The Netherlands Drug Situation 2010 - Trimbos-instituut

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