Definitions:

The coverage of treatment interventions for substance use disorders is defined as the number of people who received treatment in a year divided by the total number of people with substance use disorders in the same year. This indicator is disaggregated by two broad groups of psychoactive substances: (1) drugs, (2) alcohol and other psychoactive substances.

Whenever possible, this indicator is additionally disaggregated by type of treatment interventions (pharmacological, psychosocial and rehabilitation and aftercare services). The indicator is accompanied and can be analysed together with contextual information such as prevalence of alcohol and drug use disorders and availability coverage, i.e. Service Capacity Index for Substance Use Disorders (SCI-SUD) ^[1] that reflects the capacity of national health systems to provide treatment for substance (alcohol, drugs and other psychoactive substances) use disorders, in terms of the proportion (%) of available health system elements in a given country from a theoretical maximum.

Concepts:

The central concept of “substance abuse” in the SDG health target 3.5 implies the non-medical, hazardous, harmful or dependent pattern of use of psychoactive substances that, when taken in or administered into one's system, affect mental processes, e.g. perception, consciousness, cognition or affect. The concept of “substance use disorders” includes both “drugs use disorders” and “alcohol use disorders” according to the International Classification of Diseases (ICD-10 and ICD-11)^[2].

The term “drugs” refers to controlled psychoactive substances as scheduled by the three Drug Control Conventions (1961, 1971 and 1988), substances controlled under national legislations, new psychoactive substances (NPS) and some other that are not controlled under the Conventions, but may pose a public health threat. “Alcohol” refers to ethanol - a psychoactive substance with dependence producing properties that is consumed in ethanol-based alcoholic beverages or their surrogates.

People with substance use disorders are those with harmful patterns of substance use or substance dependence. Harmful pattern of substance use is defined in the ICD-11 as a pattern of use of substances that has caused damage to a person’s physical or mental health or has resulted in behaviour leading to harm to the health of others. According to ICD-11, dependence arises from repeated or continuous use of psychoactive substances. The characteristic feature is a strong internal drive to use psychoactive substance, which is manifested by impaired ability to control use, increasing priority given to use over other activities and persistence of use despite harm or negative consequences.

Within this context treatment interventions for substance use disorders include any structured intervention that is aimed specifically to a) reduce substance use and cravings for substance use; b) improve health, well-being and social functioning of the affected individual, and c) prevent future harms by decreasing the risk of complications and relapse. These may include pharmacological treatment, psychosocial interventions and rehabilitation and aftercare. All evidence-based used for treatment of substance use disorders are well defined in WHO and UNODC related documents. Though hazardous substance use is not included in the concept of “substance use disorder”, such patterns of substance use are important targets for prevention interventions in health systems, and such interventions are included in the overall scope of comprehensive health system responses to “substance abuse” as defined in SDG 3.5.1 indicator.

Pharmacological treatment refers to evidence-based interventions that include administration of pharmacological agents or medicines in the context of different treatment modalities and interventions, including withdrawal management; treatment of alcohol use disorders with baclofen, naltrexone, acamprosate and disulfiram; management of opioid dependence with opioid agonists (methadone, buprenorphine) and antagonists (naltrexone); and prevention and management of opioid overdose with naloxone (WHO/UNODC International Standards for the treatment of drug use disorders^[3], 2020 and WHO Mental Health Gap Action Programme (mhGAP) guideline for mental, neurological and substance use disorders, 2023^[4] ).

Psychosocial interventions refer to programs that address motivational, behavioral, psychological, social, and environmental factors related to substance use and have been shown to improve quality of life and well-being, reduce psychoactive substance use, promote abstinence and prevent relapse. For different substance use disorders, the evidence from clinical trials supports the effectiveness of treatment planning, screening and brief intervention (SBI), counselling, peer support groups, cognitive behavioral therapy (CBT), motivational interviewing (MI), community reinforcement approach (CRA), motivational enhancement therapy (MET), family therapy (FT) modalities, contingency management (CM), counselling, insight-oriented treatments, housing and employment support among others. (UNODC/WHO International Standards for the Treatment of Drug Use Disorders, 2020 and WHO Mental Health Gap Action Programme (mhGAP) guideline for mental, neurological and substance use disorders, 2023).

Rehabilitation and aftercare (Recovery Management and Social Support) refers to interventions that are based on scientific evidence and focused on the process of rehabilitation, recovery and social reintegration. (UNODC/WHO International Standards for the Treatment of Drug Use Disorders, 2020 and WHO Mental Health Gap Action Programme (mhGAP) guideline for mental, neurological and substance use disorders, 2023).

¹

https://onlinelibrary.wiley.com/doi/10.1002/mpr.1950 ↑

²

https://icd.who.int/browse/2024-01/mms/en#1676588433 ↑

³

https://iris.who.int/handle/10665/331635 ↑

⁴

https://iris.who.int/handle/10665/374250 ↑

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