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. In Belgium, competences concerning treatment are split between the federal and federate governments, but are coordinated at the national level. A recent state reform is being applied progressively throughout the country and will affect the organisation of drug treatment facilities. 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-speaking Gommunity, 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 also become available (online help and chat).
Inpatient treatment consisting of detoxification, stabilisation and motivation, and social reintegration is offered at hospital-based residential drug treatment units and specialised crisis intervention centres, 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 in specialised outpatient drug treatment centres. However, the overall number of clients in treatment is estimated to be higher, since the register does not yet collect data from GPs and does not report on long-term treatment clients.
Of the total treatment entrants in 2016, approximately one third were treated for cannabis-related problems, one third for cocaine and other stimulants and one third for opiates and hypnotics/sedatives. The long-term trend indicates that the proportion of opioid clients has been decreasing since 2011, whereas the proportion of cocaine and cannabis clients is increasing.
Accordingly, the number of people receiving OST has been falling in Belgium since 2013, and an estimated number of 16 560 people received OST in 2016. The majority of OST clients receive methadone.