routes to intervention on drinking - si- · pdf filehansen ab, hvidtfeldt ua,...
TRANSCRIPT
1022013
1
THE AMSTERDAM INSTITUTE FOR
ADDICTION RESEARCH
Academic Medical Centre
University of Amsterdam
Gerard M Schippers
The Amsterdam Institute for
Addiction Research
Routes to Intervention on Drinking
Alcohol Symposium Opening lsquoRESCueHrsquo and lsquoPAUSErsquo
University of Southern Denmark Odense 3 June 2013
Three Questions
1 Which are the interventions on drinking
2 Which interventions are effective for which
persons
1022013
2
Identifying Alcoholics in an End-State
bull almost continuously under the influence of alcohol
bull restricted life perspective due to bad somatic
condition
bull strong and persistent wish to continue drinking
bull not suicidal
bull treatment history with failures
bull refusing all treatment directed at limiting drinking
bull accepting other forms of help
bull of sound mind and judgment when sober
1022013
3
Health Care and Public Service Use and Costs Before and After Provision of Housing for Chronically Homeless
Persons With Severe Alcohol Problems
Mary E Larimer PhDDaniel K Malone MPHMichelle D Garner MSW PhDDavid C Atkins PhDBonnie Burlingham MPHHeather S Lonczak PhDKenneth Tanzer BAJoshua Ginzler PhDSeema L Clifasefi PhDWilliam G Hobson MAG Alan Marlatt PhD
JAMA 2009301(13)1349-1357
ldquoIn this population of chronically homeless
individuals with high service use and costs a
Housing First program was associated with a
relative decrease in costs after 6 months
These benefits increased to the extent that
participants were retained in housing longerrdquo
Is Alcohol Dependency a
Chronic Disease
Yes for a substantial number of people that
are or have been in treatment for alcohol
dependence
1022013
4
Is Alcohol Dependency a
Chronic Disease
McLellan AT et al JAMA 2000 DM=diabetes mellitus HTN = hypertension
Disease Management Model of
Alcohol Problems
Primary Prevention
(Health promoting actions)
Care
Specialized
Treatment Brief
intervention
Prevalence of Alcohol Problems
SourceInstitute of Medicine (1990) Broadening the Base of Treatment for
Alcohol Problems Washington DC National Academy Press
None or mild Moderate Substantial Severe
SEVERITY OF ALCOHOL PROBLEMS
1022013
5
Heavy drinking 20 and Harmful alcohol use 14
ca 1480000 persons lsquoat riskrsquo
Alcohol Dependent 3
ca 150000 persons
Alcohol problems in Denmark (2005)
Hansen AB Hvidtfeldt UA Groslashnbaeligk M Becker U Nielsen
AS Tolstrup JS (2011) The number of persons with alcohol problems
in the Danish population Scand J Public Health Mar39(2)128-36
treatment gap
Therefor alcohol problems do
present a
Estimation
in regular treatment ca 10 of the dependent and
lt 2 of the population at risk
1022013
6
But is this fully justified
This is considered a problematic
situation failure of the treatment
system
Recovery Alcohol Disorders in General
Population bull Large Dutch (n=7076) representative survey (with
comparable prevalence figures as in Denmark)
bull Dutch survey had follow-ups at 1 and 3 years
bull Alcohol abuse has a favourable course 81 after 1 year and 85 after 3 year NO abuse anymore
bull Alcohol dependency somewhat less favourable course 67 after 1 year 69 after 3 jaar NO dependency anymore
bull Only 4-12 of the abusers and only 0-14 of those recovered after 1 year relapsed (at 3 year)
CONCLUSION
in general population large lsquospontaneousrsquo recovery
De Bruijn Van den Brink De Graaf amp Volleberg (2005) The three year course
of alcohol use disorders in the general population Addiction
1022013
7
For those lsquoat riskrsquo
Many can recover on their own and many
can profit from a little help hellip
Screening and
brief interventions
(SBI)
None or mild Moderate Substantial Severe
SEVERITY OF ALCOHOL PROBLEMS
SCREENING for alcohol problems
bull As part of routine examination
bull By general practicioner emergency care
and medical specialists
bull Using simple screening tools (CAGE
AUDIT etc)
bull Or reacting to possible signals
hellip and brief interventions
1022013
8
SBI 1-4 sessions applying FRAMES
Feedback about risks of substance use Responsibility placed on client to change Advice to cut down abstain etc Menu of options and choices Empathic approach Self-efficacy using a non-confrontational counselling style which encourages amp reinforces clientrsquos strengths
Motivational Interviewing Style
Brief Interventions the Evidence
bull Effective in opportunistic samples with
hazardousharmful drinking (Moyer et al 2002)
bull Significant effect at follow-up for up to 2 years
(Berglund et al 2003)
bull Longer-term effects less evident booster
sessions required (Fleming et al 2002)
bull Reduce alcohol-related problems and mortality
(Cuypers et al 2004)
bull Involving patients crucial (RESCueH-project)
1022013
9
But
Is face-to-face contact always necessary
May be not when using the internet
eHealth
Internet Self-help and Treatment (Jellinek)
1022013
10
J Med Internet Res 201113(2)e42)
2011 Meta-analysis Alcohol
Internet Self-help (IS) Internet Therapy (IT)
Effects comparison
1022013
11
15
25
35
45
55
baseline 3 months 6 months
Time
Dri
nk
s p
er
we
ek
(T
LF
B)
IT
WL
IS
Alcohol reduction (TLFB)
IT more expensive than IS
More effects more costs
If willingness to pay gt= euro14000 per QALY then
IT has larger probability of cost-effectiveness than IS
Internet Therapy is Cost-effective
1022013
12
Treatment
None or mild Moderate Substantial Severe
SEVERITY OF ALCOHOL PROBLEMS
How does SUD treatment look
like
It is not just keeping someone from
using alcohol or drugs
1022013
13
Treatment of alcohol problems is
bull Providing insight [psycho-education]
bull Helping considering consequences [sociotherapy familytherapy self help]
bull Learning to make choices [motivational interviewing individual and group counseling]
bull Treating craving [medication]
bull Teaching skills [behavioral cognitive and emotional training relapse prevention]
bull Treating co-morbid psychopathology (pharmacotherapy andor psychotherapy)
bull Support in practical and social circumstances (social services)
What does research tell us
on the effectiveness of
treatment on addictive
behavior (consumption of
drugs)
1022013
14
1022013
15
Alcohol Top 10 Effective Interventions
bull Brief intervention
bull Motivational enhancement
bull GABA agonist
bull Opiate antagonist
bull Social skills training
bull Community reinforcement approach (CRA)
bull Behavior contracting
bull Behavioral marital therapy
bull Case management
bull Self-monitoring
General Consensus
bull Lots of evidence available
bull Best evidence for behavioural oriented treatment
bull Best in combination with medication
bull Relative modest effects (but comparable with other chronic illnesses)
bull No outcome differences between residential and outpatient treatments
bull Matching might be crucial (RESCueH)
1022013
16
Some National
Clinical Guidelines
UK 2011 NL 2009 Australia 2003
Finland 2010 Scotland 2003
Treatment self-control training
and influencing the environment
ndash motivating Influencing readiness to change
ndash self control training
changing drinking behavior
ndash relapse prevention social and affective skills training
ndash influencing environment
Social family job community
Physical medication constraints
ndash
1022013
17
Motivation enhancement fe by Motivational Interviewing
bull Responsibility for change is left with the
individual
bull The individual is free to take our advice or not
bull The strategies are more supportive than
argumentative
bull Goal is to increase the intrinsic motivation
bull The client presents the arguments for change
Self control training
bull Monitoring use (how much what when how and in what
circumstances am I using)
bull Setting limits (how much what when how and in what
circumstances do I allow myself to use)
bullConsequential rewards punishments (what do I do or not
do donrsquot keep my promisses)
bullChoice of alternative behavior (what do I do instead of)
bull Planning for emergencie (what if I fail)
1022013
18
Relapse prevention Assessing risk situations
Training alternative behaviors
Training alternative emotions
Emotional skills training (craving)
Cue exposure (RESCueH-project)
Training alternative cognitions
training in self confidence
harm reduction after relapse
training phantasies
Medications for Alcohol Dependence
Disulfiram (Antabusereg)
Naltrexone (Reviareg)
Acamprosate (Campralreg)
Nalmefene NEW
1022013
19
Integration of Psychosocial and
Pharmaceutical Treatment Necessary
Pharmacotherapy for alcohol
dependence should always be
accompanied by psychosocial andor
behavioral treatments
Disease Management Model of
Alcohol Problems
Primary Prevention
(Health promoting actions)
Care
Specialized
Treatment Brief
intervention
Prevalence of Alcohol Problems
SourceInstitute of Medicine (1990) Broadening the Base of Treatment for
Alcohol Problems Washington DC National Academy Press
None or mild Moderate Substantial Severe
SEVERITY OF ALCOHOL PROBLEMS
1022013
20
Disease Management Model
Recquires adequate measurement of
patient characteristics
Measurement of Addictions for
Triage and Evaluation
New general up-to-date assessment instrument for
patieumlnt characteristics in substance abuse treatment
ndash European alternative
Designed for treatment allocation (triage) in a disease
management model
1022013
21
Disease Management Model
Staging and profiling chronic ill
patients to match to proper level and
kinds of care
Model developed inspired by the
staging and profiling of cancer
treatment
Van den Brink amp Schippers (2012) Stageing and profiling in substance
abuse treatment
TNM System Analogy
Van den Brink amp Schippers (2012) Staging and profiling in substance
abuse treatment
ONCOLOGY
bull T = Tumor size
bull N = Nodes
bull M = Metastasis
bull G = Grade
bull R = Resection
bull c = clinical inform
bull p = pathologist inform
bull y = adjuvant therapy
ADDICTION
bull Stage of the disorder
bull Psychiatricsomatic comorbidity
bull Social dysfunctioning
bull Addictive Substance
bull Reaction on former treatment
bull Clinical (fenotypical) information
bull Endofenotypicalgenetic information
bull Combination treatment
1022013
22
Testing Allocation Algorithm
Concluding Remarks
bull Ample evidence available for effective
alcohol treatment
bull Implementation of evidence-based
treatments in routine practice
insufficient
bull Due to the course of the disorder
adequate matching procedures
necessary
bull RESCueH projects will contribute to
new and applicable knowledge
1022013
23
Success
Also available
MATE-Outcomes for treatment outcome
measurements
MATE-Crimi targeted for criminal and
addictive behaviours
MATE-Youth targeted for 12-23 year
Developed and tested in the Netherlands
and Germany
Dutch English German and Italian versions
available
1022013
24
Drinkerrsquos Check-Up
Dutch version (1994)
Drinkerrsquos Check-Up is a proven
effective two-session brief
motivational intervention
developed by W R Miller (1988)
Providing assessment and
personalized non-judgmental
feedback and motivating advice
(Screening and) Brief Interventions
bull Agenda
bull Advice
bull Assess
bull Assist
bull Arrange
bull Introduce the topic
bull Inform and advice
bull Assess use and problems
bull Inform about support in
behavior change
bull Guide and refer
One
session
2-4
sessions
Treatment gt 4 sessions
1022013
2
Identifying Alcoholics in an End-State
bull almost continuously under the influence of alcohol
bull restricted life perspective due to bad somatic
condition
bull strong and persistent wish to continue drinking
bull not suicidal
bull treatment history with failures
bull refusing all treatment directed at limiting drinking
bull accepting other forms of help
bull of sound mind and judgment when sober
1022013
3
Health Care and Public Service Use and Costs Before and After Provision of Housing for Chronically Homeless
Persons With Severe Alcohol Problems
Mary E Larimer PhDDaniel K Malone MPHMichelle D Garner MSW PhDDavid C Atkins PhDBonnie Burlingham MPHHeather S Lonczak PhDKenneth Tanzer BAJoshua Ginzler PhDSeema L Clifasefi PhDWilliam G Hobson MAG Alan Marlatt PhD
JAMA 2009301(13)1349-1357
ldquoIn this population of chronically homeless
individuals with high service use and costs a
Housing First program was associated with a
relative decrease in costs after 6 months
These benefits increased to the extent that
participants were retained in housing longerrdquo
Is Alcohol Dependency a
Chronic Disease
Yes for a substantial number of people that
are or have been in treatment for alcohol
dependence
1022013
4
Is Alcohol Dependency a
Chronic Disease
McLellan AT et al JAMA 2000 DM=diabetes mellitus HTN = hypertension
Disease Management Model of
Alcohol Problems
Primary Prevention
(Health promoting actions)
Care
Specialized
Treatment Brief
intervention
Prevalence of Alcohol Problems
SourceInstitute of Medicine (1990) Broadening the Base of Treatment for
Alcohol Problems Washington DC National Academy Press
None or mild Moderate Substantial Severe
SEVERITY OF ALCOHOL PROBLEMS
1022013
5
Heavy drinking 20 and Harmful alcohol use 14
ca 1480000 persons lsquoat riskrsquo
Alcohol Dependent 3
ca 150000 persons
Alcohol problems in Denmark (2005)
Hansen AB Hvidtfeldt UA Groslashnbaeligk M Becker U Nielsen
AS Tolstrup JS (2011) The number of persons with alcohol problems
in the Danish population Scand J Public Health Mar39(2)128-36
treatment gap
Therefor alcohol problems do
present a
Estimation
in regular treatment ca 10 of the dependent and
lt 2 of the population at risk
1022013
6
But is this fully justified
This is considered a problematic
situation failure of the treatment
system
Recovery Alcohol Disorders in General
Population bull Large Dutch (n=7076) representative survey (with
comparable prevalence figures as in Denmark)
bull Dutch survey had follow-ups at 1 and 3 years
bull Alcohol abuse has a favourable course 81 after 1 year and 85 after 3 year NO abuse anymore
bull Alcohol dependency somewhat less favourable course 67 after 1 year 69 after 3 jaar NO dependency anymore
bull Only 4-12 of the abusers and only 0-14 of those recovered after 1 year relapsed (at 3 year)
CONCLUSION
in general population large lsquospontaneousrsquo recovery
De Bruijn Van den Brink De Graaf amp Volleberg (2005) The three year course
of alcohol use disorders in the general population Addiction
1022013
7
For those lsquoat riskrsquo
Many can recover on their own and many
can profit from a little help hellip
Screening and
brief interventions
(SBI)
None or mild Moderate Substantial Severe
SEVERITY OF ALCOHOL PROBLEMS
SCREENING for alcohol problems
bull As part of routine examination
bull By general practicioner emergency care
and medical specialists
bull Using simple screening tools (CAGE
AUDIT etc)
bull Or reacting to possible signals
hellip and brief interventions
1022013
8
SBI 1-4 sessions applying FRAMES
Feedback about risks of substance use Responsibility placed on client to change Advice to cut down abstain etc Menu of options and choices Empathic approach Self-efficacy using a non-confrontational counselling style which encourages amp reinforces clientrsquos strengths
Motivational Interviewing Style
Brief Interventions the Evidence
bull Effective in opportunistic samples with
hazardousharmful drinking (Moyer et al 2002)
bull Significant effect at follow-up for up to 2 years
(Berglund et al 2003)
bull Longer-term effects less evident booster
sessions required (Fleming et al 2002)
bull Reduce alcohol-related problems and mortality
(Cuypers et al 2004)
bull Involving patients crucial (RESCueH-project)
1022013
9
But
Is face-to-face contact always necessary
May be not when using the internet
eHealth
Internet Self-help and Treatment (Jellinek)
1022013
10
J Med Internet Res 201113(2)e42)
2011 Meta-analysis Alcohol
Internet Self-help (IS) Internet Therapy (IT)
Effects comparison
1022013
11
15
25
35
45
55
baseline 3 months 6 months
Time
Dri
nk
s p
er
we
ek
(T
LF
B)
IT
WL
IS
Alcohol reduction (TLFB)
IT more expensive than IS
More effects more costs
If willingness to pay gt= euro14000 per QALY then
IT has larger probability of cost-effectiveness than IS
Internet Therapy is Cost-effective
1022013
12
Treatment
None or mild Moderate Substantial Severe
SEVERITY OF ALCOHOL PROBLEMS
