Suchergebnisse

Due to high relapse rates after leaving treatment, drug users are often recommended to participate in some form of lower intensity continuing care. The importance of aftercare is widely accepted, but little empirical data are available about the effectiveness of continuing services over longer periods of time and following various treatment modalities. In this study, we assessed the influence of various forms of aftercare on treatment outcomes and service utilization over a 33-month period among a naturalistic cohort of 653 drug users treated in prison or community settings, as part of the Drug Outcome Research in Scotland (DORIS study). Although participation in aftercare after initial treatment is rather unusual, the odds of having experienced a drug-free period (after 8 months) (OR = 1.91, 95% CI 1.10–3.33) and of being abstinent from heroin (after 33 months) (OR= 0.56, 95% CI 0.34–0.94) almost doubled. Program aftercare was of little additional value after intensive residential treatment, but particularly important after prison-based and community treatment and if combined with self-help participation. Consequently, attractive and fitted aftercare services should be offered as an integrated part of various treatment modalities.

As a result of the growing number of ethnic and cultural minority clients in substance‐abuse treatment during the last decades, a culturally responsive approach has become more and more imperative. In this article the statements (n = 1330) of professionals (n = 11) and clients (n = 11) representing the substance‐abuse treatment centres in the region of Ghent and its suburbs (Belgium) are analysed. In focus are the specific treatment needs of ethnically and culturally diverse substance‐abusing clients and the difficulties consequent to treating this target group. Possible approaches to overcoming these difficulties are highlighted and elaborated by means of semi‐structured interviews and focus groups. The participants in the study stress the importance of an integrated approach, with special attention given to the factors that can promote or jeopardise treatment.

Covers -- Guest editorial -- Eric Broekaert (1951-2016): the life and legacy of a TC pioneer andi ntegrative thinker -- Milieu approaches and other adaptations of therapeutic community method: past and future -- Identity change in a drug-free Therapeutic Community: a Lacanian interpretation of former residents' perspectives on treatment process and outcome -- Human rights, the capability approach and Quality of Life: an integrated paradigm of support in the quest for social justice -- The search for integrated paradigms of care for people with mental illness who offend: the enabling personality of Eric Broekaert -- Du choc des idées jaillit la lumière: thinking with Eric Broekaert's integrated and holistic paradigm of education -- An alternating combination of art and science: the legacy of Eric Broekaert illuminated in the honorary doctorate for Alain Platel -- Women's treatment on men's conditions: a critical evaluation of selected literature and research findings -- Evidence and practitioners' knowledge: some comments on a current discussion

Since the 1990s, case management has been implemented in the USA and Canada – and recently also in various European countries – to support substance abusers with multiple and complex needs. Although this intervention is often presented as a set of standardised functions, its application is often a subjective task involving various dilemmas, which may influence case management outcomes significantly. Based on a comparison of case managers' experiences in Denmark and Belgium, we focus on several core dilemmas in case management for substance abusers with complex problems. Case management practices vary from one project to the next and even within the same project. Such differences are apparently related to the way in which case managers approach dilemmas such as those existing between control versus self‐determination, or between systematic versus ad‐hoc planning. The conclusion is that it is vital to discuss these dilemmas during training courses and supervision meetings in order to ensure that the intended form of intervention is actually delivered on the ground.

De samenleving tolereert deviant gedrag steeds minder. Tegelijk is er meer aandacht voor zelfbeschikkingsrecht. Dit plaatst hulpverleners voor ethische dilemma's. In de beschrijving van dit onderzoek wordt nagegaan op welke manier zorggebruikers en hulpverleners binnen de geestelijke gezondheidszorg informele dwang, geïnitieerd door hulpverleners, percipiëren. Tien zorggebruikers en tien hulpverleners uit vijf residentiële psychiatrische settings binnen West-Vlaanderen namen deel aan een multiple casestudy. Uit dit onderzoek blijkt dat afdelingsregels, adviseren, confronteren en stimuleren veelgebruikte vormen van informele dwang zijn. Hulpverleners zetten informele dwang in wanneer ze de zorggebruiker willen behoeden voor risico's, vaak vanuit een gevoel van eigen onmacht. Informele dwang kan ondersteunend ervaren worden als er geen veroordeling aan gekoppeld wordt, de handeling op vraag van de zorggebruiker komt en er keuzevrijheid en transparantie wordt geboden. Om machtsreductie te bewerkstelligen is reflectie op informele dwang noodzakelijk. Een continue dialoog tussen hulpverleners en zorggebruikers en aandacht voor relatieopbouw kan de paradigmashift naar herstelgerichte zorg met minder disproportioneel gebruik van dwang bevorderen.

