The Netherlands Drug Situation 2010 - Trimbos-instituut

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5 Drug-related treatment: treatment demand andavailability5.1 Strategy/policyIn 2009, the addiction care in the Netherlands consolidated the developments that tookplace during the previous decades. The main historical developments were the professionalizationof the addiction care, especially by means of the quality management programScoring Results; and the mergers, often with mental health care, which have resulted inthirteen large regional organizations. New impulses during 2009 were given by a newKnowledge Centre for Care, a specialist study in addiction medicine and pilots with RoutineOutcome Monitoring and performance indicators. Moreover, there have been improvementsin care for chronic (complex) addicts, pilots for treating cocaine problemsand increases in online therapy.5.2 Treatment systems5.2.1 OrganisationDuring the past decade, the number of organizations for addiction care has been reducedconsiderably. This is due to the many mergers that took place in the Dutch mental healthcare and addiction care for economic reasons. After some fluctuations, the 60 regularorganizations that were present in 1993 were transformed into thirteen (mostly large)regional organizations in 2009. 1 Additional organizations that take care of addicted personsare the municipal health services, general psychiatric hospitals, several religiousorganizations (e.g. the Foundation "De Hoop") and some ten private addiction clinics. 2One private clinic was opened in Spring 2010 in the Caribbean (JellinekRetreat). 3 Theseclinics do not participate yet in public registration systems like the National Alcohol andDrugs Information System (LADIS). However, one clinic ("SolutionS") is now being evaluatedon the effectiveness of its treatment, combining the Twelve Step Minnesota Modelwith cognitive-behavioural therapies. 45.2.2 Quality assuranceThe program Scoring ResultsAlready in several former national reports, the content and evaluation results of the programScoring Results have been described. On November 25 th 2009 a Jubilee Conferencewas held because of the 10-year anniversary of this programme. During this celebration,the Minister of Health, Welfare and Sport characterized the results of the programme asa milestone for the quality of the Dutch addiction care (Ooms et al. 2010). Scoring Resultswill be continued in a new Knowledge Institute (kennisinstituut) that will be hosted1 See www.sivz.nl2 See www.sivz.nl3Psy Nieuwsbrief, February 25 th , 2009 (www.psy.nl); Schramade M., Het Parool October 10 th 2009.4 www.ivo.nl. This prospective evaluation (with a follow-up one year after finishing treatment) is focusingon patients with alcohol problems, if relevant combined with cocaine problems.63
y the National Branch Organization for Mental Health Care and Addiction Services (GGZNederland).Training and educationOn December 3rd 2009, the first eighteen addiction physicists finished their two-yearspecialist study in addiction medicine at the Radboud University Nijmegen. The studyincludes a theoretical and a practical phase. A second year-group is currently followingthis post-doc training. This specialized academic discipline is a primer in Europe. It isforeseen that in September 2010, the third wave of new students will start their specialisation.At the same time, a new 1-year study has started for the additional professionaltraining of addiction psychologists. In 2008, a national website was developed(www.verslavingskundeplein.nl) by a school for higher vocational education (InHolland).This website or portal was meant for information and education of students, teachers,professionals and researchers. The five clusters of the website included information,communication (e.g. a forum), knowledge, learning, and development. It was meant as avirtual meeting place for all professionals involved in drug prevention, treatment andcare, and drug policy (Buisman 2009). The website has now been concluded, and part ofit has been taken over by the website www.presentie.nl. Inter alia, this website givesinformation about how the "presentation approach" (Baart 2004) can be applied to addictioncare. The starting point of the "presentation approach" is being there in an outreachingmanner in the environment in which the addicts actually live.Benchmarking and Routine Outcome Monitoring pilotsIn Dutch addiction care there are three monitors that are also meant to support benchmarking:1. a monitor of cognitive-behavioural lifestyle trainings, run by the Amsterdam Institutefor Addiction Research, AIAR;2. a monitor on inpatient motivation centres (see National Report 2007, par. 5.1);3. a monitor on dual diagnosis treatment.The last two monitors are conducted by the Nijmegen Institute for Scientist-Practitioners in Addiction (NISPA). Routine Outcome Monitoring (ROM) is tried out in thethree monitors mentioned above, but also in dual diagnosis treatment and in detoxificationunits. An essential part of ROM is individual data collection on outcomes of treatment,whereas benchmarking may also collect these data on group level. The NetherlandsKnowledge Centre for Care (Kenniscentrum Zorg Nederland) published standardsfor benchmarking for mental health care including addiction care. 1Applying ROM in treatment fits in well with the introduction of performance indicators(see later this chapter). Experiences with individual level ROM data in mental health caresuggest that working with ROM on group level is helpful for outcome management (Ellwood1988). During the past years, ROM and its measurement instruments have alsobeen used for clinical management on individual level, that is for setting up and evaluatingindividual treatment plans (Andrews et al. 2005). In this sense, the use of ROM andits measurements are supporting decision making. Moreover, experiences have beenreported with outcome measures on different measurement instruments for individualpatients. For example, a case study shows that, while psychiatric symptoms decrease,the quality of life may also decrease due to setting higher goals (Keet 2010).1 www.kenniscentrumzorgnederland.nl64
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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.