How does SUD treatment look
like
It is not just keeping someone from
using alcohol or drugs
1022013
13
Treatment of alcohol problems is
bull Providing insight [psycho-education]
bull Helping considering consequences [sociotherapy familytherapy self help]
bull Learning to make choices [motivational interviewing individual and group counseling]
bull Treating craving [medication]
bull Teaching skills [behavioral cognitive and emotional training relapse prevention]
bull Treating co-morbid psychopathology (pharmacotherapy andor psychotherapy)
bull Support in practical and social circumstances (social services)
What does research tell us
on the effectiveness of
treatment on addictive
behavior (consumption of
drugs)
1022013
14
1022013
15
Alcohol Top 10 Effective Interventions
bull Brief intervention
bull Motivational enhancement
bull GABA agonist
bull Opiate antagonist
bull Social skills training
bull Community reinforcement approach (CRA)
bull Behavior contracting
bull Behavioral marital therapy
bull Case management
bull Self-monitoring
General Consensus
bull Lots of evidence available
bull Best evidence for behavioural oriented treatment
bull Best in combination with medication
bull Relative modest effects (but comparable with other chronic illnesses)
bull No outcome differences between residential and outpatient treatments
bull Matching might be crucial (RESCueH)
1022013
16
Some National
Clinical Guidelines
UK 2011 NL 2009 Australia 2003
Finland 2010 Scotland 2003
Treatment self-control training
and influencing the environment
ndash motivating Influencing readiness to change
ndash self control training
changing drinking behavior
ndash relapse prevention social and affective skills training
ndash influencing environment
Social family job community
Physical medication constraints
ndash
1022013
17
Motivation enhancement fe by Motivational Interviewing
bull Responsibility for change is left with the
individual
bull The individual is free to take our advice or not
bull The strategies are more supportive than
argumentative
bull Goal is to increase the intrinsic motivation
bull The client presents the arguments for change
Self control training
bull Monitoring use (how much what when how and in what
circumstances am I using)
bull Setting limits (how much what when how and in what
circumstances do I allow myself to use)
bullConsequential rewards punishments (what do I do or not
do donrsquot keep my promisses)
bullChoice of alternative behavior (what do I do instead of)
bull Planning for emergencie (what if I fail)
1022013
18
Relapse prevention Assessing risk situations
Training alternative behaviors
Training alternative emotions
Emotional skills training (craving)
Cue exposure (RESCueH-project)
Training alternative cognitions
training in self confidence
harm reduction after relapse
training phantasies
Medications for Alcohol Dependence
Disulfiram (Antabusereg)
Naltrexone (Reviareg)
Acamprosate (Campralreg)
Nalmefene NEW
1022013
19
Integration of Psychosocial and
Pharmaceutical Treatment Necessary
Pharmacotherapy for alcohol
dependence should always be
accompanied by psychosocial andor
behavioral treatments
Disease Management Model of
Alcohol Problems
Primary Prevention
(Health promoting actions)
Care
Specialized
Treatment Brief
intervention
Prevalence of Alcohol Problems
SourceInstitute of Medicine (1990) Broadening the Base of Treatment for
Alcohol Problems Washington DC National Academy Press
None or mild Moderate Substantial Severe
SEVERITY OF ALCOHOL PROBLEMS
1022013
20
Disease Management Model
Recquires adequate measurement of
patient characteristics
Measurement of Addictions for
Triage and Evaluation
New general up-to-date assessment instrument for
patieumlnt characteristics in substance abuse treatment
ndash European alternative
Designed for treatment allocation (triage) in a disease
management model
1022013
21
Disease Management Model
Staging and profiling chronic ill
patients to match to proper level and
kinds of care
Model developed inspired by the
staging and profiling of cancer
treatment
Van den Brink amp Schippers (2012) Stageing and profiling in substance
abuse treatment
TNM System Analogy
Van den Brink amp Schippers (2012) Staging and profiling in substance
abuse treatment
ONCOLOGY
bull T = Tumor size
bull N = Nodes
bull M = Metastasis
bull G = Grade
bull R = Resection
bull c = clinical inform
bull p = pathologist inform
bull y = adjuvant therapy
ADDICTION
bull Stage of the disorder
bull Psychiatricsomatic comorbidity
bull Social dysfunctioning
bull Addictive Substance
bull Reaction on former treatment
bull Clinical (fenotypical) information
bull Endofenotypicalgenetic information
bull Combination treatment
1022013
22
Testing Allocation Algorithm
Concluding Remarks
bull Ample evidence available for effective
alcohol treatment
bull Implementation of evidence-based
treatments in routine practice
insufficient
bull Due to the course of the disorder
adequate matching procedures
necessary
bull RESCueH projects will contribute to
new and applicable knowledge
1022013
23
Success
Also available
MATE-Outcomes for treatment outcome
measurements
MATE-Crimi targeted for criminal and
addictive behaviours
MATE-Youth targeted for 12-23 year
Developed and tested in the Netherlands
and Germany
Dutch English German and Italian versions
available
1022013
24
Drinkerrsquos Check-Up
Dutch version (1994)
Drinkerrsquos Check-Up is a proven
effective two-session brief
motivational intervention
developed by W R Miller (1988)
Providing assessment and
personalized non-judgmental
feedback and motivating advice
(Screening and) Brief Interventions
bull Agenda
bull Advice
bull Assess
bull Assist
bull Arrange
bull Introduce the topic
bull Inform and advice
bull Assess use and problems
bull Inform about support in
behavior change
bull Guide and refer
One
session
2-4
sessions
Treatment gt 4 sessions
1022013
3
Health Care and Public Service Use and Costs Before and After Provision of Housing for Chronically Homeless
Persons With Severe Alcohol Problems
Mary E Larimer PhDDaniel K Malone MPHMichelle D Garner MSW PhDDavid C Atkins PhDBonnie Burlingham MPHHeather S Lonczak PhDKenneth Tanzer BAJoshua Ginzler PhDSeema L Clifasefi PhDWilliam G Hobson MAG Alan Marlatt PhD
JAMA 2009301(13)1349-1357
ldquoIn this population of chronically homeless
individuals with high service use and costs a
Housing First program was associated with a
relative decrease in costs after 6 months
These benefits increased to the extent that
participants were retained in housing longerrdquo
Is Alcohol Dependency a
Chronic Disease
Yes for a substantial number of people that
are or have been in treatment for alcohol
dependence
1022013
4
Is Alcohol Dependency a
Chronic Disease
McLellan AT et al JAMA 2000 DM=diabetes mellitus HTN = hypertension
Disease Management Model of
Alcohol Problems
Primary Prevention
(Health promoting actions)
Care
Specialized
Treatment Brief
intervention
Prevalence of Alcohol Problems
SourceInstitute of Medicine (1990) Broadening the Base of Treatment for
Alcohol Problems Washington DC National Academy Press
None or mild Moderate Substantial Severe
SEVERITY OF ALCOHOL PROBLEMS
1022013
5
Heavy drinking 20 and Harmful alcohol use 14
ca 1480000 persons lsquoat riskrsquo
Alcohol Dependent 3
ca 150000 persons
Alcohol problems in Denmark (2005)
Hansen AB Hvidtfeldt UA Groslashnbaeligk M Becker U Nielsen
AS Tolstrup JS (2011) The number of persons with alcohol problems
in the Danish population Scand J Public Health Mar39(2)128-36
treatment gap
Therefor alcohol problems do
present a
Estimation
in regular treatment ca 10 of the dependent and
lt 2 of the population at risk
1022013
6
But is this fully justified
This is considered a problematic
situation failure of the treatment
system
Recovery Alcohol Disorders in General
Population bull Large Dutch (n=7076) representative survey (with
comparable prevalence figures as in Denmark)
bull Dutch survey had follow-ups at 1 and 3 years
bull Alcohol abuse has a favourable course 81 after 1 year and 85 after 3 year NO abuse anymore
bull Alcohol dependency somewhat less favourable course 67 after 1 year 69 after 3 jaar NO dependency anymore
bull Only 4-12 of the abusers and only 0-14 of those recovered after 1 year relapsed (at 3 year)
CONCLUSION
in general population large lsquospontaneousrsquo recovery
De Bruijn Van den Brink De Graaf amp Volleberg (2005) The three year course
of alcohol use disorders in the general population Addiction
1022013
7
For those lsquoat riskrsquo
Many can recover on their own and many
can profit from a little help hellip
Screening and
brief interventions
(SBI)
None or mild Moderate Substantial Severe
SEVERITY OF ALCOHOL PROBLEMS
SCREENING for alcohol problems
bull As part of routine examination
bull By general practicioner emergency care
and medical specialists
bull Using simple screening tools (CAGE
AUDIT etc)
bull Or reacting to possible signals
hellip and brief interventions
1022013
8
SBI 1-4 sessions applying FRAMES
Feedback about risks of substance use Responsibility placed on client to change Advice to cut down abstain etc Menu of options and choices Empathic approach Self-efficacy using a non-confrontational counselling style which encourages amp reinforces clientrsquos strengths
Motivational Interviewing Style
Brief Interventions the Evidence
bull Effective in opportunistic samples with
hazardousharmful drinking (Moyer et al 2002)
bull Significant effect at follow-up for up to 2 years
(Berglund et al 2003)
bull Longer-term effects less evident booster
sessions required (Fleming et al 2002)
bull Reduce alcohol-related problems and mortality
(Cuypers et al 2004)
bull Involving patients crucial (RESCueH-project)
1022013
9
But
Is face-to-face contact always necessary
May be not when using the internet
eHealth
Internet Self-help and Treatment (Jellinek)
1022013
10
J Med Internet Res 201113(2)e42)
2011 Meta-analysis Alcohol
Internet Self-help (IS) Internet Therapy (IT)
Effects comparison
1022013
11
15
25
35
45
55
baseline 3 months 6 months
Time
Dri
nk
s p
er
we
ek
(T
LF
B)
IT
WL
IS
Alcohol reduction (TLFB)
IT more expensive than IS
More effects more costs
If willingness to pay gt= euro14000 per QALY then
IT has larger probability of cost-effectiveness than IS
Internet Therapy is Cost-effective
1022013
12
Treatment
None or mild Moderate Substantial Severe
SEVERITY OF ALCOHOL PROBLEMS
How does SUD treatment look
like
It is not just keeping someone from
using alcohol or drugs
1022013
13
Treatment of alcohol problems is
bull Providing insight [psycho-education]
bull Helping considering consequences [sociotherapy familytherapy self help]
bull Learning to make choices [motivational interviewing individual and group counseling]
bull Treating craving [medication]
bull Teaching skills [behavioral cognitive and emotional training relapse prevention]
bull Treating co-morbid psychopathology (pharmacotherapy andor psychotherapy)
bull Support in practical and social circumstances (social services)
What does research tell us
on the effectiveness of
treatment on addictive
behavior (consumption of
drugs)
1022013
14
1022013
15
Alcohol Top 10 Effective Interventions
bull Brief intervention
bull Motivational enhancement
bull GABA agonist
bull Opiate antagonist
bull Social skills training
bull Community reinforcement approach (CRA)
bull Behavior contracting
bull Behavioral marital therapy
bull Case management
bull Self-monitoring
General Consensus
bull Lots of evidence available
bull Best evidence for behavioural oriented treatment
bull Best in combination with medication
bull Relative modest effects (but comparable with other chronic illnesses)
bull No outcome differences between residential and outpatient treatments
bull Matching might be crucial (RESCueH)
1022013
16
Some National
Clinical Guidelines
UK 2011 NL 2009 Australia 2003
Finland 2010 Scotland 2003
Treatment self-control training
and influencing the environment
ndash motivating Influencing readiness to change
ndash self control training
changing drinking behavior
ndash relapse prevention social and affective skills training
ndash influencing environment
Social family job community
Physical medication constraints
ndash
1022013
17
Motivation enhancement fe by Motivational Interviewing
bull Responsibility for change is left with the
individual
bull The individual is free to take our advice or not
bull The strategies are more supportive than
argumentative
bull Goal is to increase the intrinsic motivation
bull The client presents the arguments for change
Self control training
bull Monitoring use (how much what when how and in what
circumstances am I using)
bull Setting limits (how much what when how and in what
circumstances do I allow myself to use)
bullConsequential rewards punishments (what do I do or not
do donrsquot keep my promisses)
bullChoice of alternative behavior (what do I do instead of)
bull Planning for emergencie (what if I fail)
1022013
18
Relapse prevention Assessing risk situations
Training alternative behaviors
Training alternative emotions
Emotional skills training (craving)
Cue exposure (RESCueH-project)
Training alternative cognitions
training in self confidence
harm reduction after relapse
training phantasies
Medications for Alcohol Dependence
Disulfiram (Antabusereg)
Naltrexone (Reviareg)
Acamprosate (Campralreg)
Nalmefene NEW
1022013
19
Integration of Psychosocial and
Pharmaceutical Treatment Necessary
Pharmacotherapy for alcohol
dependence should always be
accompanied by psychosocial andor
behavioral treatments
Disease Management Model of
Alcohol Problems
Primary Prevention
(Health promoting actions)
Care
Specialized
Treatment Brief
intervention
Prevalence of Alcohol Problems
SourceInstitute of Medicine (1990) Broadening the Base of Treatment for
Alcohol Problems Washington DC National Academy Press
None or mild Moderate Substantial Severe
SEVERITY OF ALCOHOL PROBLEMS
1022013
20
Disease Management Model
Recquires adequate measurement of
patient characteristics
Measurement of Addictions for
Triage and Evaluation
New general up-to-date assessment instrument for
patieumlnt characteristics in substance abuse treatment
ndash European alternative
Designed for treatment allocation (triage) in a disease
management model
1022013
21
Disease Management Model
Staging and profiling chronic ill
patients to match to proper level and
kinds of care
Model developed inspired by the
staging and profiling of cancer
treatment
Van den Brink amp Schippers (2012) Stageing and profiling in substance
abuse treatment
TNM System Analogy
Van den Brink amp Schippers (2012) Staging and profiling in substance
abuse treatment
ONCOLOGY
bull T = Tumor size
bull N = Nodes
bull M = Metastasis
bull G = Grade
bull R = Resection
bull c = clinical inform
bull p = pathologist inform
bull y = adjuvant therapy
ADDICTION
bull Stage of the disorder
bull Psychiatricsomatic comorbidity
bull Social dysfunctioning
bull Addictive Substance
bull Reaction on former treatment
bull Clinical (fenotypical) information
bull Endofenotypicalgenetic information
bull Combination treatment
1022013
22
Testing Allocation Algorithm
Concluding Remarks
bull Ample evidence available for effective
alcohol treatment
bull Implementation of evidence-based
treatments in routine practice
insufficient
bull Due to the course of the disorder
adequate matching procedures
necessary
bull RESCueH projects will contribute to
new and applicable knowledge
1022013
23
Success
Also available
MATE-Outcomes for treatment outcome
measurements
MATE-Crimi targeted for criminal and
addictive behaviours
MATE-Youth targeted for 12-23 year
Developed and tested in the Netherlands
and Germany
Dutch English German and Italian versions
available
1022013
24
Drinkerrsquos Check-Up
Dutch version (1994)
Drinkerrsquos Check-Up is a proven
effective two-session brief
motivational intervention
developed by W R Miller (1988)
Providing assessment and
personalized non-judgmental
feedback and motivating advice
(Screening and) Brief Interventions
bull Agenda
bull Advice
bull Assess
bull Assist
bull Arrange
bull Introduce the topic
bull Inform and advice
bull Assess use and problems
bull Inform about support in
behavior change
bull Guide and refer
One
session
2-4
sessions
Treatment gt 4 sessions
