The previous 2013 Netherlands National Report mentioned as new products from Scoring Results the "Practice-based recommendations for GHB detoxification",15 the advisory report "Elderly and addiction",16 and the quick scan "Scoring results around recovery".17 Three new products have now resulted from Scoring Results: an update of the “Masterprotocol Scoring Results”, “Examples of working together on addiction prevention and care in the youth care” and the “State of affairs in science and practice about behavioural addictions”.
The update of the “Masterprotocol Scoring Results” (Scoring Results 2014)18 gives guidelines for the development of protocols, guidelines, and knowledge documents for the addiction care. All the products for Scoring Results are set up in a uniform way according to the Masterprotocol. It has now been updated by conforming it to the protocol style of the Dutch Institute for Healthcare Improvement (CBO) and the Ministry of Security and Justice, including the contributions of clients and their family, accounting for cultural diversity, and by adopting a systematic maintenance plan.
The “Examples of working together on addiction prevention and care in the youth care” (Scoring Results 2013)19 show some best practices for working together. These practices demonstrate how different institutes can work together successfully around young people having multiple problems like addiction, psychiatric problems, delinquency, and mild mental retardation.
The “State of affairs in science and practice about behavioural addictions” (Scoring Results 2014)20 reviews the current scientific knowledge and practice at the institutes for addiction care about six behavioural addictions: gambling addiction, internet addiction, video games addiction, social media addiction, sex addiction, and eating addiction. It is advised that the addiction care will develop appropriate treatments for these behavioural addictions. 15 http://www.resultatenscoren.nl/publicaties/detail/ghb-protocollen.html. 16 http://www.resultatenscoren.nl/publicaties/detail/ouderen-en-verslaving.html. 17 http://www.resultatenscoren.nl/publicaties/detail/resultaten-scoren-rond-herstel.html. 18 http://www.resultatenscoren.nl/publicaties/downloaden/masterprotocol-herziene-conceptversie-2014.html. 19 http://www.resultatenscoren.nl/publicaties/detail/samenwerken-bij-middelenproblematiek.html. 20 http://www.resultatenscoren.nl/publicaties/downloaden/gedragsverslavingen.html.
51 Apart from the quality management program Scoring Results, a new measurement instrument has been validated recently to screen current post-traumatic stress disorder in patients with substance use disorder (Kok et al. 2015).21 This new instrument is given by the “Depression, Anxiety and Stress Scale (DASS)”. This screening instrument “was assessed in an inpatient facility during intake with 58 patients and again 4 weeks after admission.
Another 138 patients were assessed 4 weeks after admission only. The results were compared to the Clinician-Administered PTSD Scale (CAPS) that was also administered after 4 weeks of abstinence.” From their validation study the authors conclude that the DASS is “a reliable and convenient measure to use as a screen for PTSD in SUD patients”. Apart from being a valid screener for PTSD, the authors summarize the following additional advantages of the DASS: “with the DASS it is also possible to screen for depression and anxiety disorders, which makes it a time-efficient and therefore cost-effective approach”, “the DASS is in the public domain, so there are no financial costs”, and “the DASS is already being used in many treatment facilities in the Netherlands and could thus be a convenient measure”.
5.3 Access to treatment
5.3.1 Regular addiction treatment
As mentioned above, the National Alcohol and Drugs Information System (LADIS) is the most comprehensive information system about clients in the regular addiction treatment in the Netherlands. Although the LADIS has a wide coverage of clients receiving treatment for their addiction problems, some private clinics, non-merged mental health care institutes, and addiction units in general psychiatric hospitals are not yet represented in the LADIS.
The data in this paragraph are based on the protocol for the Treatment Demand Indicator (TDI) as established by the EMCDDA (Standard Table TDI_2014_NL_01). This means that only those clients who have had more than one face-to-face contact with an addiction counsellor are included.
Moreover, the TDI only includes clients who subscribed in the year of registration, not those who already registered the previous year and were still in treatment. However, it includes both clients subscribed for the first time in their life for a drug problem (first treatments), and clients that re-subscribed in the registration year. The TDI controls for double counting of persons. These criteria are more restrictive than the criteria applied by the holder of the LADIS, the Foundation for the Provision of Care Information (IVZ), to assess the annual LADIS Key Figures. Therefore, the figures presented below deviate from the figures reported elsewhere (Wisselink et al. 2014).22
With regard to the regular heroin-assisted treatment, the number of treatment places has been stabilized in 2014 at 740 treatment places that are operational at 18 units in 16 different municipalities (Ministry of Health, Welfare, and Sport, personal communication). In 2015, the number of treatment places for heroin-assisted treatment will be reduced to 700 places. Some of the clients in heroin-assisted treatment also receive methadone and are represented in the LADIS among the opiates clients.
21 http://www.karger.com/Article/FullText/365283. 22 http://www.sivz.nl/nl/ladis/kerncijfers.
52
Trends
In 2013 there were 11,129 new clients (excluding probation), compared to 10,801 new clients (excluding probation) in 2012 and 11,341 new clients (excluding probation) in 2011. Including probation, the annual number of new clients from 2002 up to including 2010 varied between eight and eleven thousand, without showing a clear trend. Figure 5.3.1 shows the distribution of the new clients from 2004 up to including 2013 by primary drug of abuse.
Figure 5.3.1: Proportion of clients subscribed in the registration between 2004 and 2013 at the institutes for addiction treatment by primary drugI
I. Selection of clients based on the EMCDDA TDI protocol. Probation clients are excluded since 2008. Source: LADIS, IVZ.
Figure 5.3.1 shows the following:
The percentage of opiates clients among the new drug clients decreased from 29% in 2004 to only 10% in 2013.
Each year, the proportion of cocaine clients (including crack clients) exceeds the proportion of opiates clients. However, it should be noted that these percentages differ from the overall number of clients including the clients who were already registered in the year before the reporting year.
The proportion of cannabis clients steadily increased from 25% in 2004 to 49% in 2013. The ecstasy and amphetamines clients, when taken separately, never accounted for
more than 6% of the new drug clients.
Age
Figure 5.3.2 shows the age distribution in 2013 by primary drug of abuse. Clients seeking treatment for high-risk use of opiates most often fall in the older age groups. On the contrary, clients who have a primary problem with amphetamines or cannabis, most often fall in the youngest age groups.
2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 Others 4 4 4 4 3 6 7 7 7 8 Cannabis 25 27 32 37 38 39 45 50 48 49 Ecstasy 1 1 1 1 1 0,4 0,4 1 1 1 Amphetamines 4 5 6 6 6 5 6 6 6 6 Cocaine 37 35 35 32 33 31 26 24 27 26 Opiates 29 28 22 20 19 18 16 13 11 10 0% 20% 40% 60% 80% 100%
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Gender
The percentage of females among all the new drug clients varied over the years between 12% and 21%. Figure 5.3.3 shows the gender distribution by primary drug in 2013. The proportion of females was the highest among the amphetamines clients (22%), and was the lowest among the cocaine clients (14%).
Figure 5.3.2: Clients subscribed in 2013 at addiction treatment centers by primary drug and age groupI
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Figure 5.3.3: Gender distribution by primary drug of clients subscribed in 2013 at centers for addiction treatmentI
I. Selection of clients based on the EMCDDA TDI protocol, excluding probation clients. Source: LADIS, IVZ.