Structural disadvantages in addiction support

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Addiction support in Switzerland has grown historically and is the responsibility of the cantons and municipalities. The structures and services are correspondingly fragmented. People affected by addiction cannot always access the same help services. The place of residence and canton influence the services on offer. This is shown in a study by the Lucerne University of Applied Sciences and Arts.

In principle, Switzerland has a diverse and professional system of addiction support. However, not all those affected have access to the same help services. As responsibilities lie with the cantons and municipalities, the addiction help landscape is correspondingly fragmented. This is shown by a study conducted by Lucerne University of Applied Sciences and Arts (HSLU) on behalf of the Conference of Cantonal Commissioners for Addiction Issues (KKBS) and with the support of the Federal Office of Public Health (BAG). For the first time, the structures and services of addiction support in 22 cantons were compared.

Large cantonal and regional differences

"The cantonal and regional differences in the range of services are considerable," says Jürgen Stremlow, head of the study. "The canton or even the municipality in which a person with an addiction lives has a significant influence on which services are available," says the HSLU lecturer. For example, the majority of cantons in French-speaking Switzerland have a comprehensive range of services; however, the use of services in French-speaking Switzerland is less interconnected. In German-speaking Switzerland, there are clearer differences between the cantons; at the same time, there is greater networking between different cantons. And it is precisely this kind of intercantonal networking that can help to fill gaps in services.

One example of this is Central Switzerland: the cantons of Zug and Lucerne in particular have a comprehensive range of services covering almost all areas, while Obwalden, Nidwalden, Schwyz and Uri offer basic services. Nevertheless, addiction sufferers also have access to services in Lucerne and Zug thanks to intercantonal agreements, such as the Gassenküche consumption room in Lucerne.

According to Stremlow, the cantonal differences are not bad per se. "They allow services to be better adapted to local conditions and resources to be used efficiently," says the head of the study. However, this presupposes that cooperation between the service providers and the cantons is systematically evaluated and that the planning of services is regularly updated. In view of the various highly specialized services, the study generally recommends strengthening cooperation between the cantons in care regions.

Structural disadvantages are possible

In the absence of certain services or the possibility of obtaining them in neighboring cantons, addiction sufferers are at a disadvantage. However, this is not only due to the services available, but also due to accessibility. For example, minors are generally unable to take advantage of harm reduction services (e.g. drug checking), even though a considerable proportion of cannabis users are minors. Or the outpatient addiction counseling center: In many places, it is tied to the place of residence. It is then not possible to use the addiction counseling center of a neighboring municipality. In smaller communities with less anonymity, this can prevent those affected from using the service.

Tendency to shift to the health insurance fund

Stremlow is also critical of the fact that there has been a tendency in German-speaking Switzerland for some time now for cantons and municipalities to increasingly delegate inpatient therapy services to addiction medicine facilities (financed by health insurance companies) and to pay less attention to social therapy services (financed by the canton and municipalities) than in the past. Although this would ease the financial burden on municipalities, the costs would be passed on to those paying premiums. And for those affected, treatment in an addiction treatment facility can be associated with longer waiting times and shorter treatment periods. "These developments contradict international quality standards, according to which the focus of a treatment plan should not be on economic considerations, but on the need for treatment," says the HSLU lecturer.

Gaps are to be closed

The CABS is currently examining the implementation of selected recommendations from the study. "From a professional point of view, the long-term aim is to ensure that every person in Switzerland has access to the same level of counseling and treatment services," says Joos Tarnutzer, President of the KKBS. The comprehensive study in 22 cantons provides the basis for identifying certain gaps more precisely for the first time. Tarnutzer sees a fundamental need to improve national addiction monitoring and optimize intercantonal coordination in care regions. A roadmap is to be drawn up by the beginning of 2024.

Stremlow sees this as a good signal. It shows that the cantons are aware of the challenges. "Addiction is a complex cross-cutting issue. The study provides starting points for making the addiction support system fit for current and future challenges."

From October 2021 to April 2022, surveys were carried out in 22 cantons on the range, availability and use of services in the focus area of "counseling, therapy and housing", management and development trends in addiction support. The cantons of Appenzell-Innerrhoden, Geneva, Glarus and Ticino did not take part in this study. The survey comprised: written questionnaires and telephone interviews with 22 cantonal commissioners for addiction issues or their representatives; a written survey of 189 service-providing organizations with 301 questionnaires (response rate: 86 percent); a secondary analysis of the medical statistics of hospitals by the Swiss Health Observatory (OBSAN); 20 focus group interviews with a total of 181 experts from the cantonal addiction support systems. The analyses were prepared in separate cantonal portraits. They form the empirical basis of this report.

The study and cantonal portraits can be found here.