1022013
4
Is Alcohol Dependency a
Chronic Disease
McLellan AT et al JAMA 2000 DM=diabetes mellitus HTN = hypertension
Disease Management Model of
Alcohol Problems
Primary Prevention
(Health promoting actions)
Care
Specialized
Treatment Brief
intervention
Prevalence of Alcohol Problems
SourceInstitute of Medicine (1990) Broadening the Base of Treatment for
Alcohol Problems Washington DC National Academy Press
None or mild Moderate Substantial Severe
SEVERITY OF ALCOHOL PROBLEMS
1022013
5
Heavy drinking 20 and Harmful alcohol use 14
ca 1480000 persons lsquoat riskrsquo
Alcohol Dependent 3
ca 150000 persons
Alcohol problems in Denmark (2005)
Hansen AB Hvidtfeldt UA Groslashnbaeligk M Becker U Nielsen
AS Tolstrup JS (2011) The number of persons with alcohol problems
in the Danish population Scand J Public Health Mar39(2)128-36
treatment gap
Therefor alcohol problems do
present a
Estimation
in regular treatment ca 10 of the dependent and
lt 2 of the population at risk
1022013
6
But is this fully justified
This is considered a problematic
situation failure of the treatment
system
Recovery Alcohol Disorders in General
Population bull Large Dutch (n=7076) representative survey (with
comparable prevalence figures as in Denmark)
bull Dutch survey had follow-ups at 1 and 3 years
bull Alcohol abuse has a favourable course 81 after 1 year and 85 after 3 year NO abuse anymore
bull Alcohol dependency somewhat less favourable course 67 after 1 year 69 after 3 jaar NO dependency anymore
bull Only 4-12 of the abusers and only 0-14 of those recovered after 1 year relapsed (at 3 year)
CONCLUSION
in general population large lsquospontaneousrsquo recovery
De Bruijn Van den Brink De Graaf amp Volleberg (2005) The three year course
of alcohol use disorders in the general population Addiction
1022013
7
For those lsquoat riskrsquo
Many can recover on their own and many
can profit from a little help hellip
Screening and
brief interventions
(SBI)
None or mild Moderate Substantial Severe
SEVERITY OF ALCOHOL PROBLEMS
SCREENING for alcohol problems
bull As part of routine examination
bull By general practicioner emergency care
and medical specialists
bull Using simple screening tools (CAGE
AUDIT etc)
bull Or reacting to possible signals
hellip and brief interventions
1022013
8
SBI 1-4 sessions applying FRAMES
Feedback about risks of substance use Responsibility placed on client to change Advice to cut down abstain etc Menu of options and choices Empathic approach Self-efficacy using a non-confrontational counselling style which encourages amp reinforces clientrsquos strengths
Motivational Interviewing Style
Brief Interventions the Evidence
bull Effective in opportunistic samples with
hazardousharmful drinking (Moyer et al 2002)
bull Significant effect at follow-up for up to 2 years
(Berglund et al 2003)
bull Longer-term effects less evident booster
sessions required (Fleming et al 2002)
bull Reduce alcohol-related problems and mortality
(Cuypers et al 2004)
bull Involving patients crucial (RESCueH-project)
1022013
9
But
Is face-to-face contact always necessary
May be not when using the internet
eHealth
Internet Self-help and Treatment (Jellinek)
1022013
10
J Med Internet Res 201113(2)e42)
2011 Meta-analysis Alcohol
Internet Self-help (IS) Internet Therapy (IT)
Effects comparison
1022013
11
15
25
35
45
55
baseline 3 months 6 months
Time
Dri
nk
s p
er
we
ek
(T
LF
B)
IT
WL
IS
Alcohol reduction (TLFB)
IT more expensive than IS
More effects more costs
If willingness to pay gt= euro14000 per QALY then
IT has larger probability of cost-effectiveness than IS
Internet Therapy is Cost-effective
1022013
12
Treatment
None or mild Moderate Substantial Severe
SEVERITY OF ALCOHOL PROBLEMS
How does SUD treatment look
like
It is not just keeping someone from
using alcohol or drugs
1022013
13
Treatment of alcohol problems is
bull Providing insight [psycho-education]
bull Helping considering consequences [sociotherapy familytherapy self help]
bull Learning to make choices [motivational interviewing individual and group counseling]
bull Treating craving [medication]
bull Teaching skills [behavioral cognitive and emotional training relapse prevention]
bull Treating co-morbid psychopathology (pharmacotherapy andor psychotherapy)
bull Support in practical and social circumstances (social services)
What does research tell us
on the effectiveness of
treatment on addictive
behavior (consumption of
drugs)
1022013
14
1022013
15
Alcohol Top 10 Effective Interventions
bull Brief intervention
bull Motivational enhancement
bull GABA agonist
bull Opiate antagonist
bull Social skills training
bull Community reinforcement approach (CRA)
bull Behavior contracting
bull Behavioral marital therapy
bull Case management
bull Self-monitoring
General Consensus
bull Lots of evidence available
bull Best evidence for behavioural oriented treatment
bull Best in combination with medication
bull Relative modest effects (but comparable with other chronic illnesses)
bull No outcome differences between residential and outpatient treatments
bull Matching might be crucial (RESCueH)
1022013
16
Some National
Clinical Guidelines
UK 2011 NL 2009 Australia 2003
Finland 2010 Scotland 2003
Treatment self-control training
and influencing the environment
ndash motivating Influencing readiness to change
ndash self control training
changing drinking behavior
ndash relapse prevention social and affective skills training
ndash influencing environment
Social family job community
Physical medication constraints
ndash
1022013
17
Motivation enhancement fe by Motivational Interviewing
bull Responsibility for change is left with the
individual
bull The individual is free to take our advice or not
bull The strategies are more supportive than
argumentative
bull Goal is to increase the intrinsic motivation
bull The client presents the arguments for change
Self control training
bull Monitoring use (how much what when how and in what
circumstances am I using)
bull Setting limits (how much what when how and in what
circumstances do I allow myself to use)
bullConsequential rewards punishments (what do I do or not
do donrsquot keep my promisses)
bullChoice of alternative behavior (what do I do instead of)
bull Planning for emergencie (what if I fail)
1022013
18
Relapse prevention Assessing risk situations
Training alternative behaviors
Training alternative emotions
Emotional skills training (craving)
Cue exposure (RESCueH-project)
Training alternative cognitions
training in self confidence
harm reduction after relapse
training phantasies
Medications for Alcohol Dependence
Disulfiram (Antabusereg)
Naltrexone (Reviareg)
Acamprosate (Campralreg)
Nalmefene NEW
1022013
19
Integration of Psychosocial and
Pharmaceutical Treatment Necessary
Pharmacotherapy for alcohol
dependence should always be
accompanied by psychosocial andor
behavioral treatments
Disease Management Model of
Alcohol Problems
Primary Prevention
(Health promoting actions)
Care
Specialized
Treatment Brief
intervention
Prevalence of Alcohol Problems
SourceInstitute of Medicine (1990) Broadening the Base of Treatment for
Alcohol Problems Washington DC National Academy Press
None or mild Moderate Substantial Severe
SEVERITY OF ALCOHOL PROBLEMS
1022013
20
Disease Management Model
Recquires adequate measurement of
patient characteristics
Measurement of Addictions for
Triage and Evaluation
New general up-to-date assessment instrument for
patieumlnt characteristics in substance abuse treatment
ndash European alternative
Designed for treatment allocation (triage) in a disease
management model
1022013
21
Disease Management Model
Staging and profiling chronic ill
patients to match to proper level and
kinds of care
Model developed inspired by the
staging and profiling of cancer
treatment
Van den Brink amp Schippers (2012) Stageing and profiling in substance
abuse treatment
TNM System Analogy
Van den Brink amp Schippers (2012) Staging and profiling in substance
abuse treatment
ONCOLOGY
bull T = Tumor size
bull N = Nodes
bull M = Metastasis
bull G = Grade
bull R = Resection
bull c = clinical inform
bull p = pathologist inform
bull y = adjuvant therapy
ADDICTION
bull Stage of the disorder
bull Psychiatricsomatic comorbidity
bull Social dysfunctioning
bull Addictive Substance
bull Reaction on former treatment
bull Clinical (fenotypical) information
bull Endofenotypicalgenetic information
bull Combination treatment
1022013
22
Testing Allocation Algorithm
Concluding Remarks
bull Ample evidence available for effective
alcohol treatment
bull Implementation of evidence-based
treatments in routine practice
insufficient
bull Due to the course of the disorder
adequate matching procedures
necessary
bull RESCueH projects will contribute to
new and applicable knowledge
1022013
23
Success
Also available
MATE-Outcomes for treatment outcome
measurements
MATE-Crimi targeted for criminal and
addictive behaviours
MATE-Youth targeted for 12-23 year
Developed and tested in the Netherlands
and Germany
Dutch English German and Italian versions
available
1022013
24
Drinkerrsquos Check-Up
Dutch version (1994)
Drinkerrsquos Check-Up is a proven
effective two-session brief
motivational intervention
developed by W R Miller (1988)
Providing assessment and
personalized non-judgmental
feedback and motivating advice
(Screening and) Brief Interventions
bull Agenda
bull Advice
bull Assess
bull Assist
bull Arrange
bull Introduce the topic
bull Inform and advice
bull Assess use and problems
bull Inform about support in
behavior change
bull Guide and refer
One
session
2-4
sessions
Treatment gt 4 sessions
1022013
5
Heavy drinking 20 and Harmful alcohol use 14
ca 1480000 persons lsquoat riskrsquo
Alcohol Dependent 3
ca 150000 persons
Alcohol problems in Denmark (2005)
Hansen AB Hvidtfeldt UA Groslashnbaeligk M Becker U Nielsen
AS Tolstrup JS (2011) The number of persons with alcohol problems
in the Danish population Scand J Public Health Mar39(2)128-36
treatment gap
Therefor alcohol problems do
present a
Estimation
in regular treatment ca 10 of the dependent and
lt 2 of the population at risk
1022013
6
But is this fully justified
This is considered a problematic
situation failure of the treatment
system
Recovery Alcohol Disorders in General
Population bull Large Dutch (n=7076) representative survey (with
comparable prevalence figures as in Denmark)
bull Dutch survey had follow-ups at 1 and 3 years
bull Alcohol abuse has a favourable course 81 after 1 year and 85 after 3 year NO abuse anymore
bull Alcohol dependency somewhat less favourable course 67 after 1 year 69 after 3 jaar NO dependency anymore
bull Only 4-12 of the abusers and only 0-14 of those recovered after 1 year relapsed (at 3 year)
CONCLUSION
in general population large lsquospontaneousrsquo recovery
De Bruijn Van den Brink De Graaf amp Volleberg (2005) The three year course
of alcohol use disorders in the general population Addiction
1022013
7
For those lsquoat riskrsquo
Many can recover on their own and many
can profit from a little help hellip
Screening and
brief interventions
(SBI)
None or mild Moderate Substantial Severe
SEVERITY OF ALCOHOL PROBLEMS
SCREENING for alcohol problems
bull As part of routine examination
bull By general practicioner emergency care
and medical specialists
bull Using simple screening tools (CAGE
AUDIT etc)
bull Or reacting to possible signals
hellip and brief interventions
1022013
8
SBI 1-4 sessions applying FRAMES
Feedback about risks of substance use Responsibility placed on client to change Advice to cut down abstain etc Menu of options and choices Empathic approach Self-efficacy using a non-confrontational counselling style which encourages amp reinforces clientrsquos strengths
Motivational Interviewing Style
Brief Interventions the Evidence
bull Effective in opportunistic samples with
hazardousharmful drinking (Moyer et al 2002)
bull Significant effect at follow-up for up to 2 years
(Berglund et al 2003)
bull Longer-term effects less evident booster
sessions required (Fleming et al 2002)
bull Reduce alcohol-related problems and mortality
(Cuypers et al 2004)
bull Involving patients crucial (RESCueH-project)
1022013
9
But
Is face-to-face contact always necessary
May be not when using the internet
eHealth
Internet Self-help and Treatment (Jellinek)
1022013
10
J Med Internet Res 201113(2)e42)
2011 Meta-analysis Alcohol
Internet Self-help (IS) Internet Therapy (IT)
Effects comparison
1022013
11
15
25
35
45
55
baseline 3 months 6 months
Time
Dri
nk
s p
er
we
ek
(T
LF
B)
IT
WL
IS
Alcohol reduction (TLFB)
IT more expensive than IS
More effects more costs
If willingness to pay gt= euro14000 per QALY then
IT has larger probability of cost-effectiveness than IS
Internet Therapy is Cost-effective
1022013
12
Treatment
None or mild Moderate Substantial Severe
SEVERITY OF ALCOHOL PROBLEMS
How does SUD treatment look
like
It is not just keeping someone from
using alcohol or drugs
1022013
13
Treatment of alcohol problems is
bull Providing insight [psycho-education]
bull Helping considering consequences [sociotherapy familytherapy self help]
bull Learning to make choices [motivational interviewing individual and group counseling]
bull Treating craving [medication]
bull Teaching skills [behavioral cognitive and emotional training relapse prevention]
bull Treating co-morbid psychopathology (pharmacotherapy andor psychotherapy)
bull Support in practical and social circumstances (social services)
What does research tell us
on the effectiveness of
treatment on addictive
behavior (consumption of
drugs)
1022013
14
1022013
15
Alcohol Top 10 Effective Interventions
bull Brief intervention
bull Motivational enhancement
bull GABA agonist
bull Opiate antagonist
bull Social skills training
bull Community reinforcement approach (CRA)
bull Behavior contracting
bull Behavioral marital therapy
bull Case management
bull Self-monitoring
General Consensus
bull Lots of evidence available
bull Best evidence for behavioural oriented treatment
bull Best in combination with medication
bull Relative modest effects (but comparable with other chronic illnesses)
bull No outcome differences between residential and outpatient treatments
bull Matching might be crucial (RESCueH)
1022013
16
Some National
Clinical Guidelines
UK 2011 NL 2009 Australia 2003
Finland 2010 Scotland 2003
Treatment self-control training
and influencing the environment
ndash motivating Influencing readiness to change
ndash self control training
changing drinking behavior
ndash relapse prevention social and affective skills training
ndash influencing environment
Social family job community
Physical medication constraints
ndash
1022013
17
Motivation enhancement fe by Motivational Interviewing
bull Responsibility for change is left with the
individual
bull The individual is free to take our advice or not
bull The strategies are more supportive than
argumentative
bull Goal is to increase the intrinsic motivation
bull The client presents the arguments for change
Self control training
bull Monitoring use (how much what when how and in what
circumstances am I using)
bull Setting limits (how much what when how and in what
circumstances do I allow myself to use)
bullConsequential rewards punishments (what do I do or not
do donrsquot keep my promisses)
bullChoice of alternative behavior (what do I do instead of)
bull Planning for emergencie (what if I fail)
1022013
18
Relapse prevention Assessing risk situations
Training alternative behaviors
Training alternative emotions
Emotional skills training (craving)
Cue exposure (RESCueH-project)
Training alternative cognitions
training in self confidence
harm reduction after relapse
training phantasies
Medications for Alcohol Dependence
Disulfiram (Antabusereg)
Naltrexone (Reviareg)
Acamprosate (Campralreg)
Nalmefene NEW
1022013
19
Integration of Psychosocial and
Pharmaceutical Treatment Necessary
Pharmacotherapy for alcohol
dependence should always be
accompanied by psychosocial andor
behavioral treatments
Disease Management Model of
Alcohol Problems
Primary Prevention
(Health promoting actions)
Care
Specialized
Treatment Brief
intervention
Prevalence of Alcohol Problems
SourceInstitute of Medicine (1990) Broadening the Base of Treatment for
Alcohol Problems Washington DC National Academy Press
