EXECUTIVE SUMMARY. Key findings. Chapter 1. Psychoactive substance use: epidemiology and burden of disease

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1 EXECUTIVE SUMMARY Backgrund This reprt prvides fr the first time cmparable glbal infrmatin n the availability f a range f resurces required fr the preventin and treatment f substance use disrders by drawing tgether infrmatin frm 147 cuntries that represent 88% f the wrld ppulatin. A questinnaire was develped t measure a wide range f different resurces that benefit the preventin and treatment f substance use disrders at cuntry level, including: 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, the number f beds and the 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. Key findings Chapter 1. Psychactive substance use: epidemilgy and burden f disease Pint prevalence f alchl and drug use disrders Glbally, the prevalence f alchl use disrders is significantly higher than the prevalence f drug use disrders. Generally, alchl and drug use disrders are mre cmmn amng males than amng females. ix

2 ATLAS n substance use (2010) Resurces fr the preventin and treatment f substance use disrders Psychactive substance accuntable fr treatment demand Frm the majrity f cuntries in every WHO regin 1 but ne, alchl was reprted t be the main psychactive substance respnsible fr demand fr treatment. In the Regin f the Americas, treatment demand was chiefly due t ccaine. Number f deaths and disability-adjusted life years lst due t psychactive substance use Glbally, sme 39 deaths per ppulatin are attributable t alchl and illicit drug use, ut f which 35 deaths are attributable t alchl use and fur are attributable t illicit drug use. The use f alchl and illicit drugs accunts glbally fr almst 13 disability-adjusted life years (DALYs) lst per 1000 ppulatin. Apprximately 11 DALYs per 1000 ppulatin are lst due t alchl use, and apprximately tw DALYs are lst due t illicit drug use. Chapter 2. Health services Gvernment administratin and budget fr treatment services The presence f a gvernment unit r a gvernment fficial respnsible fr treatment services fr substance use disrders was reprted by 66.2% f cuntries. Fewer than half f the cuntries in the survey reprted having a specific budget line allcated t the treatment f substance use disrders. Financing f treatment services Cuntries identified tax-based funding, ut-f-pcket payments and scial health insurance t be amng the fremst methds f funding treatment fr alchl and drug use disrders. Africa appears t be the nly regin in which ut-f-pcket payments were reprted t be the main funding methd fr alchl and drug use disrder treatment services. Treatment setting fr alchl and drug use disrders Nminated fcal pints in cuntries reprted a variety f treatment settings fr persns with alchl and drug use disrders. In the majrity f respnding cuntries (39.8%), mental health services are the mst cmmn treatment setting fr alchl use disrders. A higher prprtin f cuntries reprted specialized treatment services as the main setting fr the treatment f drug use disrders (51.5%) cmpared with treatment f alchl use disrders (34.6%). Treatment services and cverage f alchl and drug use disrder treatment Amng different treatment services, inpatient detxificatin fr alchl and drug use disrders appears t be the mst frequently present in cuntries; it was reprted t be x 1 Fr the list f cuntries in WHO regins see page 135.

3 Executive summary present in ver 90% f cuntries respnding t the survey. Hwever, cverage f the ppulatin in need with alchl and drug use disrder treatment services seems t be lw. Fr example, in lw-incme cuntries the majrity f persns with alchl and drug use disrders are nt cvered by the respective treatment services. Number f beds and length f stay Amng the respnding cuntries, the median number f beds fr alchl and drug use disrders was 1.7 per ppulatin (range f 0 52 beds per ppulatin). The median length f stay fr alchl and drug detxificatin was 10.3 days and 14.0 days respectively. Care fr special ppulatins Substance use disrder treatment services fr prisners were reprted frm 55.9% f surveyed cuntries, fllwed by substance use disrder treatment services fr yung peple (47.6%) and fr injecting drug users (40.0%). Specialized substance use disrder treatment services fr pregnant wmen and cmmercial sex wrkers were reprted t be present in 31.0% and 25.5% f cuntries respectively. Apprximately 11.0% f cuntries reprted having substance use disrder treatment services fr indigenus ppulatins. Specialized treatment services fr persns with drug use disrders and HIV/AIDS were reprted in 43.2% f cuntries. Arund a quarter f cuntries (24.6%) reprted having treatment services fr peple with bth drug use disrders and tuberculsis. Chapter 3. Pharmaclgical treatment Plicy framewrk and guidelines fr the pharmaclgical treatment f substance use disrders Plicy dcuments n the pharmaclgical treatment f substance use disrders were reprted by 40.2% f cuntries, with Eurpe reprting the highest prprtin f cuntries with plicy dcuments n the pharmaclgical treatment f substance use disrders. Guidelines n the pharmaclgical treatment f substance use disrders were reprted by apprximately half f the surveyed cuntries (51.8%). Availability f therapeutic drugs fr alchl and drug use disrders With regard t the pharmaclgical treatment f alchl withdrawal, benzdiazepines were reprted t be used fr the management f alchl withdrawal in 90.9% f cuntries. Fr the treatment f piid dependence, availability f methadne was reprted by 41.6% f surveyed cuntries, buprenrphine by 27.7%, and buprenrphine/nalxne by 20.8% f cuntries. The highest prprtin f cuntries reprting availability f methadne (88.6%), buprenrphine (59.1%) and buprenrphine/nalxne (50.0%) was in Eurpe. xi

