DEVELOPMENT OF COCAINE-RELATED HELP- SEEKING BEHAVIOUR

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1 DEVELOPMENT OF COCAINE-RELATED HELP- SEEKING BEHAVIOUR IN OUTPATIENT ADDICTION CARE PERIOD A. Mol J.L. van Vlaanderen A. de Vos Houten, September 2002 Stichting Informatievoorziening Zorg (IVZ)

2 CONTENTS 1. INCREASE IN HELP-SEEKING BEHAVIOUR... 3 INTRODUCTION... 3 INCREASE IN HELP-SEEKING BEHAVIOUR... 3 GEOGRAPHICAL GROWTH AND GROWTH WITHIN AGE GROUPS FIVE PROFILES... 5 FIVE DIFFERENT GROUPS OF HELP-SEEKERS THE SNORTING COKE USER COMBINATION OF SOFT DRUGS AND SNORTING COKE COMBINATION OF ALCOHOL AND SNORTING COKE COCAINE BASE USER COMBINATION OF HEROIN AND COCAINE DEVELOPMENTS IN PRACTICE... 7 REACTIONS OF ADDICTION CARE INSTITUTIONS... 7 SUMMARY OF CURRENT APPROACH AND FUTURE PLANS CONCLUSION... 7 Development of cocaine-related help-seeking behaviour, period

3 1. INCREASE IN HELP-SEEKING BEHAVIOUR Introduction Since the first half of the 1990s, the number of people seeking help from outpatient addiction care centres for cocaine-related problems has grown (Ladis key figures 2000). However, little is known about the characteristics, the help-seeking behaviour and the treatment of these clients. Is the growth due above all to heroin users who are increasingly turning to cocaine, or is there for example a new group of problem drug users with other characteristics and a different need for help from the traditional heroinaddicted client? These questions were the occasion for the Ministry of Public Health, Welfare and Sport (VWS) to ask IVZ to report on developments in help-seeking behaviour of and care to cocaine clients over the period and to provide a description of this client group. This information is important to establish whether any adjustments are necessary in existing prevention and/or treatments. In order to answer the question, client details from LADIS (the Dutch National Alcohol and Drugs Information System) were analysed by IVZ over the period At the same time GGZ Nederland (the Dutch Mental Health Care Organisation) carried out a quick survey among the regional addiction institutions to assess their experience of developments in this field in their region and what initiatives if any they had taken as a result. In addition to outpatient institutions for addiction care, a number of clinical facilities took part in this quick survey. The report investigates three aspects in greater detail. In the first place, an analysis was made of the increasing help-seeking behaviour on the basis of the characteristics of volume, preference, severity and geographical development by comparing these with help-seeking behaviour in relation to alcohol and heroin. Secondly, five profiles of types of help-seekers have been compiled. Finally, the report contains a summary of the findings of a number of addiction care institutions on the basis of the quick survey. Increase in help-seeking behaviour Total help-seeking behaviour (primary and 14,615 secondary substances) Growth in help-seeking behaviour since % Primary substance secondary substance 43% - 57% Snorting coke cocaine base 35% - 65% There are 14,615 people seeking help for cocaine-related problems, with cocaine being both a primary substance and a secondary substance. The volume of helpseeking behaviour increased by 59% in the period Substance Cocaine 9218 (100) (132) (159) Heroin (100) (114) (116) Alcohol (100) (104) (114) Source: Ladis, IVZ, Houten Development of cocaine-related help-seeking behaviour, period

