17th International EWODOR Symposium “Pathways and challenges to addiction recovery: The role of treatment, self-help and other mechanisms of change” WELCOME SESSION On the need for recovery-oriented research, practices and policies Wouter Vanderplasschen, prof. dr. VAKGROEP ORTHOPEDAGOGIEK ONDERZOEKSGROEP HERSTEL EN VERSLAVING ON THE NEED FOR RECOVERY- ORIENTED RESEARCH, PRACTICES AND POLICIES Wouter Vanderplasschen, prof. dr. 1. WELCOME TO GHENT FOR THE XVIITH EWODOR SYMPOSIUM 5 ERIC BROEKAERT (1951-2016), EWODOR’S FOUNDER AND DRIVING FORCE EWODOR ̶ Founded in 1983 ̶ European Working Group on Drugs Oriented Research ̶ One of the oldest networks of drug researchers and practitioners in Europe ̶ Scientific branch of the EFTC ̶ Close collaboration between research and practice ̶ Treatment organisation supporting persons with drug problems and a university ̶ Vehicle to promote research-practice interactions and to exchange ideas regarding recovery-oriented practices in the field of substance abuse treatment 2. WHY RECOVERY? 8 BETTY FORD INSTITUTE CONSENSUS PANEL, 2007 “Recovery from substance dependence is a voluntarily maintained lifestyle, characterized by sobriety, personal health, and citizenship.” UK DRUG POLICY COMMISSION RECOVERY CONSENSUS GROUP, 2008 “The process of recovery from problematic substance use is characterised by voluntarily- sustained control over substance use, which maximises health and wellbeing and participation in the rights, roles and responsibilities of society.” MENTAL HEALTH RECOVERY Anthony (1993) defined recovery as "a deeply personal, unique process of changing one’s attitudes, values, feelings, goals, skills and/or roles. It is a way of living a satisfying, hopeful, and contributing life even with limitations caused by the illness. Recovery involves the development of new meaning and purpose in one’s life as one grows beyond the catastrophic effects of mental illness." AT LEAST TWO TYPES OF RECOVERY (SLADE ET AL., 2010) ̶ The first involves clinical recovery – when someone 'recovers' from the illness and no longer experiences its symptoms ̶ The second involves personal recovery – recovering a life worth living (without necessarily having a clinical recovery). It is about building a life that is satisfying, fulfilling and enjoyable. 3. WHY DO WE NEED A RECOVERY-ORIENTED APPROACHES? 13 ̶ Limitations of available substance use services: ̶ <3% of all persons entering MMT abstinent after 5 years (DORIS- study) ̶ High costs of (residential) treatment, poor and unsure outcomes ̶ Intergenerational dependence ̶ Often “treated as a junkie” ̶ Fragmented services + need for wrap-around support ̶ Involvement of service users + experts by experience generally limited ̶ Underutilisation of strengths and personal and social recovery capital ̶ Personal vs. societal treatment objectives (“parked on methadone”) ̶ Alternative to the chronic, relapsing brain disease model ̶ Support needed that is characterized by connectedness, hope, identity, meaning and empowerment (Leamy et al., 2012) 15 SOME RECENT DEVELOPMENTS TOWARDS RECOVERY-ORIENTED SUPPORT ̶ Emerging recovery movement in the US, Australia, Scotland, England, … ̶ Development of recovery-oriented drug and treatment policies in the UK, the Netherlands, Flanders, etc.. ̶ Renewed interest in AA, NA, and other types of self-help ̶ Private companies/ngo’s that focus on continuity of care rather tahn on primary treatment ̶ Recovery management check-ups ̶ Increased use of technology-based interventions ̶ Community-based support and activating the social network ̶ Growing research base on recovery ̶ Recovery-oriented systems of care RECOVERY PATHWAYS IN THE UK, THE NETHERLANDS AND BELGIUM WWW.REC-PATH.CO.UK FOCUS ON 5 POTENTIAL PATHWAYS TO RECOVERY 1. ‘natural recovery’ 2. 12-step self-help 3. Other self-supported recovery 4. Outpatient 5. Residential NEED FOR: ̶ Recovery-oriented policies ̶ Recovery-oriented practices ̶ Recovery-oriented research ̶ For supporting better, contributing lives and more inclusive societies, despite the limitations caused by addictions Prof. dr. Wouter Vanderplasschen Hoofddocent VAKGROEP ORTHOPEDAGOGIEK Ghent University @ugent E [email protected] Ghent University T +32 9 331 03 13 www.ugent.be Treatment and recovery and the reform of the mental health and addiction field in Belgium Dirk Vandevelde, Director of De Kiem (Belgium) No presentation available EWODOR: The oldest drug research Network in Europe Rowdy Yates, em. prof. EWODOR: The Oldest Drugs Research Network in Europe P. R. Yates, Honorary Senior Research Fellow, Scottish Addiction Studies, Faculty of Applied Social Science, University of Stirling, Scotland. President, European Federation of Therapeutic Communities Executive Director, European Working Group