4 ATLAS n substance use (2010) Resurces fr the preventin and treatment f substance use disrders Administratin f piid agnist pharmactherapy Length f treatment with piid agnist pharmactherapy was reprted t be pen-ended in the majrity f cuntries, with 74.1% f cuntries reprting n time limit fr piid agnist pharmactherapy. Over 55% f cuntries in the survey reprted using methadne syrup/slutin fr the treatment f piid dependence. Apprximately 60% f cuntries in the survey reprted cmmencing piid agnist pharmactherapy n an utpatient basis. Supervisin and prescriptin requirements fr piid agnist pharmactherapy Supervisin f methadne fr the treatment f piid dependence was required by 85.4% f cuntries in the survey. In 60.6% f cuntries buprenrphine supervisin was required, while 71.4% f cuntries required buprenrphine/nalxne supervisin. Mre than 20% f cuntries in which methadne is used reprted that dctrs withut special training are allwed t prescribe methadne. In apprximately 10% f cuntries surveyed, it was reprted that nn-dctrs are given the authrity t prescribe piid agnists. Chapter 4. Human resurces Health prfessinals A variety f health prfessinals seem t be respnsible fr the management f alchl and drug use disrders in different cuntries. The majrity f cuntries reprted psychiatrists, general practitiners and addictlgists/narclgists t be the health prfessinals chiefly invlved in the treatment f alchl and drug use disrders. Standards f care and supervisin fr health prfessinals Apprximately half f the cuntries in the survey (47.6%) reprted having natinal standards f care fr health prfessinals wrking with persns with substance use disrders. The lwest prprtins f cuntries with standards f care were reprted in the regins f Suth-East Asia (20.0%), Africa (20.9%) and the Eastern Mediterranean (28.6%). The clinical supervisin f nurses was reprted in 57.1% f cuntries in the survey, fllwed by clinical supervisin f dctrs (52.5% f cuntries), scial wrkers (44.4% f cuntries) and psychlgists (43.5% f cuntries). Acrss the regins, Eastern Mediterranean and Eurpe reprted having the highest prprtins f cuntries with clinical supervisin f health prfessinals. Nngvernmental rganizatins and self-help grups fr substance use disrders A high prprtin f cuntries have nngvernmental rganizatins (NGOs) that fcus n alchl and drug preventin, with 74.8% and 81.6% f cuntries reprting t have them fr alchl preventin and drug use preventin, respectively. Apprximately 70% f xii

