BTDIR - Belgian Treatment Demand Indicator Register

Effective prevention of health problems and other consequences of substance use requires information on the characteristics and patterns of use, as well as data on associated problems.

When people with substance use disorders come into contact with health professionals, the data collected is an essential source of information for epidemiology. To this end, the Treatment Demand Indicator (TDI) has been adopted and standardised as an epidemiological indicator in the European Union on behalf of the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA). With this indicator, the characteristics, risk behaviours and substance use patterns of patients treated for substance use are better known. This indicator also allows monitoring (ideally in combination with other indicators) of trends in the duration and patterns of substance use.

A common European data collection protocol has been developed and improved over time. Since 2000, the EMCDDA has set up a system of data reporting by the EU Member States and adopted various formal agreements with them in order to stimulate and facilitate the collection and reporting of data from the national to the European level. Currently, the indicator collects data from 30 countries (28 EU Member States, Norway and Turkey) and provides information on almost 500,000 patients per year.

Belgium started standardised data collection for TDI in 2011, when health ministers decided to set up a coordinated registration of treatment requests. Prior to this, several initiatives to gather information at different levels (region, city, groups of centres) on treatment requests for substance use problems had already taken place in Flanders, Brussels and Wallonia. But in order to provide a coherent national view of the phenomenon, it was decided to work on the basis of a national protocol.

Sciensano was appointed as the coordinator of the TDI register and charged with developing flexible and secure technical tools to facilitate the registration of data in accordance with national privacy rules. Since the 2015 registration year, the Belgian protocol has been updated to include the changes of the third European protocol.

The Belgian TDI registration attempts to collect information on each treatment episode started by a patient in a treatment centre for alcohol or substance use.

Definitions

• A patient is considered to be any person, regardless of age, nationality or place of residence, who has had direct contact with a treatment centre for his/her alcohol or substance use problem.
  This excludes anyone who has had contact by telephone, letter, internet or through their family.
  In addition, each patient must be informed about the recording of data for reasons of privacy. At a minimum, he or she should be informed of the existence and purpose of the recording, the contact details of the person responsible for the data, the purpose of the data, and his or her right of access and rectification of the data. A patient may opt out of participation in the recording by stating this in writing. There is currently no system for systematically assessing the number of patients who have refused registration.
• A treatment centre is a facility or practitioner offering treatment for substance use problems. It may be an outpatient or residential service, specialised in addiction treatment or part of a wider range of services for different patient groups, medical or non-medical. The centre may be recognised in an agreement with the authorities.
  Non-professional support groups, centres offering only harm reduction activities, social reintegration, prevention services or outreach activities are not considered as treatment centres.
• A type of treatment unit is a form of care organisation corresponding to the following categories:
  • Outpatient clinics include social and health care homes (MASS/MSOC), low-threshold care facilities and outpatient clinics offering mainly individual care based on interviews with different professionals.
  • Day centres aim to provide individual or group outpatient treatment and daytime activities.
  • Mental health services (MHS) respond to patients’ psychological and psychological difficulties in a specialised or non-specialised outpatient setting in a multidisciplinary manner.
  • Crisis intervention centres (CICs) are defined as a non-hospital, low-threshold residential facility whose short-term aim is to stabilise the patient’s crisis state.
  • Treatment programmes or therapeutic communities (TCs) offer a long-term residential therapeutic programme in which, for a period of time, the residents are themselves responsible together in a structured group for organising community life.
  • General hospitals as well as psychiatric wards in general hospitals cater for people with various mental health problems including problematic substance use. Within some general hospitals psychiatric crisis units for people with substance use disorders have also been established. Care in general hospitals is usually of short duration.
  • Most psychiatric hospitals have a specific unit for the treatment of addiction problems. The approach is medical-psychiatric and aims at individualised comprehensive care. Treatment is generally of longer duration than in general hospitals.
• Treatment is defined as any activity aimed directly at a person with substance use problems, with the aim of achieving results in terms of reducing or eliminating these problems. Possible activities are detoxification or abstinence, substitution treatment, pharmacotherapy, long-term patient rehabilitation programmes, psychotherapy, counselling, structured treatment with a strong social component, medically assisted treatment, non-medical interventions, specific treatment in prison or interventions to reduce substance-related harm if included in a planned programme.
  Treatment of consequences due to substance use in which substance use is not the main reason for seeking help and sporadic interventions that are not part of a planned programme are not considered as treatment.
• A treatment episode is defined as: the period between the start of treatment and the end of activities in the context of the prescribed programme. The beginning of the episode is the first face-to-face contact between the professional and the patient. The end of the episode is defined differently depending on whether the patient is treated in an outpatient or residential unit. In an outpatient setting, an episode of treatment ends when the patient does not attend the centre for more than 6 months. In residential care, the end of treatment is defined when the patient leaves the centre and no further admissions are planned.
  The registration of new treatment episodes continues over the years of registration, which means that a patient who regularly visits an outpatient department over several consecutive years without a break of at least 6 months will only be registered in the TDI at the time of the very first contact with that specific treatment centre.
• The substances considered are the opiate category including heroin, diverted methadone, buprenorphine, illicit fentanyl or other opioids, the cocaine category including powder cocaine, crack cocaine or other forms of cocaine, the stimulant category, other than cocaine including amphetamines, methamphetamines, MDMA or its derivatives, mephedrone or other stimulants, the category of hypnotics and sedatives including diverted barbiturates and diverted benzodiazepines, GBH/GBL or other diverted hypnotics or sedatives, the category of hallucinogens including LSD, ketamine or other hallucinogens, volatile inhalants, the category of cannabis including marijuana (herb), hashish (resin) or other types of cannabis (e.g. hashish oil, cannabinoids), the category of drugs of abuse including cocaine, methamphetamines, MDMA or its derivatives, mephedrone or other stimulants, the category of drugs of abuse including cocaine, methamphetamines, MDMA or its derivatives, methamphetamine or its derivatives, mephedrone or other stimulants Unlike the European Protocol, therefore, the Protocol does not cover the category of cannabis, but rather the category of other substances not included in the above categories. In contrast to the European protocol, therefore, the Belgian protocol includes alcohol in the substances covered.
  Tobacco and the use of substances for medical treatment or other somatic or psychiatric reasons are excluded. Behavioural addiction, including addiction to sex, gambling, video games or the Internet, is not included in this record.

The TDI questionnaire

The questionnaire is best completed by a professional during the first face-to-face interviews with the patient during a new treatment episode.

Professionals involved in the TDI registration can consult the most frequently asked questions (FR/NL)

The TDI data registration platform can be accessed via this link: ehapps.wiv-isp.be/tdi

The TDI questionnaire :

basic version

RW version (Walloon region)

Hospital version (for hospitals)

RIZIV version (Flemish region)

Protocol

Royal decree for the TDI-registration in hospitals