4 A second development concerns the growing preference for cocaine. Cocaine is used by help-seekers principally as a secondary substance (with heroin and alcohol). However, this position is changing slowly but surely. Whereas in 1994 cocaine was still the primary substance for 28.6% of help-seekers, in 2000 this figure had increased to 43.5% The third trend concerns the severity of use. Increasingly the stronger variants of cocaine are being used. Cocaine base is gaining in popularity over snorting coke. In 1994, 57.4% of help-seekers with a cocaine problem reported that they predominantly used cocaine base. In 2000, that figure had increased to 64.9%. This analysis relates to the total group of help-seekers. It says nothing about the development in the individual help-seeker. In theory, the group in 2000 may have a completely different composition from that in The extent to which cocaine-related help-seeking behaviour has developed can be well illustrated on the basis of the comparison of the growth of cocaine as the primary substance with the growth of heroin and alcohol. The number of help-seekers with cocaine as the primary substance grew by 150% to 6747 in In the same period, the number of help-seekers with heroin or alcohol as the primary substance grew by 15% to 16,562 and by 11% to 22,224, respectively. Geographical growth and growth within age groups Growth is not restricted to the large cities. In relative terms, most help-seekers still live in large cities. Growth, however, has not passed the smaller towns by Number of help-seekers per 10,000 inhabitants Size of community <20, ,000-50, , , >100, Total 2.1 Source: Ladis, IVZ, Houten Figure 1 illustrates the growth in help-seeking behaviour geographically. Slowly but surely help-seeking behaviour is spreading across the Netherlands. It is striking that helpseeking behaviour in 1994 occurred above all in the large cities and that by 1997 the (remote) outposts of the country (Den Helder, Groningen, Zeeuws-Vlaanderen and Venlo) began to feature. In 2000 it is the turn of the provinces, starting with NoordBrabant. Figure 1. Numbers seeking help with cocaine as the primary substance per 10, inhabitants 4.5 tot 9 (9) 0 tot 4.5 (495) 9 tot 15 (1) 4.5 tot 9 (18) 0 tot 4.5 (485) 9 tot 15 (7) 4.5 tot 9 (37) 0 tot 4.5 (460) Development of cocaine-related help-seeking behaviour, period

5 Source: Ladis, IVZ, Houten The growth in help-seeking behaviour is occurring among all age groups. The growth trend is more marked in the intermediate age groups (25-34 and 35-44) than in the youngest and oldest age group. Number of help seekers per 10,000 inhabitants Age category Total Source: Ladis, IVZ, Houten 2. FIVE PROFILES Five different groups of help-seekers On the basis of the content of the Ladis database, 5 different help-seeker profiles have been compiled. The profiles are partly obtained from the field and partly derived from the literature. Profile Number in 2000 % of the total Growth since Snorting coke users % 2. Combination of soft drugs and % snorting coke 3. Combination of alcohol and snorting coke % 4. Cocaine base (without heroin) % 5. Combination of heroin and cocaine % The profiles are ranked according to the degree of social integration, with the first profile being the most integrated and the last the least integrated. In the description of the profiles, the striking features are compared with the other profiles. 1. The snorting coke user These help-seekers use snorting coke and only snorting coke. They use no secondary substances, at least not problematically, and also do not receive methadone. This is the smallest but one group with the smallest but one growth rate. Characteristics: Many help-seekers are indigenous, have a career and have more than 3 years work experience, are not single and have their own home. The educational situation is relatively favourable. Problem: Most help-seekers do not (yet ) use daily, in contrast to the other profiles. Few also have been in trouble with the law and few have been admitted psychiatrically. The duration of the problem is relatively short. Development of cocaine-related help-seeking behaviour, period

