WP5 Training Manual 1 1

QUALITY STANDARDS IN DRUG DEMAND
REDUCTION IN THE EU – Training modules

and implementation report.
Carmela Martínez Vispo & Mariàngels Duch

IREFREA – European Institute of Studies on Prevention
The content of this report represents the view of the authors only and is their
responsibility. The European Commission does not accept any responsibility for use
that may be made of the information it contains.
Funded by the European Union’s Justice Programme – Drug policy initiatives
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INDEX
1. Introduction 3
2. Objectives and content of the training modules 5
2.1 Objectives of each module 5
2.2 Materials and content of the modules 6
3. Information collected through the trainings 16
3.1 Prevention worskhop 16
3.2 Risk and harm reduction workshop 20
3.3 Treatment, social integration and
25
rehabilitation workshop
4. In summary (conclusions) 29
References 30
Aditional resources 31
Annexes 33
Annex 1 Prevention – Training module
Annex 2 Harm reduction – Training module
Annex 3 Treatment, social integration and rehabilitation –
Training module
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1. Introduction
The most recent World Drug Report stimates that 269 million people used drugs in the
past year worldwide (United Nations Office on Drugs & Crime [UNODC], 2021). Of these, 35.6
million people (range: 19.0 million to 52.2 million) are estimated to suffer from Substance Use
Disorders (SUDs), meaning that their pattern of drug use impacts negatively in their physical
and psychological health, they may experience drug dependence and/or require treatment
(UNODC, 2021).
The use of evidence-based interventions for the prevention, treatment, and harm
reduction of substance use-related problems has been highlighted during the last years
(Shidhaye et al., 2015; Stockings et al., 2016). In fact, an increasing number of systematic
reviews, meta-analyses, and evidence-based guidelines have been conducted, providing
insight into the efficacy, effectiveness, and implementation of these interventions in daily
practice (Ballester et al., 2021; Keynejad et al., 2018; Louie et al., 2021). As a result, the
development of quality standards has gained increasing relevance. Quality standards should
be considered as 'generally accepted principles' or 'sets of rules for the best/most appropriate
way to implement an intervention' (European Monitoring Center for Drugs and Drug
Addiction [EMCDDA], 2013), representing the political will to address demand reduction
interventions through an evidence-based perspective.
In this context, the main aim of the work developed was to increase the quality of
services in the area of drug demand reductions in the EU Member States by an active
involvement of Civil Society Organizations (CSO) by: (1) improving the knowledge and skills
among CSOs on how to implement Minimum Quality Standards on the national level; and (2)
collecting data about the real implementation of such standards and the challenges and
difficulties associated.
Providing support to practitioners working in drug demand reduction is a key objective
of this report and training modules. The training modules have been designed to provide
essential prevention, risk and harm reduction, and treatment knowledge --to the people
implementing programmes and working in services-- about the most effective evidence-
based interventions and approaches. They might be coordinators and implementers of non-
govermental organizations delivering these programmes, coordinators and implementers in
regional and local administrations or agencies, civil servants working in development of drug
demand reduction strategies or other stakeholders involved in municipal or community
coalitions.
The training modules focus on applying key findings reported in the main established
standards at international and European level with the objective of offering theoretical
frameworks for the planning and implementation of programmes and services, work with
quality criteria and acquiere skills to assess the initial situation of an intervention with a view
towards its improvement, and offer an overview for the planning and implementation of
evidence-based prevention, harm reduction and treatment of substance use disorders.
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The main activities to achieve these goals were:
 Development and preparation of three training course modules
 Piloting and validation of the training course (9th July 2021).
 Implementation of three training events at EU level, conducted in an online format using
the Zoom platform:
- Quality standards for substance use prevention (26th October 2021).
- Quality standards for risk and harm reduction approach for Substance Use Disorders
(2nd November 2021).
- Quality standards for Substance Use Disorders treatment (9th November 2021)
The results of the work carried out are collated in this report. We hereby would like to thank
the coordinator of the project and the members of the project partnership who gently play
a part in the development of the training modules and their validation. Special thanks to the
coordinators and implemententers of non-governanmental organizations who kindly
participated in the implementation of the training modules and generously contributed with
their experience and knowledge in their development. This work would have not been
possible without their contributions.
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2. Objectives and content of the training modules
In September 2015, the Council of the European Union adopted Council conclusions on
the implementation of minimum quality standards (MQS) in drug demand reduction in the
EU. This innovative initiative represents a minimum benchmark of quality for interventions in
prevention, risk and harm reduction, treatment, social integration and rehabilitation.
Although nonbinding for national governments, this document represents the political will of
EU countries to address demand reduction interventions through an evidence-based
perspective.
Building on the work done in a previous CSFD project, where a feasibility study was
carried out on the implementation of MQS across EU Member States, training modules have
been developed to improve knowledge and skills among civil society organizations (CSO) on
how to implement quality standards, promote the adoption of qualitity standards and explore
impending factors for compliance with the standards.
Each of the three modules developed had specific objectives and content. In addition,
the design and application of these modules tried to be as much interactive as possible in
order to enhance the participation of the representatives from the CSO and collect their
opinions.
2.1 Objectives of each module

Prevention
- Offer a theoretical framework for the planning and implementation of prevention
programmes.
- Acquire skills to assess the initial situation of a programme with a view to its
improvement: Minimum Quality Standards (Council of the European Union,
2015); International Standards in Drug Use Prevention (WHO/UNODC, 2013,
2018); European Drug Prevention Quality Standards (EMCDDA, 2008-2013)
- Work with essential quality criteria (case study).
Risk and Harm Reduction

- Offer an overview of risk and harm reduction measures.
- Work with quality criteria: Minimum Quality Standards (Council of the European
Union, 2015); and Minimum European Quality Standards in Drug Demand
Reduction EQUS (Uchtenhagen & Schaub, 2011).
- Offer an overview for the planning and implementation of evidence-based RHR of
SUDs.
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Treatment, social integration and rehabilitation
- Offer an overview of substance use prevalence and SUDs current situation
- Work with quality criteria: International standards for the treatment of drug use
Disorders (WHO/UNODC, 2020); and Minimum Quality Standards (Council of the
European Union, 2015).
- Offer an overview for the planning and implementation of evidence-based
treatment of SUDs.
2.2 Materials and content of the modules

