The Federal Drug Policy Note of 2001 specifies that treatment services should be based on a multidisciplinary approach that is adapted to the complex bio-psychosocial problem of drug dependency. This approach was further emphasised in the Communal Declaration of 2010 and elaborated in the Joint Statement of the Inter-Ministerial Conference on Drugs held in 2010. In Belgium, competences concerning treatment are split between the federal and federate governments, but are coordinated nationally. A new state reform is being applied progressively throughout the country and will impact the organisation of drug treatment organisations. In Flanders, the specialised drug treatment sector will become part of the general mental health sector with a strong emphasis on cooperation and networking, which may also influence the organisation of drug treatment within the sector.
A range of services for drug use treatment and/or healthcare is available in a large part of the country, except in the German community, where there are no specialised treatment centres for drug users. Specialised outpatient care is provided by consultation and day-care centres and by medical and social care centres. In general, these centres provide low-threshold help or social reintegration services, including a wide range of psychosocial, psychological and healthcare services, including opioid substitution treatment (OST). General and mental healthcare, based on psychosocial interventions, is provided by centres for mental health, sometimes with a specialised focus on drug dependence. In Belgium, general practitioners (GPs) remain the first-line health services for accessing drug treatment, while in the French community they play a crucial role in diagnosis and the prescription of OST. Both methadone and buprenorphine are available for OST. Recently, online treatment interventions have become also available (online help and chat).
Drug treatment in Belgium: settings and number treated
NBYear of data 2015.
Trends in percentage of clients entering specialised drug treatment, by primary drug in Belgium
Opioid substitution treatment in Belgium: proportions of clients in OST by medication and trends of the total number of clients
NBYear of data 2015.
Inpatient treatment consisting of detoxification, stabilisation and motivation, and social reintegration is offered at hospital-based residential drug treatment units and specialised CICs, which provide care based on case management principles at specialised hospital units or through long-term residential treatment services. Aftercare and reintegration programmes are delivered in outpatient and inpatient settings. Examples include halfway houses in therapeutic communities, day treatment in drug centres and employment rehabilitation programmes.
Action has recently have been taken to improve treatment for clients with a dual diagnosis or polydrug use and for children and young people. A pilot project exploring a community reinforcement approach combined with a voucher treatment method has shown promising results for the treatment of cocaine users. A new treatment programme for young cannabis users has also been piloted.
Available data from the treatment demand register in Belgium indicate that slightly more than half of all clients enter treatment at outpatient specialised drug treatment centres. However, the overall number of clients in treatment is estimated to be higher, since the register does not collect data from GPs and does not report on long-term treatment clients.
In general, an increase in cannabis and cocaine treatment demands and a reduction in opioid treatment demands have been observed in Belgium among all treatment clients in specialised treatment services since 2011.
In Belgium, the estimated number of OST clients has declined since 2013, and the most recent data indicate that majority of OST clients receive methadone. Between 2011 and 2013, an open-label randomised controlled trial was carried out comparing heroin-assisted treatment with methadone maintenance treatment. The study concluded that the use of heroin-assisted treatment should remain a second-line treatment for patients who are resistant to methadone, and it was recommended that a heroin-assisted treatment programme be set up.