1. 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.

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

3. Alcohol addiction (%)

4. Drug addiction (%)

5. 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.

6. 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

7. 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.

8. 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)

9. Addiction care should focus on patient and significant others

10. 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)

11. 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)

13. 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

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

15. 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

16. References
Alexander, B.K., Coambs, R.B. & Hadaway, P.F. (1978). The effect of housing and gender on morphine self-administration in rats.  Psychopharmacology, 58, 175–179. 
American Psychiatric Association (2014). Handboek voor de classificatie van psychische stoornissen. Amsterdam: Boom.
Anthonio G.G. & Bartels A.J. (2007). Op een evenwichtige manier oproeien, Jeugdhulp Friesland, Leeuwarden.
Anthony, W. (1993). Recovery from mental illness; The guiding vision of the mental health service system in the 1990s. Psychosocial rehabilitation Journal, 16(4),
Barber, J. G., & Crisp, B. R. (1994). The effects of alcohol abuse on children and the partner's capacity to initiate change. Drug and Alcohol Review, 13,
Benishek, L. A., Kirby, K. C., & Dugosh, K. L. (2011). Prevalence and frequency of problems of concerned family members with a substance-using loved one. The American Journal Of Drug And Alcohol Abuse, 37(2),
Cunningham, J. A., & McCambridge, J. (2012). Is alcohol dependence best viewed as a chronic relapsing disorder? Addiction, 107(1), 6-12.
Engel, G. (1977), The Need for a New Medical Model: A Challenge for Biomedicine. Science, 196(4286),
Frankl, V. E. (1984). Man’s search for meaning. Toronto: Simon & Schuster.
Hussaarts, P., Roozen, H. G., Meyers, R. J., van de Wetering, B. M., & McCrady, B. S. (2012). Problem areas reported by substance abusing individuals and their concerned significant others. The American Journal On Addictions, 21(1),
Leshner, A.I. (1997). Addiction is a brain disease, and it matters. Science, 278,
Nutt D., King L. A., Saulsbury W., Blakemore C. (2007). Development of a rational scale to assess the harm of drugs of potential misuse. Lancet 369 1047–1053. 
Popma, A., Blaauw, E., & Bijlsma, E. (2012). Psychiatrische comorbiditeit van verslaving in relatie tot criminaliteit. In Blaauw, E., & Roozen, H. (Red.), Handboek Forensische Verslavingszorg (pp ). Utrecht: Bohn, Stafleu en van Loghem.
Robins, L. N., Davis, D. H., & Nurco, D. N. (1974). How permanent was Vietnam drug addiction? American Journal of Public Health, 64(12 Suppl), 38–43.
Tuithof, M,. Have, M., Brink, W., Vollebergh, W. & Graaf, R. (2013). Predicting persistency of DSM-5 alcohol use disorder and examining drinking patterns of recently remitted individuals: A prospective general population study. Addiction, 108(12), doi: /add
Wong, P. T. P. (2013). A meaning-centered approach to addiction and recovery. In L.Wong, G. Thompson, & P. Wong (Eds.), The positive psychology of meaning and addiction recovery (pp ). Birmingham, AL: Purpose Research.

17. Thank you