Service for youth with drug problems

 

The Family and Labour Market Administration (FLMA) wishes to establish a proper treatment service for young problem drug users[1], which simultaneously functions as a counseling facility for young, parents, and professionals who encounter problem drug users in their youth work. Youth, in this connection, is defined as below the age of 24.

FLMA needs a service specialised in offering young problem drug users professional treatment and counseling aiming at drug-free status. A service both young, parents and other professionals in touch with the young can attend.

Below is sketched a service for massively addicted young, containing elements of detoxification, in-patient treatment, and subsequent reestablishment in a normal life; a treatment service for young problem users of cannabis, both in the form of intensive day-time programmes and out-patient evening treatment for young who still manage to hold on to employment and education; in addition, the counseling facility itself is sketched. All as a new service which is frequently demanded in the media, is mentioned as an aspiration in the sector plan[2], and, last but not least, among staff in the FLMA who often feel powerless when confronted with young people with a problematic use of drugs.

The use of drugs among young people has increased in recent years. Thus, the proportion of 9th grade school children who have ever tried cannabis has doubled in the course of 5 years. Half the country's high school children have tried cannabis, and it is established that amphetamine, cocain, and ecstasy have become more common among the young than before. In addition, Denmark holds world record in youth alcohol consumption. On top of that, new drugs appear, whereby young people's life-styles change and new problems arise. The age at which the first drug is tried has also decreased noticeably in later years.

It is not known, however, whether the increasing and very varied use of drugs has given occasion to an increase in problem use; but this must be expected, and in any event, even today we know of a relatively large number of young people – cf. the below description of target groups – with a problem use that requires treatment, who are excluded from or cannot adapt to existing services, and who have an uncovered need for counseling, treatment, including detoxification, and socialising measures.

There is a wide-spread expectation that "the authorities" do something. If only on the assumption that young problem users should be helped before addiction takes hold and captures them, and before all too serious social and medical complications add to their drug use. In other words, there is a need for a massive and innovative effort in relation to young people who have developed a problematic use of drugs.

Given the experience with the treatment of older drug addicts, the service must provide for a target group of ages from ca. 14 up to ca. 23 years, since young people up to that age do not attend or respond positively to adult services which require that one admits to being  addicted.

FLMA does not currently provide a special counseling and treatment service for young problem users. That does not imply that young problem users are not helped. They are, but that service is not sufficiently targeted (Tjek-Punkt does street-level and out-reach work among young prostitutes, heroin addicts etc., but it is not a treatment service proper). Young problem users, in particular the heavily addicted, are often excluded from existing services (both those designed for youth and those designed for adults), where the staff often feel powerless. This is a problem known all over the country.

In conclusion, it is suggested that the efforts to provide for young problem drug users are strengthened. Specifically, the following is proposed:

1.      Establishing a flexible treatment facility

2.      Establishing a more broad-ranged counseling service

Below, those ideas are specified:

1. A flexible treatment facility

The treatment facility must be flexible and tailored to different target groups. The following depiction of target groups should be considered only an outline.

The heavily addicted
This target group is assumed to comprise 50-100 in Copenhagen. Must typically be offered detox opportunity out-patient or an actual detox-tour. 12 annual tours are estimated. These are to be followed by unique programmes, individually tailored for each person, typically involving the need for a change of milieu. A requirement of app. 15 places is estimated. A staff of 3 persons plus ad hoc personell is to be employed to run treatment plans, detox tours, follow-up on in-patient treatment, and, as the most important function, after-care / reestablishment into a meaningful life situation with steady residence and job/education (app. 30 young persons when the service is fully deployed).

