When discussing services for people who use drugs, we quickly arrive at the question of whether there is enough support available. But it is just as important to ask whether people reach the right support at the right time — and what happens when they move between the health care, social welfare, and criminal justice systems, while no one is responsible for the full picture.
This was the focus of an analysis carried out by Haap Consulting for the National Institute for Health Development. The analysis examined the functioning of services for adults who use drugs and inter-service cooperation in Estonia. The analysis was completed in 2025.
The aim of the study was to support the development of a cross-sectoral model that would help reduce drug use more effectively and provide psychosocial support to the target group. The model focuses on early identification, treatment for people with substance-use-related disorders, support for recovery and coping, and improving the quality of life of both the person and their loved ones.
The analysis consisted of four parts. First, the current situation in Estonia was mapped from the perspective of specialists: what services are provided, how people reach them, which referrals work, and where cooperation gets stuck. For this purpose, 26 individual in-depth interviews were conducted with specialists who work with people who use drugs in health care, the social sector, criminal justice, and community-based services.
Second, the experiences of service users were collected. Interviews were conducted with 23 people aged 18–54 who had had contact with at least one social or health care service due to drug use. Their stories helped us understand what seeking support looks like in practice: where people get information, what helps them access services, what makes it difficult to stay engaged, and what kind of support is most needed.
Third, Estonian practices were compared with experiences from other countries. Based on scientific literature and international practices, service and cooperation models from Canada, Australia, and the United Kingdom were mapped. As a result of the international analysis, nine models or practices were identified, four of which were discussed in more detail with Estonian specialists in focus groups to assess their suitability for the Estonian context.
The analysis showed that while Estonia has a some services for people who use drugs across the health care, social welfare, and criminal justice systems, the information is fragmented and service gaps are prominent. The problem is not only whether services exist, but whether they are accessible, connected to one another, and able to guide a person to the right support at the right time. Access to services varies considerably by region, language, type of substance used, urgency of the need for support, and co-occurring problems.
One recurring conclusion was that cooperation often relies on specific people rather than systematic collaboration. Good examples rely on personal contacts, previous cooperation experience, and the willingness of specialists to find solutions themselves. At the same time, many places lack clear cooperation agreements, a shared understanding of roles, and sufficiently visible information about the services a person can access. Specialists highlighted the need for a unified database that would bring together available support options and service providers.
The perspective of service users added an important dimension. Seeking support does not always begin with merely knowing that support exists. Some people do not have a clear idea of what a more sober or stable life could look like; others do not believe that anyone can genuinely help them. Accessing services can be hindered by previous negative experiences, shame, fear of judgement, complicated administrative procedures, fragmented information, or the need to navigate several systems alone. In such a situation, it is not enough for a service to formally exist — what matters is how a person reaches it and whether someone helps them stay on that path.
When comparing the Estonian situation with scientific literature and international practices, the lack of proactive outreach stood out. In several countries, models are used that do not rely on people finding their own way to the right place. Instead, they involve specialists actively reaching high-risk individuals in their everyday environments. Such approaches help establish contact with people who would otherwise not reach services or would quickly disengage from them.
International experience offered several ideas for Estonia, including intensive case management, outreach-based models, collaborative care arrangements, and alcohol care teams in hospitals. What these approaches have in common is more holistic support for the person’s journey: support is not limited to a single appointment, referral, or service, but focuses on helping the person remain in treatment, reach the services they need, and receive support even when their situation is complex or unstable.
Based on the analysis, both general recommendations and proposals for adapting specific international models and practices to the Estonian context were developed. One important direction was the need to develop an approach and care pathway that does not strictly separate alcohol, drugs, or misuse of prescription medicines when organising support, but instead helps specialists respond to the person’s overall needs. The analysis also emphasised the need for shared guidance materials, better information exchange, more systematic cooperation, sufficient workforce capacity, supervision, and further training.
For Haap Consulting, this analysis was a good example of why complex social and health issues need to be studied from several perspectives at once. Specialists see how the system functions, where the bottlenecks are, and where cooperation could be improved. Service users help us practically understand how the same system appears to someone who needs support but may not trust it or may not be able to reach it. International experience allows us to ask which solutions could and should be adapted in Estonia. Combining these perspectives through the analysis of client journeys helps develop services that avoid the risk of remaining unapproachable to the people needing it.
The central lesson of the study is that supporting people who use drugs requires more than individual good services. What is needed is a pathway that does not fall apart at the boundaries between systems. A person should not have to know which door to knock on, which term to use, or which institution is currently responsible for their concern. A well-functioning system notices, connects services, and maintains contact even when the person themselves does not yet have the capacity to do so.
If we want support to reach people whose needs are often multifaceted and changing, services must be developed not only separately, but also in relation to one another. Inter-service cooperation may be exactly where small organisational changes can make a very large difference in a person’s life.
Read the report on the website of the National Institute for Health Development:
https://www.tai.ee/et/valjaanded/uimasteid-tarvitavatele-inimestele-suunatud-teenuste-toimimise-ja-teenustevahelise
