The Netherlands Drug Situation 2010 - Trimbos-instituut

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7.3 Responses to other health correlates among drug users7.3.1 Psychiatric comorbidityResults of research on psychiatric comorbidity and the treatment of dual diagnosis patientshave attracted professional attention for already many years (see our former NationalReports, and § 6.2)). As a consequence, the number of treatment units for comorbidityhas increased substantially. In 2006, research was conducted among 35 facilitiesfor the treatment of comorbidity in institutes for mental health care, addiction care, andsupported living (Planije et al. 2006). It was found that, from these 35 facilities, a majorityof 26 facilities were founded between 2003 and 2006.Since 2009, a national centre for expertise and implementation has been in operationwhich offers basic and follow-up training courses in professional development and indepthcourses. The national centre boosters on specific aspects of integrated treatment,and offers advice and coaching on implementation on-the-spot. The centre is called LandelijkExpertisecentrum Dubbele Diagnose (LEDD), which can be translated as: NationalCentre of Expertise on Double Diagnosis. 1The centre offers, for example, modules on motivational interview techniques, phasespecifictreatment, and group treatment for double diagnosis patients. Moreover, thecentre has installed a Platform Double Diagnosis that initiates meetings on specific topicsconcerning the treatment of double diagnosis. It also offers a down-loadable toolkit oninterventions and methods for counseling and treating double diagnosis patients, and adown-loadable working book on integrated treatment for patients with psychiatric andsubstance use problems.A further target of the LEDD is to reduce the lack of coordination in the approach andtreatment of patients having a double diagnosis. Consequently, initiatives have been takenfor constructing guidelines for treatment of specific double diagnosis patients, for exampleanxiety problems in combination with substance abuse (Snoek et al. 2009).7.3.2 People with mild or borderline intellectual disabilitiesOur former National Report (Van Laar et al. 2010) already mentioned interventions forprofessionals who work with people with mild or borderline intellectual disabilities (InDutch: Licht Verstandelijk Gehandicapten). The aim of the interventions is to preventproblem drug use among this vulnerable group. For young people from 12 through 23years with mild or borderline intellectual disabilities, a special intervention program hasnow been developed, of which a pilot implementation has been evaluated (Hilderink et al.2010). Development, pilot implementation, and evaluation took place from 2008 up toincluding 2010. Four regions participated. In each region, the prevention department ofthe institute for addiction care worked together with the associated institute for care forpeople with mild or borderline intellectual disabilities.From the pilot implementation it is concluded that standardization of the interventionprogram has been reached, and that participants have received the program positively.However, the program can still be improved by adding information and working methodsthat are more focused on people with mild or borderline intellectual disabilities. Moreover,attention should be paid to giving information about more drugs and about a betterpolicy of the care institutes with regard to drugs. After these adaptations, the programcan be implemented at national level (Hilderink et al. 2010).1 www.ledd.nl; see also the 2009 National Report.107
In line with the national policy that targets organised crime and public nuisance, theministry of Security and Justice has funded an exploratory quick scan on the group withtriple problems, that is psychiatric problems, substance use problems, and intellectualdisabilities (Kaal et al. 2009). This study collected several data, namely the (Dutch) literatureon this target group, a secondary analysis on existing statistical databases, a telephonesurvey, a simultaneous collection of existent documents on the care currently offeredfor this target group, and an expert meeting on the most appropriate care to beoffered for this group. The results point at the current difficulty of estimating the numberof people with triple diagnosis. Specifically people with mental retardation that have contactswith the police or the judiciary are not registered. It is estimated that between 920and 4,300 people with triple diagnosis enter the judicial system on an annual basis. Thestudy also shows that the current care that is offered to this target group is insufficientlyregistered and is expected to be inadequate.7.3.3 People with ADHD and substance abuseAmong patients at the institute for addiction care Novadic-Kentron the relation has beeninvestigated between attention deficit hyperactivity disorder (ADHD) and addiction severityand other comorbid psychopathology (Carpentier et al. 2011). The research was conductedamong a total of 193 patients in long-term methadone maintenance treatment(MMT). A total of 68 patients (35%) were diagnosed for having had childhood ADHD. Inthis group 48 patients had persistent ADHD and 19 patients no longer had significantADHD as adults. It was found that "ADHD in MMT patients is characterized by greateraddiction severity and more comorbid psychopathology". A greater addiction severity wasfound "in terms of Legal Status, Relationships, and Psychiatric Status".The International Collaboration on ADHD and Substance Abuse (ICASA) co-ordinatesresearch on the relation between ADHD and substance use disorder (SUD) (ICASA 2010).ICASA's mission statement says: "ICASA aims to contribute to a substantial decrease inthe proportion of ADHD patients developing SUD and to substantially improve the detection,diagnosis and treatment of patients having both ADHD and SUD." The office of ICA-SA is currently located in Utrecht, the Netherlands, at the Trimbos Institute.ICASA currently investigates the prevalence rates of ADHD in treatment seeking patientswith substance use disorders. It also investigates differences and similarities betweencountries and between different substances and treatment settings. The data arecollected in nine European countries, the USA, and Australia. The nine European countriesparticipating in ICASA are Belgium, Bulgaria, France, Hungary, the Netherlands,Norway, Spain, Sweden, and Switzerland. The data collection will run until June 2011,and the first results are expected in 2012.108
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Margriet van Laar, Guus Cruts, Andr
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ColophonThis National Report was su
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PREFACEThe Report on the Drug Situa
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9.6 New developments 14110 Drug mar
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these groups are relatively scarce.
