Luxemburg is estimated to have a population of 634,814.
According to the Luxembourg Country Drug Report, drug statistics suggest that 9.8% of young adults between the age of 15 to 34 consume cannabis, 0.4% MDMA, 0.1% Amphetamines and 0.6% cocaine.
There are currently 1738 high-risk opioid users in Luxembourg, with 58% of treatment entrants being heroin dependant.
16% of entrants suffer from cannabis dependency, 22% cocaine, and 4% other.
Luxembourg’s National Strategy and Action Plan on Drugs and Addiction aims to address the consumption of substances by focusing on harm reduction, interventions, and research and information.
To achieve this, the Action Plan’s priorities include prevention measures and the continued development of treatment for substance dependency.
With regards to prevention, this is primarily done through the school system by providing substance-related information to students and substance dependency training to teachers.
Selective prevention is also implemented, which is aimed that those deemed high-risk of substance dependencies, such as families struggling with poverty, children showing high-risk behaviours, and those with a history of excessive alcohol consumption.
The Luxembourg government has worked to introduce a legal framework that is conducive to countering substance dependency.
This includes the introduction of needle and syringe exchange, supervised injection rooms and medically assisted heroin distribution.
In addition, possession and use of cannabis were decriminalised in 2001; this means that people caught by the authorities will likely face a fine, as opposed to a prison sentence.
As part of their National Strategy against substance dependency, Luxembourg also offers treatment for substance dependency.
They have, for example, made available counselling and care services; this is aimed at treating substance users at an earlier stage of their addiction.
The government also supports and helps fund outpatient treatment facilities, hospital-based treatment units, and therapeutic communities. (1)
This article will discuss drug and alcohol rehab in Luxembourg.
There are two types of rehabilitation available in Luxembourg: outpatient and inpatient treatment.
Outpatient treatment refers to treatment that does not require an overnight stay at a facility.
Instead, individuals will work closely alongside medical professionals who will guide them through treatment through regular appointments.
This will include seeing a general practitioner, being medically supervised during detox, and attending therapy and counselling sessions.
Some examples of outpatient treatment are opioid substitution treatment and detoxification treatment through a therapeutic community.
Outpatient treatment is provided free of charge in Luxembourg. Individuals wishing to start an outpatient programme are advised to contact a health professional.
Inpatient treatment refers to an individual entering a facility for a period; this means not leaving the facility until the treatment has finished.
Like outpatient treatment, individuals will undergo a process of detox, then medical and psychological treatment, such as therapy and counselling.
In Luxembourg, most inpatient treatment is covered by health insurance.
Again, individuals are advised to speak with a medical professional who will assess their needs and will refer them to an inpatient setting if necessary. (2)
Addiction often takes on two different forms: psychological and physical.
Prolonged use of a substance will often lead to physiological dependence upon it.
This means that an individual will require that substance to physically function.
In addition, without the substance, individuals will begin to experience physiological symptoms, such as shakes, fatigue, nausea, and vomiting.
Psychological addiction, as the name suggests, is a cognitive addiction – it is a mental preoccupation with a substance.
This refers to both the chemical need for the substance for the brain to function properly and the individuals use of the substance to obtain and maintain a certain psychological state.
This might include euphoria and confidence or the use of a substance to overcome depression and anxiety. (3)
To overcome substance dependency, it is first necessary for individuals to detox.
Detoxification is the process of harmful and addictive substances leaving the body.
The duration and process of detox can vary from substance to substance, as does the withdrawal symptoms.
Alcohol, for example, can lead to Alcohol Withdrawal Syndrome (AWS); this is the psychological and physiological reaction to alcohol leaving the body.
Detoxing from Alcohol can lead to varying withdrawal symptoms, such as mild symptoms – anxiety, depression, and nausea – and severe symptoms – breathing complications and seizures.
According to research, commonly, withdrawal is experienced by individuals suffering from alcohol dependency between 6-16 hours from their last consumption.
Symptoms can last for up to five days but will begin to reduce after 24 hours.
In Luxembourg, medical supervision can be provided to help individuals detox from alcohol at home.
However, it is advised that those suffering from severe dependency seek an inpatient setting. (4)
Heroin detox can be a more arduous process. This is due to heroin being a more addictive substance.
It is recommended that individuals suffering from heroin dependency contact a medical professional before attempting to detox.
Withdrawal from heroin usually occurs between 4-6 hours after the final dose and lasts between 5-7 days.
This can vary depending upon how long the individual has been using, and the method of intakes – such as injection or inhalation.
Symptoms can range from mild to severe. Mild symptoms include fatigue, sleeplessness, general discomfort, and anxiety.
More serious symptoms include dehydration and hypothermia. (5)
For cocaine, withdrawal symptoms will emerge between 8-12 hours and can last between 5-7 days.
Symptoms for cocaine withdrawal also range from mild to severe – from vomiting and restlessness to fatigue and fever. (6)
The Luxembourg government supports and funds both inpatient and outpatient treatment for heroin dependency.
Heroin treatment, for example, might include opioid substance treatment (OST).
OST is available through both office-based medical doctors and specialised facilities.
OST involves replacing heroin with a prescribed replacement opioid.
In Luxembourg, this includes methadone, buprenorphine, and morphine-based medication.
In Luxembourg, OST is covered by both an individual’s health insurance and by the state; the latter covers the pharmaceutical costs.
For inpatient treatment, individuals will attend one of Luxembourg’s state-funded rehabilitation facilities, such as a specialised hospital unit.