Cannabis problem users – primarily under 18 years
Young persons who perhaps ought to be characterised as poly drug users. There are assumed to be 150-250 young poly drug users plus ca. 450 youngsters with a problematic use of cannabis as primary drug. These youngsters are offered day treatment programmes with activities, work training, physical training and intensive adult support (conversations, behavioral correction etc.) in group programmes with 6-8 young persons in each group. During the first two months, the youngsters should be picked up every morning, followed by ca. 4 months programmes with an expected after-care period of app. 3-6 months where the young are still supervised closely by the adults. Two adults are attached to each group. Provision for 32 young persons are estimated on a yearly basis.

Cannabis problem users – primarily over 18
This group is offered out-patient group programmes in which the young people meet twice a week for a period of four months, followed by an individual reestablishment effort in which the adults secure the further course of the youngsters in terms of "meaningful life situation / everyday life". 48 persons in treatment are estimated each year.

The provision of treatment for the young people's problem use is to be organised flexibly enough to allow the young to start treatment on the spot . Lengthy visitation procedures and waiting lists are inappropriate. Further, the target and age groups described above should not be taken too statically, since young people mature at varying ages, and the degree and kind of problem drug use should not necessarily determine which of the three treatment programmes is the most appropriate. The young person's own motivation and choice of programme is the key factor. Thus, provision should also include individual therapy sessions for young persons who wish, by itself or as an auxiliary, or in connection with reestablishment in a new life without drugs (or with a reduced use of drugs).

2. Broad-ranged counseling service

Aims
It must be clear to both the young, their parents, and other professionals around the young where they can find advice and counseling in relation to young persons' problem drug use. The service must on the one hand be very tangible in terms of counseling of specific youngsters, and on the other hand contribute to qualifying all institutions who now or later wish to work with young problem drug users. The aim must be to qualify staff to be able to read warning signs from young persons with an emerging problem drug use (early tracking). In addition, the aim must be to deal with the powerlessness and reluctance vis-a-vis drug problems that is wide-spread in youth services.

Expertise Centre
The place must become a centre of expertise in the field, have a finger on the pulse, instigate discussions on approaches and attitudes, provide information, create dialogues and debates among parents and institutions.

Open-door and telephone services
There must be an open door at all times, and a telephone service where anyone can get professional advice. Anonymous counseling must be provided for both young, their kin, and professionals, and the service must offer support to, and if necessary participate in, teachers', youth workers' etc., dialogues with young, parents etc.

Couseling unit
The counseling unit must provide courses, give teaching, and each year arrange a conference on youth and problem drug use. In addition, the local social centres of the city districts must be offered consultation.

Youth scene
It is vital that the place over time develops a "youth scene" of its own. The young must take part in shaping the place, and inspire and develop both treatment and counseling. The young must be involved in designing overall frameworks, aims, and means. This is essential for three reasons:

·        First, the young will make sure that the place is continuously challenged and thus keeps developing

·        Second, we know that young people are very apt at influencing other young people. The young can provide a youth-to-youth counseling, participate in general meetings, initiate discussions and take part in debates etc. Several studies have shown that when professionals attempt to teach, lecture on drugs etc., we tend to either moralise and put off the young, or go into too much detail in describing drugs, so that, at worst, some weak youngsters are negatively inspired and become attracted to the drugs' potentials.

·        Third, it is crucial for young persons who have gone through treatment to be able to participate actively in a community which they know, which can continue to support them, and to which they themselves can contribute. The great success of NA-groups in many corners of the world originates in members' mutual help and support, and in the opportunity to engage in a peer network. The most difficult part is not to obtain, but to maintain a drug-free status.

 

The flexible treatment facility and the counseling unit must appear as one integrated unit / organisation in constant development and adaptation to the needs of the young, their surroundings, and the overall organisation.

 

Unna Madsen
FLMA, December, 2001



[1] Misbrug = problem use; evt. til nød addiction. Ordet 'abuse' forekommer nærliggende, men det bruges iflg velunderrettet kilde næsten kun af politi mv. i 'war-on-drugs'-retorikken

[2] Sector plan: Publicly announced plans for various sectors of municipal policy in Copenhagen