Topics
1. National context
The national drug strategy document, the ‘Federal drug policy note of 2001’, specifies that the treatment offer should be based on a multidisciplinary approach adapted to the complex bio-psychosocial problem of addiction. In Belgium, different levels of decision-making provide funding for treatment, including the regional and federal governments. For example, at the federal level, the Federal Public Service for Public Health, Food Chain Safety and Environment provides the financing for a number of therapeutic communities, crisis centres and day centres which were set up in the 1970s and have expanded their capacities in recent years. Meanwhile, mental health centres, for example, are financed by the Walloon Region or by the Flemish community.
Different services for treatment and/or healthcare for drug users are available in a large part of the country, except in the German community where specialised treatment centres for drug users are not implemented. Overall, treatment offerings encompass specialised inpatient treatment centres, outpatient centres, low threshold services, units in psychiatric hospitals or psychiatric units in general hospitals, general welfare centres in general health services and specialised self-help groups. Eight social reception centres are located in the major cities and provide a low threshold access to treatment, counselling and outreach. Most after-care and re-integration programmes are delivered in outpatient and inpatient structures. For example, there are halfway houses in therapeutic communities, day treatment in drug centres and also employment rehabilitation programmes.
Although methadone substitution treatment was introduced in 1994 and buprenorphine in 2003, only in 2006 was a Royal Decree on substitution treatment adopted, which mentions methadone and buprenorphine as substitution substances. In the Flemish Region, most methadone maintenance programmes are provided by low threshold, ambulatory and outpatient drug services. However, in smaller towns and rural areas, methadone may also be prescribed by GPs under the supervision of drug services In the French community, a broad range of agencies such as low-threshold facilities, GPs, outpatients specialised units and mental health facilities offer access both to methadone and buprenorphine, but GPs still play the most important role. According to the latest available estimates (2007), a total of 16 275 clients were on substitution treatment, 15 383 of which were on methadone. In 2007, a pilot heroin-assisted treatment project was conceived in Liege with 200 problem heroin users, which aims to effectively start delivering treatment in 2010.
2. Treatment registries and monitoring systems
A national monitoring system for clients in medically-assisted treatment is not in place yet, but foreseen under the Royal Decree of 19/3/2004 on substitution treatments and in a testing phase. Regarding clients in drug-free treatment, harmonisation of registration at national level started in the framework of the Treatment Demand Indicator (TDI)
3. Treatment demand
| Clients in treatment | 2007 | 2008 | 2009 |
|---|---|---|---|
| Number of all clients entering treatment | N. Av. | N. Av. | 8503 |
| % of which for opioid use | 35.7 | ||
| % of which for cocaine use | 15.4 | ||
| % of which for cannabis use | 31.6 | ||
| % of which for stimulants use (other than cocaine) | 11.4 | ||
| Number of new clients entering treatment | N.Av. | N. Av. | 3198 |
| % of which for opioid use | 17.0 | ||
| % of which for cocaine use | 16.9 | ||
| % of which for cannabis use | 47.3 | ||
| % of which for stimulants use (other than cocaine) | 13.5 | ||
| Notes: Data do not cover Brussels Capital Region. ‘N. Av.’ stands for ‘No information available’. For an explanation of terms used, see the definitions of terms. Sources: Reitox national reports 2009 and TDI tables (ST34) V. 1.0-2007, questions 13.1.1 and 13.1.2. EMCDDA Statistical Bulletin 2011 (Tables TDI 2 and 5). | |||
4. Treatment provision
| Type of treatment | Availability |
|---|---|
| Psychosocial out-patient interventions | Full |
| Psychosocial in-patient interventions | Full |