5 Executive summary surveyed cuntries reprted the presence f NGOs fcusing n rehabilitatin f alchl and drug use disrders. NGOs invlved in treatment f alchl disrders and drug use disrders were reprted frm 54.5% and 59.9% f cuntries respectively. Alchlics Annymus was reprted t be active in the majrity f cuntries (71.1%). Narctics Annymus was reprted t be active in apprximately half f the cuntries in the survey (56.7%), and Ccaine Annymus in 11.5% f cuntries. Ex-addicts r recvering addicts were reprted t prvide frmal care fr persns with substance use disrders in 59.9% f cuntries in the survey, and this situatin appears t be mst cmmn in high-incme cuntries. The highest prprtin f traditinal healers prviding care fr persns with substance use disrders was reprted frm lw-incme cuntries (44.7%). Religius grups r NGOs based n religius grups prviding frmal care fr substance use disrders are reprted mst cmmnly amng cuntries in the higher middle-incme grup (79.3%). Chapter 5. Plicy and legislatin Plicy framewrks and special legislative prvisins The majrity f cuntries in the survey (68.0%) reprted having a natinal substance abuse plicy, with 100% f high-incme cuntries reprting that they have ne. The highest prprtin f cuntries in the survey reprting substance abuse plicies was in the Eurpean Regin (93.2%). The African Regin (32.6%) reprted the lwest prprtin f cuntries with substance abuse plicies. Special legislatin fr the cmpulsry treatment f substance use disrders was reprted frm 42.5% f cuntries in the survey. Of these cuntries, 30% reprted having special legislatin fr the cmpulsry treatment f bth alchl and drug use disrders tgether. Gvernment benefits fr persns with alchl and drug use disrders were reprted frm 40.6% f cuntries in the survey. The Western Pacific (78.6% fr alchl, 73.3% fr drugs) and Eurpe (69.0% fr alchl, 70.5% fr drugs) reprted having the highest prprtins f cuntries prviding gvernment benefits fr persns with alchl and drug use disrders. The criminal justice system and substance use disrders The presence f drug curts was reprted in 20.5% f cuntries. The highest prprtin f cuntries with drug curts was in the Eastern Mediterranean Regin (38.5%). Africa (14.0%) and the Americas (14.3%) had the lwest prprtins f cuntries with drug curts. Half f the cuntries in the survey (52.2%) reprted having prgrammes referring r diverting clients frm the criminal justice system twards treatment. The highest prprtins f cuntries in the survey with prgrammes referring r diverting clients frm the criminal justice system twards treatment were reprted by Eurpe (66.6%), the Western Pacific (66.6%), the Eastern Mediterranean (61.6%) and Suth-East Asia (60.0%). xiii

6 ATLAS n substance use (2010) Resurces fr the preventin and treatment f substance use disrders Chapter 6. Preventin Administratin and budget In 72.4% f cuntries in the survey, ne r mre gvernment units respnsible fr the preventin f substance use disrders were reprted. Half f the cuntries in the survey (50.0%) reprted having a budget line in the annual budget fr the preventin f substance use disrders. The lwest prprtin f cuntries reprting budget lines was in Africa (30.2%). Availability and cverage f preventin services Schl-based prgrammes, cmmunity-based prgrammes, and wrkplace prgrammes fr the preventin f substance use disrders were reprted by 77.9%, 68.5% and 58.6% f cuntries respectively. Hwever, cverage f the ppulatin in need with schlbased prgrammes, cmmunity-based prgrammes, and wrkplace prgrammes fr the preventin f substance use disrders appears t be lw. Fr example, ver 50% f the cuntries indicated that the cverage f schl-based prgrammes fr the preventin f substance use disrders wuld be prvided fr less than half f the ppulatin in need. Preventin services in special ppulatins and harm reductin The mst cmmnly reprted preventin prgrammes were thse fr children and families at risk (45.2% f cuntries), fllwed by preventin prgrammes fr prisners (43.2%), fr peple living with HIV/AIDS (41.1%), fr pregnant wmen (32.2%), fr cmmercial sex wrkers (29.5%) and fr minrity grups (17.8%). The presence f needle/syringe exchange prgrammes differs within cuntries. In 41.1% f cuntries, cmmunity-based needle/syringe exchange prgrammes were reprted. Sme 6.6% f cuntries reprted having syringe exchange prgrammes in prisns. Screening and brief interventin prgrammes Screening and brief interventins implemented in primary health care fr hazardus and harmful alchl use and fr drug use were reprted by 47.9% and 46.2% f cuntries respectively. The Americas and the Western Pacific reprted the highest prprtins f cuntries with screening and brief interventins fr harmful alchl use (76.2% and 69.2% respectively) and drug use (65.0% and 71.4% respectively). Grups and agencies invlved in preventin f substance use disrders Different grups and agencies appear t be invlved in the preventin f substance use disrders in cuntries. In 78.1% f cuntries, schls are invlved in the preventin f substance use disrders, fllwed by cmmunity grups (49.3%) and emplyers (29.5%). The invlvement f law enfrcement agencies in the preventin f substance use disrders was reprted by 68.5% f cuntries. Invlvement f internatinal rganizatins in the preventin f substance use disrders was reprted by 56.8% f cuntries, fllwed by the invlvement f labur rganizatins (19.2%). xiv