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Treatment demand indicator (TDI)

Treatment demand indicator — an overview of the methods and definitions used

Information on the number of people entering treatment for a drug problem provides insight into general trends in problem drug use and also offers a perspective on the organisation and uptake of treatment facilities. ‘Treatment demand data’ come from each country with varying degrees of national coverage, principally from outpatient and inpatient clinics' treatment records.

The routine data collection, already established and implemented in almost all EU Member States and two candidate countries (Croatia and Turkey) collect data on people starting a treatment for their drug use according to an established European protocol (the TDI protocol): the Joint Pompidou Group–EMCDDA Treatment Demand Indicator Protocol version 2.0, along with a more detailed Technical Annex. This protocol is the result of the developmental work undertaken by the Pompidou Group, the study of national experiences and specific projects run by the EMCDDA.

The protocol provides a uniform structure for reporting on the number and the characteristics of clients referred to drug treatment facilities and it is based on 18 items concerning the type of treatment provided and the characteristics of clients: socio-demographic data and drugs information.

The current objective of the TDI indicator is to increase the countries comparability by increasing the harmonisation of national operational definitions and to extend the detailed data collection to a more extensive coverage, at least for the specialised treatment centres. The collection system classifies clients by primary and secondary drugs used: primary drug is the drug reported as the drug that causes the client the most problems. It can be based on problems as defined by clients or on short diagnoses, based on the ICD-10. The main drug is the main reason for entering treatment; the secondary drugs are the drugs taken in addition (at the same time or in different time) to the primary drug; up to four different drugs can be recorded for every client. Currently, the system of data collection on secondary drug is under revision (together with the more general TDI revision; see below), because of the current relevance of the polydrug issue in the recent years .

In the TDI, data are collected by centre type (outpatient treatment centres, inpatient treatment centres, low threshold agencies, general practitioners, treatment units in prison, and any other types of centres).

For further details, see the TDI protocol. The protocol provides a classification of treatment centres, defines which clients they should notify, and gives guidelines on methods of data collection, analysis and reporting.

The treatment demand indicator measures the yearly uptake of treatment facilities by the overall numbers entering treatment for drug use and by the numbers among these of people entering for the first time. Currently, no routine data are collected on clients continuing a treatment from the year(s) before the year of treatment entry, but a pilot project started in 2005 is now in its third year of data collection. 14 countries have provided data on the total treated population for 2007 (clients who were in treatment in 2007).

A revision of the TDI protocol has been launched in Autumn 2008 and should be finalised in 2010, with a revised version of the protocol. The revision will assess the need for updating the currently collected information, considering the substantial current changes in the drug clients conditions (e.g. polydrug use) and in the treatment system; the revision of some definitions (e.g. time of treatment and reference period), the opportunity to include the new data collection on people staying in treatment and the data management issues (either from the EMCDDA and from the countries sides).

There are some limitations related to the differences in data collection and reporting methods by each Member State. Although treatment information is available in almost all Member States, differences in coverage affect data comparability. Some countries lack information on treatment units and it is not always possible to know how extensive the treatment monitoring system is, to meet all treatment entries. Furthermore, the definitions used are not always 100 % compatible with the EMCDDA TDI protocol. The number of missing cases for each data item is another limitation. Most countries have different kinds of treatment facilities and, moreover, the differences in the availability and use of drug treatment services could bias the results. The network of drug treatment centres has changed in the last decade; for example, methadone programmes have expanded. These changes in treatment services could have influenced treatment figures over time.

Specific analyses based on treatment demand data are reported in the web page, detailing client profiles.

Page last updated: Monday, 16 November 2009