None or mild Moderate Substantial Severe
SEVERITY OF ALCOHOL PROBLEMS
1022013
20
Disease Management Model
Recquires adequate measurement of
patient characteristics
Measurement of Addictions for
Triage and Evaluation
New general up-to-date assessment instrument for
patieumlnt characteristics in substance abuse treatment
ndash European alternative
Designed for treatment allocation (triage) in a disease
management model
1022013
21
Disease Management Model
Staging and profiling chronic ill
patients to match to proper level and
kinds of care
Model developed inspired by the
staging and profiling of cancer
treatment
Van den Brink amp Schippers (2012) Stageing and profiling in substance
abuse treatment
TNM System Analogy
Van den Brink amp Schippers (2012) Staging and profiling in substance
abuse treatment
ONCOLOGY
bull T = Tumor size
bull N = Nodes
bull M = Metastasis
bull G = Grade
bull R = Resection
bull c = clinical inform
bull p = pathologist inform
bull y = adjuvant therapy
ADDICTION
bull Stage of the disorder
bull Psychiatricsomatic comorbidity
bull Social dysfunctioning
bull Addictive Substance
bull Reaction on former treatment
bull Clinical (fenotypical) information
bull Endofenotypicalgenetic information
bull Combination treatment
1022013
22
Testing Allocation Algorithm
Concluding Remarks
bull Ample evidence available for effective
alcohol treatment
bull Implementation of evidence-based
treatments in routine practice
insufficient
bull Due to the course of the disorder
adequate matching procedures
necessary
bull RESCueH projects will contribute to
new and applicable knowledge
1022013
23
Success
Also available
MATE-Outcomes for treatment outcome
measurements
MATE-Crimi targeted for criminal and
addictive behaviours
MATE-Youth targeted for 12-23 year
Developed and tested in the Netherlands
and Germany
Dutch English German and Italian versions
available
1022013
24
Drinkerrsquos Check-Up
Dutch version (1994)
Drinkerrsquos Check-Up is a proven
effective two-session brief
motivational intervention
developed by W R Miller (1988)
Providing assessment and
personalized non-judgmental
feedback and motivating advice
(Screening and) Brief Interventions
bull Agenda
bull Advice
bull Assess
bull Assist
bull Arrange
bull Introduce the topic
bull Inform and advice
bull Assess use and problems
bull Inform about support in
behavior change
bull Guide and refer
One
session
2-4
sessions
Treatment gt 4 sessions
1022013
6
But is this fully justified
This is considered a problematic
situation failure of the treatment
system
Recovery Alcohol Disorders in General
Population bull Large Dutch (n=7076) representative survey (with
comparable prevalence figures as in Denmark)
bull Dutch survey had follow-ups at 1 and 3 years
bull Alcohol abuse has a favourable course 81 after 1 year and 85 after 3 year NO abuse anymore
bull Alcohol dependency somewhat less favourable course 67 after 1 year 69 after 3 jaar NO dependency anymore
bull Only 4-12 of the abusers and only 0-14 of those recovered after 1 year relapsed (at 3 year)
CONCLUSION
in general population large lsquospontaneousrsquo recovery
De Bruijn Van den Brink De Graaf amp Volleberg (2005) The three year course
of alcohol use disorders in the general population Addiction
1022013
7
For those lsquoat riskrsquo
Many can recover on their own and many
can profit from a little help hellip
Screening and
brief interventions
(SBI)
None or mild Moderate Substantial Severe
SEVERITY OF ALCOHOL PROBLEMS
SCREENING for alcohol problems
bull As part of routine examination
bull By general practicioner emergency care
and medical specialists
bull Using simple screening tools (CAGE
AUDIT etc)
bull Or reacting to possible signals
hellip and brief interventions
1022013
8
SBI 1-4 sessions applying FRAMES
Feedback about risks of substance use Responsibility placed on client to change Advice to cut down abstain etc Menu of options and choices Empathic approach Self-efficacy using a non-confrontational counselling style which encourages amp reinforces clientrsquos strengths
Motivational Interviewing Style
Brief Interventions the Evidence
bull Effective in opportunistic samples with
hazardousharmful drinking (Moyer et al 2002)
bull Significant effect at follow-up for up to 2 years
(Berglund et al 2003)
bull Longer-term effects less evident booster
sessions required (Fleming et al 2002)
bull Reduce alcohol-related problems and mortality
(Cuypers et al 2004)
bull Involving patients crucial (RESCueH-project)
1022013
9
But
Is face-to-face contact always necessary
May be not when using the internet
eHealth
Internet Self-help and Treatment (Jellinek)
1022013
10
J Med Internet Res 201113(2)e42)
2011 Meta-analysis Alcohol
Internet Self-help (IS) Internet Therapy (IT)
Effects comparison
1022013
11
15
25
35
45
55
baseline 3 months 6 months
Time
Dri
nk
s p
er
we
ek
(T
LF
B)
IT
WL
IS
Alcohol reduction (TLFB)
IT more expensive than IS
More effects more costs
If willingness to pay gt= euro14000 per QALY then
IT has larger probability of cost-effectiveness than IS
Internet Therapy is Cost-effective
1022013
12
Treatment
None or mild Moderate Substantial Severe
SEVERITY OF ALCOHOL PROBLEMS
How does SUD treatment look
like
It is not just keeping someone from
using alcohol or drugs
1022013
13
Treatment of alcohol problems is
bull Providing insight [psycho-education]
bull Helping considering consequences [sociotherapy familytherapy self help]
bull Learning to make choices [motivational interviewing individual and group counseling]
bull Treating craving [medication]
bull Teaching skills [behavioral cognitive and emotional training relapse prevention]
bull Treating co-morbid psychopathology (pharmacotherapy andor psychotherapy)
bull Support in practical and social circumstances (social services)
What does research tell us
on the effectiveness of
treatment on addictive
behavior (consumption of
drugs)
1022013
14
1022013
15
Alcohol Top 10 Effective Interventions
bull Brief intervention
bull Motivational enhancement
bull GABA agonist
bull Opiate antagonist
bull Social skills training
bull Community reinforcement approach (CRA)
bull Behavior contracting
bull Behavioral marital therapy
bull Case management
bull Self-monitoring
General Consensus
bull Lots of evidence available
bull Best evidence for behavioural oriented treatment
bull Best in combination with medication
bull Relative modest effects (but comparable with other chronic illnesses)
bull No outcome differences between residential and outpatient treatments
bull Matching might be crucial (RESCueH)
1022013
16
Some National
Clinical Guidelines
UK 2011 NL 2009 Australia 2003
Finland 2010 Scotland 2003
Treatment self-control training
and influencing the environment
ndash motivating Influencing readiness to change
ndash self control training
changing drinking behavior
ndash relapse prevention social and affective skills training
ndash influencing environment
Social family job community
Physical medication constraints
ndash
1022013
17
Motivation enhancement fe by Motivational Interviewing
bull Responsibility for change is left with the
individual
bull The individual is free to take our advice or not
bull The strategies are more supportive than
argumentative
bull Goal is to increase the intrinsic motivation
bull The client presents the arguments for change
Self control training
bull Monitoring use (how much what when how and in what
circumstances am I using)
bull Setting limits (how much what when how and in what
circumstances do I allow myself to use)
bullConsequential rewards punishments (what do I do or not
do donrsquot keep my promisses)
bullChoice of alternative behavior (what do I do instead of)
bull Planning for emergencie (what if I fail)
1022013
18
Relapse prevention Assessing risk situations
Training alternative behaviors
Training alternative emotions
Emotional skills training (craving)
Cue exposure (RESCueH-project)
Training alternative cognitions
training in self confidence
harm reduction after relapse
training phantasies
Medications for Alcohol Dependence
Disulfiram (Antabusereg)
Naltrexone (Reviareg)
Acamprosate (Campralreg)
Nalmefene NEW
1022013
19
Integration of Psychosocial and
Pharmaceutical Treatment Necessary
Pharmacotherapy for alcohol
dependence should always be
accompanied by psychosocial andor
behavioral treatments
Disease Management Model of
Alcohol Problems
Primary Prevention
(Health promoting actions)
Care
Specialized
Treatment Brief
intervention
Prevalence of Alcohol Problems
SourceInstitute of Medicine (1990) Broadening the Base of Treatment for
Alcohol Problems Washington DC National Academy Press
None or mild Moderate Substantial Severe
SEVERITY OF ALCOHOL PROBLEMS
1022013
20
Disease Management Model
Recquires adequate measurement of
patient characteristics
Measurement of Addictions for
Triage and Evaluation
New general up-to-date assessment instrument for
patieumlnt characteristics in substance abuse treatment
ndash European alternative
Designed for treatment allocation (triage) in a disease
management model
1022013
21
Disease Management Model
Staging and profiling chronic ill
patients to match to proper level and
kinds of care
Model developed inspired by the
staging and profiling of cancer
treatment
Van den Brink amp Schippers (2012) Stageing and profiling in substance
abuse treatment
TNM System Analogy
Van den Brink amp Schippers (2012) Staging and profiling in substance
abuse treatment
ONCOLOGY
bull T = Tumor size
bull N = Nodes
bull M = Metastasis
bull G = Grade
bull R = Resection
bull c = clinical inform
bull p = pathologist inform
bull y = adjuvant therapy
ADDICTION
bull Stage of the disorder
bull Psychiatricsomatic comorbidity
bull Social dysfunctioning
bull Addictive Substance
bull Reaction on former treatment
bull Clinical (fenotypical) information
bull Endofenotypicalgenetic information
bull Combination treatment
1022013
22
Testing Allocation Algorithm
Concluding Remarks
bull Ample evidence available for effective
alcohol treatment
bull Implementation of evidence-based
treatments in routine practice
insufficient
bull Due to the course of the disorder
adequate matching procedures
necessary
bull RESCueH projects will contribute to
new and applicable knowledge
1022013
23
Success
Also available
MATE-Outcomes for treatment outcome
measurements
MATE-Crimi targeted for criminal and
addictive behaviours
MATE-Youth targeted for 12-23 year
Developed and tested in the Netherlands
and Germany
Dutch English German and Italian versions
available
1022013
24
Drinkerrsquos Check-Up
Dutch version (1994)
Drinkerrsquos Check-Up is a proven
effective two-session brief
motivational intervention
developed by W R Miller (1988)
Providing assessment and
personalized non-judgmental
feedback and motivating advice
(Screening and) Brief Interventions
bull Agenda
bull Advice
bull Assess
bull Assist
bull Arrange
bull Introduce the topic
bull Inform and advice
bull Assess use and problems
bull Inform about support in
behavior change
bull Guide and refer
One
session
2-4
sessions
Treatment gt 4 sessions
1022013
7
For those lsquoat riskrsquo
Many can recover on their own and many
can profit from a little help hellip
Screening and
brief interventions
(SBI)
None or mild Moderate Substantial Severe
SEVERITY OF ALCOHOL PROBLEMS
SCREENING for alcohol problems
bull As part of routine examination
bull By general practicioner emergency care
and medical specialists
bull Using simple screening tools (CAGE
AUDIT etc)
bull Or reacting to possible signals
hellip and brief interventions
1022013
8
SBI 1-4 sessions applying FRAMES
Feedback about risks of substance use Responsibility placed on client to change Advice to cut down abstain etc Menu of options and choices Empathic approach Self-efficacy using a non-confrontational counselling style which encourages amp reinforces clientrsquos strengths
Motivational Interviewing Style
Brief Interventions the Evidence
bull Effective in opportunistic samples with
hazardousharmful drinking (Moyer et al 2002)
bull Significant effect at follow-up for up to 2 years
(Berglund et al 2003)
bull Longer-term effects less evident booster
sessions required (Fleming et al 2002)
bull Reduce alcohol-related problems and mortality
(Cuypers et al 2004)
bull Involving patients crucial (RESCueH-project)
1022013
9
But
Is face-to-face contact always necessary
May be not when using the internet
eHealth
Internet Self-help and Treatment (Jellinek)
1022013
10
J Med Internet Res 201113(2)e42)
2011 Meta-analysis Alcohol
Internet Self-help (IS) Internet Therapy (IT)
Effects comparison
1022013
11
15
25
35
45
55
baseline 3 months 6 months
Time
Dri
nk
s p
er
we
ek
(T
LF
B)
IT
WL
IS
Alcohol reduction (TLFB)
IT more expensive than IS
More effects more costs
If willingness to pay gt= euro14000 per QALY then
IT has larger probability of cost-effectiveness than IS
Internet Therapy is Cost-effective
1022013
12
Treatment
None or mild Moderate Substantial Severe
SEVERITY OF ALCOHOL PROBLEMS
How does SUD treatment look
like
It is not just keeping someone from
using alcohol or drugs
1022013
13
Treatment of alcohol problems is
bull Providing insight [psycho-education]
bull Helping considering consequences [sociotherapy familytherapy self help]
bull Learning to make choices [motivational interviewing individual and group counseling]
bull Treating craving [medication]
bull Teaching skills [behavioral cognitive and emotional training relapse prevention]
bull Treating co-morbid psychopathology (pharmacotherapy andor psychotherapy)
bull Support in practical and social circumstances (social services)
What does research tell us
on the effectiveness of
treatment on addictive
behavior (consumption of
drugs)
1022013
14
1022013
15
Alcohol Top 10 Effective Interventions
bull Brief intervention
bull Motivational enhancement
bull GABA agonist
bull Opiate antagonist
bull Social skills training
bull Community reinforcement approach (CRA)
bull Behavior contracting
bull Behavioral marital therapy
bull Case management
bull Self-monitoring
General Consensus
bull Lots of evidence available
bull Best evidence for behavioural oriented treatment
bull Best in combination with medication
bull Relative modest effects (but comparable with other chronic illnesses)
bull No outcome differences between residential and outpatient treatments
bull Matching might be crucial (RESCueH)
1022013
16
Some National
Clinical Guidelines
UK 2011 NL 2009 Australia 2003
Finland 2010 Scotland 2003
Treatment self-control training
and influencing the environment
ndash motivating Influencing readiness to change
ndash self control training
changing drinking behavior
ndash relapse prevention social and affective skills training
ndash influencing environment
Social family job community
Physical medication constraints
ndash
1022013
17
Motivation enhancement fe by Motivational Interviewing
bull Responsibility for change is left with the
individual
bull The individual is free to take our advice or not
bull The strategies are more supportive than
argumentative
bull Goal is to increase the intrinsic motivation
bull The client presents the arguments for change
Self control training
bull Monitoring use (how much what when how and in what
circumstances am I using)
bull Setting limits (how much what when how and in what
circumstances do I allow myself to use)
bullConsequential rewards punishments (what do I do or not
do donrsquot keep my promisses)
bullChoice of alternative behavior (what do I do instead of)
bull Planning for emergencie (what if I fail)
1022013
18
Relapse prevention Assessing risk situations
Training alternative behaviors
Training alternative emotions
Emotional skills training (craving)
Cue exposure (RESCueH-project)
Training alternative cognitions
training in self confidence
harm reduction after relapse
training phantasies
Medications for Alcohol Dependence
Disulfiram (Antabusereg)
Naltrexone (Reviareg)
Acamprosate (Campralreg)
Nalmefene NEW
1022013
19
Integration of Psychosocial and
Pharmaceutical Treatment Necessary
Pharmacotherapy for alcohol
dependence should always be
accompanied by psychosocial andor
behavioral treatments
Disease Management Model of
Alcohol Problems
Primary Prevention
(Health promoting actions)
Care
Specialized
Treatment Brief
intervention
Prevalence of Alcohol Problems