Different quality standards are available for each drug demand area, level, and
coverage. During these seminars, we had worked with various documents. Following, we
detail each of the documents we have worked with, providing a summary of the information
we used in each module.
Council of the European Union – Council Conclusions on the implementation of the EU Action
Plan on Drugs 2013-2016 regarding Minimum Quality Standards in Drug Demand Reduction
in the European Union – 2015
The Council Conclusion regarding Minimum Quality Standards (MQSs) in drug demand
reduction is a document developed by the Horizontal Group on Drugs of the European Union
in cooperation with external experts and the EMCDDA. These MQSs are guidelines that
represent a minimum benchmark of quality for interventions in the areas of (1) drug use
prevention, (2) risk and harm reduction, and (3) treatment, social integration and
rehabilitation (Table 1).
Table 1 - Minimum Quality Standards in Drug Demand Reduction in the European Union
Prevention
 Prevention interventions are targeted at the general population, at populations at risk
of developing a substance use problem or at populations/individuals with an identified
problem. They can be aimed at preventing, delaying or reducing drug use, its escalation
and/or its negative consequences in the general population and/or subpopulations; and
are based on an assessment of and tailored to the needs of the target population;
 Those developing prevention interventions have competencies and expertise on
prevention principles, theories and practice, and are trained and/or specialised
professionals who have the support of public institutions (education, health and social
services) or work for accredited or recognised institutions or NGOs;
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 Those implementing prevention interventions have access to and rely on available
evidence-based programmes and/or quality criteria available at local, national and
international levels;
 Prevention interventions form part of a coherent long-term prevention plan, are
appropriately monitored on an ongoing basis allowing for necessary adjustments, are
evaluated and the results disseminated so as to learn from new experiences.
Risk and harm reduction
 Risk and harm reduction measures, including but not limited to measures relating to
infectious diseases and drug-related deaths, are realistic in their goals, are widely
accessible, and are tailored to the needs of the target populations;
 Appropriate interventions, information and referral are offered according to the
characteristics and needs of the service users, irrespective of their treatment status;
 Interventions are available to all in need, including in higher risk situations and settings;
 Interventions are based on available scientific evidence and experience and provided by
qualified and/or trained staff (including volunteers), who engage in continuing professional
development.
Treatment, social integration and rehabilitation
 Appropriate evidence-based treatment is tailored to the characteristics and needs of
service users and is respectful of the individual's dignity, responsibility and preparedness
to change;
 Access to treatment is available to all in need upon request, and not restricted by
personal or social characteristics and circumstances or the lack of financial resources of
service users. Treatment is provided in a reasonable time and in the context of continuity
of care;
 In treatment and social integration interventions, goals are set on a step-by-step basis
and periodically reviewed, and possible relapses are appropriately managed;
 Treatment and social integration interventions and services are based on informed
consent, are patient-oriented, and support patients' empowerment;
 Treatment is provided by qualified specialists and trained staff who engage in continuing
professional development;
 Treatment interventions and services are integrated within a continuum of care to
include, where appropriate, social support services (education, housing, vocational
training, welfare) aimed at the social integration of the person;
 Treatment services provide voluntary testing for blood-borne infectious diseases,
counselling against risky behaviours and assistance to manage illness;
 h. Treatment services are monitored and activities and outcomes are subject to regular
internal and/or external evaluation
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EMCDDA – European Drug Prevention Quality Standards (EDPQS). A manual for prevention
professionals – 2011
This manual was elaborated by the EMCDDA and the Prevention Standards Partnership.
It describes basic and expert level quality standards for drug prevention. These standars cover
the following areas: (1) needs and resource assessment, (2) programme planning, (3)
intervention design, (4) resource management, (5) implementation, (6) monitoring and
evaluation, (7) dissemination, (8) sustainability, (8) stakeholder involvement, (9) staff
development, and (10) ethics.
Figure 1 – The drug prevention project cycle
EMCDDA – European Drug Prevention Quality Standards: a quick guide – 2013
This publication aims to make practical and useful information on prevention quality
standards available outside the European Union. It includes a description of the eight stages
involved in the drug prevention cycle, which are: (1) needs assessment, (2) Resource
assessment, (3) Programme formulation, (4) Intervention design, (5) Management and
mobilisation of resources, (6) Delivery and monitoring, (7) Final evaluations, and (8)
Dissemination and improvement. In addition, this guide includes a self-reflection checklist
that can be used when planning and implementing prevention activities.
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EMCDDA – Implementing quality standards for drug services and systems: A six-step guide
to support quality assurance – 2021
This publication summarises the main problems and obstacles that people engaged in
implementing quality standards in drug demand reduction need to consider. This guide
describes six steps to support quality assurance: (1) Diagnosis: what is the problem the quality
assurance project will address? (2) Scoping: what are the goals and who to involve? (3)
Mapping and selection: what standards apply and how can we verify them? (4) Assessment
of systems and services: how to evaluate; (5) Drafting an improvement plan and disseminating
results: when, where and to whom to communicate; and (6) Preparing for the next cycle: how
to ensure continuous evaluation.
Figure 2 – The six key steps to implementing quality standards
In addition, this guide highlights the idea that a single correct way to implement quality
assurance processes does not exist, which would depend on timing, objectives, and the
availability of resources. Therefore, it offers guidance to choose the best approach to suit the
specific circumstances providing a practical introduction to quality standards and quality
assurance mechanisms and the key steps involved in their implementation in drug services
and systems.
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Minimum European Quality Standards in Drug Demand Reduction EQUS (Uchtenhagen &
Schaub, 2011).
This document aims to collect national and international information on quality
standards and benchmarks in drug demand reduction.
Tables 2, 3 and 4 collect the minimum quality standards proposed by the EQUS project
for each drug demand reduction area.
Table 2 - Minimum European Quality Standards in Drug Demand Reduction EQUS for
prevention
Prevention standards
Structural Standards of Services
 Adherence to ethical principles (e.g. service must protect participants' rights)
 Reference to drug-related policy and legislation as required for the implementation of
the service/intervention
 Routine cooperation with other agencies and institutions in correspondence with the
multi-service nature of drug prevention
 Financial requirements (realistic cost estimate; available funding streams are sufficient
to cover costs)
 Internal resources and capacities are sufficiently available for implementation
 Transdisciplinarity and qualifications of staff are appropriate for the service
 Staff support: staff members are supported in their work as appropriate
Process Standards of Services/Interventions
 Adherence to ethical standards (e.g. ensuring confidentiality, safety of participants)
 Assessment procedures to collect information on drug use in the community/target
population/environment of interest through primary or secondary study.
 Assessment procedures of target population's culture.
 Assessment procedures of other relevant characteristics of the community/target
population/environment (e.g. cognitions, attitudes, risk behaviours)
 Assessment procedures of target population and community readiness for the
service/intervention.
 Assessment of gaps in current service provision
 Stakeholder relevant to the service/intervention should be involved in its development
and implementation.
 Long term sustainability.
 Intervention goals are specific, realistic and informed by the previous assessment.
 Service/intervention is evidence-based.
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 Service/interventions are tailored according to individual and population
characteristics.
 Criteria for end of the service/intervention are defined.
 Service/intervention activities are feasible and internally consistent.
 Existing interventions are adapted considering the differences between the original
and the actual circumstances.
 Staff have the competencies which are required for a successful implementation.
 Recruitment: participants are drawn from the defined target population
 A systematic project plan exists in writing
 Implementation is monitored and necessary adjustments identified
 The service/intervention is implemented according to the project plan and adjusted
with the monitoring findings
 The implementation is documented and explained
 Dissemination through a written and clear description of the service/intervention.
 Information about the service/intervention is disseminated in an appropriate format
Outcome Standards at the System Level
 Goal of prevention: reduced drug use.
 Appropriate evaluation is carried out as part of the service/intervention
 The service/intervention is continued based on evidence provided by monitoring.
Table 3 - Minimum European Quality Standards in Drug Demand Reduction EQUS for
Interventions
Treatment/rehabilitation standards
 Accessibility
 Adequate spacing for the activities in the service
 Safe physical environment (service is equipped for emergencies)
 Treatment indication is always made on the basis of a diagnosis.
 Staff education (e.g. at least half of staff has a diploma in medicine, nursing, social
work, or psychology)
 Staff composition: transdisciplinarity (e.g. at least 3 professions)
Process Standards at the Services an Interventions level
 Substance use history, diagnosis and treatment history have to be assessed.
 Somatic status and social status have to be assessed
 Psychiatric status has to be assessed
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 Treatment plans are tailored individually to the needs of the patient
 Patients must receive information on available treatment options and agree with a
proposed regime or plan or a change of plan before starting treatment.
 Assessment results, intervention plan, interventions, expected changes and
unexpected events are documented complete in a patient record.
 Confidentiality of client data.
 Routine cooperation with other agencies
 Continued staff training
 Goal: health stabilisation/improvement.
 Goal: social stabilization/integration
 Goal: reduced substance use.
 Utilisation monitoring.
 Discharge monitoring
 Internal evaluation: (services must regularly perform an internal evaluation of their
activities and outcomes)
 External evaluation: (services must regularly allow an evaluation of their activities and
outcomes by an independent external evaluator).
Table 4 – Minimum European Quality Standards in Drug Demand Reduction EQUS for Risk
and Harm Reduction
Harm reduction standards
 Accessibility: location and opening hours.
 Staff has to be qualified and the staff qualification has to be made transparent, e.g.
amongst two trained peers involved in the service, two have a diploma in social
 Services have to be age appropriate and staff has to be trained to meet age
appropriate clients needs; and there should be no age limits in harm reduction
services)
Process Standards of the Interventions
 Risk behaviour should be assessed.
 Complete needs assessment and priorisation
 The client's/patient's health status is assessed.
 Informed consent: clients/patients must receive information on available service
options and agree with a proposed regime or plan.
 Confidentiality of client data
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 Individualised treatment planning
 Routine cooperation with other agencies
 Continued staff training
 Neighbourhood/community consultation
 Goal: reduced risk behaviour
 Goal: referrals (treatment services must be prepared to refer clients/patients to other
health/social/treatment/legal services if needed and agreed)
 Internal evaluation: (services must regularly perform an internal evaluation of their
activities and outcomes)
 External evaluation: (services must regularly allow an evaluation of their activities and
outcomes by an independent external evaluator)
UNODC / WHO – International Standards for the Treatment of Drug Use – 2020
The UNODC / WHO Standards are proposed to provide guidance on how to organize the
delivery of interventions of SUDs, supporting the evaluation and ongoing improvement of
services and the development of new policies and treatment systems. The International
Standards define a set of requirements that have to be in place for any treatment modality
or intervention to be considered safe and effective. In Table 5, the seven principles proposed
in this document and explained during the modules are described.
Table 5 – International Standards for the Treatment of Drug Use (UNODC-WHO, 2020)
Principle 1. Treatment should be available, accessible, attractive, and appropriate
 Minimize all barriers that limit access to treatment services
 Provide social support, protection, and general medical care
 Friendly and culturally sensitive environment
 Focus on the specific clinical needs
Principle 2. Ensuring ethical standards of care in treatment services
 Respect for human rights and the patient's dignity
 Avoiding any form of discrimination and/or stigmatization
 Patient's consent should be obtained before any treatment intervention
 The individual with SUD should be recognized as a person with a health problem,
avoiding any form of discrimination and/or stigmatization
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Principle 3. Promoting treatment for drug use disorders through effective coordination
between the criminal justice system and health and social services
 SUDs as health problems requiring access to appropriate support and treatment
 SUDs should be treated in the health care system not in the criminal justice system
 Criminal justice system should collaborate closely with the health and social
 Law enforcement, court and prison system staff should receive appropriate training
 Treatment should be offered during and after their stay in jail
 People should receive treatment equally to the treatment offered in the community
Principle 4. Treatment should be based on scientific evidence and respond to the
specific needs of individuals with drug use disorders
 Scientific knowledge on SUDs and their treatment should guide interventions and
investments in treatment.
 Applicability of pharmacological and psychosocial interventions should be limited to
those whose effectiveness has been demonstrated through research.
Principle 5. Responding to the special treatment and care needs of population groups
 Unique requirements, vulnerabilities and needs for specific subgroups of individuals
 Individuals from groups with specific needs may include, but are not limited to:
women and pregnant women; children and adolescents; elderly people; indigenous
populations; migrants; sex workers; people with different sexual orientation and
gender identity; people with disabilities; among others.
Principle 6. Ensuring good clinical governance of treatment services and programmes for
SUDs
The treatment programme, policies, procedures and coordination mechanisms should be
defined in advance and made clear to all (patientes and therapeutic/administrative staff).
Measures to support services staff and encourage the provision of good quality services.
Principle 7. Treatment services, policies and procedures should support an integrated
treatment approach, and linkages to complementary services require constant
monitoring and evaluation
Comprehensive treatment systems should be developed to facilitate effective management
of SUDs and associated health and social problems.
Whenever possible, different services need to be engaged in treatment delivery with
appropriate coordination
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UNODC / WHO – International Standards in Drug Use Prevention – 2013 & 2018
The International Standards in Drug Use Prevention summarize the underlying science
in interventions and policies based on scientific evidence. These standards were developed
by the United Nations Office on Drugs and Crime (UNODC) in conjuction with the World
Health Organization in 2013 and have an updated version published in 2018. The standards
facilitate the selection of interventions according to their content, structure, and the most
appropriate strategy for interventions.
There are three main sections of the the Standards. The first one is an introduction to
drug prevention and prevention science summarizing the extensive progress that has been
made to understand the underlying principles of prevention and the best approaches to drug
prevention. The second one collates evidence-based interventions and policies, lays out what
is meant by the terms “evidence-based” and the criteria that were used to “filter” published
research findings.
Table 6 – Interventions for each developmental stage (UNODC-WHO, 2013)
Finally, the third section underlines the main components of a national drug prevention
system that either were identified through meta-analysis of several evaluation studies or
rigorous systemativ reviews across meta-analytic reports.
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3. Information collected through the trainings
A piloting of the training modules was conducted in July 2021 with the participation of
the project coordinator (Correlation) and representatives from several project teams (IDPC,
Forum Droghe Onlus, Yoda, UTRIP and IREFREA) as well as representatives from CSO
participating in the Forum (San Patrignano, Dianova and Proyecto Hombre). Participants
provided a critical point of view, gave feedback on the prepared materials and organizational
and pedagogical aspects of the training and suggested additional content that were
incorporated in the modules used for the trainings.
During the implementation of the three training modules, information about knowledge
and implementation of the quality standards was collected using the Mentimeter tool, the
Zoom chat and allowing participants to speak and share their experiences. In this section we
provide the qualitative information provided by participants of different organizations in each
module.
3.1 Prevention workshop

