NEW DEVELOPMENTS IN SUBSTANCE USE TREATMENT IN THE NETHERLANDS

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NEW DEVELOPMENTS IN SUBSTANCE USE TREATMENT IN
THE NETHERLANDS

• THE DUTCH EXPERIENCE
•  
• Drs. Wim Buisman (Dutch Council for Competence
  Building in Addiction, GGZ Nederland, Jellinek
• Bern, 27 September 2006

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Knowledge management

• The process whereby (new) knowledge is
  implemented into medical fields services and
  applied in daily practice
• Knowledge management is a circular process that
  consists of

knowledge development
knowledge evaluation
knowledge dissemination

• knowledge implementation

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Knowledge dissemination

• Thousands of research reports articles are
  published, but circulation of outcomes is limited
• From http//www.clinicalevidence.com/ For up to
  40 of the most prevailing medical problems
  there is strong scientific evidence for the
  existence of successful treatments
• How do people get access to this information,
  e.g. recent presentation at the International
  Congress of Cardiology (of new medicine
  rimonabant (Acomplia) against obesitas and
  possibly smoking and other addictions
• How do addiction professionals acquire new
  knowledge?

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From knowledge to practice
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From knowledge to practice

• It appears from research that
• The gap between the scientific knowledge and
  daily practice is increasing
• Clinicians think that they perform evidence-based
  medicine, but in fact less then 50 do so
• Although the majority of the patients have a
  favourable attitude to compliance, only 30
  comply with the treatment advice instruction,
• Many clinicians lack proper communication and
  negotiation skills (chronic diseases)
• Many clinicians dont perceive incentives or
  rewards for applying evidence based medicine

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Best Practice in knowledge management National
Project Scoring Results in Substance Use
Management

• Netherlands Association for Mental Health
  Addiction
• Objective and assumptions
• Quality empowerment of the national systems for
  treatment, care and prevention
• Focus on main phases in treatment
  (intake/assessment, detoxification, lifestyle
  training, M.I, relapse prevention etc., aftercare
• All new interventions are evidence based, piloted
  and produced by 4 research development centres
  in which addiction services cooperate with local
  research institutes
• Two levels treatment of motivated clients aimed
  at recovery and self-control and social care for
  chronic addicts aimed at harm reduction and
  stabilisation
• Addiction services can apply for funding to
  implement new interventions

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Best Practice in knowledge management National
Project Scoring Results in Substance Use
Management (2)

• List of main clusters of protocols
  interventions
• Cluster of intake, assessment and motivation
• Cluster of CBT interventions
• Cluster of medical interventions
• Cluster of social interventions
• Cluster of clinical interventions
• Cluster of care interventions for chronic addicts
• Cluster of preventive interventions
• (Cluster of juridicial/probation interventions)

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Best Practice in knowledge management National
Project Scoring Results in Substance Use
Management (3)

• Results of a broad national implementation study,
  representative for 80 of services (2004)
• All new interventions/protocols/guidelines are
  widely known in the field
• Majority (more then 50) of new interventions are
  implemented in majority of services
• Protocols on lifestyle training are applied up to
  92
• Guidelines on intake/screening and prevention up
  to 54

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Best Practice in knowledge management National
Project Scoring Results in Substance Use
Management (4)

• Predictors for successful implementation of new
  interventions (project Scoring Results)
• Availability of an implementation plan
• In-company training with booster sessions
• Applying new interventions in pilot treatment
• Appropriate setting
• Appreciation/satisfaction by care provider and
  clients

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Knowledge management and core competences

• Knowledge (bio-psycho-social) of
• Evidence based treatment of addictive behaviour
• New substances and dependence behavior
• (Psycho)pathology and medication
• How to cope with addicts/behavior
• Intake and assessment (incl.co-occurrence)
• Adequate referral and social map of services
• Be able to apply well-founded psycho-social
  interventions
• Motivational interviewing, life style training,
  relapse prevention
• Be able to work with protocols, guidelines,
  handbooks

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Knowledge implementation role tasks of the
Council for Competence Building

• Support the development of (evidence based)
  substance use education for core professions
  under-graduate-continuous
• Define, discuss and present core
  competences/qualifications in treatment/prevention
  
• Apply procedures of accreditation
• Stimulate innovations in higher education (Master
  in Addiction Treatment, new Chairs in Addiction)
• Contribute to creation of new, educational
  techniques and materials based on up-to-date
  knowledge
• Evaluate competence building in addiction by
  publishing monitoring reports
• Actively disseminate new knowledge and expertise

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Composition of the Council

• . Representatives of 6 main professional
  associations
• (addiction medicine, psychology, nursing,
  social work, occupational therapy, prevention)
• . Lecturers of academic vocational/applied
  universities (undergraduate, continuous
  education)
• . Experts from the field of addiction and mental
  health
• . Representatives of ministries, policy
  research institutes
• . Councils Office/secretariat

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Councils actions (2005 2006)

• . National evaluation survey in higher education
  on substance abuse education (quick scan)
• . Support and advise on new 1 year
  multidisciplinary course on substance use
  training in university for applied science
  (launch Autumn 2006)
• . Advisory report on development of Master in
  Addiction (continuous education for physicians)
• . Educational needs assessment of (addiction)
  psychologists working in addiction mental
  health (report)

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Councils actions (2005 2006)(2)

• . Advise on curriculum for (addiction)
  psychologists
• . Organisation of National Conference for
  Substance Use Education in universities for
  applied science
• . Publishing of monitoring/state of the art
  reports
• . Preparation and start of accreditation system
  for postgraduate training in addiction services

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Any questions?wbuisman_at_ggznederland.nl
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STATEMENTS FOR DISCUSSION

• . Continued education (CE) in addiction demands
  for a permanent monitoring of professial
  needs/competencies (but how?)
• .In company training (multidisciplinary) is a
  valuable tool and (cost)effective investment (how
  to organize?)
• .CE not rooted in evidence based addiction
  science is a waste of time energy
• .Besides training in knoweldge/ interventions, CE
  should pay equally attention to the attitude and
  person(ality) of the care provider