The Netherlands Drug Situation 2010 - Trimbos-instituut

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