SourceInstitute of Medicine (1990) Broadening the Base of Treatment for
Alcohol Problems Washington DC National Academy Press
None or mild Moderate Substantial Severe
SEVERITY OF ALCOHOL PROBLEMS
1022013
20
Disease Management Model
Recquires adequate measurement of
patient characteristics
Measurement of Addictions for
Triage and Evaluation
New general up-to-date assessment instrument for
patieumlnt characteristics in substance abuse treatment
ndash European alternative
Designed for treatment allocation (triage) in a disease
management model
1022013
21
Disease Management Model
Staging and profiling chronic ill
patients to match to proper level and
kinds of care
Model developed inspired by the
staging and profiling of cancer
treatment
Van den Brink amp Schippers (2012) Stageing and profiling in substance
abuse treatment
TNM System Analogy
Van den Brink amp Schippers (2012) Staging and profiling in substance
abuse treatment
ONCOLOGY
bull T = Tumor size
bull N = Nodes
bull M = Metastasis
bull G = Grade
bull R = Resection
bull c = clinical inform
bull p = pathologist inform
bull y = adjuvant therapy
ADDICTION
bull Stage of the disorder
bull Psychiatricsomatic comorbidity
bull Social dysfunctioning
bull Addictive Substance
bull Reaction on former treatment
bull Clinical (fenotypical) information
bull Endofenotypicalgenetic information
bull Combination treatment
1022013
22
Testing Allocation Algorithm
Concluding Remarks
bull Ample evidence available for effective
alcohol treatment
bull Implementation of evidence-based
treatments in routine practice
insufficient
bull Due to the course of the disorder
adequate matching procedures
necessary
bull RESCueH projects will contribute to
new and applicable knowledge
1022013
23
Success
Also available
MATE-Outcomes for treatment outcome
measurements
MATE-Crimi targeted for criminal and
addictive behaviours
MATE-Youth targeted for 12-23 year
Developed and tested in the Netherlands
and Germany
Dutch English German and Italian versions
available
1022013
24
Drinkerrsquos Check-Up
Dutch version (1994)
Drinkerrsquos Check-Up is a proven
effective two-session brief
motivational intervention
developed by W R Miller (1988)
Providing assessment and
personalized non-judgmental
feedback and motivating advice
(Screening and) Brief Interventions
bull Agenda
bull Advice
bull Assess
bull Assist
bull Arrange
bull Introduce the topic
bull Inform and advice
bull Assess use and problems
bull Inform about support in
behavior change
bull Guide and refer
One
session
2-4
sessions
Treatment gt 4 sessions
1022013
8
SBI 1-4 sessions applying FRAMES
Feedback about risks of substance use Responsibility placed on client to change Advice to cut down abstain etc Menu of options and choices Empathic approach Self-efficacy using a non-confrontational counselling style which encourages amp reinforces clientrsquos strengths
Motivational Interviewing Style
Brief Interventions the Evidence
bull Effective in opportunistic samples with
hazardousharmful drinking (Moyer et al 2002)
bull Significant effect at follow-up for up to 2 years
(Berglund et al 2003)
bull Longer-term effects less evident booster
sessions required (Fleming et al 2002)
bull Reduce alcohol-related problems and mortality
(Cuypers et al 2004)
bull Involving patients crucial (RESCueH-project)
1022013
9
But
Is face-to-face contact always necessary
May be not when using the internet
eHealth
Internet Self-help and Treatment (Jellinek)
1022013
10
J Med Internet Res 201113(2)e42)
2011 Meta-analysis Alcohol
Internet Self-help (IS) Internet Therapy (IT)
Effects comparison
1022013
11
15
25
35
45
55
baseline 3 months 6 months
Time
Dri
nk
s p
er
we
ek
(T
LF
B)
IT
WL
IS
Alcohol reduction (TLFB)
IT more expensive than IS
More effects more costs
If willingness to pay gt= euro14000 per QALY then
IT has larger probability of cost-effectiveness than IS
Internet Therapy is Cost-effective
1022013
12
Treatment
None or mild Moderate Substantial Severe
SEVERITY OF ALCOHOL PROBLEMS
How does SUD treatment look
like
It is not just keeping someone from
using alcohol or drugs
1022013
13
Treatment of alcohol problems is
bull Providing insight [psycho-education]
bull Helping considering consequences [sociotherapy familytherapy self help]
bull Learning to make choices [motivational interviewing individual and group counseling]
bull Treating craving [medication]
bull Teaching skills [behavioral cognitive and emotional training relapse prevention]
bull Treating co-morbid psychopathology (pharmacotherapy andor psychotherapy)
bull Support in practical and social circumstances (social services)
What does research tell us
on the effectiveness of
treatment on addictive
behavior (consumption of
drugs)
1022013
14
1022013
15
Alcohol Top 10 Effective Interventions
bull Brief intervention
bull Motivational enhancement
bull GABA agonist
bull Opiate antagonist
bull Social skills training
bull Community reinforcement approach (CRA)
bull Behavior contracting
bull Behavioral marital therapy
bull Case management
bull Self-monitoring
General Consensus
bull Lots of evidence available
bull Best evidence for behavioural oriented treatment
bull Best in combination with medication
bull Relative modest effects (but comparable with other chronic illnesses)
bull No outcome differences between residential and outpatient treatments
bull Matching might be crucial (RESCueH)
1022013
16
Some National
Clinical Guidelines
UK 2011 NL 2009 Australia 2003
Finland 2010 Scotland 2003
Treatment self-control training
and influencing the environment
ndash motivating Influencing readiness to change
ndash self control training
changing drinking behavior
ndash relapse prevention social and affective skills training
ndash influencing environment
Social family job community
Physical medication constraints
ndash
1022013
17
Motivation enhancement fe by Motivational Interviewing
bull Responsibility for change is left with the
individual
bull The individual is free to take our advice or not
bull The strategies are more supportive than
argumentative
bull Goal is to increase the intrinsic motivation
bull The client presents the arguments for change
Self control training
bull Monitoring use (how much what when how and in what
circumstances am I using)
bull Setting limits (how much what when how and in what
circumstances do I allow myself to use)
bullConsequential rewards punishments (what do I do or not
do donrsquot keep my promisses)
bullChoice of alternative behavior (what do I do instead of)
bull Planning for emergencie (what if I fail)
1022013
18
Relapse prevention Assessing risk situations
Training alternative behaviors
Training alternative emotions
Emotional skills training (craving)
Cue exposure (RESCueH-project)
Training alternative cognitions
training in self confidence
harm reduction after relapse
training phantasies
Medications for Alcohol Dependence
Disulfiram (Antabusereg)
Naltrexone (Reviareg)
Acamprosate (Campralreg)
Nalmefene NEW
1022013
19
Integration of Psychosocial and
Pharmaceutical Treatment Necessary
Pharmacotherapy for alcohol
dependence should always be
accompanied by psychosocial andor
behavioral treatments
Disease Management Model of
Alcohol Problems
Primary Prevention
(Health promoting actions)
Care
Specialized
Treatment Brief
intervention
Prevalence of Alcohol Problems
SourceInstitute of Medicine (1990) Broadening the Base of Treatment for
Alcohol Problems Washington DC National Academy Press
None or mild Moderate Substantial Severe
SEVERITY OF ALCOHOL PROBLEMS
1022013
20
Disease Management Model
Recquires adequate measurement of
patient characteristics
Measurement of Addictions for
Triage and Evaluation
New general up-to-date assessment instrument for
patieumlnt characteristics in substance abuse treatment
ndash European alternative
Designed for treatment allocation (triage) in a disease
management model
1022013
21
Disease Management Model
Staging and profiling chronic ill
patients to match to proper level and
kinds of care
Model developed inspired by the
staging and profiling of cancer
treatment
Van den Brink amp Schippers (2012) Stageing and profiling in substance
abuse treatment
TNM System Analogy
Van den Brink amp Schippers (2012) Staging and profiling in substance
abuse treatment
ONCOLOGY
bull T = Tumor size
bull N = Nodes
bull M = Metastasis
bull G = Grade
bull R = Resection
bull c = clinical inform
bull p = pathologist inform
bull y = adjuvant therapy
ADDICTION
bull Stage of the disorder
bull Psychiatricsomatic comorbidity
bull Social dysfunctioning
bull Addictive Substance
bull Reaction on former treatment
bull Clinical (fenotypical) information
bull Endofenotypicalgenetic information
bull Combination treatment
1022013
22
Testing Allocation Algorithm
Concluding Remarks
bull Ample evidence available for effective
alcohol treatment
bull Implementation of evidence-based
treatments in routine practice
insufficient
bull Due to the course of the disorder
adequate matching procedures
necessary
bull RESCueH projects will contribute to
new and applicable knowledge
1022013
23
Success
Also available
MATE-Outcomes for treatment outcome
measurements
MATE-Crimi targeted for criminal and
addictive behaviours
MATE-Youth targeted for 12-23 year
Developed and tested in the Netherlands
and Germany
Dutch English German and Italian versions
available
1022013
24
Drinkerrsquos Check-Up
Dutch version (1994)
Drinkerrsquos Check-Up is a proven
effective two-session brief
motivational intervention
developed by W R Miller (1988)
Providing assessment and
personalized non-judgmental
feedback and motivating advice
(Screening and) Brief Interventions
bull Agenda
bull Advice
bull Assess
bull Assist
bull Arrange
bull Introduce the topic
bull Inform and advice
bull Assess use and problems
bull Inform about support in
behavior change
bull Guide and refer
One
session
2-4
sessions
Treatment gt 4 sessions
1022013
9
But
Is face-to-face contact always necessary
May be not when using the internet
eHealth
Internet Self-help and Treatment (Jellinek)
1022013
10
J Med Internet Res 201113(2)e42)
2011 Meta-analysis Alcohol
Internet Self-help (IS) Internet Therapy (IT)
Effects comparison
1022013
11
15
25
35
45
55
baseline 3 months 6 months
Time
Dri
nk
s p
er
we
ek
(T
LF
B)
IT
WL
IS
Alcohol reduction (TLFB)
IT more expensive than IS
More effects more costs
If willingness to pay gt= euro14000 per QALY then
IT has larger probability of cost-effectiveness than IS
Internet Therapy is Cost-effective
1022013
12
Treatment
None or mild Moderate Substantial Severe
SEVERITY OF ALCOHOL PROBLEMS
How does SUD treatment look
like
It is not just keeping someone from
using alcohol or drugs
1022013
13
Treatment of alcohol problems is
bull Providing insight [psycho-education]
bull Helping considering consequences [sociotherapy familytherapy self help]
bull Learning to make choices [motivational interviewing individual and group counseling]
bull Treating craving [medication]
bull Teaching skills [behavioral cognitive and emotional training relapse prevention]
bull Treating co-morbid psychopathology (pharmacotherapy andor psychotherapy)
bull Support in practical and social circumstances (social services)
What does research tell us
on the effectiveness of
treatment on addictive
behavior (consumption of
drugs)
1022013
14
1022013
15
Alcohol Top 10 Effective Interventions
bull Brief intervention
bull Motivational enhancement
bull GABA agonist
bull Opiate antagonist
bull Social skills training
bull Community reinforcement approach (CRA)
bull Behavior contracting
bull Behavioral marital therapy
bull Case management
bull Self-monitoring
General Consensus
bull Lots of evidence available
bull Best evidence for behavioural oriented treatment
bull Best in combination with medication
bull Relative modest effects (but comparable with other chronic illnesses)
bull No outcome differences between residential and outpatient treatments
bull Matching might be crucial (RESCueH)
1022013
16
Some National
Clinical Guidelines
UK 2011 NL 2009 Australia 2003
Finland 2010 Scotland 2003
Treatment self-control training
and influencing the environment
ndash motivating Influencing readiness to change
ndash self control training
changing drinking behavior
ndash relapse prevention social and affective skills training
ndash influencing environment
Social family job community
Physical medication constraints
ndash
1022013
17
Motivation enhancement fe by Motivational Interviewing
bull Responsibility for change is left with the
individual
bull The individual is free to take our advice or not
bull The strategies are more supportive than
argumentative
bull Goal is to increase the intrinsic motivation
bull The client presents the arguments for change
Self control training
bull Monitoring use (how much what when how and in what
circumstances am I using)
bull Setting limits (how much what when how and in what
circumstances do I allow myself to use)
bullConsequential rewards punishments (what do I do or not
do donrsquot keep my promisses)
bullChoice of alternative behavior (what do I do instead of)
bull Planning for emergencie (what if I fail)
1022013
18
Relapse prevention Assessing risk situations
Training alternative behaviors
Training alternative emotions
Emotional skills training (craving)
Cue exposure (RESCueH-project)
Training alternative cognitions
training in self confidence
harm reduction after relapse
training phantasies
Medications for Alcohol Dependence
Disulfiram (Antabusereg)
Naltrexone (Reviareg)
Acamprosate (Campralreg)
Nalmefene NEW
1022013
19
Integration of Psychosocial and
Pharmaceutical Treatment Necessary
Pharmacotherapy for alcohol
dependence should always be
accompanied by psychosocial andor
behavioral treatments
Disease Management Model of
Alcohol Problems
Primary Prevention
(Health promoting actions)
Care
Specialized
Treatment Brief
intervention
Prevalence of Alcohol Problems
SourceInstitute of Medicine (1990) Broadening the Base of Treatment for
Alcohol Problems Washington DC National Academy Press
None or mild Moderate Substantial Severe
SEVERITY OF ALCOHOL PROBLEMS
1022013
20
Disease Management Model
Recquires adequate measurement of
patient characteristics
Measurement of Addictions for
Triage and Evaluation
New general up-to-date assessment instrument for
patieumlnt characteristics in substance abuse treatment
ndash European alternative
Designed for treatment allocation (triage) in a disease
management model
1022013
21
Disease Management Model
Staging and profiling chronic ill
patients to match to proper level and
kinds of care
Model developed inspired by the
staging and profiling of cancer
treatment
Van den Brink amp Schippers (2012) Stageing and profiling in substance
abuse treatment
TNM System Analogy
Van den Brink amp Schippers (2012) Staging and profiling in substance
abuse treatment
ONCOLOGY
bull T = Tumor size
bull N = Nodes
bull M = Metastasis
bull G = Grade
bull R = Resection
bull c = clinical inform
bull p = pathologist inform
bull y = adjuvant therapy
ADDICTION
bull Stage of the disorder
bull Psychiatricsomatic comorbidity
bull Social dysfunctioning
bull Addictive Substance
bull Reaction on former treatment
bull Clinical (fenotypical) information
bull Endofenotypicalgenetic information
bull Combination treatment
1022013
22
Testing Allocation Algorithm
Concluding Remarks
bull Ample evidence available for effective
alcohol treatment
bull Implementation of evidence-based
treatments in routine practice
insufficient
bull Due to the course of the disorder
adequate matching procedures
necessary
bull RESCueH projects will contribute to
new and applicable knowledge
1022013
23
Success
Also available
MATE-Outcomes for treatment outcome
measurements
MATE-Crimi targeted for criminal and
addictive behaviours
MATE-Youth targeted for 12-23 year
Developed and tested in the Netherlands
and Germany
Dutch English German and Italian versions
available
1022013
24
Drinkerrsquos Check-Up
Dutch version (1994)
Drinkerrsquos Check-Up is a proven
effective two-session brief
motivational intervention
developed by W R Miller (1988)
Providing assessment and
personalized non-judgmental
feedback and motivating advice
(Screening and) Brief Interventions
bull Agenda
bull Advice
bull Assess
bull Assist
bull Arrange
bull Introduce the topic