Workshop on the prevention module was conducted online, on the 26 th of October
2021, with the participation of eight participants from five EU countries (Serbia, Spain, Italy,
Slovenia and Ireland) and two African countries (Nigeria and South Africa). A summary of the
traning carried out is described below.
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a) Definition of Quality Standard. Before getting into the formal definitions of standards,
participants were asked to provide their own definition throught the Mentimeter tool
(Figure 2). Then the EMCDDA definition was provided and commented.
Figure 3 – Quality Standard definition provided by the participants through Mentimeter tool
b) Availability of Quality Standards. Table 7 collates the information on main quality

standards being implemented according to the different drug demand reduction
areas.
Table 7 – Availability of Qualtiy Standards

Standard Coverage Level(s) Area(s) Targets
UNODC World n.a. Prevention, Treatment Evidence for

interventions
EDPQS Europe Basic & Expert Prevention Intervention design

& process +
Workforce
CCSA Canada n.a. Prevention Intervention design

& process +
Evidence
COPOLAD Latin America Basic & Advanced Prevention, Treatment, Intervention design
Harm Reduction, & process +
Reintegration Evidence
SPR USA Highly advanced Prevention Evidence of

interventions
MQS European Union Minimum Prevention, Risk and Harm Benchmark of

Reduction, Treatment, quality for
Social Integration and interventions
Rehabilitation
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c) Minimum Quality Standards (Council of the European Union, 2015)
After explaning each of the MQS, participants were asked to discuss the factors
impending or facilitating compliance with the standards (Figure 3). These are the main
comments provided:
- Most participants implemented universal interventions (mainly in school
settings) and selective interventions (for youth at risk of using drugs or people
who has already initiated substance use) in their own services.
- Needs assessment is mainly conducted on national data for prevention but in
harm reduction interventions their own data was the one mainly used.
- In most countries, no specific competencies and/or expertise (formal or
informal education) for the staff working in prevention is required. No official
system is in place either.
- Evidence-based programmes and use of evidence-based registries. Most
European participants knew about the European registries but the
organizations do not use them so much.
- Funding is not linked to the use of quality standards or evidence-based
interventions.
Figure 4 – Which are the factors impending or precluding compliance with the MQS
d) International Standards in Drug Use Prevention (UNODC/WHO, 2013 & 2018)

After the introduction of the standards, participants were asked if they were using
these standards and which would be the the factors impending or precluding
compliance with the standards (Figure 4). The reasons were mainly the same stated
with the Minimum Quality Standards.
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Figure 5 – Which are the factors impending or precluding compliance with the UNODC
standards
e) European Drug Prevention Quality Standards – EDPQS (EMCDDA, 2011)

The EDPQS have been designed to: (1) Improve the development and
implementation of interventions and policies; (2) Reduce the implementation of
approaches that have shown to be ineffective; and, (3) Guarantee that prevention
activities are carried out by competent organizations and personnel in accordance
with the context and target group of the intervention. After an overall presentation
of the project cycle, structured in eight stages, the 35 quality components were
presented (Figure 5).
Figure 6 – EDPQS – Project stages and components
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f) Working with the EDPQS – Case study: the STELLA programme
After the presentation of the EDPQS, a fictious school prevention programme
“STELLA” was presented and used as a case study for practical application of the
standards and revision of the programme using the EDPQS checklist (Figure 6)
Figure 7 – EDPQS – Working with the checklist
The standards and the checklist were useful to identify strengths and
weeknessess (areas for improvement) and stimulate constructive discussion about
aims and methods of prevention which are very useful for revision of projects when
planning or developing an intervention. Participants liked that the EDPQS could be
used as a reference framework to make implicit activities explicit and to
conceptualise prevention work in a structured way.
3.2 Risk and Harm Reduction workshop

Workshop on the risk and harm reduction module was conducted online, on the 2nd
of November 2021, with the participation of nine participants from five EU countries
(Serbia, Spain, Netherlands, Slovenia, Italy) and two participants from African countries
(South Africa and Nigeria). A summary of the traning carried out is described below.
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a) Harm reduction definition and the WHO comprehensive harm reduction package.
Participants were asked about a definition of Harm Reduction. To collect this
information, the tool Mentimeter was used (Figure 8).
Figure 8 - Harm Reduction definition by participants through Mentimeter tool
b) Definitions and differences between quality standards and guidelines.

Participants were asked about a definition of Quality Standards. To collect this
information we used Mentimeter (Figure 9)
Figure 9 – Definition of Quality Standards by participants through Mentimeter tool
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c) Availability of Quality Standards. Table 8 collates the information on main quality
standards being implemented according to the different drug demand reduction
areas.
Table 8 – Availability of Qualtiy Standards
d) Minimum quality standards (Council of the European Union, 2015)

After explaining each of the MQS, participants were asked about which were the
Standards most difficult to implement and why. Their responses were as follows:
- Training staff (including volunteers)
- Availability of interventions to all in need. There are several group populations
that are forgotten as women or those injecting drugs/opiods. This occurs due to
the scarcity of funding and also the lack/difficulties for assessing harm reduction
strategies' success.
- Lack of needs assessment. There is a need to tailor the interventions to the needs
of the target population at regional and national levels.
- Difficulties in reaching the target population. For instance, in Italy harm reduction
approaches are provided only in a few territories because the Italian health
system is regional-based.
- Policies approving Harm Reduction interventions and funding/economic
investment to support harm reduction interventions. For instance, some African
organizations participants reported that in their countries, harm reduction
approaches are not encouraged (e.g. Nigeria).
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e) Minimum European Quality Standards in Drug Demand Reduction EQUS
(Uchtenhagen & Schaub, 2011)
During this part of the Module, some questions were made to participants after
explaining each set of Quality Standars. The questions and answers were as follows:
- Are RHR interventions accessible to users in your country/ organization?
HR services are well-stablished in some countries as Slovenia or Italy. However,
another ones, as Nigeria, are not.
- Which curriculum, education or training treatment requires your organization?
Education for Harm Reduction Services is related in most cases with Social Work
or Social Care degree. Additionally, it is recommended to take additional training
sessions, workshops, seminars, etc. In addition, Social Workers usually conduct non-
formal training sessions for drug services staff and volunteers.
Moreover, most organizations provide specific training for gradual reduction of
alcohol and drug use, management plans, syringe exchange training, etc.
The representative from Correlation, posted a question about how to combine
formal education with working with peers (ex-drug users) in HR services, especially for
those programmes that have a more community-based approach.
The representative from the Forum Droghe / Itrardd considered the need for
training to prevent staff burnout due to the challenges and difficulties that HR
professionals have to face daily. It was also highlighted the relevance of staff advocacy
and their mental health promotion and protection. Therefore, in the future mental
health and burnout prevention should be considered for HR services providers.
- Does your organization assess… .client's/patient's risk behaviours?....
client's/patient's health status?
Most organizations assess risk behaviors as well as client's/patient's health status.
For instance, for the risk behaviors, in South Africa follow the Matrix Model for the
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community based-treatment, including recovery groups and relapse prevention
groups. For mental and physical health status assessment, they have health care
practitioners for all the duration of the treatment programme.
- How your organization provides information on available treatment/intervention

options?
In Ireland, they make a short and long-term risk assessment before planning the
intervention, and then, they provide information about treatment and HR options.
- Does your organization provide informed consent before the intervention?

All the organizations provide informed consent before the intervention begins.
For instance, in Ireland, they store all the information collected in a database (they do
not keep anything on paper). They have two types of consents (external database for
sharing data with the country council and internal database). In addition, the consent
is reviewed every year by the client/patient.
In the case of South Africa, adult clients have to sign a Service Agreement and
Consent Form and a drug testing consent form. In the case of children and adolescents,
a client/patient of 12 years old or older can provide consent for medical treatment.
Therefore, they also ask for explicit consent in these cases.
- How treatment/intervention is planned or tailored to the needs of the

client/patient?
Participants of all organizations tailor the intervention to clients/patients'
specific needs after a complete assessment of each case.
- Does your organization conduct internal and/or external evaluations?

Half of the participants informed that they conduct both external and internal
assessments, while the other half reported only internal evaluations. Participants
highlight that these evaluations are required, and in some cases mandatories, by
funding providers (i.e., Governments).
e) Regarding factors impeding or precluding compliance with standards, participants

highlighted that most of the factors for not compliying with the standards are external
factors such as: lack or insufficient funding, lack or insufficient political will, and l lack
or insufficient human resources.
24
3.3 Treatment, social integration and rehabilitation worskhop
Workshop on the risk and harm reduction module was conducted online, on the 9th of
November 2021, with the participation of nine participants from four EU countries (Italy,
Romania, Bosnia, Croatina) one participant from Turkey, and two participants from African
countries (South Africa and Nigeria). A summary of the traning carried out is described below.
The information collected is reported in each of the following sections of the module:
25
a) Working with the International Standards for the Treatment of SUDs (WHO/UNODC,
2020)
After explaining each of the seven principles, participants were asked about the
factors impeding or precluding the compliance with the Standards
Funding and economic aspects were the most mentioned factors related to difficulties
in implementing these standards adequately.
They also stated that the COVID-19 pandemic had impacted negatively in their
implementation due to social-related restrictions and the economic issues associated.
Finally, participants stand out the lack of accessibility and availability of SUDs
treatments to all people in need, and especially to some population groups that are in
a high-risk situation (i.e., homeless, sex workers).
b) Working with Minimum quality standards (Council of the European Union, 2015)
After explaining each of the MQS, participants were asked about specific aspects of
each one. The questions and their answers were as follows:
- How your organization assesses the users' characteristics? How your organization
tailor interventions to such users' characteristics?
Participants reported that in their organization users' characteristics are assessed.
For instance, they collect information about sociodemographics (i.e., sex, age, marital
status), dependence severity, desire to change, and motivation. Most of the participants
stated that they tailor their interventions to the specific needs of users' characteristics.
Some difficulties have arisen during the discussion. For instance, participants
mentioned the lack of time to conduct the recovery process (from detoxification to the
social reintegration of the client), or the emphasis on quantity instead of quality (i.e.,
treating as many SUDs clients as possible).
26
- Does your organisation provide treatment to all in need upon request, or does it have
an inclusion policy based on social characteristics or financial resources? How many time
your organization last in providing treatment after request? How your organization
provides treatment in the context of continuity of care?
Most organizations inform that they provide treatment to all in need upon request,
but such treatment is paid by the patient or their family in most cases. They highlight
difficulties in having funding for treatment.
Some countries have public services that offer treatment free of charge for one year
approximately.
Regarding the continuity of care, most organizations inform that they provide
services for two or three years. Therefore, the clients/patients can be followed and
supported to facilitate their social reintegration during the recovery process.
- How your organization set goals of treatment & social integration interventions on a
step-by-step basis? Which is the frequency of your organization reviewing goals of
treatment & social integration interventions?
They inform the treatment goals, and social integration interventions are
reviewed during the individual recovery process, highlighting the different steps (from
medical intervention to psychological intervention and social reintegration). Most have
a residential phase in a therapeutic community. They highlight that recovery is a long-
term process and that the continuity of care is fundamental.
- Which strategies your organization use to promote patient-oriented interventions &

