The Use of Drugs and its
Impact on Public Health
People2People Programme
Brussels, 18th of May, 2011
Drug Addiction Therapies: the
Example of the Network of De
Sleutel, Belgium.
Robrecht Keymeulen,psychologist;
behavioural therapist
Senior advisor to the general director.
Drugs ... Talk about it
Network De Sleutel
Our activities are concentrated in 3
sectors:
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Prevention
Treatment: ambulatory
(outpatient) and residential
(inpatient) care units
Employment and training
department
Some facts and figures
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De Sleutel was founded in 1974 and is
now part of the network of the Brothers of
Charity
Staff: 230 full time equivalents
Budget: 40 million euro
Each year around 3100 unique people
apply for help
60% of them start a treatment
Around 120 ( ex-)addicts participate in
the vocational training
Financial Resources…come from
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The National Health Insurance System,
The Federal Government, Department for
Internal Affairs,
The Federal Government, Department for
Social Integration,
The Federal Government, Department for
Employment,
The Flemish Community, Department for
Health Care,
Some cities,
Private sponsors.
Our Mission: De Sleutel –
People, Opportunities, Growth
We help drug addicts and their
environment to optimize selfrealization and to reintegrate as
maximal as possible into our society.
We believe in the added value of a
drug-free life.
Our vision about addiction and the
treatment of addicted people
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Is very important for us !
Because care units can have a
specific activity, but we want that all
our care units start from this vision,
An engagement to adhere to this
vision is demanded for all our
collaborators.
Core elements of our vision
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Addiction is a chronic disease
We aim for change
We strive for recovery of the
autonomy of the individual ( as far
as possible)
Cooperation between care units is
demanded, we make care paths
We use the bio-psycho-social model
We accept the vulnerability of the
addicted person
A chronic disease ?
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Addiction develops through several
stages
The last stage = a chronic disease
with severe neurobiological changes
These changes have consequences
for all life area’s,
Demoralisation is an aspect of it,
creating hope is an important task
Continuity in the care is needed,
This care is complex
Change and vulnerability
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We are convinced that every person
can learn new alternatives for his
drug taking behaviour,
But addicts are vulnerable,
Not every person can recover to the
same point,
We accept that there are limits in
the degree to which a person can
change his life(style).
Cooperation to make care paths
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Not all interventions can be done at
the same moment,
We recommend to work in modules,
each module has his specific aims,
Multi-disciplinarity: nobody is able to
do all the interventions by himself,
Continuity of the care: interventions
should be adjusted to other
interventions,
Care is a chain with many links !
The bio-psycho-social model =
A theory about a complex and
multiple perspective on (mental)
disease and (mental) health.
Which Perspectives?
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The biological perspective: causes
and symptoms ( explaining),
The psycho-social perspective : the
area’s of life, the relation between
the person and his environment (
understanding),
The moral-existential perspective:
the values that give meaning to life.
The four ‘R’s
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Remoralisation: create hope,
stability and support,
Remediation: change the addiction
and his symptoms; learn about an
alternative to addiction,
Rehabilitation: improve the
functioning on several aspects of
life,
Recovery of the autonomy of the
person.
Consequences of our vision for the
organisation of our network
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All perspectives should be represented in
every team
Time for consultation should be provided
Several disciplines work together at the
same moment in one plan of treatment
There is an area of tension between time
for consultation and speed in making a
decision
Who has the mandate to coordinate, to
make the consensus?
Consequences of our vision for a team
member
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Cooperation is more than sharing
information in a passive way,
Cooperation is not only a skill but
also an attitude,
Cooperation demands an active
‘translation’ to the other disciplines,
Have trust in your colleques and
set limits to your own, passionate
interventions !!
Prevention department
Prevention
Social Influence
programmes at
school
Bobbie reading
books for children
with addicted
parents
3 month program for
young people in high
risk groups
21
Evidence Base: components of effectiveness in schoolbased
drugprevention (meta-analysis Nancy Tobler 2000)
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Teacher training
Information about drugs
Include normative beliefs
Focus on specific influence based skills
Interactive delivery
Involve family and community
Cultural sensitivity (local adaptation)
Treatment
Outpatient and Inpatient Units
The outpatient services offer
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Orientation module
Individual therapy, counseling ( CRA)
Early intervention,
Daycare and group treatment
Substitution therapy and somatic
treatment
Motivation development
Relapse prevention and aftercare
Family therapy
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Crisis and Detoxification Centre (CIC)
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The offer of the CIC
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A safe, drug-free and
structured environment
Detoxification
Stabilisation
Orientation, motivation
Referral
The “classic” Therapeutic Community
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Target group:
Adults addicted to illegal drugs
With severe problems in different life area’s
Admission:
After detoxification
After a motivational program
Goals:
Learn ho to cope with individual, relational and
social problems
Learn to take responsibilities
Learn to have a happy life without drugs
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Elements of the cure:
 self-help
 Group interaction
 Education
 Several stages
 Aftercare unit
The TC for Double Diagnosed Clients
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Cfr. the classic TC, but with some modifications :
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Target group:
People with a combination of dependency on illegal
drugs and a major psychiatric disorder.
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Admission:
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After the acute stage of the psychiatric disorder
After detoxfication,
Therapy:
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Long term group therapy
With specific individual psychological and psychiatric
counseling.
Residential facility for youngsters
(RKJ)
Target group: youngsters between
12 en 18 years old
 who have a case at the Youth
Court
 or who are there voluntarily
 who abuse drugs or are
dependent on it.
Therapy :
group therapy in several stages
Employment and training
department
In the cities of Ghent and Antwerp
Goals:
Socio economic reintegration
Training of attitudes and general skills, necessarry
for the normal economic circuit
Training of specific skills, needed for a specific job
Possibilities:
Industry
Parks and Public Garden
Renovation of Buildings
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This department offers also specific
observation and orientation
modules
This department cooperates very
intensive with
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Several treatment units and hospitals (
not belonging to the network of De
Sleutel)
The Social Services of the cities of
Ghent and Antwerp
The Flemish Employment Agency
How to Monitor our Network?
Which indicators did we choose?
Our Set of Basic Indicators
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Indicators about the outcome:
inform us about the result of the
care.
Indicators about the process:
inform us about how the process of
care is running.
Indicators about the structure:
inform us about the quantity of the
means we have and the quality of
our resources.
Indicators about the Outcome
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Caseload of the Units
Completion of the modules
Retention
Indicators about the Process
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Proportion of real starters/possible
starters
Quality of the orientation module (
for outpatient units) or flow through
the stages ( for inpatient units)
Intensity of the care
Indicators about the Structure
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Quality of the training of the staff
Amount of available staff
Turnover of staff in the teams
Quality of follow-up of the team
members by the management of
the units
THANK YOU !