[Impact of a smoke free policy on smoking behaviour of clients in treatment for substance use disorder]. / Impact van rookvrijbeleid op rookgedrag van cliënten in behandeling voor stoornis in middelengebruik.

BACKGROUND: In 2018 Jellinek became a smoke free institution. By implementing ‘Jellinek Smoke free’ in all locations (15), a policy has been implemented to facilitate smoking cessation in clients with a comorbid tobacco use disorder seeking treatment for substance use disorders at Jellinek. AIM: To investigate whether the implementation of the new policy impacted smoking behaviour of clients in treatment for substance use disorders at Jellinek. METHOD: Based on data from anonymized client files, changes in smoking behaviour (cessation or reduction) were analysed for clients with other addictions who started treatment in 2016 versus clients who started in 2019 - after the implementation of the new smoke free policy. Comparative analyses were conducted on the population as a whole, per type of treatment (outpatient care, residential care, Minnesota, outreaching care) as well as per type of smoker (light, moderate, heavy). RESULTS: In the client population as a whole, significantly more people stopped smoking in 2019 (22%) in comparison to 2016 (16%) and there was a trend toward statistical significance with regard to reduction. When a cessation period was part of treatment, significantly more clients stopped and decreased the number of cigarettes a day. Moreover, light and moderate smokers (≤ 20 cigarettes a day) stopped and reduced significantly more in 2019 (32%) than in 2016 (23%). In outpatient care, outreaching care and with heavy smokers (> 20 cigarettes a day), there was no significant difference in percentage of cessation and reduction between 2016 and 2019. CONCLUSION: After implementing Jellinek Smoke free, significant changes in smoking behaviour occurred in the client population as a whole with a comorbid tobacco use disorder, in treatments where a cessation period was part of treatment as well as with light and moderate smokers.

[Psychological treatment in substance use disorders: focus for the future]. / Psychologische behandeling van verslaving: focus voor de toekomst.

BACKGROUND: Cognitive behavioural therapy and motivational interviewing are evidence-based treatments for substance use disorders (SUDs). However, treatment for SUDs is still at an early stage and patients are being deprived of many new forms of treatment from which they could benefit. Low treatment compliance and limited treatment success are also problems that need attention. AIM: To find out from the literature how these problems can be or are being tackled and to formulate suggestions for improvements. METHOD: We reviewed the literature, collecting and formulating suggestions about possible improvements in the treatment of SUD patients. We mention strategies to reduce the treatment gap, to improve treatment compliance and treatment results. RESULTS: According to the literature, clinics and hospital wards can introduce more structured screening for substance use disorders. Internet treatment has proven to lower the threshold for treatment. Patients reluctant to begin treatment can be motivated by their loved ones (via CRAFT) to join treatment programmes. E-health is a promising technique for enhancing patients' compliance with tasks that can be performed at home. The addition of contingency management can increase treatment compliance and encourage abstinence. Furthermore, the treatment of comorbid psychiatric disorders and the provision of continuing-care are strategies that are likely to optimise treatment results. CONCLUSION: A number of viable strategies are available or are being developed for improving the treatment of SUD patients. Dutch research has made an important contribution in this area.

Does psychosocial treatment enhance the efficacy of acamprosate in patients with alcohol problems?

AIMS: Acamprosate in combination with psychosocial treatment has been shown to be effective for the treatment of alcohol dependence. The goal of the present study was to determine whether the addition of psychosocial intervention to the medical prescription of acamprosate contributes to treatment outcome. METHODS: Patients (n = 248) meeting DSM-IV criteria for alcohol dependence or abuse were recruited in 14 outpatient treatment centres and randomized into one of three treatment conditions: acamprosate; acamprosate plus minimal intervention aimed at motivational enhancement (3-weekly sessions of 20 min); and acamprosate plus brief cognitive behavioural therapy (7-weekly sessions of 60 min). Acamprosate was prescribed for 28 weeks, medically monitored by a physician on six occasions lasting 10 min. Drinking behaviour, medication compliance and psychological distress were assessed throughout the treatment period. Follow-up assessment was undertaken 6 months after termination of pharmacological treatment. RESULTS: Of 241 patients with intention to treat (ITT), 114 (47.3%) remained in treatment for the full 28 weeks; 169 of the ITT population (70.1%) were seen for follow-up. No statistically significant differences were found between treatment groups for any of the drinking outcomes either at the end of the 28 weeks of treatment or at 6-month follow-up. There were no statistically significant differences in medication compliance, drop-out rates, or psychological distress. However, a significant interaction effect was observed between treatment centre and treatment group, indicating that brief interventions were differentially effective in different treatment centres. CONCLUSIONS: A clear supplemental value of minimal and brief psychosocial interventions to the prescription of acamprosate was not demonstrated. The widely held belief that pharmacotherapy for alcohol dependence should always be combined with psychosocial intervention is debatable and merits further research.