. Chapter 1 intrduces the epidemilgical aspects and the burden f disease attributable t alchl and drug use and prvides infrmatin n the level f need fr treatment f substance use disrders. Chapter 2 illustrates health service resurces such as financing and availability f treatment services, and the number f beds and length f stay fr treatment f substance use disrders. Data n implementatin f pharmaclgical treatment fr substance use 2

3 Intrductin disrders are presented in chapter 3. Chapter 4 cvers human resurce aspects, and prvides infrmatin abut the health wrkfrce fr substance use disrders. Plicy and legal resurces fr peple with substance use disrders are discussed in chapter 5, befre cncluding with resurces fr the preventin f psychactive substance use in chapter 6. Each chapter begins with an expert intrductin befre data frm the ATLAS-SU survey are presented. Data frm the ATLAS-SU survey are presented graphically in bar and pie charts. Salient findings are described, and ntes and cmments n the data are given. The raw data n which the ATLAS-SU reprt was prepared will be available in a searchable nline database n the web site f the Management f Substance Abuse prgramme at WHO (www.wh.int/substance_abuse/en). This will enable mre detailed analyses t be cnducted. 3

4 ATLAS n substance use (2010) Resurces fr the preventin and treatment f substance use disrders METHODOLOGY Prcedures f the ATLAS-SU prject and sequence f actin The ATLAS prject has invlved staff at WHO headquarters and WHO reginal and cuntry ffices in cllecting data and infrmatin n natinal resurces fr the treatment and preventin f alchl- and drug-related prblems. The ATLAS survey instrument, which is a paper-based survey instrument designed specifically fr this purpse, is the prject s cre cmpnent. The ATLAS-SU prject was cnducted accrding t different administrative and methdlgical steps, starting frm the develpment f the questinnaire and ending with the statistical analyses and presentatin f data. The sequence f actin is briefly utlined belw. Stage 1: Questinnaire develpment. The ATLAS-SU questinnaire was develped in cllabratin with WHO reginal ffices. Categries f resurces fr the treatment and preventin f substance use disrders were defined and indicatrs were develped accrdingly. Standardized answers were prvided fr the respective indicatrs in rder t facilitate data cmpilatin. Respnse ptins fr clse-ended questins were exhaustive and mutually exclusive. Alngside the questins, a glssary was prvided t standardize terms and t ensure that the cnceptualizatins f resurces were understd equally by all respndents. The questinnaire was drafted in English, and was translated int fur fficial United Natins languages Arabic, French, Russian and Spanish. Stage 2: Fcal pint nminatin. In the respective cuntries, WHO headquarters tgether with WHO reginal ffices requested ministries f health r ther respnsible ministries t appint a fcal pint t cmplete the ATLAS-SU questinnaire. The fcal pint was encuraged t cntact ther experts in the field t btain infrmatin relevant t answering the survey questins. In a few WHO Member States, fcal pint nminatins culd nt be btained; in these cuntries, ther prminent technical experts in the field f psychactive substance use were identified thrugh WHO cllabrating centres and prfessinal assciatins (such as the Wrld Psychiatric Assciatin and the Internatinal Sciety f Addictin Medicine) and were cntacted and requested t prvide the relevant infrmatin. This step was taken t enhance the respnse rate f the survey. Stage 3: Questinnaire submissin. Clse cntact with the fcal pints was maintained during the curse f their nminatin and thrugh t questinnaire submissin. A service desk was set up at WHO headquarters t respnd t fcal pint enquiries, t prvide additinal guidance, and t assist fcal pints in filling ut the ATLAS-SU survey instrument. Upn expiry f a timeline, fcal pints were required t submit the questinnaire electrnically r by pstal mail t WHO headquarters r t the respective WHO reginal ffice. Stage 4: Clarificatin prcess. Once received, the questinnaire and the questinnaire respnses were screened fr incmplete and incnsistent answers. T ensure high quality data, respndents were cntacted again and were asked t respnd t the requests fr clarificatin and t crrect their respnses. 4

5 Methdlgy Stage 5: Data management. Upn receipt f final questinnaires, data were entered int a statistical package (SPSS 16). Fr the ease f statistical analyses, sme questins were regruped. An identifier was applied t the respnses f each cuntry t facilitate disaggregatin f data by WHO regin and by the Wrld Bank list f ecnmies (based n the Wrld Bank list f ecnmies f 2007). Ecnmies are divided accrding t grss natinal incme per capita. Accrding t the Wrld Bank these grups are lw-incme cuntries (having a grss natinal incme f US$ 935 r less), lwer middle-incme cuntries (US$ 936 t US$ 3,705), higher middle-incme cuntries (US$ 3,706 t US$ 11,455) and high-incme cuntries (US$ 11,455 r ver). Lists f cuntries by WHO regin and by the Wrld Bank list f ecnmies are prvided at the end f this reprt. Stage 6: Statistical analyses f data and presentatin f data. Frequency distributins and measures f central tendency were calculated as apprpriate, and data were disaggregated accrding t WHO regins and different incme grups f cuntries. T illustrate the infrmatin btained, data were exprted int Micrsft Office Excel t prduce bar and pie charts. Stage 7: Data availability n a searchable database. Data will be upladed t a searchable database (i.e. t a glbal infrmatin system) n the WHO web site. Within the glbal infrmatin system indicatrs f the ATLAS prject can be selected and presented accrding t cuntry and WHO regins. Representativeness and limitatins f data The questinnaire was develped in 2007, and sent ut t the cuntries fr cmpletin in Data were btained frm all WHO regins, althugh nt all WHO Member States within the regins respnded t the survey questinnaire. Data presented in the ATLAS reprt reflects infrmatin frm cuntries which respnded t the survey. In ttal, 147 ut f 193 cuntries tk part in the ATLAS-SU prject and submitted a questinnaire, thus cvering 76% f all WHO Member States and 88% f the wrld ppulatin. Hwever, fr sme questins the denminatr was belw the verall number f questinnaires received. Numbers in the respective categries (i.e. regin and incme grup) are indicated if n mre than 15% f cuntries respnded t the survey questin. In the WHO African Regin 43 cuntries respnded t the ATLAS-SU questinnaire (93% cverage f cuntries in the regin), in the WHO Regin f the Americas 21 cuntries respnded (58% cverage f cuntries in the regin), in the WHO Eastern Mediterranean Regin 14 cuntries respnded (67% cverage f cuntries in the regin), in the WHO Eurpean Regin 44 cuntries respnded (83% cverage f cuntries in the regin), in the WHO Suth-East Asia Regin 10 cuntries respnded (91% cverage f cuntries in the regin), and in the WHO Western Pacific Regin 15 cuntries respnded (54% cverage f cuntries in the regin). Data were cllected frm cuntries which nminated a natinal fcal pint t respnd t the survey. Data reflect expert pinin in the majrity f cases. Hwever, respndents t the survey were encuraged t cnsult with ther technical experts in the field, and t supprt their data with scientific evidence. 5

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