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Drugs: Education, Prevention and Policy

ISSN: 0968-7637 (Print) 1465-3370 (Online) Journal homepage: http://www.tandfonline.com/loi/idep20

Research in substance abuse treatment: Contributions by the Centre for Alcohol and Drug Research Mads Uffe Pedersen, Morten Hesse & Birgitte Thylstrup To cite this article: Mads Uffe Pedersen, Morten Hesse & Birgitte Thylstrup (2013) Research in substance abuse treatment: Contributions by the Centre for Alcohol and Drug Research, Drugs: Education, Prevention and Policy, 20:6, 435-442, DOI: 10.3109/09687637.2013.840460 To link to this article: http://dx.doi.org/10.3109/09687637.2013.840460

Published online: 16 Oct 2013.

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Date: 12 October 2015, At: 05:49

Drugs: education, prevention and policy, December 2013; 20(6): 435–442 ß 2013 Informa UK Ltd. ISSN: 0968-7637 print/1465-3370 online DOI: 10.3109/09687637.2013.840460

Research in substance abuse treatment: Contributions by the Centre for Alcohol and Drug Research Mads Uffe Pedersen, Morten Hesse, & Birgitte Thylstrup

illicit drug use problems lies within the Ministry of Social Affairs and Integration, and is administered by the National Board of Social Service. As a consequence of Centre for Alcohol and Drug Research’s (CRF) affiliation with the Faculty of Social Sciences at Aarhus University, and the traditionally close collaboration with the Ministry of Social Affairs and Integration, the CRF has for a number of years primarily been granted economic resources for treatment research within the drug abuse field, however, research taking place at the CRF involves both the alcohol and drug field. This article describes three key areas within treatment research that are carried out at the CRF: (1) evaluation research and development of monitoring systems/registers, (2) development of treatment and screening methods, and (3) treatment system research. This article presents some of the findings from the three key areas and links them to contributions nationally and internationally. The three areas have been introduced at the CRF at various time points: evaluation research has been part of the research activities since the early1990s; development of screening and treatment methods were introduced around year 2000; and approximately since 2005 the research has involved the larger context of treatment systems. As a result of the research areas, the CRF plays an important role in the monitoring and evaluation of Danish treatment services for people with alcohol and drug use disorders, and for the development of screening and treatment methods within these services. As a part of this collaboration, researchers at the CRF are in a continuous dialogue with stakeholders and policy makers within the field of substance use treatment (e.g. Ministry of Social Affairs, National Board of Social Service, local civil servants, treatment centers and a broad range of educational institutions).

This article describes contributions from the Centre for Alcohol and Drug Research (CRF), Faculty of Business and Social Sciences, Aarhus University, within treatment for alcohol and drug problems. This article focuses on three key research areas: evaluation research and development of monitoring systems/registers, development of screening and treatment methods, and treatment system research. Some of the important findings from the studies conducted within these three areas will be presented and the impact that these findings have had on Danish treatment policy will be described.

INTRODUCTION

Drug and alcohol problems represent a significant burden of public health around the globe (e.g. Degenhardt & Hall, 2012; Rehm, Shield, Gmel, Rehm, & Frick, 2012). While there is evidence that both intensive treatment for substance use disorders (Dutra et al., 2008) and brief motivational interventions (Lundahl & Burke, 2009) can be effective in reducing alcohol and drug use problems, severe drug and alcohol problems tend to have a chronic course with cycles of relapse and new remission (McLellan, 2002). Additionally, alcohol and drug-related disorders are frequently associated with other types of mental disorders, such as anxiety, depression and personality disorders (Grant et al., 2004; Jane-Llopis & Matytsina, 2006). The physical and mental health problems related to substance use disorders give research within substance abuse treatment a vital role when it comes to improving quality of treatment and treatment effect. In Denmark, the responsibility for treatment for alcohol problems is placed within the Ministry of Health, and is administered by the National Board of Health, whereas the responsibility for the treatment for

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Faculty of Business and Social Sciences, Centre for Alcohol and Drug Research, Aarhus University, Aarhus, Denmark

Correspondence: Birgitte Thylstrup, Faculty of Business and Social Sciences, Centre for Alcohol and Drug Research, Aarhus University, Artillerivej 90, 2. Floor, 2300 Copenhagen, Denmark. Tel: (þ45) 871 65336. E-mail: [email protected]

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M. U. PEDERSEN ET AL.