bull Inform and advice
bull Assess use and problems
bull Inform about support in
behavior change
bull Guide and refer
One
session
2-4
sessions
Treatment gt 4 sessions
1022013
10
J Med Internet Res 201113(2)e42)
2011 Meta-analysis Alcohol
Internet Self-help (IS) Internet Therapy (IT)
Effects comparison
1022013
11
15
25
35
45
55
baseline 3 months 6 months
Time
Dri
nk
s p
er
we
ek
(T
LF
B)
IT
WL
IS
Alcohol reduction (TLFB)
IT more expensive than IS
More effects more costs
If willingness to pay gt= euro14000 per QALY then
IT has larger probability of cost-effectiveness than IS
Internet Therapy is Cost-effective
1022013
12
Treatment
None or mild Moderate Substantial Severe
SEVERITY OF ALCOHOL PROBLEMS
How does SUD treatment look
like
It is not just keeping someone from
using alcohol or drugs
1022013
13
Treatment of alcohol problems is
bull Providing insight [psycho-education]
bull Helping considering consequences [sociotherapy familytherapy self help]
bull Learning to make choices [motivational interviewing individual and group counseling]
bull Treating craving [medication]
bull Teaching skills [behavioral cognitive and emotional training relapse prevention]
bull Treating co-morbid psychopathology (pharmacotherapy andor psychotherapy)
bull Support in practical and social circumstances (social services)
What does research tell us
on the effectiveness of
treatment on addictive
behavior (consumption of
drugs)
1022013
14
1022013
15
Alcohol Top 10 Effective Interventions
bull Brief intervention
bull Motivational enhancement
bull GABA agonist
bull Opiate antagonist
bull Social skills training
bull Community reinforcement approach (CRA)
bull Behavior contracting
bull Behavioral marital therapy
bull Case management
bull Self-monitoring
General Consensus
bull Lots of evidence available
bull Best evidence for behavioural oriented treatment
bull Best in combination with medication
bull Relative modest effects (but comparable with other chronic illnesses)
bull No outcome differences between residential and outpatient treatments
bull Matching might be crucial (RESCueH)
1022013
16
Some National
Clinical Guidelines
UK 2011 NL 2009 Australia 2003
Finland 2010 Scotland 2003
Treatment self-control training
and influencing the environment
ndash motivating Influencing readiness to change
ndash self control training
changing drinking behavior
ndash relapse prevention social and affective skills training
ndash influencing environment
Social family job community
Physical medication constraints
ndash
1022013
17
Motivation enhancement fe by Motivational Interviewing
bull Responsibility for change is left with the
individual
bull The individual is free to take our advice or not
bull The strategies are more supportive than
argumentative
bull Goal is to increase the intrinsic motivation
bull The client presents the arguments for change
Self control training
bull Monitoring use (how much what when how and in what
circumstances am I using)
bull Setting limits (how much what when how and in what
circumstances do I allow myself to use)
bullConsequential rewards punishments (what do I do or not
do donrsquot keep my promisses)
bullChoice of alternative behavior (what do I do instead of)
bull Planning for emergencie (what if I fail)
1022013
18
Relapse prevention Assessing risk situations
Training alternative behaviors
Training alternative emotions
Emotional skills training (craving)
Cue exposure (RESCueH-project)
Training alternative cognitions
training in self confidence
harm reduction after relapse
training phantasies
Medications for Alcohol Dependence
Disulfiram (Antabusereg)
Naltrexone (Reviareg)
Acamprosate (Campralreg)
Nalmefene NEW
1022013
19
Integration of Psychosocial and
Pharmaceutical Treatment Necessary
Pharmacotherapy for alcohol
dependence should always be
accompanied by psychosocial andor
behavioral treatments
Disease Management Model of
Alcohol Problems
Primary Prevention
(Health promoting actions)
Care
Specialized
Treatment Brief
intervention
Prevalence of Alcohol Problems
SourceInstitute of Medicine (1990) Broadening the Base of Treatment for
Alcohol Problems Washington DC National Academy Press
None or mild Moderate Substantial Severe
SEVERITY OF ALCOHOL PROBLEMS
1022013
20
Disease Management Model
Recquires adequate measurement of
patient characteristics
Measurement of Addictions for
Triage and Evaluation
New general up-to-date assessment instrument for
patieumlnt characteristics in substance abuse treatment
ndash European alternative
Designed for treatment allocation (triage) in a disease
management model
1022013
21
Disease Management Model
Staging and profiling chronic ill
patients to match to proper level and
kinds of care
Model developed inspired by the
staging and profiling of cancer
treatment
Van den Brink amp Schippers (2012) Stageing and profiling in substance
abuse treatment
TNM System Analogy
Van den Brink amp Schippers (2012) Staging and profiling in substance
abuse treatment
ONCOLOGY
bull T = Tumor size
bull N = Nodes
bull M = Metastasis
bull G = Grade
bull R = Resection
bull c = clinical inform
bull p = pathologist inform
bull y = adjuvant therapy
ADDICTION
bull Stage of the disorder
bull Psychiatricsomatic comorbidity
bull Social dysfunctioning
bull Addictive Substance
bull Reaction on former treatment
bull Clinical (fenotypical) information
bull Endofenotypicalgenetic information
bull Combination treatment
1022013
22
Testing Allocation Algorithm
Concluding Remarks
bull Ample evidence available for effective
alcohol treatment
bull Implementation of evidence-based
treatments in routine practice
insufficient
bull Due to the course of the disorder
adequate matching procedures
necessary
bull RESCueH projects will contribute to
new and applicable knowledge
1022013
23
Success
Also available
MATE-Outcomes for treatment outcome
measurements
MATE-Crimi targeted for criminal and
addictive behaviours
MATE-Youth targeted for 12-23 year
Developed and tested in the Netherlands
and Germany
Dutch English German and Italian versions
available
1022013
24
Drinkerrsquos Check-Up
Dutch version (1994)
Drinkerrsquos Check-Up is a proven
effective two-session brief
motivational intervention
developed by W R Miller (1988)
Providing assessment and
personalized non-judgmental
feedback and motivating advice
(Screening and) Brief Interventions
bull Agenda
bull Advice
bull Assess
bull Assist
bull Arrange
bull Introduce the topic
bull Inform and advice
bull Assess use and problems
bull Inform about support in
behavior change
bull Guide and refer
One
session
2-4
sessions
Treatment gt 4 sessions
1022013
11
15
25
35
45
55
baseline 3 months 6 months
Time
Dri
nk
s p
er
we
ek
(T
LF
B)
IT
WL
IS
Alcohol reduction (TLFB)
IT more expensive than IS
More effects more costs
If willingness to pay gt= euro14000 per QALY then
IT has larger probability of cost-effectiveness than IS
Internet Therapy is Cost-effective
1022013
12
Treatment
None or mild Moderate Substantial Severe
SEVERITY OF ALCOHOL PROBLEMS
How does SUD treatment look
like
It is not just keeping someone from
using alcohol or drugs
1022013
13
Treatment of alcohol problems is
bull Providing insight [psycho-education]
bull Helping considering consequences [sociotherapy familytherapy self help]
bull Learning to make choices [motivational interviewing individual and group counseling]
bull Treating craving [medication]
bull Teaching skills [behavioral cognitive and emotional training relapse prevention]
bull Treating co-morbid psychopathology (pharmacotherapy andor psychotherapy)
bull Support in practical and social circumstances (social services)
What does research tell us
on the effectiveness of
treatment on addictive
behavior (consumption of
drugs)
1022013
14
1022013
15
Alcohol Top 10 Effective Interventions
bull Brief intervention
bull Motivational enhancement
bull GABA agonist
bull Opiate antagonist
bull Social skills training
bull Community reinforcement approach (CRA)
bull Behavior contracting
bull Behavioral marital therapy
bull Case management
bull Self-monitoring
General Consensus
bull Lots of evidence available
bull Best evidence for behavioural oriented treatment
bull Best in combination with medication
bull Relative modest effects (but comparable with other chronic illnesses)
bull No outcome differences between residential and outpatient treatments
bull Matching might be crucial (RESCueH)
1022013
16
Some National
Clinical Guidelines
UK 2011 NL 2009 Australia 2003
Finland 2010 Scotland 2003
Treatment self-control training
and influencing the environment
ndash motivating Influencing readiness to change
ndash self control training
changing drinking behavior
ndash relapse prevention social and affective skills training
ndash influencing environment
Social family job community
Physical medication constraints
ndash
1022013
17
Motivation enhancement fe by Motivational Interviewing
bull Responsibility for change is left with the
individual
bull The individual is free to take our advice or not
bull The strategies are more supportive than
argumentative
bull Goal is to increase the intrinsic motivation
bull The client presents the arguments for change
Self control training
bull Monitoring use (how much what when how and in what
circumstances am I using)
bull Setting limits (how much what when how and in what
circumstances do I allow myself to use)
bullConsequential rewards punishments (what do I do or not
do donrsquot keep my promisses)
bullChoice of alternative behavior (what do I do instead of)
bull Planning for emergencie (what if I fail)
1022013
18
Relapse prevention Assessing risk situations
Training alternative behaviors
Training alternative emotions
Emotional skills training (craving)
Cue exposure (RESCueH-project)
Training alternative cognitions
training in self confidence
harm reduction after relapse
training phantasies
Medications for Alcohol Dependence
Disulfiram (Antabusereg)
Naltrexone (Reviareg)
Acamprosate (Campralreg)
Nalmefene NEW
1022013
19
Integration of Psychosocial and
Pharmaceutical Treatment Necessary
Pharmacotherapy for alcohol
dependence should always be
accompanied by psychosocial andor
behavioral treatments
Disease Management Model of
Alcohol Problems
Primary Prevention
(Health promoting actions)
Care
Specialized
Treatment Brief
intervention
Prevalence of Alcohol Problems
SourceInstitute of Medicine (1990) Broadening the Base of Treatment for
Alcohol Problems Washington DC National Academy Press
None or mild Moderate Substantial Severe
SEVERITY OF ALCOHOL PROBLEMS
1022013
20
Disease Management Model
Recquires adequate measurement of
patient characteristics
Measurement of Addictions for
Triage and Evaluation
New general up-to-date assessment instrument for
patieumlnt characteristics in substance abuse treatment
ndash European alternative
Designed for treatment allocation (triage) in a disease
management model
1022013
21
Disease Management Model
Staging and profiling chronic ill
patients to match to proper level and
kinds of care
Model developed inspired by the
staging and profiling of cancer
treatment
Van den Brink amp Schippers (2012) Stageing and profiling in substance
abuse treatment
TNM System Analogy
Van den Brink amp Schippers (2012) Staging and profiling in substance
abuse treatment
ONCOLOGY
bull T = Tumor size
bull N = Nodes
bull M = Metastasis
bull G = Grade
bull R = Resection
bull c = clinical inform
bull p = pathologist inform
bull y = adjuvant therapy
ADDICTION
bull Stage of the disorder
bull Psychiatricsomatic comorbidity
bull Social dysfunctioning
bull Addictive Substance
bull Reaction on former treatment
bull Clinical (fenotypical) information
bull Endofenotypicalgenetic information
bull Combination treatment
1022013
22
Testing Allocation Algorithm
Concluding Remarks
bull Ample evidence available for effective
alcohol treatment
bull Implementation of evidence-based
treatments in routine practice
insufficient
bull Due to the course of the disorder
adequate matching procedures
necessary
bull RESCueH projects will contribute to
new and applicable knowledge
1022013
23
Success
Also available
MATE-Outcomes for treatment outcome
measurements
MATE-Crimi targeted for criminal and
addictive behaviours
MATE-Youth targeted for 12-23 year
Developed and tested in the Netherlands
and Germany
Dutch English German and Italian versions
available
1022013
24
Drinkerrsquos Check-Up
Dutch version (1994)
Drinkerrsquos Check-Up is a proven
effective two-session brief
motivational intervention
developed by W R Miller (1988)
Providing assessment and
personalized non-judgmental
feedback and motivating advice
(Screening and) Brief Interventions
bull Agenda
bull Advice
bull Assess
bull Assist
bull Arrange
bull Introduce the topic
bull Inform and advice
bull Assess use and problems
bull Inform about support in
behavior change
bull Guide and refer
One
session
2-4
sessions
Treatment gt 4 sessions
1022013
12
Treatment
None or mild Moderate Substantial Severe
SEVERITY OF ALCOHOL PROBLEMS
How does SUD treatment look
like
It is not just keeping someone from
using alcohol or drugs
1022013
13
Treatment of alcohol problems is
bull Providing insight [psycho-education]
bull Helping considering consequences [sociotherapy familytherapy self help]
bull Learning to make choices [motivational interviewing individual and group counseling]
bull Treating craving [medication]
bull Teaching skills [behavioral cognitive and emotional training relapse prevention]
bull Treating co-morbid psychopathology (pharmacotherapy andor psychotherapy)
bull Support in practical and social circumstances (social services)
What does research tell us
on the effectiveness of
treatment on addictive
behavior (consumption of
drugs)
1022013
14
1022013
15
Alcohol Top 10 Effective Interventions
bull Brief intervention
bull Motivational enhancement
bull GABA agonist
bull Opiate antagonist
bull Social skills training
bull Community reinforcement approach (CRA)
bull Behavior contracting
bull Behavioral marital therapy
bull Case management
bull Self-monitoring
General Consensus
bull Lots of evidence available
bull Best evidence for behavioural oriented treatment
bull Best in combination with medication
bull Relative modest effects (but comparable with other chronic illnesses)
bull No outcome differences between residential and outpatient treatments
bull Matching might be crucial (RESCueH)
1022013
16
Some National
Clinical Guidelines
UK 2011 NL 2009 Australia 2003
Finland 2010 Scotland 2003
Treatment self-control training
and influencing the environment
ndash motivating Influencing readiness to change
ndash self control training
changing drinking behavior
ndash relapse prevention social and affective skills training
ndash influencing environment
Social family job community
Physical medication constraints
ndash
1022013
17
Motivation enhancement fe by Motivational Interviewing
bull Responsibility for change is left with the
individual
bull The individual is free to take our advice or not
bull The strategies are more supportive than
argumentative
bull Goal is to increase the intrinsic motivation
bull The client presents the arguments for change
Self control training
bull Monitoring use (how much what when how and in what
circumstances am I using)
bull Setting limits (how much what when how and in what
circumstances do I allow myself to use)
bullConsequential rewards punishments (what do I do or not
do donrsquot keep my promisses)
bullChoice of alternative behavior (what do I do instead of)
bull Planning for emergencie (what if I fail)
1022013
18
Relapse prevention Assessing risk situations
Training alternative behaviors
Training alternative emotions
Emotional skills training (craving)
Cue exposure (RESCueH-project)
Training alternative cognitions
training in self confidence
harm reduction after relapse
training phantasies
Medications for Alcohol Dependence
Disulfiram (Antabusereg)
Naltrexone (Reviareg)
Acamprosate (Campralreg)
Nalmefene NEW
1022013
19
Integration of Psychosocial and
Pharmaceutical Treatment Necessary
Pharmacotherapy for alcohol
dependence should always be
accompanied by psychosocial andor
behavioral treatments
Disease Management Model of
Alcohol Problems
Primary Prevention
(Health promoting actions)
Care
Specialized
Treatment Brief
intervention
