The Netherlands Drug Situation 2010 - Trimbos-instituut

methadone treatment, and guidelines for registration and for cooperation with externalorganizations and with other levels within the judicial circuit (DJI 2008).11.2.8 Treatment of cannabis problems in youth and young adultsThe guideline annex protocol for the treatment of cannabis problems deals with the outpatienttreatment of cannabis problems among young people from 12 up to including 23years (Ivens et al. 2008). At the same time a working book was published for homeworkfor the clients (Ivens 2008). Both were written by an expert affiliated with one institutefor addiction care. During the coming years, comparable publications for problems withother drugs than cannabis are foreseen for this target group.For the cannabis guideline a supportive literature review was conducted, presentingthe following topics: 1) epidemiological data on cannabis use among the target group, 2)the effects of cannabis use on young people, 3) the use of classification systems, instrumentsfor screening and diagnosis, main results of treatment effect studies, and 4) theusefulness of client profiles for determining the most adequate treatment options (Wittenberg2006). The guideline briefly mentions several principles for treatment, forexample the targets, criteria for inclusion, comorbid problems, the role of significant others(family, friends), the flexible role of phases of behaviour change, the materials to beused, and guiding principles of the treatment process. Principles are for example: clientsfirst, start with motivational enhancement, give homework, building a therapeutic relationship,tackling patient compliance, urine tests, relapses, and prevention of drop-out.Finally, some background information is presented for the professional about types ofcannabis use among young people, existent treatment options, and methods and techniques.Two intervention types are mentioned: lifestyle training 1 and 2 for adults (based oncognitive-behavioural principles) and the Cannabis Youth Treatment Series (Webb et al.2002). The interventions focus on correcting inadequate coping strategies and dysfunctionalcognitions via motivational enhancement techniques, self control, cue exposure,behaviour skills, and relaps prevention. The number of sessions depends on the need ofthe client.11.2.9 Disorders in alcohol use: diagnosis and treatmentThe last guideline for dealing with disorders in alcohol use was produced by a specialworking group of the National Steering Group Multidisciplinary Guideline Development inMental Health (see § 11.1). It was done with the accordance of several professional organizations(e.g. for physicians, nurses, psychologists, psychiatrists) and was supportedby the Trimbos Institute and the Institute for Quality in Health Care (CBO) (Trimbosinstituut/CBO2009). The guideline was initiated by the Dutch Foundation for Psychiatryand funded by the Order of Medical Specialists.In general, alcohol dependence is traced when it exists already for a long time. Thetarget is to improve (early) diagnosis and treatment for one of the biggest problems inhealth care. This guideline has 15 chapters and gives recommendations and advice for 1)the diagnosis of alcohol problems of adult patients, 2) criteria for choosing in- or outpatientdetoxification, and 3) recommendations for treatment. The guideline further describesinstruments for case finding in the general medical practice, and laboratory teststhat determine acute and chronic alcohol abuse. Other subjects are 1) the effectivenessof pharmacological treatments (e.g. acamprosate, naltrexone and disulphiram in targetingabstinence or reduction of use), 2) the effectiveness of psychosocial interventions for166