Addiction care in the Netherlands: Background, best practices and opportunities for social workers Dr. Eric Blaauw Professor in Addiction studies Hanze University of Applied Sciences Dit is het voorblad. De enige tekst die hier toegevoegd mag worden is de naam van de persoon die de presentatie geeft.

Prevalence of use Recent use in the Netherlands (2009) Alcohol: 78% Tobacco: 27% Cannabis: 3,3% Cocaine: 0.3% Opioids: 0.1%

Alcohol addiction (%)

Drug addiction (%)

What is addiction? Craving or using more than intended Taking the substance in larger amounts or for longer than you meant to Wanting to cut down or stop using the substance but not managing to Spending a lot of time getting, using, or recovering from use of the substance Cravings and urges to use the substance Negative consequences, also for others Not managing to do what you should at work, home or school, because of substance use Continuing to use, even when it causes problems in relationships Giving up important social, occupational or recreational activities because of substance use Using substances again and again, even when it puts the you in danger   Tolerance and dependence Continuing to use, even when the you know you have a physical or psychological problem that could have been caused or made worse by the substance Needing more of the substance to get the effect you want (tolerance) Development of withdrawal symptoms, which can be relieved by taking more of the substance.

Burden of addiction Addiction can get worse. After prolongued addiction 25-30% tends to become chronic Risk of diseases and premature death (Nutt, King & Philips, 2010; Rehm et al., 2017) Disorders in use of alcohol (40%) or drugs (60%) often associated with comorbid disorders (Popma, Blaauw & Bijlsma, 2010) Comorbidity and chronic diseases difficult to treat (Hunt et al., 2013) More clinical admissions More premature deaths More suicides More homelessness More somatic diseases More violence More detentions

What is addiction? Craving or using more than intended Taking the substance in larger amounts or for longer than you meant to Wanting to cut down or stop using the substance but not managing to Spending a lot of time getting, using, or recovering from use of the substance Cravings and urges to use the substance Negative consequences, also for others Not managing to do what you should at work, home or school, because of substance use Continuing to use, even when it causes problems in relationships Giving up important social, occupational or recreational activities because of substance use Using substances again and again, even when it puts the you in danger   Tolerance and dependence Continuing to use, even when the you know you have a physical or psychological problem that could have been caused or made worse by the substance Needing more of the substance to get the effect you want (tolerance) Development of withdrawal symptoms, which can be relieved by taking more of the substance.

Significant others suffer Partners have problems (Benishek, Kirby & Dugosh, 2011) All have relationship (100%) and emotional problems (100%) Many have financial problems (90%) and problems with family (87%) More than half have health problems (68%) and exposed to violence (70%) Many have problems with police (17%) Partners have physical and psychological problems and decreased quality of life (Hussaerts, Roozen & Meyers, 2007) Children suffer from many complaints (Overview: Barber & Crisp, 1994) Transgenerational transfer or addiction (Anthonio et al., 2016)

Addiction care should focus on patient and significant others

Views on addiction It is a character weakness (moral model) It is the substance itself (pharmacological model) It is a disease for those who are vulnerable to it (disease model) Leshner (1997): Addiction is a chronic brain disease (brain disease model)

Comments on brain disease model Chronicity mostly in addiction clinics In general society 70% after three years no longer meeting diagnostic criteria (Tuithof, 2015) Model has not led to clinical applications (Hall, Carter & Forlini, 2015) Model does not meet with holistic view from recovery movement, where finding new meaning is the central issue (Anthony, 1993) recovery involves the development of new meaning and purpose in one's life as one grows beyond the catastrophic effects of mental illness” (Anthony, 1993, p.21)

What is addiction? Addiction is a complexe interplay of biological, psychological and social factors (biopsychosocial model) But also pay attention to things that give meaning to addiction and life (a.o. Frankl, 1946, 2011). Wong (2010): Addiction is a self-destructive coping mechanism to deal with the pain of social suffering and a lack of meaning Peele (2015): Finding a higher order meaning is a main goal when fighting addiction

Addiction care should pay attention to the personal story and then decide together on treatment (bpsm)

Addiction care in the Netherlands Very much focused on cognitive behavioral therapy + 10 percent inpatient treatment Strong focus on multidisciplinary teams providing (function) assertive community treatment Guidelines prescribe to pay attention to Housing Finances Work and daily activities Comorbid psychiatric disorders Not much focus on significant others There is much room for social work in the arena of addiction

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Thank you r.w.blaauw@pl.hanze.nl