6 2. Combination of soft drugs and snorting coke. These help-seekers combine soft drugs with snorting coke. They use no heroin or methadone. The combination of soft drugs and snorting coke has increased by 117% to 832 people. This is the smallest group. Characteristics: They have the youngest average age. Two-thirds of this group is under 30 years of age. Compared to the group of snorting coke users, they come slightly more often via the police, are more often single, less educated, have a lower income and less work experience and less often have their own home. Problem: Slightly more than half use daily, which is the same as cocaine base users and alcohol/snorting coke users. The length of time the problem has been present is average. 3. Combination of alcohol and snorting coke This profile involves the group that combines alcohol with snorting coke. There is no mention of heroin or methadone. The combination of alcohol and snorting coke increased by 140% to 1833 in the year Characteristics: There are few women in this group. On average the group has the next to highest age. Many help-seekers come via the police, have a high educational level and live with children, have considerable work experience and more often have their own home. In general they are of Dutch origin. Problem: Approximately half of help-seekers use daily. The problem has been present for a long time. 4. Cocaine base user These help-seekers use cocaine base alone or in combination with another substance, but not with heroin or another opiate. This group of help-seekers has increased the most and is the next to largest group. Characteristics: The average age is a good 5 years younger than the heroin/cocaine group. Many help-seekers have been referred by the police. The high number of people of non-indigenous origin is striking. Problem: More than half use daily. Almost half use a secondary substance, particularly soft drugs, but also alcohol. 5. Combination of heroin and cocaine These help-seekers combine their cocaine use with heroin or methadone. The group is by far the largest (8118 in the year 2000). The 26% growth rate, however, has lagged behind that of the other categories. No distinction is made between cocaine base and snorting coke on the grounds that heroin use already characterises a person as a marginalised hard drugs user. Characteristics: The mean age is the highest and in relative terms the most women belong to this group. Many help-seekers refer themselves, while a small number come via the police. Many of them are single, are receiving unemployment benefit and have little work experience. A number are of no fixed abode or stay in accommodation for the homeless. A relatively large number are of non-indigenous origin. Problem: The great majority use daily. Many help-seekers inject the substance. In three quarters the problem has been present for more than 5 years. The treatment lasts almost twice as long as that of the other categories. Development of cocaine-related help-seeking behaviour, period

7 3 DEVELOPMENTS IN PRACTICE Reactions of addiction care institutions All institutions for addiction care affiliated to GGZ-Nederland were asked a number of questions. In this quick survey, they were asked among other things what they noticed in practice of the growing demand for help, how they responded and what their plans were for the future. Summary of current approach and future plans Seventeen of the 28 institutions for addiction care responded. Available provision High dose methadone Lifestyle training Self-control courses Use rooms Regular care provision Preventive provision Future plans Study of medical treatment options Extra attention to cocaine use and aggression Focus of regularly protocolled provision on snorting coke and cocaine base users Enhancement of preventive provision 4 CONCLUSION Cocaine-related help-seeking behaviour in the period elapsed increased substantially, both quantitatively and qualitatively. The situation associated with cocaine use in which help-seekers find themselves appears increasingly more problematical from a somatic, psychosomatic and social angle. The volume of help-seeking behaviour has grown by 59% since For an increasing number of help-seekers cocaine is the primary substance and the most addictive form of cocaine (cocaine base or crack) is becoming increasingly popular. The growth in help-seeking behaviour is not limited to the large cities. Help-seeking behaviour is spreading slowly but surely across the Netherlands. Five different types of cocaine help-seekers can be distinguished. (The numbers of helpseekers must not be confused with the number of users. The ratio of the number of users to the number of help-seekers may also differ between profiles!) A new group of hard drug users is growing up around cocaine base. This group of about 3000 help-seekers has seen the most rapid growth (of 184%) since There are indications from the field that increasingly more hard drug users are starting with cocaine and passing heroin by. Reclassification is playing a large role in attendance at and treatment in outpatient addiction care centres. A good third come via the police. A relatively large number (more than a quarter) of these help-seekers are of nonindigenous origin. Heroin users are the largest group of (secondary) users of cocaine, but this group is growing the least rapidly. Their problem is still the most serious in terms of duration of the problem and frequency of use. Their social position is the least favourable. They thus receive the most medical care and social assistance. They often make long-term demands on addiction care. Development of cocaine-related help-seeking behaviour, period

8 There is a large group of regular users of snorting coke in the Netherlands. This group is the most integrated in society. A number of them get into problems and seek help. In absolute terms this group is not yet large (less than 1000 people). Almost 2000 people attend addiction care centres with the combination of snorting coke and alcohol. Alcohol and snorting coke appears to be a dangerous combination as one substance influences the negative effects of the other. This style of use has an extra high risk. The quick survey shows that health care organisations have recognised the growing trend and have developed a variety of activities in response. Activities and future plans, both in terms of prevention and information, as new treatment modules are on the stocks. The treatment of the cocaine help-seeker will have to adapt more to the various profiles. Further study of the profiles of help-seekers, the path that they follow and the most effective treatment for each profile is necessary. The quick survey highlights the desire to intensify the search for a medical treatment of cocaine addiction. We wish to join in this desire. Development of cocaine-related help-seeking behaviour, period

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