services ? How your organization's services support patients' empowerment?
Most organizations support patients' empowerment and self-confidence for recovery
in collaboration with their family members. The plan intervention is also individually
elaborated using different psychosocial approaches (i.e., motivational interviewing,
psychological counseling, cognitive-behavioral treatment, drug refusal training). They
also highlight not only focusing on the drug problem but also providing additional social
skills training, daily life skills, etc.
- Which curriculum, education or training on treatment requires your organization? How

frequently continuing education/training on treatment is provided or supported by your
organization?
In most cases, formal education/curriculum for SUDs treatment is related to social
work, education, nursery, psychiatry, or psychology. In addition, some organizations
are based on peer support (people who have recovered from a SUD), also taking
formal and informal training sessions on SUDs.
They also mention that professionals take additional training sessions, workshops,
seminars, etc.
27
- Does your organization provide voluntary testing for blood-borne infectious diseases?
Most organizations provide voluntary testing for blood-borne infectious diseases (i.e.,
Hepatitis C, HIV) to be medically treated.
- What type of counseling against risky behaviours is provided by your organization?

During the intervention, most organizations conduct prevention strategies of risky
behaviors.
- How does your organization evaluate its treatment interventions? Is there any
internal/external evaluation system/plan of treatment services, activities and
outcomes?
Most informed that they conduct internal and external assessments. Participants
highlight that these evaluations are required, and in some cases mandatories, by
funding providers (i.e., Governments).
Some of them also assess the client's satisfaction with treatment and services.
c) Regarding factors impeding or precluding compliance with standards, participants

highlighted the following: Lack/insufficient funding, and Insufficient human resources
and trained professionals in addiction treatment.
d) Which treatment models are available in your country?

Most of the treatment models are available in each country but is region-dependent.
28
4. In summary (conclusions)
The work carried out during the implementation of the trainings has allow us to check
compliance with the Minimum Quality Standards, and other European an International
Standards, and discuss the situation with representatives of NGOS implementing
interventions in the three areas of drug demand reduction (Prevention; Harm Reduction; and
Treatment, Social Integration, and Rehabilitation) and critically explore the challenges for
implementation in practice.
A common challenge across EU countries is the lack of a legal framework to facilitate
incorporation of the standards. In most countries, the implementation of quality standards
has not been formally adopted (at national, regional or local level), and the standards are just
informally applied in the daily work performed by these organizations. In addition, some
organizations have the possibility to desing and implement their own quality standards, which
are not monitored by any external agency. In general, specially in the harm reduction field,
different kind of guidelines are more likely to be in place than standards.
In most cases, funding is not linked to the implementation of quality standards and
evidence-based interventions and policies. In a number of countries, support for the
implementation of quality standards is provided through the available trainings for
practitioners and through the integration of some parts of the standards (bits and pieces) in
plans and strategies at national, regional or local level.
The contributions made by the participants highlight the need to advocate at EU level
for the implementation of quality standards according to the countries needs and challenges,
and the need to train frontline practitioners to facilitate adoption and implementation of the
standards. There is also a need to train policy and decision makers, to facilitate political
willingness and the facilitation of organizational structures, something like a central/national
agency, to standardize training and enable the incorporaton of quality standards among the
organizations providing drug demand reduction interventions and services. Furthermore,
quality standards should be translated so that practitioners can use them.
Besides, insufficient and discontinuous funding has also been pointed out by
participants, wich has a direct impact on the continuous eduction and training of practitioners
and leaves no resources, or very scarce ones, for evaluation and monitoring (both internal and
external) of the interventions and services.
The implementation of quality standard has improved during the past few years but
there is still a lack of a clear structure to set up adoption, implementation and monitoring. To
facilitate incorporation of quality standards in all EU countries there is, firstly, a need to
strengthen the political will for creating the conditions; and, secondly, to strengthen the
capacity of practitioners to ensure a high quality implementation of the standards. The fact
that this project will not have a continuity –due to lack of funding-- works against both
objectives.
29
References
Ballester, L., Amer, J., Sánchez-Prieto, L., & Valero de Vicente, M. (2021). Universal family drug
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COPOLAD (2014). Calidad y Evidencia en Reducción de la Demanda de Drogas. Marco de referencia
para la acreditación de programas. Madrid: COPOLAD.
Council of the European Union (2015). Council conclusions on the implementation of the EU Action
Plan on Drugs (2013-2016) regarding Minimum quality standards in drug demand reduction in
the European Union. Brussels: General Secretariat of the Council.
European Monitoring Centre for Drugs and Drug Addiction (2011). European Drug Prevention Quality
Standards. A manual for prevention professionals. Luxembourg: Publications Office of the
European Union.
European Monitoring Centre for Drugs and Drug Addiction (2021). Implementing Quality Standards
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Keynejad, R. C., Dua, T., Barbui, C., & Thornicroft, G. (2018). WHO Mental Health Gap Action
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Shidhaye, R., Lund, C., & Chisholm, D. (2015). Closing the treatment gap for mental, neurological and
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Stockings, E., Hall, W. D., Lynskey, M., Morley, K. I., Reavley, N., Strang, J., ... & Degenhardt, L. (2016).
Prevention, early intervention, harm reduction, and treatment of substance use in young
people. The Lancet Psychiatry, 3(3), 280-296.
Uchtenhagen, A. & Schaub, M. (2011). Minimum Quality Standards in Drug Demand Reduction EQUS.
Research Institute for Public Health and Addiction: Zurich.
http://www.isgf.ch/fileadmin/downloads/EQUS_final_report.pdf
United Nations Office on Drugs and Crime (2018). International Standards on Drug Use Prevention.
Second updated edition. Vienna: United Nations Office on Drugs and Crime.
United Nations Office on Drugs and Crime (2021). World Drug Report. Vienna: United Nations
Publication.
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standards for the treatment of drug use disorders: revised edition incorporating results of field-
testing. Geneva: United Nations Publication.
30
Additional resources
References
Brotherhood, A., Sumnall, H.R., & the European Prevention Standards Partnership. (2015). EDPQS
Toolkit 4. Promoting quality standards in different contexts. Centre for Public Health, Liverpool.
Charvat, M., Jurystova, L., & Miovsky, M. (2012). Four level model qualitications for the practitioners
of the primary prevention of risk behaviours in the school system, Adiktology 12 (3). 190-211.
Coffman, J. (2007) Whats different about evaluating advocacy and policy change?, Exchange 13, 2-4.
Degenhardt, L., Whiteford, H.A., Ferrari, A.J., Baxter, A.J., Charlson, F.J., Hall, W.D., Freedman, G &
Burstein, R (2013) Global burden of disease attributable to illicit drug use and dependence:
findings from the Global Burden of Disease Study 2010. Lancet 382, 1564-1574.
European Monitoring Centre for Drugs and Drug Addiction (2013). European Drug Prevention Quality
Standards: a quick guide. Luxembourg: Publications Office of the European Union.
European Monitoring Centre for Drugs and Drug Addiction (2015). New psychoactive substances in
Europe: an update from the EU early warning system. Luxembourg: EMCDDA Rapic
Communication, Publications Office of the European Union.
European Monitoring Centre for Drugs and Drug Addiction (2017). Health and social responses to drug
problems: a European guide. Luxembourg: EMCDDA Rapic Communication, Publications Office
of the European Union.
Livingston, J.D., Milne, T., Fang, M.L., & Amari, E. (2012) The effectiveness of interventions for reducing
stigma related to substance use disorders: a systematic review. Addiction 107 (1), 39-50. Doi:
10.1111/j.1360-0443.2011.03601.x.
Marlatt, G.A., Larimer, M.E., & Witkiewitz, K. (eds) (2011). Harm reduction: pragmatic strategies for
managing high-risk behaviours. New York: Guilford Press.
National Institute on Drug Abuse (2012) Principles of drug addiction treatment: A research based
guide. Available at: https://nida.nih.gov/sites/default/files/podat_1.pdf
Rhodes, T. (1996) Outreach work with drug users: principles and practice. Strasbourg: Council of
Europe Publications.
Torrens, M., Mestre-Pintó, J.I., & Salvany, D. (2015) Comorbidity of substance use and mental disorders
in Europe. Luxembourg: EMCDDA Insights, Publications Office of the European Union
United Nations Office on Drugs and Crime (2012) TREATNET Quality Standards for Drug Dependance,
Treatment and Care Services. Available at:
https://www.unodc.org/docs/treatment/treatnet_quality_standards.pdf
United Nations Office on Drugs and Crime & World Health Organization (2019) Treatment and care
for people with drug use disorders in contact with the criminal justice system. Alternatives to
Conviction or Punishment. Available at:
https://www.unodc.org/documents/UNODC_WHO_Alternatives_to_conviction_or_punishme
nt_ENG.pdf
White, L.W. (2012) Recovery/Remission from Substance Use Disorders: An Analysis of Reported
Outcomes in 415 Scientific Reports, 1868-2011. Available at:
https://www.naadac.org/assets/2416/whitewl2012_recoveryremission_from_substance_abu
se_disorders.pdf
31
Online resources and tools
Blueprints for Healthy Youth Development - https://cspv.colorado.edu/what-we-

do/#what-we-do-section-4
EMCDDA – Best Practice Portal - https://www.emcdda.europa.eu/best-practice_en
EMCDDA - Xchange prevention registry - https://www.emcdda.europa.eu/best-
practice/xchange
EPPI Centre – Evidence for Policy and Practice Information -
http://eppi.ioe.ac.uk/cms/Default.aspx?tabid=56
Evidence Based Practice Institute - https://www.ebp.institute/
Harm Reduction EU - https://harmreduction.eu/
SAMHSA – Substance Abuse and Mental Health Service Administration -
https://www.samhsa.gov/
Social Programs that Works - https://evidencebasedprograms.org/
Society for Prevention Research - https://www.preventionresearch.org/
Standards for High-Quality and Objective Research and Analysis -
https://www.rand.org/about/standards.html
The Cochrane Library - https://www.cochranelibrary.com/
UNGASS 2016 – Outcome document of the 2016 United Nations General Assembly Special
Session on the World Drug Problem -
https://www.unodc.org/documents/postungass2016/outcome/V1603301-E.pdf
UNODC – HIV and AIDS - https://www.unodc.org/unodc/es/hiv-aids/new/about_us.html
UNODC – Opiods - https://www.unodc.org/unodc/en/opioid-crisis/index.html
UNODC – TREATNET Training Package - https://www.unodc.org/unodc/en/treatment-and-
care/treatnet-training-package.html
WHO - Factsheets - https://www.who.int/news-room/fact-sheets
WHO - Guidelines - https://www.who.int/publications/who-guidelines
32
Annexes
Annex 1 Prevention – Training module

