Topics
1. National context
In the Netherlands, the responsibility for the organisation, implementation and coordination of addiction care is delegated to regional and local authorities. Drug treatment is mainly delivered by non-governmental organisations on a regional level, followed by private organisations including physicians, hospitals and private clinics. Drug treatment is also provided in regional public hospitals. In the past decade, however, the number of addiction service providers has reduced considerably due to many mergers which took place in the Dutch mental healthcare and addiction care, for economic reasons. In 2009, addiction care was provided at 13 regional organisations. Additional organisations that take care of addicted persons are the municipal health services, general psychiatric hospitals, several religious organisations, and some 10 private clinics. The private clinics and the addiction units in general psychiatric hospitals do not participate yet in the National Alcohol and Drugs Information System (LADIS).
Funding for drug treatment is mainly provided by the public budget at national and local level. Detoxification and residential treatment is funded by health insurance.
Possibilities for drug treatment interventions in the Netherlands are diverse. Outpatient substitution treatment is dominant for opiate dependence. Psychosocial interventions are again more frequently provided to complement substitution treatment in order to attain longer term effectiveness and to reduce relapses and to promote social reintegration.
Types of frequently-used psychosocial treatments in drug treatment centres are motivational interviewing, relapse prevention techniques, cognitive-behavioural therapies, family, community and home-based treatment therapies.
Since 1968, methadone is the most commonly prescribed substitution substance. Heroin-assisted treatment (HAT, introduced in 1998) and high-dosage buprenorphine treatment (introduced in 1999) are also available. HAT is only provided in specialised treatment centres and is meant for a restricted and controlled group of treatment-resistant opiate users. Methadone, on the other hand, is available via various outpatient treatment providers, including office-based practitioners and mobile units.
According to the latest available data (2009), a total of 10 624 clients were in opioid subtitution treatment, of whom an estimated 9 909 were on methadone maintenance treatment, including 715 clients receiving diamorphine prescriptions.
2. Treatment registries and monitoring systems
The Dutch Alcohol and Drug Information System (LADIS) has been operational since 1986 and covers 95% of all alcohol and drug treatment out-patient services in the Netherlands. From 1994 it has been operating as a population-based register in which contact episodes of individual clients can be linked over time with a unique code made anonymous by encryption. With the acceptance of the welfare law in 1998, the flow of various categories of data (diagnostic, demographic, treatment and evaluation) and the continuity of LADIS have been secured. Data capture, processing and quality control are highly automated. The information from LADIS concerns annual reports as well as numerous profiles of various groups of clients (Ouwehand and van Alem, 1999). A National Centre for Substance Registration (LCMR) is being formed and should deliver data on clients in pharmacologically-assisted treatment from 2006 onwards. So far, no data from the LCMR have been made. There were plans for a new registration system Zorgis but these plans have been replaced by plans for a new registration system called ALI, but these are still plans for the future. ALI will be the registration systems for the forthcoming Diagnosis Treatment Combinations.
3. Treatment demand
| Clients in treatment | 2007 | 2008 | 2009 |
|---|---|---|---|
| Number of all clients entering treatment | 8718 | 10132 | 11650 |
| % of which for opioid use | 19.7 | 18.6 | 18.2 |
| % of which for cocaine use | 31.8 | 33.1 | 31.4 |
| % of which for cannabis use | 37.1 | 37.6 | 38.4 |
| % of which for stimulants use (other than cocaine) | 8.4 | 6.0 | 5.9 |
| Number of new clients entering treatment | 6078 | 6547 | 6196 |
| % of which for opioid use | 11.8 | 9.5 | 7.9 |
| % of which for cocaine use | 29.1 | 30.2 | 26.8 |
| % of which for cannabis use | 44.9 | 46.6 | 50.4 |
| % of which for stimulants use (other than cocaine) | 10.3 | 7.1 | 6.6 |
| Notes: The variation across time, in particular with regard to the absolute numbers of clients in treatment, should be interpreted with caution as coverage data may have changed over time. For further information on coverage details please refer to the relevant EMCDDA Statistical Bulletin. 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 2007 (Tables TDI 4 and 5), 2009 and 2011 (Tables TDI 2 and 5). | |||
4. Treatment provision
| Type of treatment | Availability |
|---|---|
| Psychosocial out-patient interventions | Extensive |
| 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 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. | |
| Opioid substitution treatment | 2007 | 2008 | 2009 |
|---|---|---|---|
| Number of clients in opioid substitution treatment | 12715 | N. Av. | 10624 |
| of which with methadone | 12000 | N. Av. | 9909 |
| of which with buprenorphine | N. Av. | N. Av. | N. Av. |
| 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) | 1968 |
| Buprenorphine (HDBT) | 1999 |
| Heroin assisted treatment,including as trials | 1998 |
| Slow-release morphine | N. Av. |
| Buprenorphine/naloxone combination | N. Av. |
| Notes: For a detailed European overview please see Table HSR-1 in the EMCDDA Statistical Bulletin 2011. ‘N. App.’ stands for ‘Not applicable’. ‘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. | |
| 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 |
| Do office-based specialised medical doctors have the right to initiate the prescription of substitution treatment? | Yes | Yes |
| 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 Netherlands
- Country overview for Netherlands
- 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.
- Ouwehand AW and van Alem VCM (1999). The Dutch National Alcohol and Drugs Database: Progress in Monitoring, Monitoring in Progress, European Addiction Research 1999;5:173-178
Treatment inventories
Treatment research centres
- Amsterdam Institute of Addiction Research (EN)
- Nijmegen Institute for Scientist-Practitioner in Addiction (NISPA) (NL)
- Parnassia Addiction Research Centre (PARC) (NL)
- Novadic-Kentron (NL)
- Trimbos Institute (NL, EN)
- Addiction Research Institute Rotterdam (IVO) (NL)
- Central Committee on the Treatment of Heroin Addicts (NL, EN)
- ZonMw (NL, EN)
