The Netherlands Drug Situation 2010 - Trimbos-instituut

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Table 11.2.1 Published Dutch guidelines for addiction care*GuidelinePublication year1. Comorbidity: diagnosis and treatment 20032. Compulsory discharge from treatment 20043. Inpatient and outpatient detoxification 20044. RIOB: Methadone maintenance treatment 2005/20065. Case management 20076. Client profiles 20077. Pharmacological treatment for drug dependence in prisoners 20088. Treatment of cannabis problems in youth and young adults 20099. Disorders in alcohol use: diagnosis and treatment 2009*Protocols, manuals and modules are not included. Source: National Branch Organization for Mental HealthCare and Addiction Services (GGZ Nederland).Six of the nine Dutch guidelines for addiction care are initiated and/or (co-)funded by theten-year program Scoring Results, while the guidelines for mental health care were allthe result of the organizational activities of the National Steering Group MultidisciplinaryGuideline Development in Mental Health. The guideline for compulsory discharge fromtreatment was realized by the Coordination Group Guideline Development in AddictionCare. A second guideline on pharmacological treatment for drug dependent prisoners wassupported and funded by the Ministry of Security and Justice (see § 11.2.5), and asecond one on disorders in alcohol use was supported by the National Steering GroupMultidisciplinary Guideline Development in Mental Health (see § 11.2.7).It is observed that the sequence of guideline construction is presumably not guided bythe prevalence rates of specific drug problems or disorders that cause most public nuisanceor costs. Contrary to the Netherlands, the centralized guideline construction in theUnited Kingdom by the National Institute for Clinical Excellence (NICE) focuses both onmental health care and addiction care. It should be noted that in the United Kingdom amean amount of £ 480,000 is spent per guideline. This is substantially more than themoney spent on the Dutch guidelines. 111.2.1 Comorbidity: diagnosis and treatmentThe first Dutch guideline in addiction care deals with comorbidity. The publication was theresult of a project conducted in a research department of one institute for addiction care(Posthuma et al. 2003). It presents guidelines and instruments for screening and diagnosisof comorbid problems. Manuals and specified recommendations are presented for professionalsin both addiction care and mental health care. Guidelines for professionaltreatment practices are not described.In the first chapter the concept "double diagnosis" is defined, epidemiological data arepresented, and the aetiology of this phenomenon is presented. Chapter two presents theresults of the literature review and the pilot studies, the guidelines and recommendations.Included are also limiting factors and recommendations for the implementation ofthe guidelines. A limiting factor is for instance the existing treatment climate in the organizationsof mental health care that may hamper the treatment of drug problems. For1 Tim Kendall. Joint Director, National Collaborating Centre for Mental Health, UK. Presentation on NICE guidelines at the BigGuideline Conference in Amsterdam, Dec. 8 th 2009.161
example, there may be a climate in which drug use is considered a contra-indication forpsychiatric treatment or is simply ignored. The recommendations given in the guidelinenot only stress the importance of education and training (mutually in psychiatric and addictionproblems), but also stress discussions about prevalent professional attitudes. Furthermore,a lack of time and capacity (money and expertise) are considered limiting factors.An implementation plan is recommended in order to structure the process.The last chapter gives an overview of instruments for screening and assessment. Inthe appendices a thorough description is given of the pilot studies and the literature reviews,for example instruments for measuring motivational enhancement, severalscreening instruments for substance use among psychiatric patients, instruments forscreening and assessment of psychopathology among drug dependent patients, and anoverview of evidence-based treatment for double diagnosis patients, which is specifiedfor several psychiatric disorders.11.2.2 Compulsory discharge from treatmentThe second guideline has been realized by a group of experts from professional organizationsin addiction care and psychiatric nursing (Regiegroep richtlijnontwikkeling in de verslavingszorg2004). The group was funded by the Ministry of Health, Welfare and Sport.The guideline targets the organization of medical treatment and nursery care (in- andoutpatient), and targets decision making for patients who are treatment-refractory or areseriously misbehaving during treatment or care. Examples of these behaviours are breakingthe house rules, disobeying the treatment plan, or behaving dangerously. A morespecific target is to guide the decision making process towards discharging patients fromtreatment and care, in case several earlier corrective measures were not successful. Theguideline should offer more guarantees for maintaining the safety for other patients andprofessionals, and for