Prevalence of Alcohol Problems
SourceInstitute of Medicine (1990) Broadening the Base of Treatment for
Alcohol Problems Washington DC National Academy Press
None or mild Moderate Substantial Severe
SEVERITY OF ALCOHOL PROBLEMS
1022013
20
Disease Management Model
Recquires adequate measurement of
patient characteristics
Measurement of Addictions for
Triage and Evaluation
New general up-to-date assessment instrument for
patieumlnt characteristics in substance abuse treatment
ndash European alternative
Designed for treatment allocation (triage) in a disease
management model
1022013
21
Disease Management Model
Staging and profiling chronic ill
patients to match to proper level and
kinds of care
Model developed inspired by the
staging and profiling of cancer
treatment
Van den Brink amp Schippers (2012) Stageing and profiling in substance
abuse treatment
TNM System Analogy
Van den Brink amp Schippers (2012) Staging and profiling in substance
abuse treatment
ONCOLOGY
bull T = Tumor size
bull N = Nodes
bull M = Metastasis
bull G = Grade
bull R = Resection
bull c = clinical inform
bull p = pathologist inform
bull y = adjuvant therapy
ADDICTION
bull Stage of the disorder
bull Psychiatricsomatic comorbidity
bull Social dysfunctioning
bull Addictive Substance
bull Reaction on former treatment
bull Clinical (fenotypical) information
bull Endofenotypicalgenetic information
bull Combination treatment
1022013
22
Testing Allocation Algorithm
Concluding Remarks
bull Ample evidence available for effective
alcohol treatment
bull Implementation of evidence-based
treatments in routine practice
insufficient
bull Due to the course of the disorder
adequate matching procedures
necessary
bull RESCueH projects will contribute to
new and applicable knowledge
1022013
23
Success
Also available
MATE-Outcomes for treatment outcome
measurements
MATE-Crimi targeted for criminal and
addictive behaviours
MATE-Youth targeted for 12-23 year
Developed and tested in the Netherlands
and Germany
Dutch English German and Italian versions
available
1022013
24
Drinkerrsquos Check-Up
Dutch version (1994)
Drinkerrsquos Check-Up is a proven
effective two-session brief
motivational intervention
developed by W R Miller (1988)
Providing assessment and
personalized non-judgmental
feedback and motivating advice
(Screening and) Brief Interventions
bull Agenda
bull Advice
bull Assess
bull Assist
bull Arrange
bull Introduce the topic
bull Inform and advice
bull Assess use and problems
bull Inform about support in
behavior change
bull Guide and refer
One
session
2-4
sessions
Treatment gt 4 sessions
1022013
13
Treatment of alcohol problems is
bull Providing insight [psycho-education]
bull Helping considering consequences [sociotherapy familytherapy self help]
bull Learning to make choices [motivational interviewing individual and group counseling]
bull Treating craving [medication]
bull Teaching skills [behavioral cognitive and emotional training relapse prevention]
bull Treating co-morbid psychopathology (pharmacotherapy andor psychotherapy)
bull Support in practical and social circumstances (social services)
What does research tell us
on the effectiveness of
treatment on addictive
behavior (consumption of
drugs)
1022013
14
1022013
15
Alcohol Top 10 Effective Interventions
bull Brief intervention
bull Motivational enhancement
bull GABA agonist
bull Opiate antagonist
bull Social skills training
bull Community reinforcement approach (CRA)
bull Behavior contracting
bull Behavioral marital therapy
bull Case management
bull Self-monitoring
General Consensus
bull Lots of evidence available
bull Best evidence for behavioural oriented treatment
bull Best in combination with medication
bull Relative modest effects (but comparable with other chronic illnesses)
bull No outcome differences between residential and outpatient treatments
bull Matching might be crucial (RESCueH)
1022013
16
Some National
Clinical Guidelines
UK 2011 NL 2009 Australia 2003
Finland 2010 Scotland 2003
Treatment self-control training
and influencing the environment
ndash motivating Influencing readiness to change
ndash self control training
changing drinking behavior
ndash relapse prevention social and affective skills training
ndash influencing environment
Social family job community
Physical medication constraints
ndash
1022013
17
Motivation enhancement fe by Motivational Interviewing
bull Responsibility for change is left with the
individual
bull The individual is free to take our advice or not
bull The strategies are more supportive than
argumentative
bull Goal is to increase the intrinsic motivation
bull The client presents the arguments for change
Self control training
bull Monitoring use (how much what when how and in what
circumstances am I using)
bull Setting limits (how much what when how and in what
circumstances do I allow myself to use)
bullConsequential rewards punishments (what do I do or not
do donrsquot keep my promisses)
bullChoice of alternative behavior (what do I do instead of)
bull Planning for emergencie (what if I fail)
1022013
18
Relapse prevention Assessing risk situations
Training alternative behaviors
Training alternative emotions
Emotional skills training (craving)
Cue exposure (RESCueH-project)
Training alternative cognitions
training in self confidence
harm reduction after relapse
training phantasies
Medications for Alcohol Dependence
Disulfiram (Antabusereg)
Naltrexone (Reviareg)
Acamprosate (Campralreg)
Nalmefene NEW
1022013
19
Integration of Psychosocial and
Pharmaceutical Treatment Necessary
Pharmacotherapy for alcohol
dependence should always be
accompanied by psychosocial andor
behavioral treatments
Disease Management Model of
Alcohol Problems
Primary Prevention
(Health promoting actions)
Care
Specialized
Treatment Brief
intervention
Prevalence of Alcohol Problems
SourceInstitute of Medicine (1990) Broadening the Base of Treatment for
Alcohol Problems Washington DC National Academy Press
None or mild Moderate Substantial Severe
SEVERITY OF ALCOHOL PROBLEMS
1022013
20
Disease Management Model
Recquires adequate measurement of
patient characteristics
Measurement of Addictions for
Triage and Evaluation
New general up-to-date assessment instrument for
patieumlnt characteristics in substance abuse treatment
ndash European alternative
Designed for treatment allocation (triage) in a disease
management model
1022013
21
Disease Management Model
Staging and profiling chronic ill
patients to match to proper level and
kinds of care
Model developed inspired by the
staging and profiling of cancer
treatment
Van den Brink amp Schippers (2012) Stageing and profiling in substance
abuse treatment
TNM System Analogy
Van den Brink amp Schippers (2012) Staging and profiling in substance
abuse treatment
ONCOLOGY
bull T = Tumor size
bull N = Nodes
bull M = Metastasis
bull G = Grade
bull R = Resection
bull c = clinical inform
bull p = pathologist inform
bull y = adjuvant therapy
ADDICTION
bull Stage of the disorder
bull Psychiatricsomatic comorbidity
bull Social dysfunctioning
bull Addictive Substance
bull Reaction on former treatment
bull Clinical (fenotypical) information
bull Endofenotypicalgenetic information
bull Combination treatment
1022013
22
Testing Allocation Algorithm
Concluding Remarks
bull Ample evidence available for effective
alcohol treatment
bull Implementation of evidence-based
treatments in routine practice
insufficient
bull Due to the course of the disorder
adequate matching procedures
necessary
bull RESCueH projects will contribute to
new and applicable knowledge
1022013
23
Success
Also available
MATE-Outcomes for treatment outcome
measurements
MATE-Crimi targeted for criminal and
addictive behaviours
MATE-Youth targeted for 12-23 year
Developed and tested in the Netherlands
and Germany
Dutch English German and Italian versions
available
1022013
24
Drinkerrsquos Check-Up
Dutch version (1994)
Drinkerrsquos Check-Up is a proven
effective two-session brief
motivational intervention
developed by W R Miller (1988)
Providing assessment and
personalized non-judgmental
feedback and motivating advice
(Screening and) Brief Interventions
bull Agenda
bull Advice
bull Assess
bull Assist
bull Arrange
bull Introduce the topic
bull Inform and advice
bull Assess use and problems
bull Inform about support in
behavior change
bull Guide and refer
One
session
2-4
sessions
Treatment gt 4 sessions
1022013
14
1022013
15
Alcohol Top 10 Effective Interventions
bull Brief intervention
bull Motivational enhancement
bull GABA agonist
bull Opiate antagonist
bull Social skills training
bull Community reinforcement approach (CRA)
bull Behavior contracting
bull Behavioral marital therapy
bull Case management
bull Self-monitoring
General Consensus
bull Lots of evidence available
bull Best evidence for behavioural oriented treatment
bull Best in combination with medication
bull Relative modest effects (but comparable with other chronic illnesses)
bull No outcome differences between residential and outpatient treatments
bull Matching might be crucial (RESCueH)
1022013
16
Some National
Clinical Guidelines
UK 2011 NL 2009 Australia 2003
Finland 2010 Scotland 2003
Treatment self-control training
and influencing the environment
ndash motivating Influencing readiness to change
ndash self control training
changing drinking behavior
ndash relapse prevention social and affective skills training
ndash influencing environment
Social family job community
Physical medication constraints
ndash
1022013
17
Motivation enhancement fe by Motivational Interviewing
bull Responsibility for change is left with the
individual
bull The individual is free to take our advice or not
bull The strategies are more supportive than
argumentative
bull Goal is to increase the intrinsic motivation
bull The client presents the arguments for change
Self control training
bull Monitoring use (how much what when how and in what
circumstances am I using)
bull Setting limits (how much what when how and in what
circumstances do I allow myself to use)
bullConsequential rewards punishments (what do I do or not
do donrsquot keep my promisses)
bullChoice of alternative behavior (what do I do instead of)
bull Planning for emergencie (what if I fail)
1022013
18
Relapse prevention Assessing risk situations
Training alternative behaviors
Training alternative emotions
Emotional skills training (craving)
Cue exposure (RESCueH-project)
Training alternative cognitions
training in self confidence
harm reduction after relapse
training phantasies
Medications for Alcohol Dependence
Disulfiram (Antabusereg)
Naltrexone (Reviareg)
Acamprosate (Campralreg)
Nalmefene NEW
1022013
19
Integration of Psychosocial and
Pharmaceutical Treatment Necessary
Pharmacotherapy for alcohol
dependence should always be
accompanied by psychosocial andor
behavioral treatments
Disease Management Model of
Alcohol Problems
Primary Prevention
(Health promoting actions)
Care
Specialized
Treatment Brief
intervention
Prevalence of Alcohol Problems
SourceInstitute of Medicine (1990) Broadening the Base of Treatment for
Alcohol Problems Washington DC National Academy Press
None or mild Moderate Substantial Severe
SEVERITY OF ALCOHOL PROBLEMS
1022013
20
Disease Management Model
Recquires adequate measurement of
patient characteristics
Measurement of Addictions for
Triage and Evaluation
New general up-to-date assessment instrument for
patieumlnt characteristics in substance abuse treatment
ndash European alternative
Designed for treatment allocation (triage) in a disease
management model
1022013
21
Disease Management Model
Staging and profiling chronic ill
patients to match to proper level and
kinds of care
Model developed inspired by the
staging and profiling of cancer
treatment
Van den Brink amp Schippers (2012) Stageing and profiling in substance
abuse treatment
TNM System Analogy
Van den Brink amp Schippers (2012) Staging and profiling in substance
abuse treatment
ONCOLOGY
bull T = Tumor size
bull N = Nodes
bull M = Metastasis
bull G = Grade
bull R = Resection
bull c = clinical inform
bull p = pathologist inform
bull y = adjuvant therapy
ADDICTION
bull Stage of the disorder
bull Psychiatricsomatic comorbidity
bull Social dysfunctioning
bull Addictive Substance
bull Reaction on former treatment
bull Clinical (fenotypical) information
bull Endofenotypicalgenetic information
bull Combination treatment
1022013
22
Testing Allocation Algorithm
Concluding Remarks
bull Ample evidence available for effective
alcohol treatment
bull Implementation of evidence-based
treatments in routine practice
insufficient
bull Due to the course of the disorder
adequate matching procedures
necessary
bull RESCueH projects will contribute to
new and applicable knowledge
1022013
23
Success
Also available
MATE-Outcomes for treatment outcome
measurements
MATE-Crimi targeted for criminal and
addictive behaviours
MATE-Youth targeted for 12-23 year
Developed and tested in the Netherlands
and Germany
Dutch English German and Italian versions
available
1022013
24
Drinkerrsquos Check-Up
Dutch version (1994)
Drinkerrsquos Check-Up is a proven
effective two-session brief
motivational intervention
developed by W R Miller (1988)
Providing assessment and
personalized non-judgmental
feedback and motivating advice
(Screening and) Brief Interventions
bull Agenda
bull Advice
bull Assess
bull Assist
bull Arrange
bull Introduce the topic
bull Inform and advice
bull Assess use and problems
bull Inform about support in
behavior change
bull Guide and refer
One
session
2-4
sessions
Treatment gt 4 sessions
1022013
15
Alcohol Top 10 Effective Interventions
bull Brief intervention
bull Motivational enhancement
bull GABA agonist
bull Opiate antagonist
bull Social skills training
bull Community reinforcement approach (CRA)
bull Behavior contracting
bull Behavioral marital therapy
bull Case management
bull Self-monitoring
General Consensus
bull Lots of evidence available
bull Best evidence for behavioural oriented treatment
bull Best in combination with medication
bull Relative modest effects (but comparable with other chronic illnesses)
bull No outcome differences between residential and outpatient treatments
bull Matching might be crucial (RESCueH)
1022013
16
Some National
Clinical Guidelines
UK 2011 NL 2009 Australia 2003
Finland 2010 Scotland 2003
Treatment self-control training
and influencing the environment
ndash motivating Influencing readiness to change
ndash self control training
changing drinking behavior
ndash relapse prevention social and affective skills training
ndash influencing environment
Social family job community
Physical medication constraints
ndash
1022013
17
Motivation enhancement fe by Motivational Interviewing
bull Responsibility for change is left with the
individual
bull The individual is free to take our advice or not
bull The strategies are more supportive than
argumentative
bull Goal is to increase the intrinsic motivation
bull The client presents the arguments for change
Self control training
bull Monitoring use (how much what when how and in what
circumstances am I using)
bull Setting limits (how much what when how and in what
circumstances do I allow myself to use)
bullConsequential rewards punishments (what do I do or not
do donrsquot keep my promisses)
bullChoice of alternative behavior (what do I do instead of)
bull Planning for emergencie (what if I fail)
1022013
18
Relapse prevention Assessing risk situations
Training alternative behaviors
Training alternative emotions
Emotional skills training (craving)
Cue exposure (RESCueH-project)
Training alternative cognitions
training in self confidence
harm reduction after relapse
training phantasies
Medications for Alcohol Dependence
Disulfiram (Antabusereg)
Naltrexone (Reviareg)
Acamprosate (Campralreg)
Nalmefene NEW
1022013
19
Integration of Psychosocial and
Pharmaceutical Treatment Necessary
Pharmacotherapy for alcohol
dependence should always be
accompanied by psychosocial andor
behavioral treatments
Disease Management Model of
Alcohol Problems
Primary Prevention
(Health promoting actions)
Care
Specialized
Treatment Brief
intervention
Prevalence of Alcohol Problems
SourceInstitute of Medicine (1990) Broadening the Base of Treatment for
Alcohol Problems Washington DC National Academy Press
None or mild Moderate Substantial Severe