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oasted by means of programs to prev
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Part A: New developments and trends
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Regulation Opium Act Exemptions (mi
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Medicinal cannabisOn 6 October 2009
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The Public Administration Probity S
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local circumstances into account. T
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The police district of West and Cen
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treatment for drug addiction. "Labe
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2 Drug use in the population2.1 Dru
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Table 2.1.3Annual prevalence and nu
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Cannabis and age (of onset)Figure 2
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ment of regular cannabis use (4 or
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Table 2.3.1Prevalence (%) of substa
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the ecstasy (see also § 10.3), som
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Table 2.3.2Prevalence of substance
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3 PreventionIntroductionIn the Neth
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CVGU). this Centre will support loc
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friends list in Windows live Messen
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entiate for group characteristics l
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in the number of problem opiate use
Page 57 and 58: emaining 131 problem hard drug user
Page 59 and 60: The largest difference in the propo
Page 61 and 62: Logistic regression analysis showed
Page 64 and 65: 5 Drug-related treatment: treatment
Page 66 and 67: National performance indicatorsAn i
Page 68 and 69: From May 2010 FACT will be offered
Page 70 and 71: using cannabis, it is developed by
Page 72 and 73: clients received treatment in Amste
Page 74 and 75: Figure 5.3.1: Distribution of new c
Page 76 and 77: Figure 5.3.3: Gender distribution b
Page 78: Table 5.3.1: Clinical admissions to
Page 81 and 82: In 2009, 692 new HIV diagnoses were
Page 83 and 84: Other risk behaviour included tatto
Page 85 and 86: Of the 168 new AIDS diagnoses in 20
Page 87 and 88: The Municipal Health Service (GGD)
Page 89 and 90: addiction care centre (hepatitis B
Page 91 and 92: o Chronic carriership was found in
Page 93 and 94: (4%), and hallucinogenic mushrooms
Page 95 and 96: Table 6.2.2: Information requests r
Page 97 and 98: 6.3 Drug-related deaths and mortali
Page 99: Figure 6.3.2: Trends in age distrib
Page 103 and 104: Figure 7.2.1 Number of syringes exc
Page 105 and 106: The expert group also discussed the
Page 107: Iriszorg is further experimenting w
Page 111 and 112: "The proportions of non-Western eth
Page 113 and 114: drugs. However, there is a narrow b
Page 115 and 116: Table 8.2.1: Programs for social re
Page 117 and 118: Evaluation researchFor the city of
Page 119 and 120: and 2009 has found that hostels rol
Page 121 and 122: against money laundering and other
Page 123 and 124: Table 9.1.1: Investigations into mo
Page 125 and 126: amounts, which are considered as me
Page 127 and 128: Opium Act offenders in prisons (fig
Page 129 and 130: cases is increasing. The proportion
Page 131 and 132: property crimes is decreasing, wher
Page 133 and 134: country. They offer a combination o
Page 135 and 136: mated 250 to 1,150 detainees in the
Page 137 and 138: Table 9.3.3: Types of assistance of
Page 139 and 140: Figure 9.3.1: Number of persons per
Page 141 and 142: It is important that detainees are
Page 143 and 144: The coming Law on Compulsory Mental
Page 145 and 146: Over half (53%) of the coffee shops
Page 147 and 148: Research on organised crime shows t
Page 149 and 150: Table 10.2.1: Number of dismantleme
Page 151 and 152: Table 10.3.2: Content of tablets so
Page 153 and 154: caine samples solely contained anot
Page 155 and 156: nabidiol (CBD) - in contributing to
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11 History, methods and implementat
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diction care was published in 1997
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example, there may be a climate in
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tion transfer between physicians an
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methadone treatment, and guidelines
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11.3.1 Implementation of guidelines
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Institute for Quality in Health Car
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For most guidelines, the rate of im
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The question has remained how to im
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Name of Assessors: André van Gagel
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WHO guidelines coherence: only to b
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Figure 12.1.1:Number of deaths amon
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were about 341 deaths among the pro
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Part C: Bibliography and annexes185
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13 Bibliography13.1 ReferencesAarts
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Burns, T., Fioritti, A., Holloway,
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De Jong I, Dijkstra M, Van der Poel
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Ganpat, S., Wits, E., Schoenmakers,
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Ivens, Y. and Wittenberg, S. (2008)
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Malmberg, M., Overbeek, G., Monshou
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RIEC (2009). Bestuurlijke aanpak va
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Smolders, M., Laurant, M., Van Duin
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T.K.24077-255. Tweede Kamer der Sta
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T.K.32159-5. Tweede Kamer der State
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Van den Berg C, et al. (2007). Majo
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Van Veldhuizen, J.R. (2007). FACT:
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13.2 Alphabetic list of relevant da
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LMR, Landelijke Medische Registrati
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13.3 List of relevant internet addr
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http://www.tactus.nl/http://www.ggz
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Table 9.1.1: Investigations into mo
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14.3 List of abbreviations used in
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PPCRIOBRIScRIVMROMSCPSHMSOVSRMSTISV
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