| Detoxification | Full |
| Substitution/maintenance treatment | Full |
| Notes: For an explanation of terms used, see the definitions of terms. Based on question 3.1 " Please assess the current availability of the treatment interventions below in relation to the user needs, judging the degree to which treatment capacity matches the demand" of Structured Questionnaire SQ27P1 on 'Treatment programmes'. Rating Scale (level of availability):
Reitox national reports 2008, Structured Questionnaire on 'Treatment programmes'(SQ27P1), submitted in 2008 and 2005, Standard Tables 24 (ST24) on 'Treatment availability' submitted in 2004, 2006 and 2008. | |
| Opioid substitution treatment | 2007 | 2008 | 2009 |
|---|---|---|---|
| Number of clients in opioid substitution treatment | 16275 | N.Av. | N.Av. |
| of which with methadone | 14714 | ||
| of which with buprenorphine | 892 | ||
| Notes: For a detailed European overview please see Table HSR-3 in the EMCDDA Statistical Bulletin 2011. ‘N. Av.’ stands for ‘No information available’. For an explanation of terms used, see the definitions of terms. Sources: Reitox national reports 2009, Structured Questionnaire on 'Treatment programmes'(SQ27P1), submitted in 2008 and 2005, Standard Tables 24 (ST24) on 'Treatment availability' submitted in 2004, 2006 and 2008. | |||
| Applied substances in opioid substitution treatment | Officially introduced in |
|---|---|
| Methadone (MMT) | 1994 |
| Buprenorphine (HDBT) | 2003 |
| Heroin assisted treatment | N.App. |
| Slow-release morphine | N.App. |
| Buprenorphine/naloxone combination | N.App. |
Notes: | |
| Legal framework of opioid substitution treatment | Methadone | Buprenorphine |
|---|---|---|
| Do office-based medical doctors have the right to initiate the prescription of substitution treatment? | Yes | Yes, but only in the French community |
| Do specialised medical doctors have the right to initiate the prescription of substitution treatment? | Yes, but only in the Flemish community | Yes, but only in the Flemish community |
| Notes: For a detailed European overview please see Table HSR-2 in the EMCDDA Statistical Bulletin 2011. For an explanation of terms used, see the definitions of terms. 'Specialised medical doctors' refers to specifically trained or accredited office-based medical doctors. Sources: Reitox national reports 2009, Structured Questionnaire on 'Treatment programmes'(SQ27P1), submitted in 2008 and 2005, Standard Tables 24 (ST24) on 'Treatment availability' submitted in 2004, 2006 and 2008. | ||
Treatment availablity in Europe
The graphic below presents an overview of treatment provision by different types of service (psychosocial outpatient, substitution, psychosocial inpatient and detoxification) in different European countries and can be used for comparative purposes. Click on the thumbnail to view it.
Figure 1: Treatment availability in Europe, 2007
5. References and links
Related EMCDDA resources
- Health and social responses statistics
- Treatment demand statistics
- Annual report on the state of the drugs problem
- National reports for Belgium
- Country overview for Belgium
- Drug treatment responses page
- Best practice portal
- Treatment demand key indicator page
For a comprehensive overview on drug treatment systems, availability and utilisation in Europe, please consult the 2008 online report on ‘Quality of treatment services in Europe — drug treatment — situation and exchange of good practice’ published by the Directorate General for Health and Consumers.
External links
Please note that the EMCDDA is not responsible for the content of external sites.
- CTB/ODB (NL, FR) - Concertation Toxicomanies Bruxelles
- Eurotox (FR)
- Citadelle (FR) - Réseau d'aide en toxicomanie
- Réseau ALTO (FR)
- Adic (NL) - Antwerp drug intervention center
- De Spiegel (NL)
- De Kiem (NL)
Treatment inventories
- Guide Social (FR)
- Sociale Kaart (NL)
Treatment research centres
- University of Ghent (NL, EN)
- University of Antwerp (NL)
- University of Leuven (NL, EN)
- University of Liège (FR)
- University of Brussels (FR)
- Vereniging voor Alcohol- en andere Drugproblemen (NL, FR, EN)
- De Sleutel (NL, EN)
