The Dutch national drug treatment strategy places an emphasis on the empowerment of clients and their reintegration and self-regulation.
Responsibility for the organisation, implementation and coordination of addiction care in the Netherlands has been delegated to regional and local authorities and is part of the broader mental health care agenda. Drug treatment is provided by specialised addiction care organisations. Municipal public health services, general psychiatric hospitals, several religious organisations and some private clinics also offer care for people with substance use problems. Since the reorganisation of mental health care in 2014, drug treatment has been provided in a three-step approach: frontline support from a general practitioner or a general practice mental health worker, followed by generalist primary mental health care and specialised mental health care. Some treatment providers deliver inpatient treatment programmes.
In general, funding for drug treatment is provided by health insurance, while the public budget for social support at the national and local levels funds specific programmes, such as heroin-assisted treatment and supported living.
The options for drug treatment interventions in the Netherlands are diverse. Opioid substitution treatment (OST), complemented by psychosocial treatment, is the treatment of choice for opioid dependence, and OST with methadone has been available since 1968. Heroin-assisted treatment (HAT) is provided at 17 outpatient treatment units in 16 cities (668 treatment slots), while methadone-based treatment is available from various treatment providers, including office-based practitioners and mobile units. In case of gamma-hydroxybutyrate (GHB) dependence, treatment with medical GHB is available, and research is being done into relapse prevention by means of baclofen.
Available psychosocial treatments in drug treatment centres include motivational interviewing, relapse prevention techniques, cognitive-behavioural therapies, and family, community and home-based therapies. New treatment options have been introduced for young cannabis users, people with multiple (dependencies and mental health) problems, crack cocaine users and GHB users. In addition, new treatment settings for homeless drug users in several municipalities have been developed.
In 2015, more than 31 000 people received drug treatment in the Netherlands, mainly in outpatient settings. Around one third of them were treated for primary cannabis use, while opioid users constituted the second largest group of treatment clients, followed by cocaine users.
Cannabis users also formed the largest group among those who entered treatment in 2015. Primary cocaine users were the second largest group, followed by primary opioid users.
Fewer than 2 out of 10 treated opioid users entered treatment in 2015, and most were already in long-term treatment programmes, such as OST. Moreover, the number of new treatment entries attributable to opioid use has reduced and the mean age of opioid treatment clients has increased, indicating an ageing of the opioid-using population in the Netherlands. According to the latest available data, in 2014, close to 7 500 clients received OST, a large decrease from 2011. It should be noted that the steep decrease after 2011 is probably related to changes in registration. All OST clients were treated in methadone maintenance programmes, some of which also received heroin-assisted treatment.