Annex 2 Harm reduction – Training module
Annex 3 Treatment, social integration and rehabilitation – Training module
33
Quality Standards
in Drug Prevention
CSFD – Civil Society Forum on Drugs Project
IREFREA – Mariàngels Duch – Montse Juan – Carmela Martínez
Objective
Main objective
The main objective of this training is to present and
work with four foundational documents in the
science of drug prevention:
 The Council Conclusion on MQS

 The International Standards in Drug Use Prevention
 The European Drug Prevention Quality Standards
 The European Prevention Curriculum
Objective 1 Objective 2 Objective 3
Offer a theoretical Acquire skills to Work with essential
framework for the assess the initial quality criteria
planning and situation of a
implementation of programme with a
prevention view to its
programmes improvement
Epidemilogy – Nature and extend of substance use – ESPAD report 2019
Alcohol use
Lifetime – 79% of the students

Last 30 days – 47% of the students
Intoxication – 13% of the students Frequency of alcohol intake in the last 30 days (mean number
(last month) of occasions among users)
% students using substance at age ≤13
Cigarettes – 18% of the students

E-cigarettes – 11% of the students
Alcohol – 33% of the students
Intoxication – 6,7% of the students
% students reporting use of illicit drugs
Any illicit drug – 17% of the students

Cannabis – 16% of the students
Objective 1
Mentimeter
Offer a theoretical
framework for the What are drug prevention quality
planning and standards?
implementation of
prevention
programmes
Objective 1
Offer a theoretical
framework for the What are the European drug prevention
planning and
implementation of quality standards?
prevention
programmes Quality standards are generally accepted principles or sets of
rules for the best/most appropriate way to implement an
intervention. Frequently they refer to structural (formal)
aspects of quality assurance, such as environment and staff
composition. However, they may also refer to process aspects
such as adequacy of content, process of the intervention or
evaluation processes.
EMCDDA online glossary: ‘Quality standards’

See http://www.emcdda.Europa.eu/publications/glossary
Availability of Quality Standards

interventions
EDPQS Europe Basic & Expert Prevention Intervention design &
process + Workforce
CCSA Canada n.a. Prevention Intervention design &
process + Evidence
COPOLAD Latin America Basic & Advanced Prevention, Treatment, Intervention design &
Harm Reduction, process + Evidence
Reintegration
CICAD South-America Minimum Prevention, Treatment Intervention process
+ Workforce
interventions
MQS European Union Minimum Prevention, Risk and Harm Benchmark of quality
Reduction, Treatment, Social for interventions
Integration and
Rehabilitation
Minimum Quality
Standards in drug
demand reduction
in the European
Union, 2015
Minimum Quality Standards (MQS) – Prevention part (1)
Prevention (environmental, universal, selective and indicative)

interventions are targeted at the general population, at populations
at risk of developing a substance use problem or at
populations/individuals with an identified problem;
They can be aimed at preventing, delaying or reducing drug use,

its escalation and/or its negative consequences in the general
population and/or subpopulations; and are based on an
assessment of and tailored to the needs of the target populations;
What kind of prevention interventions and strategies
does your organization implement? What are they
aimed at?
 Environmental strategies
 Universal interventions
 Selective interventions
 Indicated interventions
Does your organization conduct needs assessments
of the target population? When?
 During intervention design

 During intervention implementation
 During intervention process evaluation
 During intervention outcome evaluation
What kind of data sources on substance use does

your organization use?
Those developing prevention interventions have

competencies and expertise on prevention
principles, theories and practice, and are trained
and/or specialized professionals who have the
support of public institutions (education, health and
social services) or work for accredited or
recognized institutions or NGOs;
Does your
Does your organization require government/authorities/education
any specific competencies and system officially accredit you to
expertise for the staff working in
work in prevention?
prevention?
Does your organization require Has your organization received
any specific competencies and any support or funding for
expertise for the staff working in education/ training from public
prevention? institutions?
Those implementing prevention interventions

have access to and rely on available
evidence-based programmes and/or quality
criteria available at local, national and
international levels;
Are there any available evidence-based
registries in your country?
Do prevention professionals use existing

internationally recognized registries? Which
ones?
Does your organization have access and

rely on available evidence-based
programmes?
Does your organization use any of the

available registries?
Does your organization use any Are these guidelines/standards
guidelines or standards for mandatory for funding?
working in prevention?
Prevention interventions form part of a coherent

long-term prevention plan, are appropriately
monitored on an ongoing basis allowing for
necessary adjustments, are evaluated and the
results disseminated so as to learn from new
experiences.
Does your organization have a long-term
plan in place for sustaining your
prevention activities?
Dose your organization monitor or

evaluate its prevention interventions?
Is the funding that your organization

receives linked to monitoring or
evaluation?
Is there any dissemination system, plan
or policy in place in your country to
disseminate the results of funded
interventions?
Does your organization have a

system/plan for its interventions?
Mentimeter
Does your organization

completely or partially
follow all these
standards? Yes, No, Partly
Mentimeter
Which are the factors impending or
precluding compliance with the
standards?
International
Standards in Drug
Use Prevention,
UNODC/WHO 2013
& 2018
International Standards in Drug Use Prevention – Main sections
Introduction to substance use prevention

and prevention science
Evidence-based interventions and

policies
Components of a national drug-

prevention system
International Standards in Drug Use Prevention – Main goals
To summarise the currently available

scientific evidence, describing effective
interventions and policies and their
characteristics.
To identify the major components and

features of an effective national drug
prevention system.
To help policy makers to develop

programmes, policies and systems that
are a truly effective investment in the
future of children, youth, families and
communities.
Interventions for each developmental stage – UNODC, 2013
Interventions for each developmental stage – UNODC, 2018
International Standards in Drug Use Prevention –
New areas with little substantive research
Sports and other leisure time activities
Prevention of the non-medical use of

prescription drugs
Interventions and policies targeting children and

youth particularly at risk including: out-of-school
children and youth, street children, current and
ex-child soldiers, displaced or post-conflict
population, children and youth in foster care,
orphanages and the juvenile justice system.
Prevention of the use of new psychoactive

substances not controlled under the Conventions
International Standards in Drug Use Prevention –
National drug prevention system scheme
Financial and human resources
Supporting regulatory frameworks
Ongoing training
Evidence-based interventions and policies
Data collection on the drug use situation and

existing resources
Rigorous monitoring and evaluation

Does your organization
completely or partially
follow all these
standards?
Which are the factors impending or

precluding compliance with the
standards?
European Drug
Prevention Quality
Standards
EMCDDA 2008-2013
Participant Teams
Estándares de
Calidad para la
Prevención de las
Drogodependencias
(EDPQS), EMCDDA
2013
The EDPQS were developed for ‘drug prevention’ activities
According to the EDPQS, drug prevention activities:
 Have the potential do prevent, delay or reduce drug use and/or its negative
consequences Estándares de
 Can target entire populations, subpopulations,
Calidador individuals
para la
 Can target legal drugs (such as alcohol or tobacco), illegal drugs, pharmaceuticals,
Prevención
new psychoactive substances, or substances in general.de las
 Can work to reduce risk factors andDrogodependencias
create protective factors that influence drug use,
or can target common factors that affect or reduce vulnerability to drug use and drug
(EDPQS),
use problems; or promote healthy development and EMCDDA
resilience
 2013
Might be relevant to all age groups, although they are commonly aimed at young
people
The EDPQS provide a broad, though not normative, definition of drug prevention
The EDPQS can be useful for other types of preventive work

Why do we need resources such
as the EDPQS?
Few people would argue with the view that
prevention is better (and cheaper) than cure.
However, ...
Justsay
... a lot of what is done in the
N DRUGS
name of drug prevention is still
not based on what “works” or
on what constitutes “quality”.
Money is still being spent on

ineffective approaches.
What are the important aspects of ‘quality’?
According to the EDPQS, ‘high quality’ activities are:
Relevant to target populations and policy
Ethical (no unintended ‘side effects’, takes into account reasons for drug use
Based on scientific evidence of what works
Provide evidence on their own effectiveness
(Cost)Effective
Feasible
Sustainable
EDPQS – Theory of change
EDPQS – The project cycle
EDPQS – Project stages and components
What are the EDPQS?
The European Drug Prevention Quality Standards:
Provide a comprehensive set of criteria to

help users learn how to recognise ‘high
quality’ prevention activities
Outline the necessary structural and

procedural aspects of high quality prevention
(i.e. the context in which quality interventions
and policies can take place).
Support strategies to develop, implement, and

review effective evidence-based prevention
EDPQS – How can we used to improve prevention
Planning new projects (innovations in objectives,

content, and implementations.
Reviewing the quality of ongoing or completed

prevention initiatives.
Identifying strengths and weaknesses of

prevention initiatives
Assessing whether a prevention related activity

is undertaken or likely to operate in a way that
can be considered ‘high quality’
Developing and improving the quality the

quality of existing prevention provision
EDPQS – Toolkit for practitioners
Tools to support practitioners facilitating self-assessment and self-
improvement:
 Checklist ⇒ For self-assessment of the interventions

