The Netherlands Drug Situation 2010 - Trimbos-instituut

From May 2010 FACT will be offered for the first time to patients in three locations in theNorth-eastern part of the Netherlands and it is foreseen to spread FACT-methods over alllocations in this region during the year. 1Intensive community-based treatment is considered a crucial element of AssertiveCommunity Treatment. The occurrence and the goals of intensive community-based carefor drug users with complex problems (bemoeizorg) has been described in our formerNational Report. Current activities are focused on extracting the elementary parts thatare most effective (National Report 2009, par 5.2.3). Creating and maintaining personalcontacts with the target group of ACT and intensive community-based care (people withcomplex problems who are in need of long-term care arrangements) is a necessary conditionfor success with seducing them into treatment or care (Cornet 2010;Sytema et al.2007;Sytema et al. 2010).The effectiveness of ACT, defined as a type of 'intensive outpatient community-basedcare', on mental health problems (in most cases schizophrenia or a related psychotic disorder)has been studied in an RCT and the results may also be relevant for patients withsubstance use disorder (Sytema et al. 2007). Among the participant group of treatmentrefractorypatients with complex and serious mental health problems (e.g. alcoholic drifters)the dropout rate among the ACT-group was significantly lower than in the control(treatment-as-usual) group. The ACT group was also on several items significantly moresatisfied with the care offered than the control group. For the other outcome measures(number of days in hospital, psychosocial functioning, and quality-of-life) both groups didnot differ significantly. The authors conclude that this resulted in a more stabilized situation,enabling efforts for social rehabilitation.Deep Brain StimulationDuring the past decade Deep Brain Stimulation has been used for somatic, psychiatricand substance use disorders (Denys et al. 2010;Mantione et al. 2010). In this type of'drug-free treatment', electrodes are planted in pre-selected parts of the brain and highandlow-frequency signals are used to limit or stimulate neuron activity. In the AmsterdamMedical Centre experiments are currently running with Deep Brain Stimulation fortreatment-refractory patients with serious cocaine and heroin addiction. These preexperimental,trial and error treatments are meant to explore the effects and side-effectsof this method among 4-5 persons with cocaine addiction and another 4-5 persons withheroin addiction. It takes 3-6 months to determine optimal adjustment of the implants(Evenblij 2009).Minnesota Model treatmentElements of the Minnesota Model of treatment of drug dependence are used in sometreatment units of organizations of addiction care, but until now a wider disseminationand acceptance of this kind of treatment is hindered in the Netherlands. This is probablydue to the lack of sufficient scientific evidence for effectiveness of self help, an importantelement of the Minnesota Model. Still, it appears to attract many clients. Some feelthemselves easier with this type of treatment and others feel easier with, for instance,cognitive-behavioural treatment principles.Drug-dependent people are inclined to search for treatment on the internet and followtheir own preferences. 2 A first measurement of a six-month old national Minnesota Modeltreatment programme, conducted by JellinekMinnesota in Amsterdam, shows that more1www.vnn.nl/index.cfm?pid=4&itemid=207&contentItemID=1634&method=display2 http://www.e-hulp.nl/nieuws/verslaafden-orieumlnteren-zich-op-internet-voor-behandeling/54667