Page 13 and 14: oasted by means of programs to prev
Page 16: Part A: New developments and trends
Page 19 and 20: Regulation Opium Act Exemptions (mi
Page 21 and 22: Medicinal cannabisOn 6 October 2009
Page 23 and 24: The Public Administration Probity S
Page 25 and 26: local circumstances into account. T
Page 27 and 28: The police district of West and Cen
Page 29 and 30: treatment for drug addiction. "Labe
Page 32 and 33: 2 Drug use in the population2.1 Dru
Page 34 and 35: Table 2.1.3Annual prevalence and nu
Page 36 and 37: Cannabis and age (of onset)Figure 2
Page 38 and 39: ment of regular cannabis use (4 or
Page 40 and 41: Table 2.3.1Prevalence (%) of substa
Page 42 and 43: the ecstasy (see also § 10.3), som
Page 44 and 45: Table 2.3.2Prevalence of substance
Page 46 and 47: 3 PreventionIntroductionIn the Neth
Page 48 and 49: CVGU). this Centre will support loc
Page 50 and 51: friends list in Windows live Messen
Page 52: entiate for group characteristics l
Page 55 and 56: in the number of problem opiate use
Page 57 and 58: emaining 131 problem hard drug user
Page 59 and 60: The largest difference in the propo
Page 61 and 62: Logistic regression analysis showed
Page 66 and 67: National performance indicatorsAn i
Page 68 and 69: From May 2010 FACT will be offered
Page 70 and 71: using cannabis, it is developed by
Page 72 and 73: clients received treatment in Amste
Page 74 and 75: Figure 5.3.1: Distribution of new c
Page 76 and 77: Figure 5.3.3: Gender distribution b
Page 78: Table 5.3.1: Clinical admissions to
Page 81 and 82: In 2009, 692 new HIV diagnoses were
Page 83 and 84: Other risk behaviour included tatto
Page 85 and 86: Of the 168 new AIDS diagnoses in 20
Page 87 and 88: The Municipal Health Service (GGD)
Page 89 and 90: addiction care centre (hepatitis B
Page 91 and 92: o Chronic carriership was found in
Page 93 and 94: (4%), and hallucinogenic mushrooms
Page 95 and 96: Table 6.2.2: Information requests r
Page 97 and 98: 6.3 Drug-related deaths and mortali
Page 99: Figure 6.3.2: Trends in age distrib
Page 103 and 104: Figure 7.2.1 Number of syringes exc
Page 105 and 106: The expert group also discussed the
Page 107 and 108: Iriszorg is further experimenting w
Page 109 and 110: In line with the national policy th
Page 111 and 112: "The proportions of non-Western eth
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drugs. However, there is a narrow b
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Table 8.2.1: Programs for social re
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Evaluation researchFor the city of
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and 2009 has found that hostels rol
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against money laundering and other
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Table 9.1.1: Investigations into mo
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amounts, which are considered as me
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Opium Act offenders in prisons (fig
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cases is increasing. The proportion
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property crimes is decreasing, wher
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country. They offer a combination o
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mated 250 to 1,150 detainees in the
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Table 9.3.3: Types of assistance of
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Figure 9.3.1: Number of persons per
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It is important that detainees are
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The coming Law on Compulsory Mental
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Over half (53%) of the coffee shops
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Research on organised crime shows t
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Table 10.2.1: Number of dismantleme
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Table 10.3.2: Content of tablets so
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caine samples solely contained anot
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nabidiol (CBD) - in contributing to
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11 History, methods and implementat
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diction care was published in 1997
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example, there may be a climate in
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tion transfer between physicians an
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methadone treatment, and guidelines
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11.3.1 Implementation of guidelines
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Institute for Quality in Health Car
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For most guidelines, the rate of im
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The question has remained how to im
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Name of Assessors: André van Gagel
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WHO guidelines coherence: only to b
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Figure 12.1.1:Number of deaths amon
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were about 341 deaths among the pro
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Part C: Bibliography and annexes185
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13 Bibliography13.1 ReferencesAarts
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Burns, T., Fioritti, A., Holloway,
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De Jong I, Dijkstra M, Van der Poel
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Ganpat, S., Wits, E., Schoenmakers,
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Ivens, Y. and Wittenberg, S. (2008)
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Malmberg, M., Overbeek, G., Monshou
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RIEC (2009). Bestuurlijke aanpak va
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Smolders, M., Laurant, M., Van Duin
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T.K.24077-255. Tweede Kamer der Sta
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T.K.32159-5. Tweede Kamer der State
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Van den Berg C, et al. (2007). Majo
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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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