Plano Nacional para a Redução dos Comportamentos Aditivos e das Dependências 2013-2020

Objectives

Portugal’s National Plan for the Reduction of Addictive Behaviours and Dependencies 2013–2020 establishes an integrated national framework for reducing health, social and security harms associated with addictive behaviours, extending policy beyond illicit drugs and drug dependence to alcohol, medicines, anabolic steroids, gambling and other substance-related and behavioural dependencies. It seeks sustainable improvements in health and social wellbeing through a balanced, citizen-centred combination of demand reduction and supply reduction.[1][2][3]

• Place citizens at the centre of interventions organised around the life course, individual needs, capabilities and the settings in which people live, study, work and socialise.[4][5]
• Deliver an integrated continuum of health promotion, prevention, deterrence, risk reduction and harm minimisation, treatment, rehabilitation and social reintegration.[6][7]
• Prevent initiation and delay the age of first use, reduce perceived accessibility of psychoactive substances, and increase understanding of the risks associated with their use.[8][9][10]
• Reduce recent use, harmful consumption, dependence, morbidity and mortality related to addictive behaviours and dependencies, including alcohol-related disease, drug overdoses, HIV/AIDS associated with drug dependence, and risky or pathological gambling.[11][12][13]
• Address vulnerabilities across pregnancy, childhood, adolescence, adulthood and older age, while prioritising people experiencing greater health, social or economic vulnerability and exclusion.[14][15]
• Reduce illicit-drug and new-psychoactive-substance availability, trafficking and organised crime; regulate licit psychoactive-substance markets; and provide legal, safe gambling that does not encourage addictive behaviour.[16][17][18]
• Apply prevention, humanism, pragmatism, security, subsidiarity, participation, international cooperation and rational use of resources as guiding principles.[19]

Implementation

The Plan uses an intersectoral, evidence-informed and territorially responsive delivery model. It combines national coordination with local diagnosis, integrated response programmes and referral networks, aiming to align public services, civil society, specialist providers and enforcement bodies around complementary demand- and supply-reduction action.[6][20][21]

• Implement the strategy through two four-year Action Plans for 2013–2016 and 2017–2020, supported by the reformed coordination structure for drug problems, drug dependence and harmful alcohol use, whose remit is extended to wider addictive behaviours and dependencies.[6][22][23]
• Coordinate public administration, regional health administrations, Social Security, Education, Justice, Public Security, municipalities, private social-solidarity institutions, non-governmental organisations, professional networks and citizens through partnership and participation mechanisms.[7][21][24]
• Use territorial diagnoses to identify local needs, risks, protective factors, resources and service gaps, then develop Integrated Response Programmes that combine appropriate prevention, deterrence, harm-reduction, treatment and reintegration measures.[25][26]
• Provide differentiated prevention through universal, selective and indicated interventions, supplemented by environmental measures concerning availability, marketing, taxation, advertising, pricing and sales conditions for legal substances.[27][28][29]
• Operate nationally through the Commissions for the Dissuasion of Drug Addiction, which assess people referred by security forces and link them to health services under the decriminalisation framework.[30]
• Deliver individualised, multidisciplinary care, preferably on an outpatient basis, through Integrated Response Centres, detoxification units, therapeutic communities and alcohol treatment units, with continuing support for treatment, rehabilitation and social reintegration.[31][32]
• Strengthen early identification, brief intervention, motivational interviewing, referral and professional capacity across primary care, schools, workplaces, prisons, recreational settings and community services.[33][34][35]
• Coordinate supply reduction through judicial, police, customs, intelligence and border-management cooperation, including collaboration with Europol, Eurojust and the European Monitoring Centre for Drugs and Drug Addiction.[17][36]
• Regulate alcohol through age restrictions, restrictions on specified sales hours, enforcement, inspection and protective measures for minors, with the Food and Economic Safety Authority, Public Security Police and National Republican Guard among the responsible bodies.[37][38][39]
• Build an integrated information system, standardise data collection and indicators, support research, training and communication, and improve the use of evidence in policy design and implementation.[40][41]
• Monitor implementation continuously through production, quality and outcome indicators at local, regional and national levels; conduct internal evaluations at the end of each Action Plan; and commission external multidisciplinary evaluation covering process, results, impact where feasible, efficiency, quality and cost-effectiveness.[42][43][44]
• Finance implementation primarily through the budgets of competent entities, while seeking European Union co-financing and considering proceeds from gambling concessions, including online gambling, for relevant activities; no autonomous Plan budget or quantified allocations are specified.[22][45][46]