 Synthesis profile ⇒ To identify critical areas
 Self-improvement questionnaire ⇒ To review and identify actions
to develop own activities
Case Study
The programme
“STELLA”
EDPQS – The programme“STELLA”
Fictitious example:
 “STELLA” is a school-base intervention
 For pupils aged 15 to 17 years
 Seeks to prevent or reduce alcohol, tobacco and illegal drug use as well as
other risk behaviours
 Structured manualized programme
 Interactive methods are used to increase participants’ self-awareness,

resilience and life-skills (e.g. discussion, role playing, and film-making)
 It is implemented nation-wide
Lets take a few minutes to read the full
project description
“Stella” is a nation-wide school-based Activities are delivered in the classroom by

intervention. It has been developed for all trained teachers following a manual.
pupils aged 15 to 17 years. The Across the country, the same activities are
programme seeks to prevent or reduce undertaken in all implementing schools
alcohol, tobacco and illegal drug use as using the same materials. Schools can
well as other risk behaviours. It hopes to choose whether to deliver the intervention
achieve this by increasing participants’ self- as weekly sessions (15 units of 50
awareness, resilience and life-skills. The minutes) or as a ‘blocked’ programme with
programme is supposed to help young a few intense days spread over several
people identify and build upon their months. Intervention activities utilise
personal strengths. The programme draws interactive methods, such as discussion,
on a number of theoretical models, role play, and film-making. Pupils also
including social influence theory, as well as receive a workbook, which was developed
literature reviews on ‘what works’ in by University researchers.
prevention.
The teachers’ training consists of four days obtained from the teachers is used to revise the
focussing on programme content and delivery. programme in order to offer an improved version
Teachers also learn how to prevent risky in the next school year. A formal report on the
situations during the intervention (e.g. bullying process evaluation is not available.
among pupils), and how to appropriately respond
to possible incidents (e.g. if a pupil discloses drug A pilot study was carried out in one region to
use). Teachers also learn about relevant understand whether the intervention brings about
legislation and receive factual information about the desired changes in participants. An evaluation
different substances and how they might affect specialist led the evaluation. School classes were
young people. assigned to intervention and control conditions;
randomisation and blinding were intended but not
Process data are collected on a continuous basis. possible due to practical limitations. A number of
After each session, teachers complete a evaluation indicators were used, including
questionnaire to indicate how the session went substance-related knowledge and self-reported
and whether they were able to deliver it according substance use. Measurements were taken using
to the manual. The feedback anonymous
questionnaires one week before the
beginning of the intervention, and one
week after the end of the intervention. The
findings from the pilot study were used to
revise the intervention, and the study was
rolled out nation-wide.
Information about “Stella” is available on

the project website. There are different
sections on the website for interested
schools, young people, and members of
the scientific community. Project news
about “Stella” are regularly posted on
social media pages (e.g. Facebook,
Twitter). Results from the outcome
evaluation have been published in a
scientific journal article.
EDPQS – Working with the checklist
3 Programme formulation
Notes on current position Actions to take
3.1 Defining
the target
population
3.2 Using a
theoretical
model
3.1 Defining • Target group defined (15- to
the target 17-year-old school pupils;
population universal programme)
3.2 Using a
theoretical
model
3.1 Defining • Target group defined (15- to
the target 17-year-old school pupils;
population universal programme)
• The programme draws on a
number of theoretical
models, including social
3.2 Using a
influence theory
theoretical
• Mediators are specified (self-
model
awareness, resilience and
life-skills)
• Specifies what is to be Clarify: what are the
prevented (alcohol, tobacco “other risk
3.3 Defining and illegal drug use, other behaviours”?
aims, goals risk behaviours)
and objectives • Targeted mediators are
specified (self-awareness,
resilience and life-skills)
3.4 Defining
the setting
• Specifies what is to be Clarify: what are the
prevented (alcohol, tobacco “other risk
3.3 Defining and illegal drug use, other behaviours”?
aims, goals risk behaviours)
and objectives • Targeted mediators are
specified (self-awareness,
resilience and life-skills)
• Setting = classroom Clarify: where does
3.4 Defining the film-making
the setting activity take place?
3.5 Referring to • Refers to literature reviews
evidence of on ‘what works’ in
effectiveness prevention
3.6 Determining
the timeline
• Refers to literature reviews Clarify: What sources
3.5 Referring to on ‘what works’ in were used? Is the
evidence of prevention literature up-to-date?
effectiveness Is it an unbiased
review?
3.6 Determining
the timeline
3.5 Referring to on ‘what works’ in prevention were used? Is the
evidence of literature up-to-date?
review?
• Schools can choose whether
to deliver the intervention as
weekly sessions (15 units of
3.6 Determining
50 minutes) or as a ‘blocked’
the timeline
programme with a few
intense days spread over
several months.
3.5 Referring to on ‘what works’ in prevention were used? Is the
evidence of literature up-to-date?
review?
• Schools can choose whether Clarify: What is the
to deliver the intervention as overall timeline for this
weekly sessions (15 units of project?
3.6 Determining
50 minutes) or as a ‘blocked’
the timeline
programme with a few
intense days spread over
several months.
4 Diseño de la intervención
• Use of methods that the
target group is likely to find
engaging (discussion, role
4.1 Designing for play, and film-making)
quality and • The programme is
effectiveness supposed to help young
people identify and build
upon their personal
strengths.
4.2 If selecting an
existing intervention
• Use of methods that the Clarify: What are the
target group is likely to find specific principles and
engaging (discussion, role techniques used when
4.1 Designing for play, and film-making) working with the pupils?
upon their personal
strengths.
4.2 If selecting an
• Use of methods that the Clarify: What are the
target group is likely to find specific principles and
engaging (discussion, role techniques used when
4.1 Designing for play, and film-making) working with the pupils?
upon their personal
strengths.
• Not applicable - not an Clarify: Is it an adaptation
4.2 If selecting an
adaptation of an existing of an existing intervention?
intervention
4.3 Tailoring the

intervention to the
target population
4.4 If planning final

evaluations
• Manualised approach (i.e.
following a standardised
approach according to a
4.3 Tailoring the
written manual)
intervention to the
• Same activities are
target population
undertaken in all
implementing schools using
the same materials.
evaluations
• Manualised approach (i.e. Clarify: To what extent is
following a standardised the programme tailored to
approach according to a the specific circumstances
4.3 Tailoring the
written manual) (e.g. geographical region,
intervention to the
• Same activities are participant
target population
undertaken in all characteristics?).
implementing schools using
the same materials.
evaluations
• Manualised approach (i.e. Clarify: To what extent is the
following a standardised programme tailored to the
approach according to a specific circumstances (e.g.
4.3 Tailoring the
written manual) geographical region,
intervention to the
• Same activities are participant characteristics?).
target population
undertaken in all implementing
schools using the same
materials.
• Drug use (self-reported) and
drug-related knowledge were
measured 1 week before and
1 week after the intervention
evaluations
• Teachers complete a
questionnaire after each
• Manualised approach (i.e. Clarify: To what extent is the
following a standardised programme tailored to the
approach according to a specific circumstances (e.g.
4.3 Tailoring the
written manual) geographical region,
intervention to the
• Same activities are participant characteristics?).
target population
undertaken in all implementing
schools using the same
materials.
• Drug use (self-reported) and Clarify: Are long-term follow-
drug-related knowledge were up measurements and
measured 1 week before and additional evaluations
1 week after the intervention planned?
evaluations
• Teachers complete a
questionnaire after each
EDPQS – Strengths identified
using the standards
 Commitment to science and evidence-base

work (EDPQS 3.2, 3.5)
 Use of interactive, engaging methods

(EDPQS 4.1)
 Strengths-focused (EDPQS 4.1)
 Elements of process and outcome evaluation

in place EDPQS 4.4, 7.1, 7.2)
EDPQS – Potential weaknesses – Areas for further
development/discussion
How does the project
“Stella” address specific
What support if offered to
target population needs
pupils identified as being
aand complement existing
at ‘high risk’ of drug use
preventive activities? (EDPQS
or drug related
1.2-1.4, 4.3)
harms?(EDPQS D; 4.1)
Are long-term follow-up

measurements planned? (EDPQS
4.4; 7.1)
EDPQS – Benefits of using the standards
EDPQS as a reference framework to make implicit (taken-for-granted) activities

explicit and to conceptualise prevention work in a structured way.
Standards useful to:

 Identify strengths and weaknesses (areas for improvement)
 Stimulate constructive discussion about aims/methods of prevention
Review of strengths and weaknesses, particularly useful for projects in the

planning or under development.
For more information and access to the toolkits, please visit:

www.emcdda.europa.eu/publications/manuals/prevention-standards_en
The European
Prevention
Curriculum, EMCDA
2019
The European Prevention Curriculum (EUPC) - I
The European Prevention Curriculum is an adaptation of the Universal Prevention

Curriculum developed in the US to the European context. This adaptation was
carried out by 11 organization from 9 EU countries.
The founding basis of the EUPC are the International Standards in drug use
prevention (UNODC) and the European Drug Prevention Quality Standards
(EDPQS),
The EUPC is a high-quality introduction to prevention science and, in particular, to

science based interventions for an interested reader.
The European Prevention Curriculum (EUPC) - II
The curriculum is primarily designed for decision, opinion, and policy makers working
in the prevention field and provides to participants attending the trainings information
on:
 The foundations of prevention science

 An overview of the information needed to inform the selection and
implementation of prevention interventions
 The tools to inform stakeholders on the foundations of evidence-based
substance use prevention
 Tools to coordinate the implementation and evaluation of evidence-based
interventions
 An introduction to family, school, workplace, community, environment and
media-based principles and practices.
The European Prevention Curriculum (EUPC) - Contents
PART I – General concepts PART II – Prevention approaches in

underpinning effective prevention different settings
 Epidemiology – understanding the  Family-based prevention

nature and extend of substance use
 School-based and workplace-based
 Foundations of prevention science prevention
and evidence-based prevention
interventions  Environmental prevention
 Evidence-based prevention  Media-based prevention

interventions and policies
 Community-based prevention
 Monitoring and evaluation
 Advocacy for prevention
Thank you!
Mariàngels Duch
mduch@irefrea.org
Quality Standards in Harm Reduction

IREFREA –Carmela Martínez – Montse Juan – Mariàngels Duch
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device used to join the presentation
Objectives
The main objective of this seminar is to present and work with quality criteria in Risk
and Harm Reduction measures

Offer an overview for
the planning and
Offer an overview of risk Work with quality
implementation of
and harm reduction criteria
evidence-based RHR of
measures
SUDs
Risk and harm reduction: definition
Encompasses interventions, programmes and policies that seek to reduce the health,
social and economic harms of drug use to individuals, communities and societies.
It is considered as a “combination intervention”, made up of a package of

interventions tailored to local setting and need, which give primary emphasis to
reducing the harms of drug use (Adapted from EMCDDA monograph, 2010)
Harm reduction
(World Health Organization, 2016)

