The Netherlands Drug Situation 2010 - Trimbos-instituut

process. The results of the two pilot studies showed that this process needs support, especiallyin outpatient detoxification treatment. Other activities, for instance psychosocialsupport and motivational enhancement, are not included in this guideline. It representsan evidence-based description of the pharmacological treatment possibilities for detoxificationspecified per psychoactive substance. The important role of the patient with regardto withdrawing symptoms and craving, and the important role of a systematic registrationas a basis for evaluation and improvement are stressed.The content of the chapters covers the main aspects of detoxification, information onseveral psychoactive substances (alcohol, opiates, benzodiazepines, cannabis, cocaine,polydrug use), guidelines/instructions for physicians and for nurses separately, and forboth professional groups together. The guideline also presents standards for substancespecificdetoxification treatment, and patient data registration issues (treatment plan,treatment agreement, measurement instruments, and an illustrative example). The lastpart describes a literature review on this subject.11.2.4 RIOB: Methadone maintenance treatmentThe RIOB guideline was developed by two institutes of addiction care to tackle existingproblems in maintenance treatment. Methadone maintenance treatment already existedin 1968 in the Netherlands. During the nineties, the target of maintenance treatmentchanged from abstinence to the more realistic target of stabilization. In later years thetarget mainly changed toward reducing public nuisance (Driessen 2004). Partly due tothis last target, the practice of methadone treatment was reduced to merely methadonedispensing. Since 2004 this change was increasingly criticized by individual authors(Loth, 2003 238 /id;Loth, 2009 3041 /id), by professional organizations, by the HealthCare Inspectorate (IGZ 2004), and by the Netherlands Court of Audit (T.K.29660-1-2.Tweede Kamer der Staten-Generaal vergaderjaar 2003-2004 publicatienummer 29660nrs.1-2 2004). The RIOB targets physicians and nurses separately. It stresses the necessityof adding nursery care to methadone dispensing practices. It also describes the requirementsfor the setting, organization, and management of this treatment.The RIOB has been developed via several pilot studies. During these studies, both themanagers and the professionals learned to reflect on their daily professional behaviorsand learned to change it when necessary. The management should, for instance, enablenursing professionals to include nursing practices and psychosocial care in their dailytasks, by changing the system for time management.The RIOB guideline (Loth et al. 2005) first describes different profiles of the opiatesdependent client with special attention for women and cultural minorities. Secondly, thesystematic collection of client data is considered, both for the physician and the nurse. Athird subject is how to reach an adequate medication regime for methadone or for buprenorphine.Attention is paid to special patient groups, namely pregnant women,double-diagnosis patients, the young and older addicts, and polydrug users. Special circumstancesare also highlighted, for example holidays and detention. Finally, attention ispaid to multidisciplinary diagnosis and support, based on so-called "categories of intensityof care" (in Dutch: zorgzwaartecategorieën). These categories were based on a guidelineon client profiles (see § 11.2.6). Furthermore, guidelines were formulated for theorganization of maintenance treatment, including registration, funding, and the compositionof a professional team. Next, attention was paid to national registration requirements,cooperation with general hospitals, mental health care organizations, judicial organizations,and institutions for mentally retarded people. At the end of each chapter,appendices are added about many subjects, for instance about the necessity of informa-163