on Drugs Oriented Research e-mail: [email protected] url: https://eftc.ngo/ Founded in 1983, Rotterdam, The Netherlands Charles Kaplan, Eric Broekaert & Martien Kooyman saw a need to improve the scientific outputs from European therapeutic communities. Sustained & Developed for 35 years Eric Broekaert & Vera Segraeus extended the scope of EWODOR to encourage greater interest amongst academics and build bridges between the research and practitioner communities EWODOR - Early Symposia • 1983 – Erasmus UniversityRotterdam, The Netherlands • 1984 – Erasmus UniversityRotterdam, The Netherlands • 1985 – Erasmus UniversityRotterdam, The Netherlands • 1986 – Erasmus UniversityRotterdam, The Netherlands • 1988 – Erasmus UniversityRotterdam, The Netherlands • 1989 – Universiteit Gent, Belgium EWODOR Symposia in the 90s • 1990 – Universiteit Gent, Belgium • 1991 – La Sapienza Universita di Roma, Italy • 1993 – Universidad de Deusto (Bilbao), Spain • 1994 – Universidad de Deusto (Bilbao), Spain • 1996 – University of Stirling, Scotland • 1998 – Universidade do Porto, Portugal • 1999 – Universiteit Gent, Belgium EWODOR Symposia in the 00s • 2000 – Universiteit Gent, Belgium • 2001 – Universiteit Gent, Belgium • 2002 – CeIS Modena, Italy • 2003 – University of Stirling/Phoenix Futures, Scotland • 2004 – Aarhus Universitet, Denmark • 2005 – Universteit Gent (Blankenberge), Belgium • 2006 – STAKES (Helsinki), Finland • 2007 – Institutt fur Klinisk Medisin (Oslo), Norway • 2008 – Linnaeus University (Vaxjo), Sweden • 2009 – University of Stirling/Phoenix Futures, Scotland EWODOR Symposia in the 10s • 2011 – Universidad de Barcelona/Proyecto Hombre, Spain (Catalonia) • 2012 – Aristotle University/KETHEA(Thessaloniki) Greece • 2014 – Trinity College Dublin/Coolmine TC, Ireland • 2016 – Lumsa Universita/Dianova (Rome) Italy • 2018 – Universiteit Gent/ De Kiem TC, Belgium EWODOR Symposia: Changes and Trends • A total of 28 symposia/meetings (not 17!!!!) • An increasing emphasis on co-organising with TCs • An increasing emphasis on publishing proceedings in peer-reviewed journals • Proceedings published in various monographs and in International Journal of Social Welfare, European Addiction Research, International Journal of Therapeutic Communities, Journal of Substance Abuse, (+ edited book published by Universidad de Barcelona Medical School). EWODOR: Milestones • IPTRP – 1994. A major international comparative study of parallel disorders amongst TC residents • Involved academics from 9 European universities and utilised 28 separate field sites • 1996 – EWODOR establishes an online discussion forum for addiction researchers • 2003 – EWODOR pilots a multinational online course using lecturers from 5 European universities • Original Goals – improve scientific understanding amongst TC staff; encourage addiction interest amongst academics; and create a bridge between the research and practitioner communities EWODOR 2018 Eric Broekaert 1951–2016: The Lord of the Dance Drug treatment demand and drug- related problems in Belgium Lies Gremeaux, dr. Drug Treatment demand and drug-related problems in Belgium 17th International EWODOR Symposium - 2018 dr Lies Gremeaux Belgian Reitox national focal point Epidemiology and public health SCIENSANO Mission of EMCDDA & the Reitox Network National Focal Points in 28 Member States (+ Norway and Turkey) Collect objective and reliable information on the drug situation Support an evidence-based drug policy Information system for national and international policy makers & professionals The drug problem in Belgium at a glance Overview: 1. Treatment entries in Belgium: Key data and trends 2. Current situation and developments for the main substances of (ab)use 3. Conclusions TREATMENT OF SUBSTANCE USE IN BELGIUM: WHAT WE KNOW (AND WHAT WE DON’T KNOW) Drug treatment in Belgium: setting and number treated A. Treatment demand indicator (TDI) register • Key Indicator EMCDDA • New entries for problematic use of alcohol or illicit substances = incidence! • Registration since 2011 • Use of the national identification number Drug treatment in Belgium: setting and number treated (2017) A. Treatment demands (Outpatient & Inpatient) : 12,037 Illicit Substances Drug treatment in Belgium: setting and number treated (2017) A. Treatment demands (Outpatient & Inpatient) : 12,037 B. Opioid Substitution Treatment (OST) : 16,453 4% 15% Methadon Buprenorphine both 81% Source: OST register, Sciensano Drug treatment in Belgium: setting and number treated (2017) A. Treatment demands (Outpatient & Inpatient) : 12,037 B. Opioid Substitution Treatment (OST) : 16,453 C. Census Prison OST : 706 TOTAL 2017 ~29,289 D. Alcohol (TDI) ~9,200 – 12,000 Treatment demands by substance type 2017 50% ! Source: TDI register, Sciensano