Continuity of care is seen as a challenge for youth care services. Research on continuity of care in relation to youth care services is scarce, and there is a strong tendency to overly stress the managerial and technical aspects of care. However, research on continuity from a youngster's perspective suggests a more complex construction of continuity. The connection with youth care services is especially under pressure in the confrontation with difficulties and critical moments. In this narrative study, we aim at gaining insight into youngsters' different strategies in vulnerable situations when facing difficulties in their trajectories in relation to youth care interventions. By retrospective reconstruction of their trajectories in relation to youth care interventions, youngsters were able to express significant moments in their biographical timeline. The narratives are analysed using the framework given in literature on users' coping strategies in relation to dissatisfaction in services: loyalty, voice, exit and neglect. We have chosen three topical life stories of youngsters to represent the research findings that illustrate identified strategies of fighting, freezing and fleeing care, which are to be viewed as translations of the Hirschman coping strategies. However, a deeper analysis of these interactions results in a more complex view on strategies and shows that these can be misinterpreted by youth care workers. Different elements such as timing, clinical overshadowing or the pre-structured nature of youth care interventions are linked to this mismatch between what youngsters want and what youth care workers offer. Options are presented to handle these difficult interconnections.

AbstractContinuity is seen as an important aim for the quality of youth-care services. However, views on continuity are predominantly guided by experts, without much attention to user perspectives. This paper focuses on youngsters' experienced continuity in relation to youth-care services. Twenty-five youngsters, who were in residential care or reached by low-threshold youth services, were interviewed about their experiences in and out of care. In thematically exploring the biographical narratives for important experiences of continuity, three major themes emerged: (i) the need for footholds in moments of existential chaos, (ii) the importance of timing of interventions to match the youngsters' perspectives and (iii) the importance of the youngsters' impact on their own care pathways. This study shows the need for support that is imbedded in a relational network within the context of youngsters in vulnerable situations. Rethinking youth services towards a better connection with these contexts is essential. Furthermore, the amount of control youngsters experience in their care interventions seems to be beneficial to the experience of continuity. It is argued that continuity should be seen as a process, in order to leave more space for negotiation and flexibility throughout the youngsters' experiences in youth-care services.

Resilience and self‐reliance have become central in humanitarian responses to refugee situations. Based on a two‐year longitudinal qualitative study, this article explores how South Sudanese refugee youngsters in Uganda imagine and act towards their futures, and questions what resilience and self‐reliance can mean in the temporary space of the refugee camp. Youngsters need to become accustomed to a future without substantial progress, or be ready to play the game of chance. As such, a resilience and self‐reliance policy not only reveals the powerlessness of refugee youth, but also the limits of a humanitarian project to seek actual solutions to refugee situations.

Background/Aim: Evidence-based guidelines for substance abuse treatment are available in many European countries. In Belgium, no such guidelines have been developed yet at a national level although their need has repeatedly been emphasized. This study aims to assess Belgian practitioners' attitudes concerning evidence-based guidelines for substance abuse treatment. Methods: A survey was conducted with clinical coordinators in a representative sample of 60 agencies dispensing specialized treatment to alcohol and drug abusers. Results: The study revealed that evidence-based guidelines are rarely used in substance abuse treatment in Belgium, but that many agencies use self-developed guidelines. The attitude concerning evidence-based guidelines is mainly positive. Practitioners' concerns mostly relate to the risk of disregarding their clients' needs and the constraining character of using evidence-based guidelines. The study also reveals some barriers concerning the implementation of evidence-based guidelines and suggests some strategies to overcome them. Conclusion: Practitioners appear to be prepared to work with evidence-based guidelines. When developing, adapting and implementing evidence-based guidelines for substance abuse treatment, it is important for policy makers to take into account the state of the art in clinical practice as well as practitioners' needs and requirements.

