Needs Assessment: A Practical Guide to Assessing Local Needs for Services for Drug Users
Chapter 10: Needs Assessment for Psychostimulant Users
In Scotland, psychostimulant use - and in particular, cocaine misuse - is at a relatively low level compared to England. But it does appear to be increasing, and there is a growing concern about whether current services are able to adequately address the needs of psychostimulant users. The number of cocaine-related deaths in Scotland has increased dramatically from three in 1996 to 31 in 2002 (GROS 2003). Similarly, among drug users entering Scottish treatment services, the percentage of cocaine users seeking treatment has increased from 2% in 1997/98 to 7% in 2001/02. This trend is reflected in all age groups (ISD 2003). The actual prevalence of cocaine use is likely to be much higher than these figures suggest, partly because many users will not be in contact with treatment services, and partly because many users will not see their psychostimulant use as a problem and so will not mention it when seeking help for their heroin problem.
Psychostimulant users are not a homogenous group, and this should be taken into account when defining the target population for needs assessment. The EIU publication, 'Psychostimulants. A Practical Guide' pointed out that psychostimulant users can be categorised into four main groups: i) youthful experimenters; ii) regular stimulant users; iii) problem stimulant users and iv) opiate and stimulant co-users. The first two groups may not feel they are experiencing any negative effects from using psychostimulants and therefore are unlikely to be engaged with drug treatment agencies. The third group may feel that they are in need of services which (in many areas) do not exist, while the fourth group may be in contact with services, but their psychostimulant use may not be addressed (EIU 2002d).
Because so many psychostimulant users are not in contact with treatment services, they may be considered to be a "hidden population." Therefore, local areas will have to use innovative and creative methods for finding out about their needs, and for designing services to meet those needs. Examples of such methods are described below.
Methods for finding out about the needs of psychostimulant users
The use of 'peer researchers', outreach services and snowballing techniques have all been shown to be successful in making contact with psychostimulant users - particularly for exploring the nature of users' needs. And while psychostimulant users may not be engaged with drug treatment services, they may well be involved with other types of services. The Criminal Justice system, for example, is likely to be in contact with large numbers of psychostimulant users, and the police may have a much clearer perspective on the nature and extent of the problem than other local services.
Example: The Piper Project The Piper Project, based in Manchester, employed nine current drug users as fieldworkers to undertake a needs assessment of the local crack-using population. These individuals were involved in all stages of the project, including the design of the questionnaire. Snowballing was used, in the hope of interviewing users not previously known to the interviewers.
(Source: Bottomley et al, 1997) |
As mentioned above, published statistics based on SMR24 forms are likely to under-report the size of the psychostimulant problem in local areas. The National Prevalence Study (Estimating the National and Local Prevalence of Problem Drug Misuse in Scotland) used capture-recapture methodology to estimate the prevalence of opiate and benzodiazepine use in the Scottish population in 2000. This study is being repeated in 2003, and will be expanded to also estimate the prevalence of psychostimulant use by opiate service users. The findings will be reported in September 2004 at Health Board, Local Authority, Police Force, DAAT and LHCC areas.
Options for addressing the needs of psychostimulant users
Services for adult drug users in Scotland are largely designed around the needs of heroin users. However, many specialist drug workers do have the necessary expertise to meet the needs of cocaine or amphetamine users. On the other hand, there is some evidence to suggest that psychostimulant users avoid seeking treatment because they do not want to be associated with the heroin-using population and they have little faith that services will be able to address their psychostimulant problem.
Services may need to work hard at improving their credibility among this population if they are to be engaged and retained in treatment. In addition, services will need to be proactive in outreach, and should not rely on word-of-mouth publicity, as cocaine users are less likely than heroin users to disclose their drug use to others.
Interventions need to be geared to the specific assessed needs of psychostimulant users. The provision of information and advice, and a rapid response to requests for appointments, will be important to this population. This is little evidence to strongly support any single pharmacological treatment for cocaine or amphetamine users. The focus of much of the research to date has been on medications that relieve the symptoms of withdrawal. Further information about the effectiveness of interventions for psychostimulant use is available in the EIU Psychostimulants Guide (EIU 2002d). The National Treatment Agency (NTA) has also published a guide to commissioning cocaine / crack treatment services (NTA 2002). Some of the key findings from that guide are shown below.
Commissioning Services for Cocaine / Crack Users The criminal justice system picks up large numbers of very heavy crack and crack/heroin misusers. Crack misusers say they are most likely to seek help through informal services tailored to their needs and staffed by knowledgeable workers, including ex-users. Drop-in services, peer networks, and 24-hour telephone helplines have successfully contacted this client group. Many approaches to the treatment of crack misuse are already familiar to drug services in the UK, but there are few services specific to the treatment of crack dependence. Drug-free psychosocial interventions such as counselling, provided on a non-residential basis, are the most cost-effective options for clients with few complicating problems. For more dependent and heavier users, cognitive behavioural approaches have been shown to be effective. Group therapy has been found to be as effective as individual therapy. Clients with multiple needs respond best in services offering group support from other clients and a full daytime schedule of therapeutic and practical activities. Clients lacking social supports or with severe psychological problems do best in residential care. Early abstinence in treatment is strongly related to long-term abstinence.
(Source: NTA 2002) |