The Netherlands Drug Situation 2010 - Trimbos-instituut

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Table 8.2.1 (Continued)Institute, residence,year reportedNovadic-Kentron, Vught, 2008GGZ-groep Noord- en Midden-Limburg, Venray, 2008Program for social reintegrationSocial approach towards addictionSupervised livingCommunity Reinforcement Approach (CRA)Multi Dimensional Family Treatment (MDFT)Development of the Division Long-Term Complex Care (housing,care, and daily activities) into outpatient SupportedLivingDepartment for daily activitiesDepartment for work rehabilitationOutreaching treatment Intensive community care within the framework of the FunctionAssertive Community Treatment (FACT)Mondriaan Zorggroep, Heerlen,2008 Recovery by expertise by experienceSource: http://www.jaarverslagenzorg.nl.From the twelve main institutes in table 8.2.1, five institutes mention to have given specialattention to forms of Assertive Community Treatment (ACT), Community ReinforcementApproach (CRA), or support of the social environment. In a review study, CommunityReinforcement and Family Training (CRAFT) "has been found to be superior in engagingtreatment-resistant substance-abusing individuals compared with the traditionalprogrammes" (Roozen et al. 2010). Supervised living is mentioned by eight institutes."Experts By Experience" (in Dutch: ervaringsdeskundigen) are former addicts who havebeen trained as care givers in such a way that they can apply their lived experiences asformer addicts when giving help to current addicts. Appointing Experts By Experience canbe seen as a form of two-sided social rehabilitation. On the one hand it promotes therehabilitation of the former addict and on the other hand it serves to promote the rehabilitationof the still addicted client. Putting in Experts By Experience, or expertise by experience,is mentioned explicitly by three institutes. Other reintegration projects set upby the institutes for addiction care target at daily activities, schooling, or work, and arementioned by six institutes.International Remembrance DaySocial exclusion is not restricted to a (problem) drug user's lifetime. It even extendsbeyond death and beyond the grave. If, after death, a person only ends up as an anonymousnumber, and is no longer remembered as a person having had a name, thatcounts as a form of 'post-mortem social exclusion'. As a way to socially reintegrate thedeadly victims of drugs into the community of past ones who are remembered as namedhuman beings, the 21st of July has been declared "International Remembrance Day"(http://inpud.wordpress.com/).In the Netherlands, International Remembrance Day was held first in 2009 in Amsterdam,and was held for the second time in 2010 in The Hague. This year's solemn ceremonywas conducted by the street pastors from the Street Pastoral Care The Hague(Straatpastoraat Den Haag) (Brekelmans et al. 2010). The moving ceremony was openedto the general public, and surviving relative drug users played an active role, especiallyin taking care of the memorial music, and reviving anonymous numbers into personalnames.115
Evaluation researchFor the city of Rotterdam, Van der Poel has evaluated the effects of policy measures onthe living conditions of drug users in 2007 compared to 2003, the role of low-thresholdcare agencies, and the effects of drug consumption rooms (Van der Poel 2009). First ofall, with regard to the process of social exclusion, among thirty current and former crackusers aged 16 through 24 years, it was found that "the use of crack accelerated theprocess of marginalization", because crack users "experience a shrinking social networkthat developed around other users, and because they performed illegal activities to buycrack". Moreover, it was found that "homelessness and crack use are intertwined". Theyoung crack users "have moved from a marginal position in society to a marginal positionwithin the drug scene". With regard to the process of social reintegration it was foundthat "former crack-using youngsters appreciated the youth rehabilitation clinic, especiallybecause it enabled them to regain social contact with non-using peers". With regard tothe effects of policy measures, it was found that the "combination of repressive (punitiveand judicial) measures and care (housing and other assistance) measures seem to havepositive effects on the living conditions of the target groups".Among 1,181 patients of the Street General Practice in Rotterdam it was found that,apart from giving medical care, this practice "may play an important role in discontinuingthe process of marginalization and possibly even start a process of socialization forhomeless people". All in all, Van der Poel concludes that low-threshold facilities can functionin three ways, as a "broom wagon" (keeping drug users off the streets), as a "safetynet" (providing minimal care) and as a "springboard" (providing socialisation).The role of good medical care in socialization is underscored by research among thehomeless in Amsterdam conducted by street doctor Van Laere. This researcher has madea plea for integrated social and medical care (Van Laere 2009). The Municipal HealthService Amsterdam (GGD Amsterdam) operates the "Dr Valckenier Outreach Practice forHomeless People", which offers "a shelter-based convalescence program for ill homelessadults in Amsterdam". A seven-year period of the program, running from January 2001up to October 2007, has now been evaluated for 25 convalescence care beds run by theSalvation Army at the Gastenburgh (Van Laere et al. 2009). There were a total of 889admissions from 629 unduplicated individuals, the majority being admitted once (75%)or twice (18%); 83% was male, and the mean age was 45 years. From these care users41% were addicted to heroin (with or without cocaine) and 18% were addicted to cocaine(without heroin). The mortality rate was 13.2%, seven and a half time as high as amongthe peer group in the general population. All in all, the authors conclude that the "communityservices have been able to cater for more marginalized people", and that the"convalescence facility has been flexible and responsive to the needs of the users andservices available".As mentioned above, the social reintegration of homeless addicts in the 43 centre municipalitiesis embedded within the Strategy Plan for Social Relief. This Plan targets allhomeless people as well as people at risk to become homeless, whether or not they havean addiction problem. The results of the Plan are monitored by the Strategy Plan for SocialRelief Monitor, which is part of the National Monitor on Homelessness (MMO). Recently,the Strategy Plan for Social Relief Monitor has evaluated the results of the Plan bythe end of 2009 (Maas et al. 2010).Starting in 2006, intakes and individual trajectories were drawn up by the end of 2009for 3,814 homeless in Amsterdam, 2,989 homeless in Rotterdam, 1,833 homeless in The116
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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
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emaining 131 problem hard drug user
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The largest difference in the propo
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Logistic regression analysis showed
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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 and 108: Iriszorg is further experimenting w
Page 109 and 110: In line with the national policy th
Page 111 and 112: "The proportions of non-Western eth
Page 113 and 114: drugs. However, there is a narrow b
Page 115: Table 8.2.1: Programs for social re
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
Page 157 and 158: 156
Page 159 and 160: 11 History, methods and implementat
Page 161 and 162: diction care was published in 1997
Page 163 and 164: example, there may be a climate in
Page 165 and 166: 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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