Monitoring & Evaluation

The Plan establishes continuous monitoring and evaluation as part of the public-policy cycle, covering implementation processes, results and, where feasible, impact across both demand- and supply-reduction measures.[46][42][43]It combines internal review through the national coordination structure with independent external evaluation to assess efficiency, effectiveness, quality, cost-effectiveness and cost-benefit.[43][44]

• Monitor key production, quality and outcome indicators at local, regional and national levels through a dedicated monitoring model.[43]
• Review targets and objectives regularly, using an interim internal evaluation at the end of the 2013–2016 Action Plan to adjust the 2017–2020 Action Plan.[42][43]
• Complete internal evaluations at the end of each four-year Action Plan and a comprehensive assessment at the end of the 2013–2020 cycle.[43][44]
• Commission an external multidisciplinary body, involving national and international specialists selected against agreed terms of reference, to define its methodology and reporting schedule, assess target achievement and deviations, and make recommendations for the next strategic cycle.[43][44]
• Disseminate regular monitoring reports to implementation partners and share results from intervention monitoring, research and evaluation.[40][43]
• Strengthen impact evaluation, research into intervention benefits, benchmarking of good practice, and the use of analytical accounting by project, programme and intervention.[42][43]

The indicator framework includes targets on perceived availability of psychoactive substances, perceived risk, age of initiation, recent use, harmful consumption, dependence, gambling, morbidity and mortality.[8][9][10][11][12][13]Examples include reducing perceived access to selected illicit substances relative to the European average, reducing perceived access to alcohol by 15% by 2016 and 30% by 2020, and delaying first use of illicit drugs, alcohol and medicines by one year by 2016 and two years by 2020.[8][10]

Further outcome targets include reducing recent use, risky consumption and dependence on psychoactive substances by 10% by 2016 and 20% by 2020; reducing risky and pathological gambling by the same proportions; and reducing morbidity related to addictive behaviours and dependencies by 25% and 50%, respectively.[11][12]Mortality monitoring includes alcohol-attributable mortality, alcohol-related road deaths, fatal overdoses and AIDS-related deaths associated with drug dependence.[13]

Data sources include the European School Survey Project on Alcohol and Other Drugs, national population surveys, the Directorate-General of Health, the Central Administration of the Health System and the National Institute of Health.[11][12]The Plan also seeks standardised data collection, scientifically validated indicators, an integrated information system, common intervention metadata, and improved detection of emerging public-health and safety threats.[41]

Accountability is supported by the Interministerial Council, its Technical Commission, the National Council, specialised forums and the wider coordination structure, which monitor and evaluate the Action Plans.[43][44][23]Sector-specific mechanisms include the International Narcotics Control Board’s monitoring of United Nations drug-control conventions, European Union action-plan indicators and evaluation instruments, and the European Monitoring Centre for Drugs and Drug Addiction’s harmonised reporting through the Reitox network.[47][48][49]

Costing & Financing

The Plan has no autonomous budget: implementation is financed from the budgets of competent entities, which are expected to hold sufficient resources for their assigned responsibilities.[22][45]It prioritises adequate central-government budgeting for the Plan and its Action Plans, including national co-financing for relevant European Union programmes.[45][46]

• Secure access to European Union funds for responsible public entities, institutional partners and civil-society organisations, while recognising that available European Union funding has declined and may require greater national co-financing.[45][46]
• Consider allocating proceeds from gambling concessions, including online gambling, to knowledge development, professional training and action on gambling-related addictive behaviours and dependencies.[45][46]
• Provide supplementary financing through competitive procedures where territorial diagnosis identifies absent or insufficient local responses.[26]
• Use analytical accounting by project, programme and intervention to support financial evaluation and identify cost-effective activities.[43]
• Rationalise and coordinate existing resources, services and institutional capacities, particularly under fiscal constraints and public-administration restructuring.[50][7]

Macroeconomic uncertainty and an anticipated contraction in gross domestic product were identified as constraints on short-term budget planning; the 2013 Retificative State Budget retained a general-government deficit objective of 5.5%.[45]The source does not provide total programme costs, allocations by intervention, unit costs, quantified funding gaps or other monetary economic assumptions.[46][43]

Economic evidence from retrospective assessment found that the social cost of drug dependence fell by approximately 11% between 1999 and the period immediately following implementation of the National Strategy to Combat Drugs, identified as 2000–2004.[50]The assessment also reported a 20% reduction in health-related social costs, a 7% reduction in direct non-healthcare costs, and a further 12% reduction in social costs linked mainly to lower direct and indirect costs of drug-related consequences.[50]