The comprehensive harm reduction package (WHO)
➢ Needle and syringe programmes (NSPs)
➢ Opioid substitution therapy (OST) and other evidence-based drug dependence
treatments
➢ HIV testing and counselling
➢ Antiretroviral therapy
➢ Prevention and treatment of sexually transmitted infections (STIs)
➢ Condom programmes for people who inject drugs and their sexual partners
➢ Targeted information, education and communication for people who inject drugs
and their sexual partners
➢ Prevention, vaccination, diagnosis and treatment for viral hepatitis
➢ Prevention, diagnosis and treatment of Tuberculosis (TB)
Harm reduction for people who use drugs: WHO recommendations
➢ All people who inject drugs should have access to sterile injecting equipment
through needle and syringe programmes
Additional remarks
❖ It is suggested that needle and syringe programmes also provide low dead-space
syringes (LDSS) along with information about their preventive advantage over
conventional syringes
❖ Injecting equipment should be appropriate to the local context, taking into account
factors as the type and preparation of drugs that are commonly injected
➢ All people who are dependent on opioids should be offered and have access to opioid
substitution therapy (OST)
Additional remarks
❖ Policies and regulations should encourage flexible dosing structures
❖ Take-home doses can be offered when the dose and social situation are stable
❖ OST should be used for the treatment of opioid dependence in pregnancy rather than attempt opioid
detoxification
❖ Psychosocial support and pharmacological treatments should be available to all opioid-dependent people
❖ For opioid-dependent people with TB, viral hepatitis B or C or HIV, opioid agonists should be administered in
conjunction with medical treatment
❖ Treatment services should offer hepatitis B vaccination to all opioid-dependent patients (whether or not they
are participating in OST programmes)
❖ Care settings that provide OST should initiate and maintain ART for eligible people living with HIV
➢ All people with harmful alcohol or other substance use should have access to
evidence-based interventions, including brief psychosocial interventions involving
assessment, specific feedback and advice
➢ People likely to witness an opioid overdose should have access to naloxone and be
instructed in its use for emergency management of suspected opioid overdose
Objective 2
Work with quality
standards
Objective 2
Work with quality
standards Quality standards
✓ These are principles and rules about what to do and what to aim for in
drugs field
✓They are used to implement interventions recommended by guidelines
✓Quality standards in the drugs field are aspirational
✓They can refer to content issues, processes, or to structural aspects

Objective 2
Work with quality
standards
Guidelines
✓ Are systematically developed evidence-based statements to assist practitioners to

make informed decisions about appropriate interventions
✓ Support the implementation of evidence-based recommendations for practice
based on appraisal, synthesis (usually through systematic review) and grading of
the available evidence
✓ Represent a mechanism for knowledge transfer of drugs evidence into practice
✓ Provide a guide to recommended practice and may operate alongside quality
standards, setting a benchmark against which the quality of organisations
Objective 2
WHICH
Work with WHY?
quality criteria
ONES?

the planning and
Offer an overview of
implementation of
SUDs current situation
evidence-based
treatment of SUDs

interventions
process + Workforce
process + Evidence
Reintegration
+ Workforce
interventions
Integration and
Rehabilitation
Minimum quality standards
(Council of the European
Union, 2015)
Risk and harm reduction measures, including but not limited
to measures relating to infectious diseases and drug-related
deaths, are realistic in their goals, are widely accessible, and
are tailored to the needs of the target populations
Appropriate interventions, information and referral are

offered according to the characteristics and needs of the
service users, irrespective of their treatment status
Interventions are available to all in need, including in higher
risk situations and settings
Interventions are based on available scientific evidence and

experience and provided by qualified and/or trained staff
(including volunteers), who engage in continuing professional
development
Minimum European Quality
Standards in Drug Demand
Reduction
EQUS
(Uchtenhagen & Schaub, 2011)
Minimum Quality Standards (MQS) – Risk and Harm Reduction part
Structural Standards of Interventions

HR1 Accessibility: location and opening hours. Services have to match the
needs of their clients; costs should never be a barrier to a service.
HR2 Staff qualification: staff has to be qualified and the staff qualification
has to be made transparent
HR3 Indication criteria: age limits
1. Services have to be age appropriate and staff has to be trained to

meet age-appropriate clients needs
2. There should be no age limits in harm reduction services

Are RHR interventions accessible to users in your country/

organization?
Which curriculum, education or training treatment requires

your organization?
Process Standards of Interventions

HR4/5/6 Assessment procedures:
❖ Risk behaviour assessment (client’s/patient’s risk behaviour is
assessed)
❖ Complete needs assessment and priorisation (e.g. 1. Harm reduction
of intravenous drug use and, 2. Reduction of used syringes in public
spaces etc.)
❖ Client/patient status (the client’s/patient’s health status is assessed)
Does your organization assess….
client’s/patient’s risk behaviours?
client’s/patient’s health status ?


HR7 Informed consent (Clients/patients must receive information on
available service options and agree with a proposed regime or plan before
starting an intervention. Interventions should not be based on written
informed consent, but rather on a transparently information about all the
offers by a service.)
HR8 Confidentiality of client data (client/patient records are confidential and

exclusively accessible to staff involved in a client’s/patient’s intervention or
regime)
How your organization provide information on available

treatment/intervention options?
Does your organization provide an informed consent before

the intervention?

HR9 Individualised treatment planning (intervention regime and
intervention plans, if applicable, are tailored individually to the needs
of the client/patient)
HR10 Routine cooperation with other agencies (whenever a service is

not equipped to deal with all needs of a given client/patient, an
appropriate other service is at hand for referral)
How treatment/intervention is planned or tailored to the

needs of the client/patient?
HR11 Continued staff training (staff is regularly updated on relevant new

knowledge in their field of action)
HR12 Neighbourhood/community consultation (avoiding nuisance and

conflict with other people around the service)
HR13 Goal: reduced risk behaviour (reducing unsafe injections, unsafe

drug use and unprotected sex)
HR14 Goal: referrals (treatment services must be prepared to refer

clients/patients to other health/social/treatment/legal services if needed
and agreed)
HR15 Internal evaluation (services must regularly perform an internal

evaluation of their activities and outcomes)
HR16 External evaluation (services must regularly allow an evaluation

of their activities and outcomes by an independent external
evaluator)
How to implement quality standards?
Practical introduction to quality

standards and quality assurance
mechanisms
It includes the key steps involved in

their implementation in drug services
and systems
Six steps to consider for implementing quality standards
Thank you!
Carmela Martínez Vispo
carmela.martinez@uva.es
Quality Standards in the treatment
of drug use disorders
IREFREA – Carmela Martínez – Mariàngels Duch – Montse Juan
We will use mentimeter for collecting some data
Please, go to www.menti.com and use the code

provided in each slide
You can then vote using the smartphone or internet

device used to join the presentation
Objectives
The main objective of this seminar is to present and work with quality criteria in the
science of the treatment of substance use disorders (SUDs)

the planning and
Offer an overview of Work with quality
implementation of
SUDs current situation standards
evidence-based
treatment of SUDs
Objective 1
Overview current
situation
World Drug Report 2021 (UNODC)
World Drug Report 2021 (UNODC)
13% of the total number of persons

who use drugs, suffer from SUDs
One in eight of those suffering

from a drug use disorder received
professional help in 2019
European Drug Report 2021 (EMMCDA)
Around 111 000 people Around 20 717 people

entered specialized drug entered specialized drug
treatment (35 % of all treatment (7 % of all
treatment demands) treatment demands)
Around 56 050 people Around 1 154 people

entered specialized drug entered specialized drug
treatment (18.8 % of all treatment (0.4 % of all
treatment demands) treatment demands)
Objective 2
WHICH
Work with WHY?
quality criteria
ONES?

the planning and
Offer an overview of
implementation of
SUDs current situation
evidence-based
treatment of SUDs
Objective 2
Work with quality
standards Quality standards
✓ These are principles and rules set by recognised national or

international bodies about what to do and what to aim for
✓They are used to implement interventions recommended by guidelines
✓Quality standards in the drugs field are aspirational
✓They can refer to content issues, processes, or to structural aspects
Objective 2
Work with quality
standards
Guidelines
✓ Are systematically developed evidence-based statements to assist practitioners to

make informed decisions about appropriate interventions
✓ Support the implementation of evidence-based recommendations for practice
based on appraisal, synthesis (usually through systematic review) and grading of
the available evidence
✓ Represent a mechanism for knowledge transfer of drugs evidence into practice
✓ Provide a guide to recommended practice and may operate alongside quality
standards, setting a benchmark against which the quality of organisations

interventions
process + Workforce
process + Evidence
Reintegration
+ Workforce
interventions
Integration and
Rehabilitation
International standards for
the treatment of drug use Disorders
WHO/UNODC
(2020)
The Standards seek to provide guidance on how to
organize the delivery of interventions
Recommendations on treatment interventions are

included, with reference to existing WHO guidelines
To support the evaluation and ongoing

improvement of services as well as the
development of new policies and treatment
systems
Seven principles
Principle 1. Treatment should be available, accessible, attractive, and appropriate
✓ Minimize all barriers that limit access to treatment services

✓ Provide social support, protection, and general medical care
✓ Friendly and culturally sensitive environment
✓ Focus on the specific clinical needs
Principle 2. Ensuring ethical standards of care in treatment services
✓ Respect for human rights and the patient’s dignity

✓ Avoiding any form of discrimination and/or stigmatization
✓ Patient’s consent should be obtained before any treatment intervention
✓ The individual with SUD should be recognized as a person with a health problem
Seven principles
Principle 3. Promoting treatment for drug use disorders through effective coordination between the
criminal justice system and health and social services
✓ SUDs as health problems requiring access to appropriate support and treatment
✓ SUDs should be treated in the health care system not in the criminal justice system
✓ Criminal justice system should collaborate closely with the health and social
✓ Law enforcement, court and prison system staff should receive appropriate training
✓ Treatment should be offered during and after their stay in jail
✓ People should receive treatment equally to the treatment offered in the community
Principle 4. Treatment should be based on scientific evidence and respond to the specific needs of
individuals with drug use disorders
Seven principles
Principle 5. Responding to the special treatment and care needs of population groups
✓ Unique requirements, vulnerabilities and needs

✓ Individuals with SUDs often face stigma and discrimination
Principle 6. Ensuring good clinical governance of treatment services and programmes for SUDs
Principle 7. Treatment services, policies and procedures should support an integrated treatment
approach, and linkages to complementary services require constant monitoring and evaluation
Vital to monitor, evaluate and adapt the treatment system constantly
REQUIRES: multi-disciplinary planning and implementation of services in a logical, step-by-step sequence