Considering the complexity of drug dependence and the multiplicity of services for substance abusers, co-ordination and continuity of care are important prerequisites for the quality of substance abuse treatment. However, several shortcomings concerning co-operation, communication and co-ordination have been reported in most European countries. In this study, different aspects of co-ordination and continuity (e.g. first contact, intake, referral, follow-up) have been studied among all services (n = 27) that are addressed by substance abusers in a clear-cut region in Belgium. Structured interviews with key informants show a lack of systematic communication between services and a lack of follow-up of clients. A study of 57 client records in 12 of these 27 centers illustrates that relatively little information is registered concerning the course of the treatment process and that only 10% of all client files contain a treatment plan. Following the introduction of a formalized plan that was regarded as a precondition for systematizing and optimizing communication between services, key informants considered the implementation of a model of case management as an appropriate way of improving co-ordination and continuity of care in this region.

AbstractBackgroundRecovery is a widely accepted paradigm in mental health care, whilst the correctional and forensic–psychiatric field is still searching for foundations for its implementation. Knowledge regarding recovery of persons with intellectual disabilities in secure contexts is limited. This study assesses recovery needs and resources among persons with intellectual disabilities labelled not criminally responsible and investigates the impact of the judicial label on recovery processes.MethodsA sample of 26 individuals was composed purposively, and in‐depth interviews were conducted. Recurrent themes were identified using thematic analysis.ResultsTraditional recovery themes emerged from the narratives, next to aspects of recovery in a forensic or correctional context. However, the operationalization and proportional impact are specific for this sample.ConclusionsThe social dimension overarches all other recovery dimensions. The integration of an explicit social rhetoric is imperative, including contextual, relational, interactional and societal dimensions. This offers pathways to reverse the traditional, paternalistic model of exclusion and classification.

<b><i>Background:</i></b> Substance users' quality of life (QoL) is influenced by several variables, including psychiatric comorbidity and addiction severity. Thus far, the impact of the type of dependence (alcohol, drug or dual dependence) remains unclear. Therefore, the objectives of the study were to evaluate QoL in a clinical sample of alcohol-, drug- and dual-dependent patients and to assess the independent impact of psychiatric comorbidity, addiction severity and type of dependence on QoL. <b><i>Methods:</i></b> Face-to-face interviews with 274 patients admitted to residential substance abuse treatment were conducted using the European Addiction Severity Index (EuropASI), the Mini-International Neuropsychiatric Interview and the Assessment of Personality Disorders self-report questionnaire. <b><i>Results:</i></b> Multivariate analyses showed that anxiety, mood or personality disorder, employment status and the severity rating on the EuropASI domain alcohol use were associated with overall QoL. Gender, anxiety disorder and the severity ratings on the EuropASI domains alcohol use, drug use, physical health and emotional and psychological health were associated with overall perception of health. <b><i>Conclusion:</i></b> Addiction severity and psychiatric comorbidity explained the greatest amount of QoL variance, whereas the type of dependence did not play a central role.

<b><i>Background:</i></b> Cocaine-dependent individuals (CDI) display increased impulsivity. However, despite its multifactorial nature most studies in CDI have treated impulsivity monolithically. Moreover, the impact of attention-deficit/hyperactivity disorder (ADHD) has often not been taken into account. This study investigates whether CDI with ADHD (CDI+ADHD) differ from CDI without an ADHD diagnosis and healthy controls (HC) on several impulsivity measures. <b><i>Methods:</i></b> Thirty-four CDI, 25 CDI+ADHD and 28 HC participated in this study. Trait impulsivity was assessed with the motor, attentional and non-planning subscales of the Barratt Impulsiveness Scale (BIS-11). Neurocognitive dimensions of impulsivity were examined with the stop signal task (SST), delay discounting task (DDT) and information sampling task (IST). <b><i>Results:</i></b> Relative to HC, both CDI and CDI+ADHD scored higher on all BIS-11 subscales, required more time to inhibit their responses (SST) and sampled less information before making a decision (IST). Greater discounting of delayed rewards (DDT) was only found among CDI+ADHD. Compared to CDI without ADHD, CDI+ADHD scored higher on the BIS-11 non-planning and total scale and showed higher discounting rates. <b><i>Conclusion:</i></b> CDI score higher on several indices of impulsivity relative to HC, regardless of whether they have concomitant ADHD or not. CDI+ADHD are specifically characterized by a lack of future orientation compared to CDI without ADHD.