Cocaine treatment demands in 10 western European countries: observed trends between 2011 and 2018.

AIMS: To describe cocaine treatment demand in 10 western European countries and to examine the size, direction and temporality of recent trends in the proportion of cocaine users among all clients entering treatment. DESIGN: Aggregated data collected through the European Union standardized treatment demand monitoring system (TDI) between 2011 and 2018 were used. SETTING: Belgium, England, France, Germany, Ireland, Italy, Luxembourg, Spain, Switzerland and the Netherlands. PARTICIPANTS: In total, more than 700 000 cocaine treatment records were analysed. Clients in treatment for cocaine as primary drug were predominantly male (85%), with an average age of 35 years. MEASUREMENTS: Number of treatment episodes for substance use and for cocaine as primary or secondary drug were collected year- and country-wise. When available, powder cocaine and crack and patients with and without previous treatment were differentiated. FINDINGS: Among the participating countries the share of cocaine as primary drug in treatment demand ranged between 4.7% [95% confidence interval (CI) = 4.6-4.9%] in Germany and 43.1% in Spain (95% CI = 42.6-43.5%). The general trend analysis showed a decreasing proportion of cocaine-related treatment entrants between 2011 and 2014 among all subgroups followed by a strong increase in 2015. The increase appeared stronger than for powder cocaine. Seven of 10 countries observed a recent significant increase in the proportion of treatment entrants reporting cocaine as the primary substance: Belgium [annual percentage change (APC) = 9.6%, P < 0.01], England (APC = 14.9%, P < 0.05), France (APC = 21.8%, P < 0.01), Ireland (APC = 28.2%, P < 0.01), Italy (APC = 7.8%, P < 0.01), Spain (APC = 7.0%, P < 0.05) and Switzerland (APC = 12.0%, P < 0.05). Trends were similar when looking at cocaine reported as primary or adjunctive substance. CONCLUSIONS: Despite substantial country-specific variation regarding cocaine prevalence and treatment demand, there has been an overall significant increase since 2015 in the share of cocaine-related treatment demand in western Europe.

Addiction research centres and the nurturing of creativity: The Swiss Institute for the Prevention of Alcohol and Drug Problems. Past, present and future.

The aim of this paper is to offer an account of the history, the current status and the future of substance use research at the Swiss Institute for the Prevention of Alcohol and Drug Problems (SIPA). Although founded originally by the temperance movement in 1901, its policy has shifted over time towards one which accepts an alcohol-consuming culture made up of self-determined but well-informed consumers, while still supporting those who choose to live an abstinent life. In the beginning, SIPA was involved primarily in collecting alcohol-related information and making it available to professionals and the general public. From the late 1960s SIPA began conducting its own research projects; by the mid-1970s it had set up its own in-house research department. In 2001, SIPA was appointed a World Health Organization (WHO) Collaborating Centre for Substance Abuse, Research, Prevention and Documentation. As a private non-governmental organization, most of its funding comes from external research commissions. SIPA participates in a variety of international projects [e.g. Gender Alcohol and Culture: An International Study (GenACIS), European School Survey Project on Alcohol and Drugs (ESPAD) and Health Behaviour in School-aged Children (HBSC)] and contributes to numerous national research projects dealing with substance use. It has also forged close links with more than 50 other research institutions in Switzerland and world-wide. Thanks to its work over the last 30 years, SIPA has become a chief port of call for alcohol use research in Switzerland. In the future, SIPA will continue to monitor substance use, while stepping up its prevention research activities and ensuring that it is able to react more promptly to emerging phenomena.

Treatment of substance-related problems in Switzerland: implementing a new harmonised monitoring system.

OBJECTIVES: In the past, five different monitoring systems were used in the various areas of the care supply for substance-related problems in Switzerland, without any real coordination between them. In 1999, a project aiming at the harmonisation of these five monitoring systems was launched by federal agencies. A further aim was to ensure compatibility with the Treatment Demand Indicator (TDI) adopted as European standard. METHODS: The different steps of the conceptualisation process and their rationales are described. They involve a first phase of consultation among all key players, a second phase of preliminary realisation according to the target criteria, a third phase of probation by the application of a pilot survey, and a last phase of consolidation and adjustments before the official implementation. RESULTS: A comprehensive and flexible monitoring system was settled for all fields of the addiction care in Switzerland. It consists of a fully standardised pool of core items to be shared by the five treatment sectors as well as optional items intended for specific needs. The practical aspects of the implementation, like data protection, organisation of data collection, and valorisation of the results are presented. The first experiences in the different treatment sectors are also reported. CONCLUSION: The implementation of "act-info" is still an ongoing process that began in 2003. Since 2005, the new monitoring system is well implemented in three out of five treatment sectors, whereas its introduction proves more challenging in the two remaining sectors. Perspectives of improvement regarding coverage and data quality are proposed.

Alcohol and domestic violence in a sample of incidents reported to the police of Zurich City.

The purpose of the study is to examine episodes of domestic violence reported to the police, focusing on the drinking behavior of the individuals involved. Over a period of 110 days, (November 1999-February 2000) a total of 53 calls to the emergency line of the police of the city of Zurich (Switzerland), related to domestic violence, were registered. Detailed data concerning the forms of violence, the persons involved, their alcohol intake, and the context of the incidents were collected in 42 cases by means of structured interviews of the officers who achieved the interventions and inquiries. Moreover, interviews by agreement of victims were performed in 12 cases, providing complementary data. Evidence of alcohol involvement was found in 40% of the investigated situations. Police officers thus believed there was a clear link between alcohol and violence in at least 26% of the 42 cases. The interviews of the victims suggest a wide range of attributions made to the role of alcohol in situations of domestic violence.