Minimum Quality
Standards in drug
demand reduction in
the European Union,
2015
Minimum Quality Standards (MQS) – Treatment, social integration and
rehabilitation part (1)
Appropriate evidence-based treatment is tailored to the

characteristics and needs of service users and is respectful of
the individual’s dignity, responsibility and preparedness to
change
How your organization assess the users' characteristics?
How your organization tailor interventions to such users'

characteristics?
Access to treatment is available to all in need upon request,

and not restricted by personal or social characteristics and
circumstances or the lack of financial resources of service
users. Treatment is provided in a reasonable time and in the
context of continuity of care
Does your organisation How your organization
provide treatment to all How many time your provide treatment in
in need upon request or it organization last in the context of
has an inclusion policy providing treatment after continuity of care?
based on social request?
characteristics or financial
resources?
In treatment and social integration interventions, goals are

set on a step-by-step basis and periodically reviewed, and
possible relapses are appropriately managed
How your organization set goals of Which is the frequency your
treatment & social integration organization review goals of treatment
interventions on a step-by-step basis? & social integration interventions?
rehabilitation (4)
Treatment and social integration interventions and

services are based on informed consent, are patient-
oriented, and support patients’ empowerment
Which strategies your organization How your organization's services
use to promote patient-oriented support patients’ empowerment?
interventions & services ?
rehabilitation (5)
Treatment is provided by qualified specialists and trained

staff who engage in continuing professional development
Which curriculum, education or How frequently continuing
training on treatment requires your education/training on treatment is
organization? provided or supported by your
organization?
rehabilitation (6)
Treatment interventions and services are integrated within a

continuum of care to include, where appropriate, social
support services (education, housing, vocational training,
welfare) aimed at the social integration of the person
Which social support services How is promoted the social
includes your organisation? integration of the person?
rehabilitation (7)
Treatment services provide voluntary testing for blood-borne

infectious diseases, counselling against risky behaviours and
assistance to manage illness
Does your organisation provide What type of counselling against
voluntary testing for blood-borne risky behaviours is provided by
infectious diseases? your organization?
rehabilitation (8)
Treatment services are monitored, and activities and

outcomes are subject to regular internal and/or external
evaluation
How your organization evaluate its Is there any internal/external
treatment interventions? evaluation system/plan of
treatment services, activities and
outcomes?
Objective 3
the planning and
implementation of
evidence-based
treatment of SUDs
Treatment settings,
modalities
and interventions
Models of service organisation
One-stop-shop
approach
Models of service organization
Community-based
network approach
Case
management
Recovery-oriented
rehabilitation and
social reintegration
Models of service organization: conclusions
Treatment system should ensure that treatment services are accessible, affordable,
evidence-based, diversified and delivered with a focus on improved functioning and
wellbeing
Treatment system resources should be invested where they are most needed
To focus on low-threshold and easily accessible outpatient treatment and care services
as a first step
Systems should prioritize the least invasive intervention with the highest level of
effectiveness and the lowest cost to patients
Treatment systems should feature a ‘pyramid’ of drug treatment modalities (more
intensive interventions for patients with more severe or complex needs)
Effective treatment systems for SUDs should be designed and planned using available
data generated and collated in the scope of needs assessment and drug information
systems
Different models of service organization can be used to deliver an accessible and

diversified continuum of treatment and care for drug use disorders
Effective services require close coordination between different sectors (health, social,
justice, etc.)
Settings for providing treatment interventions: continuum care
Community-based outreach
Settings not specialised in the treatment of people

with substance use disorders
Specialised outpatient treatment
Specialised short-term inpatient treatment
Specialised long-term residential treatment

Community-based outreach
Goals:
➢ To identify target populations, engage them and provide them unconditional community-based services
and interventions
➢ To offer and encourage access to available treatment modalities
▪ Provision of basic support: shelter, food, etc.

▪ Provision of support for:
✓ Overdose prevention, identification and management
✓ Prevention and treatment of HIV, TB and viral hepatitis
✓ Prevention and treatment of sexually transmitted infections
✓ Identification and management of other health conditions (i.e., mental disorders)
▪ Changes regarding drug use and health behaviours
▪ Legal support, crisis intervention
▪ Building trust within the community, reducing stigma and discriminatory attitudes
Settings not specialised for the treatment of people with SUDs
Goals:
➢ To identify people who use drugs and those with drug use disorders, provide them interventions to
encourage behaviour change and to refer them to specialized treatment
▪ Services such as
✓ Primary care settings in economically disadvantaged areas
✓ Mental health care services without specialized treatment programmes for SUDs
✓ General hospitals, including emergency services
✓ Sexual health clinics
✓ Infectious disease clinics, HIV/hepatitis/TB services
✓ Social services and welfare agencies
▪ Important function in providing and disseminating scientific information on drug use and its effects on health
Specialized outpatient treatment
Goals: Components and activities:

➢ To help patients stop or reduce drug use ✓ Comprehensive medical and psychosocial assessment
➢ To minimize the negative health and social ✓ Development of individual treatment plans
effects of drug use ✓ Medication-assisted detoxification
➢ To identify and manage comorbid psychiatric ✓ Psychosocial treatment interventions
and physical health conditions
✓ Pharmacological treatment interventions
➢ To provide psychosocial support
✓ Pharmacological and psychosocial treatment for co-occurring
➢ To reduce the risk of relapse and overdose psychiatric and physical health conditions
➢ To improve well-being and social functioning ✓ Intensive social support
✓ Relapse and overdose prevention, referrals to other services;
recovery management; continuing treatment
High-intensity vs. mid- to low-intensity programmes

Specialized short-term inpatient treatment
Goals:
➢ To diagnose and manage clinical conditions due to drug use

➢ To facilitate the cessation or reduction of drug use
➢ To initiate the treatment of drug use disorders
➢ To motivate patients to continue with treatment after the short-term inpatient treatment
Components and activities:
✓ Management of withdrawal syndrome and other acute drug-induced clinical conditions

✓ Evidence-based psychological and pharmacological treatment accompanied by social support
Specialized long-term or residential treatment
Goals:
➢ To reduce the risk of returning to active drug use

➢ To maintain abstinence from drug use, improve health and personal and social functioning
➢ To facilitate rehabilitation and social reintegration
Different settings:
✓ Stand-alone long-term residential treatment centres or rehabilitation units set up specifically for SUDs
✓ Hospital-based programmes (typically in a dedicated ward or building of a psychiatric hospital)
Specific treatment
modalities and
interventions
Specific treatment modalities and interventions
Screening, Brief Interventions and Referral to Treatment (SBIRT)
Evidence-based psychosocial interventions
Evidence-based pharmacological interventions
Overdose identification and management
Treatment of co-occurring psychiatric and physical health conditions

Effective treatment for
drug use disorders
requires a stepwise,
integrated approach
People with drug use

disorders require a
continuity of care
between all treatment
settings and modalities to
improve their health and
wellbeing
Populations with special treatment and care needs
• Women and pregnant women
• Children and adolescents
• Elderly people
• Indigenous populations
• Migrants
• Sex workers
• People with different sexual orientation and gender identity
• People with disabilities
• Illiterate people and those with limited education
• People with comorbid health conditions
• People in contact with the criminal justice system
• Anyone without social support (i.e., homeless or unemployed people)
Thank you!
Carmela Martínez Vispo
carmela.martinez@uva.es

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QUALITY STANDARDS IN DRUG DEMAND

REDUCTION IN THE EU – Training modules

Carmela Martínez Vispo & Mariàngels Duch

2.1 Objectives of each module

Risk and Harm Reduction

2.2 Materials and content of the modules

Figure 1 – The drug prevention project cycle

EMCDDA – European Drug Prevention Quality Standards: a quick guide – 2013

Figure 2 – The six key steps to implementing quality standards

Table 6 – Interventions for each developmental stage (UNODC-WHO, 2013)

3.1 Prevention workshop

b) Availability of Quality Standards. Table 7 collates the information on main quality

Table 7 – Availability of Qualtiy Standards

UNODC World n.a. Prevention, Treatment Evidence for

EDPQS Europe Basic & Expert Prevention Intervention design

CCSA Canada n.a. Prevention Intervention design

SPR USA Highly advanced Prevention Evidence of

MQS European Union Minimum Prevention, Risk and Harm Benchmark of

d) International Standards in Drug Use Prevention (UNODC/WHO, 2013 & 2018)

e) European Drug Prevention Quality Standards – EDPQS (EMCDDA, 2011)

Figure 6 – EDPQS – Project stages and components

Figure 7 – EDPQS – Working with the checklist

3.2 Risk and Harm Reduction workshop

Figure 8 - Harm Reduction definition by participants through Mentimeter tool

b) Definitions and differences between quality standards and guidelines.

Figure 9 – Definition of Quality Standards by participants through Mentimeter tool

Table 8 – Availability of Qualtiy Standards

d) Minimum quality standards (Council of the European Union, 2015)

- How your organization provides information on available treatment/intervention

- Does your organization provide informed consent before the intervention?

- How treatment/intervention is planned or tailored to the needs of the

- Does your organization conduct internal and/or external evaluations?

e) Regarding factors impeding or precluding compliance with standards, participants

- Which strategies your organization use to promote patient-oriented interventions &

- Which curriculum, education or training on treatment requires your organization? How

- What type of counseling against risky behaviours is provided by your organization?

c) Regarding factors impeding or precluding compliance with standards, participants

d) Which treatment models are available in your country?

Blueprints for Healthy Youth Development - https://cspv.colorado.edu/what-we-

Annex 1 Prevention – Training module

 The Council Conclusion on MQS

Lifetime – 79% of the students

% students using substance at age ≤13

Cigarettes – 18% of the students

% students reporting use of illicit drugs

Any illicit drug – 17% of the students

EMCDDA online glossary: ‘Quality standards’

Standard Coverage Level(s) Area(s) Targets

Prevention (environmental, universal, selective and indicative)

They can be aimed at preventing, delaying or reducing drug use,

 During intervention design

What kind of data sources on substance use does

Those developing prevention interventions have

Those implementing prevention interventions

Do prevention professionals use existing

Does your organization have access and

Does your organization use any of the

Prevention interventions form part of a coherent

Dose your organization monitor or

Is the funding that your organization

Does your organization have a

Does your organization

Introduction to substance use prevention