The Netherlands Drug Situation 2010 - Trimbos-instituut

using cannabis, it is developed by using target group information, scientific literature,theories and methods (Ter Huurne 2009).5.2.4 Withdrawal treatmentUltra rapid detoxificationThe EDOCRA project concerns ultra-rapid detoxification with naltrexone. The project consistsof two phases. In the first phase, which ran from 1999 to 2003, high abstinencerates and improved health conditions were found compared with traditional methadonewithdrawal treatment. It also appeared that adding general anaesthesia to this treatmentwas not only expensive but ineffective and dangerous. n the first phase a follow-uptreatment strategy (the Community Reinforcement Approach) was added to maintainabstinence (see also our National Report 2007, par. 5.3). The second phase targeted areplication of this withdrawal treatment option in a non-experimental context and a checkon the implementation of this treatment (Dijkstra et al. 2009). The questions to be answeredin the second phase were directed at the clinical relevance of the outcomes andwhether the outcomes could be generalized. That means, is ultra-rapid detoxification alsoeffective in regular Dutch addiction care and is implementation feasible?Comparison of the results of the second with the first phase revealed that both atpost-test and one-month after the end of detoxification, the abstinence rates did not differsignificantly (62% versus 59% respectively) The same conclusion could be drawn forother outcomes, e.g. craving, withdrawal symptoms, psychological condition, and qualityof life. However, there were fewer patients in the second phase that completed thistreatment (87% versus 100%) and patients were also more difficult to reach for a followuptest (63% versus 87%). The authors claim that these differences were probably dueto the experimental conditions in the first phase, i.e. more strict controls and correctionsof irregularities that were less easily applicable in the second phase. For instance, in thesecond phase, the Community Reinforcement Approach as a fixed follow-up treatmentstrategy was changed in regular follow-up treatment (as usual) and follow-up measurementswere restricted to one-month after detoxification only.Several interventions were realized to support implementation, e.g. information ofpatients, relatives and professionals caring for diagnosis-based treatment allocation;training professionals in this treatment technique; taking care of necessary additionalconditions (e.g. extra beds, a camera monitoring system and of additional materials andmedication. In the first phase of this project professionals were trained in a special diagnosis-basedtreatment allocation procedure, while in the second phase the professionalswere only informed how to refer patients to this treatment. The other implementationinterventions for both phases did not differ.In total 135 of the 297 eligible patients were included in the first phase of the project,and 121 in the second phase. During the treatment-allocation phase (intakefase) no researcherswere involved and no dropout rates could be determined. It is remarkable thatin the second phase fewer patients were included in treatment and that smaller numberscompleted this treatment compared to the first phase (105 versus 135), while the durationof the second phase was longer (40 versus 27 months respectively). Factors thatmay have caused the lower implementation success of the second phase are for instancethe use of a regular treatment allocation procedure with longer waiting periods beforetreatment, and a non-continuous treatment supply (due to shortage of professionals andmoney). Treatment need and treatment supply did not fit. The abstinence rates amongthe participant patients however, did not differ significantly. The authors conclude that itis feasible to implement ultra-rapid detoxification in the Dutch addiction care, but that69