D E V E L O P M E N T OF MO N I T O R I N G SYS TE MS/RE GISTERS

As a result of this collaboration, treatment research at the CRF is closely linked to different practice modalities which also pays great attention to the treatment research carried out at the CRF. Besides being a benefit for conducting relevant research that have an evident impact on the field, it also presents an ongoing challenge when it comes to keeping the balance between producing publications aimed at informing stakeholders and practitioners on a national level (primarily through evaluation research published in reports and presented at national seminars), and publications aimed at informing the international researcher community (primarily through international peer reviewed journals and conferences). It should be mentioned that a large proportion of the treatment research at the CRF has been carried out in collaboration with other institutions; Lund University; the Centre for Addiction Treatment at Ringgaarden; the National Institute of Public Health and the Copenhagen Health Team among others.

In the year 2000, the CRF developed a Danish registration and information system for Danish residential substance abuse treatment institutions that included the European Addiction Severity Index questions concerning the past 30 days (EuropASI Composite score) (CRF, 2012). Some of the main objectives of the DanRIS were to provide a software system that the treatment institutions could use for documentation and self-evaluation of their services, and facilitate a more rational system for matching of patients and treatment institutions for the public referral authorities. Two other main objectives were to use the data from DanRIS to enable comparisons between residential treatment services in Denmark and other countries, and to develop a monitoring system that permitted identification and research of specific subsamples of substance abusers (Pedersen 2012; Vind & Hecksher, 2004). After the establishment of DanRIS, all residential treatment institutions that received subsidies from the state were obliged to register their patients in the DanRIS from 2004 (https:// www.retsinformation.dk), which enabled the CRF to publish a yearly report on development and changes within residential treatment services since 2004 (discussed in detail in the following). Besides enabling an overview over changes and developments in substance abuse treatment in Denmark in general, the DanRIS database also allowed the monitoring of the consequences of new passing of legislations and reforms within the field, which has then been fed back to politicians and relevant stakeholders (Figure 1).

TREATM ENT F OR DRUG AND A LCOHOL PROBLEMS IN DENMARK

Since the CRF was established, services provided for people with substance use disorders have undergone several developments and changes, including changes in legislation that regulates where the responsibility for treatment is placed, the substance abuse treatment guarantee of 2003 and the legislation on treatment offers in Danish prisons. In the following, we shall highlight the impact that some of these changes have had on the treatment research conducted at the CRF and vice versa. 1600

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TREATMENT RESEARCH IN DENMARK

The figure illustrates how the number of patient admissions to residential drug treatment is related to different national milestones between 1996 and 2011. As can be seen, the number referrals increased significantly from 1996 to 2003, an increase that coincided with (a) the transfer of treatment responsibility from the local general practitioner (GP) to the counties, (b) implementation of the treatment guarantee (a treatment offer must be made no later than 14 days after a request has been received) and (c) a rising number of private foundations offering residential treatment to drug dependent persons. From 2004 to 2007, referrals dropped, a drop that ended when the responsibility for alcohol and drug treatment was moved from the 15 counties to the 98 municipalities as a result of the Danish structural reform in January 2007.The number of admissions increased over the next couple of years, but dropped significantly after 2008, possibly in part as a result of the impact that the financial crisis had on the financial priorities of the municipalities and a shift from residential treatment towards day treatment within especially the larger municipalities, and an increase in outreach services and coordination with social psychiatry across the country. The vital role that DanRIS played in describing the changes and developments in substance abuse treatment resulted in an expansion of the DanRIS database in the year 2011, now also covering outpatient drug treatment services. It is now mandatory for all municipalities to monitor the services offered to patients in inpatient drug treatment services, and estimate the severity of patient problems at patient intake (baseline), using the European Addiction Severity Index Composite Score. Currently, researchers at the CRF have, in cooperation with two treatment services, developed the YouthMAP monitoring system, that targets youth 17 years old or younger that have been admitted to outor in-patient treatment settings. Here, data include information about school, leisure time, family support, friends, use of alcohol and drugs in the social network and psychiatric problems (e.g. General Health Questionnaire/GHQ; the ADHD screener ASRS and questions about psychological wellbeing from the Adolescence Drug abuse Diagnosis/ADAD). Until now, it is not mandatory for treatment services to report data to the YouthMAP, however, so far 22 municipalities and 5 residential treatment centers have sent in data on 739 teenagers in treatment. Analyses show that this patient group to a large extent report serious problematic use of cannabis and/or central stimulants and serious mental health problems (Pedersen & Frederiksen, 2012). E V AL U AT I O N R ES EA R CH

As a result of the close collaboration with the Ministry of Social Affairs and Integration, the CRF has produced numerous reports on the situation within

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substance abuse treatment since 1993. At a national level, the reports have been disseminated at national conferences and meetings with policy makers, stakeholders and practitioners, and contributed to future strategies on the development and qualification within the field of substance abuse treatment. A positive side effect of these reports is that the disseminated results have contributed to research articles on relevant and significant aspects of treatment research, and in this way added to the international treatment research field. Treatment for adolescents In 2005 the Danish parliament passed a service law on treatment guarantee for adolescents (