Here, individuals will undergo 24/7 medical care, detox, potentially OST – this depends on the severity of the substance dependency – and post-detox therapy and counselling. (7)
The Luxembourg government also provides inpatient and outpatient treatment for alcohol and cocaine dependency.
Outpatient treatment can vary, but generally, for both alcohol and cocaine, will involve a supervised detox – often by a general practitioner or medical expert.
For individuals suffering from severe alcohol dependency, they may be prescribed medication to help with the detox process.
Medication can vary from benzodiazepines and antidepressants to anxiolytics. Each has been found to help alleviate withdrawal symptoms.
Once detox has finished, individuals will participate in therapy and counselling.
For inpatient treatment, the process is similar, but individuals will be expected to remain at a facility for the duration of their treatment.
Individuals will detox under medical supervision and spend several weeks attending various therapy and counselling sessions.
Regardless of whether individuals are suffering from heroin, alcohol or cocaine dependency, all rehab facilities offer post-treatment care.
This will involve continued support and supervision, and continued therapy. (8)
Dual Diagnosis refers to an individual that has both a mental health issue and a substance dependency. Both often influence each other, with studies suggesting that one can often lead to the other.
For example, studies have found that it is not uncommon for someone suffering from depression or anxiety to use a substance to alleviate mental health symptoms.
However, if an individual uses a substance for a prolonged period, there is the potential for them to develop a physical or psychological dependency.
Alternatively, substance dependency can lead to mental health issues.
Studies have shown that individuals that continually consume alcohol, heroin or cocaine are at risk of developing depression, anxiety, paranoia, and personality disorders. (9)
The length of rehab is dependent upon the required treatment, the substance and whether an individual is an inpatient or outpatient.
However, according to Luxembourg’s National Strategy and Action Plan on Drugs and Addiction, most treatment programmes last between 3 months to 1 year. (10)
In Luxembourg, those suffering from substance dependency will be offered therapy and counselling. This is available in both inpatient and outpatient settings.
The purpose of therapy is to address the cause of the dependency, the issues surrounding it, and to provide a platform to talk about the dependency.
It will also provide the tools and coping strategies needed to overcome dependency and maintain sobriety.
Therapy can be wide-ranging and individuals will attend different ones based on their needs.
However, some of the most common therapies are psychoanalysis – or talk therapy – Cognitive Behavioural Therapy (CBT), Dialectical Behaviour Therapy (DBT), Contingency Management (CM), and group therapy.
CBT refers to the process of recognising that thoughts often lead to actions – or, that cognitive processes influence behaviours.
The purpose of CBT is to analyse thought processes, particularly negative ones, and understand how they might lead to negative behaviours.
It then helps teach the individual how to think differently – this is done with the hope that positive thinking will lead to positive behaviours, and vice versa. (11)
DBT is a variation of CBT but instead of solely focusing on cognition, it analyses moods.
Negative moods are believed to be a by-product of past traumatic experiences and negatively influence thoughts and behaviours. (12)
Both CBT and DBT will provide important coping tools, such as expression management, reappraisal, and emotional regulation.
Contingency Management focuses mostly on patterns of behaviour. The basic premise is that individuals behave in a way that rewards their needs and desires.
By reframing the reward system and the behaviour patterns, CM can help overcome addiction and maintain sobriety. (13)
CM rewards individuals when they enact positive behaviours and punishes them when they behave in negative ways.
The reward and punishment can vary but commonly are the giving or withholding of presents or money.
Group therapy, as the name suggests, is a therapy that is conducted in a group setting – usually with a therapist and several others that are in a similar circumstance, such as trying to overcome substance dependency.
Often, individuals will sit in a circle and take turns discussing their difficulties. The group will offer feedback and support.
Group therapy has been found to encourage support systems and help with feelings of isolation.
One of the most tried and tested group therapies is the 12-step approach to recovery and can be found in Luxembourg.
The 12-step approach to recovery was invented by Alcoholics Anonymous.
It suggests that individuals, on their own, are relatively helpless in overcoming substance dependency.
The only way to overcome substance dependency is to submit it to a higher power.
The higher power can be anything – religion, something spiritual or nature, for example – but must be something greater than substance dependency.
The 12-steps encourage the individual to take accountability by submitting to the higher power.
It also helps individuals to make amends, create a moral compass and reflect upon what led them to their dependency. (14)
In Luxembourg, once an individual has completed their treatment, either in an outpatient or inpatient setting, medical professionals will help create a relapse prevention plan.
The individual will discuss with medical professionals what might lead to a relapse, such as certain relationships or environments, and how they can better deal with them.
Individuals will then focus on developing the tools to help maintain their sobriety. This often includes an aftercare programme of continued therapy and counselling.
Therapy might include a one-on-one session or group therapy, such as Alcoholics Anonymous and Narcotics Anonymous.
Both offer fellowship programmes that help individuals integrate back into society and can provide a useful support network.
Coping strategy counselling is also provided. This will help individuals focus on stress management, how to communicate, and how to deal with negative thoughts and emotions. (15)
(3) Johnson, B., 2003. Psychological Addiction, Physical Addiction, Addictive Character, and Addictive Personality Disorder: A Nosology of Addictive Di. Canadian Journal of psychoanalysis, 11(1), pp.135-160.
(6) Wallace, B.C., 1987. Cocaine dependence treatment on an inpatient detoxification unit. Journal of Substance Abuse Treatment, 4(2), pp.85-92.