maintaining a care environment that remains workable for both. Itspurpose is that members of patient organizations and professionals will use this guidelinefor constructing a more specified local or regional protocol for compulsory discharge.The guideline first describes important concepts concerning circumstances in treatmentand care related to compulsory discharge. It also describes generally acceptedpoints of departure or rules related to treatment and care. It continues with describingthe processes and examples of breaking those rules, of acute danger and possible actionsto be taken in those circumstances. In some chapters case descriptions are added forfurther illustration. Decision steps and actions are summarized in two decision trees forboth the organization and the patient. Finally, the ways of terminating the treatmentcontract and the process of discharge are described.11.2.3 Inpatient and outpatient detoxificationThe third Dutch guideline in the field of addiction care was composed by a working groupof experts from two Dutch institutes of addiction care (De Jong et al. 2004). The fundamentof this guideline was given by a literature review on the pharmacological treatmentof withdrawal symptoms and by criteria that are important for the decision to chooseoutpatient or inpatient detoxification. Based on the results of this review, a draft protocolwas written and evaluated during meetings with physicians and nurses. Both professionalorganizations and patients were asked to comment on this draft. The guideline has finallybeen tested in two pilot studies on its feasibility.The guideline mainly describes the medical-biological process of detoxification thattakes around two to three weeks, and supports the choices to be made during that162
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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
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National performance indicatorsAn i
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From May 2010 FACT will be offered
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using cannabis, it is developed by
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clients received treatment in Amste
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Figure 5.3.1: Distribution of new c
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Figure 5.3.3: Gender distribution b
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Table 5.3.1: Clinical admissions to
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In 2009, 692 new HIV diagnoses were
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Other risk behaviour included tatto
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Of the 168 new AIDS diagnoses in 20
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The Municipal Health Service (GGD)
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addiction care centre (hepatitis B
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o Chronic carriership was found in
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(4%), and hallucinogenic mushrooms
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Table 6.2.2: Information requests r
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6.3 Drug-related deaths and mortali
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Figure 6.3.2: Trends in age distrib
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Figure 7.2.1 Number of syringes exc
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The expert group also discussed the
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Iriszorg is further experimenting w
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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 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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Page 159 and 160: 11 History, methods and implementat
Page 161: diction care was published in 1997
Page 165 and 166: tion transfer between physicians an
Page 167 and 168: methadone treatment, and guidelines
Page 169 and 170: 11.3.1 Implementation of guidelines
Page 171 and 172: Institute for Quality in Health Car
Page 173 and 174: For most guidelines, the rate of im
Page 175 and 176: The question has remained how to im
Page 177 and 178: Name of Assessors: André van Gagel
Page 179 and 180: WHO guidelines coherence: only to b
Page 181 and 182: Figure 12.1.1:Number of deaths amon
Page 183 and 184: were about 341 deaths among the pro
Page 186 and 187: Part C: Bibliography and annexes185
Page 188 and 189: 13 Bibliography13.1 ReferencesAarts
Page 190 and 191: Burns, T., Fioritti, A., Holloway,
Page 192 and 193: De Jong I, Dijkstra M, Van der Poel
Page 194 and 195: Ganpat, S., Wits, E., Schoenmakers,
Page 196 and 197: Ivens, Y. and Wittenberg, S. (2008)
Page 198 and 199: Malmberg, M., Overbeek, G., Monshou
Page 200 and 201: RIEC (2009). Bestuurlijke aanpak va
Page 202 and 203: Smolders, M., Laurant, M., Van Duin
Page 204 and 205: T.K.24077-255. Tweede Kamer der Sta
Page 206 and 207: T.K.32159-5. Tweede Kamer der State
Page 208 and 209: Van den Berg C, et al. (2007). Majo
Page 210 and 211: 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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