SEVERITY OF ALCOHOL PROBLEMS
1022013
20
Disease Management Model
Recquires adequate measurement of
patient characteristics
Measurement of Addictions for
Triage and Evaluation
New general up-to-date assessment instrument for
patieumlnt characteristics in substance abuse treatment
ndash European alternative
Designed for treatment allocation (triage) in a disease
management model
1022013
21
Disease Management Model
Staging and profiling chronic ill
patients to match to proper level and
kinds of care
Model developed inspired by the
staging and profiling of cancer
treatment
Van den Brink amp Schippers (2012) Stageing and profiling in substance
abuse treatment
TNM System Analogy
Van den Brink amp Schippers (2012) Staging and profiling in substance
abuse treatment
ONCOLOGY
bull T = Tumor size
bull N = Nodes
bull M = Metastasis
bull G = Grade
bull R = Resection
bull c = clinical inform
bull p = pathologist inform
bull y = adjuvant therapy
ADDICTION
bull Stage of the disorder
bull Psychiatricsomatic comorbidity
bull Social dysfunctioning
bull Addictive Substance
bull Reaction on former treatment
bull Clinical (fenotypical) information
bull Endofenotypicalgenetic information
bull Combination treatment
1022013
22
Testing Allocation Algorithm
Concluding Remarks
bull Ample evidence available for effective
alcohol treatment
bull Implementation of evidence-based
treatments in routine practice
insufficient
bull Due to the course of the disorder
adequate matching procedures
necessary
bull RESCueH projects will contribute to
new and applicable knowledge
1022013
23
Success
Also available
MATE-Outcomes for treatment outcome
measurements
MATE-Crimi targeted for criminal and
addictive behaviours
MATE-Youth targeted for 12-23 year
Developed and tested in the Netherlands
and Germany
Dutch English German and Italian versions
available
1022013
24
Drinkerrsquos Check-Up
Dutch version (1994)
Drinkerrsquos Check-Up is a proven
effective two-session brief
motivational intervention
developed by W R Miller (1988)
Providing assessment and
personalized non-judgmental
feedback and motivating advice
(Screening and) Brief Interventions
bull Agenda
bull Advice
bull Assess
bull Assist
bull Arrange
bull Introduce the topic
bull Inform and advice
bull Assess use and problems
bull Inform about support in
behavior change
bull Guide and refer
One
session
2-4
sessions
Treatment gt 4 sessions
1022013
16
Some National
Clinical Guidelines
UK 2011 NL 2009 Australia 2003
Finland 2010 Scotland 2003
Treatment self-control training
and influencing the environment
ndash motivating Influencing readiness to change
ndash self control training
changing drinking behavior
ndash relapse prevention social and affective skills training
ndash influencing environment
Social family job community
Physical medication constraints
ndash
1022013
17
Motivation enhancement fe by Motivational Interviewing
bull Responsibility for change is left with the
individual
bull The individual is free to take our advice or not
bull The strategies are more supportive than
argumentative
bull Goal is to increase the intrinsic motivation
bull The client presents the arguments for change
Self control training
bull Monitoring use (how much what when how and in what
circumstances am I using)
bull Setting limits (how much what when how and in what
circumstances do I allow myself to use)
bullConsequential rewards punishments (what do I do or not
do donrsquot keep my promisses)
bullChoice of alternative behavior (what do I do instead of)
bull Planning for emergencie (what if I fail)
1022013
18
Relapse prevention Assessing risk situations
Training alternative behaviors
Training alternative emotions
Emotional skills training (craving)
Cue exposure (RESCueH-project)
Training alternative cognitions
training in self confidence
harm reduction after relapse
training phantasies
Medications for Alcohol Dependence
Disulfiram (Antabusereg)
Naltrexone (Reviareg)
Acamprosate (Campralreg)
Nalmefene NEW
1022013
19
Integration of Psychosocial and
Pharmaceutical Treatment Necessary
Pharmacotherapy for alcohol
dependence should always be
accompanied by psychosocial andor
behavioral treatments
Disease Management Model of
Alcohol Problems
Primary Prevention
(Health promoting actions)
Care
Specialized
Treatment Brief
intervention
Prevalence of Alcohol Problems
SourceInstitute of Medicine (1990) Broadening the Base of Treatment for
Alcohol Problems Washington DC National Academy Press
None or mild Moderate Substantial Severe
SEVERITY OF ALCOHOL PROBLEMS
1022013
20
Disease Management Model
Recquires adequate measurement of
patient characteristics
Measurement of Addictions for
Triage and Evaluation
New general up-to-date assessment instrument for
patieumlnt characteristics in substance abuse treatment
ndash European alternative
Designed for treatment allocation (triage) in a disease
management model
1022013
21
Disease Management Model
Staging and profiling chronic ill
patients to match to proper level and
kinds of care
Model developed inspired by the
staging and profiling of cancer
treatment
Van den Brink amp Schippers (2012) Stageing and profiling in substance
abuse treatment
TNM System Analogy
Van den Brink amp Schippers (2012) Staging and profiling in substance
abuse treatment
ONCOLOGY
bull T = Tumor size
bull N = Nodes
bull M = Metastasis
bull G = Grade
bull R = Resection
bull c = clinical inform
bull p = pathologist inform
bull y = adjuvant therapy
ADDICTION
bull Stage of the disorder
bull Psychiatricsomatic comorbidity
bull Social dysfunctioning
bull Addictive Substance
bull Reaction on former treatment
bull Clinical (fenotypical) information
bull Endofenotypicalgenetic information
bull Combination treatment
1022013
22
Testing Allocation Algorithm
Concluding Remarks
bull Ample evidence available for effective
alcohol treatment
bull Implementation of evidence-based
treatments in routine practice
insufficient
bull Due to the course of the disorder
adequate matching procedures
necessary
bull RESCueH projects will contribute to
new and applicable knowledge
1022013
23
Success
Also available
MATE-Outcomes for treatment outcome
measurements
MATE-Crimi targeted for criminal and
addictive behaviours
MATE-Youth targeted for 12-23 year
Developed and tested in the Netherlands
and Germany
Dutch English German and Italian versions
available
1022013
24
Drinkerrsquos Check-Up
Dutch version (1994)
Drinkerrsquos Check-Up is a proven
effective two-session brief
motivational intervention
developed by W R Miller (1988)
Providing assessment and
personalized non-judgmental
feedback and motivating advice
(Screening and) Brief Interventions
bull Agenda
bull Advice
bull Assess
bull Assist
bull Arrange
bull Introduce the topic
bull Inform and advice
bull Assess use and problems
bull Inform about support in
behavior change
bull Guide and refer
One
session
2-4
sessions
Treatment gt 4 sessions
1022013
17
Motivation enhancement fe by Motivational Interviewing
bull Responsibility for change is left with the
individual
bull The individual is free to take our advice or not
bull The strategies are more supportive than
argumentative
bull Goal is to increase the intrinsic motivation
bull The client presents the arguments for change
Self control training
bull Monitoring use (how much what when how and in what
circumstances am I using)
bull Setting limits (how much what when how and in what
circumstances do I allow myself to use)
bullConsequential rewards punishments (what do I do or not
do donrsquot keep my promisses)
bullChoice of alternative behavior (what do I do instead of)
bull Planning for emergencie (what if I fail)
1022013
18
Relapse prevention Assessing risk situations
Training alternative behaviors
Training alternative emotions
Emotional skills training (craving)
Cue exposure (RESCueH-project)
Training alternative cognitions
training in self confidence
harm reduction after relapse
training phantasies
Medications for Alcohol Dependence
Disulfiram (Antabusereg)
Naltrexone (Reviareg)
Acamprosate (Campralreg)
Nalmefene NEW
1022013
19
Integration of Psychosocial and
Pharmaceutical Treatment Necessary
Pharmacotherapy for alcohol
dependence should always be
accompanied by psychosocial andor
behavioral treatments
Disease Management Model of
Alcohol Problems
Primary Prevention
(Health promoting actions)
Care
Specialized
Treatment Brief
intervention
Prevalence of Alcohol Problems
SourceInstitute of Medicine (1990) Broadening the Base of Treatment for
Alcohol Problems Washington DC National Academy Press
None or mild Moderate Substantial Severe
SEVERITY OF ALCOHOL PROBLEMS
1022013
20
Disease Management Model
Recquires adequate measurement of
patient characteristics
Measurement of Addictions for
Triage and Evaluation
New general up-to-date assessment instrument for
patieumlnt characteristics in substance abuse treatment
ndash European alternative
Designed for treatment allocation (triage) in a disease
management model
1022013
21
Disease Management Model
Staging and profiling chronic ill
patients to match to proper level and
kinds of care
Model developed inspired by the
staging and profiling of cancer
treatment
Van den Brink amp Schippers (2012) Stageing and profiling in substance
abuse treatment
TNM System Analogy
Van den Brink amp Schippers (2012) Staging and profiling in substance
abuse treatment
ONCOLOGY
bull T = Tumor size
bull N = Nodes
bull M = Metastasis
bull G = Grade
bull R = Resection
bull c = clinical inform
bull p = pathologist inform
bull y = adjuvant therapy
ADDICTION
bull Stage of the disorder
bull Psychiatricsomatic comorbidity
bull Social dysfunctioning
bull Addictive Substance
bull Reaction on former treatment
bull Clinical (fenotypical) information
bull Endofenotypicalgenetic information
bull Combination treatment
1022013
22
Testing Allocation Algorithm
Concluding Remarks
bull Ample evidence available for effective
alcohol treatment
bull Implementation of evidence-based
treatments in routine practice
insufficient
bull Due to the course of the disorder
adequate matching procedures
necessary
bull RESCueH projects will contribute to
new and applicable knowledge
1022013
23
Success
Also available
MATE-Outcomes for treatment outcome
measurements
MATE-Crimi targeted for criminal and
addictive behaviours
MATE-Youth targeted for 12-23 year
Developed and tested in the Netherlands
and Germany
Dutch English German and Italian versions
available
1022013
24
Drinkerrsquos Check-Up
Dutch version (1994)
Drinkerrsquos Check-Up is a proven
effective two-session brief
motivational intervention
developed by W R Miller (1988)
Providing assessment and
personalized non-judgmental
feedback and motivating advice
(Screening and) Brief Interventions
bull Agenda
bull Advice
bull Assess
bull Assist
bull Arrange
bull Introduce the topic
bull Inform and advice
bull Assess use and problems
bull Inform about support in
behavior change
bull Guide and refer
One
session
2-4
sessions
Treatment gt 4 sessions
1022013
18
Relapse prevention Assessing risk situations
Training alternative behaviors
Training alternative emotions
Emotional skills training (craving)
Cue exposure (RESCueH-project)
Training alternative cognitions
training in self confidence
harm reduction after relapse
training phantasies
Medications for Alcohol Dependence
Disulfiram (Antabusereg)
Naltrexone (Reviareg)
Acamprosate (Campralreg)
Nalmefene NEW
1022013
19
Integration of Psychosocial and
Pharmaceutical Treatment Necessary
Pharmacotherapy for alcohol
dependence should always be
accompanied by psychosocial andor
behavioral treatments
Disease Management Model of
Alcohol Problems
Primary Prevention
(Health promoting actions)
Care
Specialized
Treatment Brief
intervention
Prevalence of Alcohol Problems
SourceInstitute of Medicine (1990) Broadening the Base of Treatment for
Alcohol Problems Washington DC National Academy Press
None or mild Moderate Substantial Severe
SEVERITY OF ALCOHOL PROBLEMS
1022013
20
Disease Management Model
Recquires adequate measurement of
patient characteristics
Measurement of Addictions for
Triage and Evaluation
New general up-to-date assessment instrument for
patieumlnt characteristics in substance abuse treatment
ndash European alternative
Designed for treatment allocation (triage) in a disease
management model
1022013
21
Disease Management Model
Staging and profiling chronic ill
patients to match to proper level and
kinds of care
Model developed inspired by the
staging and profiling of cancer
treatment
Van den Brink amp Schippers (2012) Stageing and profiling in substance
abuse treatment
TNM System Analogy
Van den Brink amp Schippers (2012) Staging and profiling in substance
abuse treatment
ONCOLOGY
bull T = Tumor size
bull N = Nodes
bull M = Metastasis
bull G = Grade
bull R = Resection
bull c = clinical inform
bull p = pathologist inform
bull y = adjuvant therapy
ADDICTION
bull Stage of the disorder
bull Psychiatricsomatic comorbidity
bull Social dysfunctioning
bull Addictive Substance
bull Reaction on former treatment
bull Clinical (fenotypical) information
bull Endofenotypicalgenetic information
bull Combination treatment
1022013
22
Testing Allocation Algorithm
Concluding Remarks
bull Ample evidence available for effective
alcohol treatment
bull Implementation of evidence-based
treatments in routine practice
insufficient
bull Due to the course of the disorder
adequate matching procedures
necessary
bull RESCueH projects will contribute to
new and applicable knowledge
1022013
23
Success
Also available
MATE-Outcomes for treatment outcome
measurements
MATE-Crimi targeted for criminal and
addictive behaviours
MATE-Youth targeted for 12-23 year
Developed and tested in the Netherlands
and Germany
Dutch English German and Italian versions
available
1022013
24
Drinkerrsquos Check-Up
Dutch version (1994)
Drinkerrsquos Check-Up is a proven
effective two-session brief
motivational intervention
developed by W R Miller (1988)
Providing assessment and
personalized non-judgmental
feedback and motivating advice
(Screening and) Brief Interventions
bull Agenda
bull Advice
bull Assess
bull Assist
bull Arrange
bull Introduce the topic
bull Inform and advice
bull Assess use and problems
bull Inform about support in
behavior change
bull Guide and refer
One
session
2-4
sessions
Treatment gt 4 sessions
1022013
19
Integration of Psychosocial and
Pharmaceutical Treatment Necessary
Pharmacotherapy for alcohol
dependence should always be
accompanied by psychosocial andor
behavioral treatments
Disease Management Model of
Alcohol Problems
Primary Prevention
(Health promoting actions)
Care
Specialized
Treatment Brief
intervention
Prevalence of Alcohol Problems
SourceInstitute of Medicine (1990) Broadening the Base of Treatment for
Alcohol Problems Washington DC National Academy Press
None or mild Moderate Substantial Severe
SEVERITY OF ALCOHOL PROBLEMS
1022013
20
Disease Management Model
Recquires adequate measurement of
patient characteristics
Measurement of Addictions for
Triage and Evaluation
New general up-to-date assessment instrument for
patieumlnt characteristics in substance abuse treatment
ndash European alternative
Designed for treatment allocation (triage) in a disease
management model
1022013
21
Disease Management Model
Staging and profiling chronic ill
patients to match to proper level and
kinds of care
Model developed inspired by the
staging and profiling of cancer
treatment
Van den Brink amp Schippers (2012) Stageing and profiling in substance
abuse treatment
TNM System Analogy
Van den Brink amp Schippers (2012) Staging and profiling in substance
abuse treatment
ONCOLOGY
bull T = Tumor size
bull N = Nodes
bull M = Metastasis
bull G = Grade
bull R = Resection
bull c = clinical inform
bull p = pathologist inform
bull y = adjuvant therapy
ADDICTION
bull Stage of the disorder
bull Psychiatricsomatic comorbidity
bull Social dysfunctioning
bull Addictive Substance
bull Reaction on former treatment
bull Clinical (fenotypical) information
bull Endofenotypicalgenetic information
bull Combination treatment
1022013
22
Testing Allocation Algorithm
Concluding Remarks
bull Ample evidence available for effective
alcohol treatment
bull Implementation of evidence-based
treatments in routine practice
insufficient
bull Due to the course of the disorder
adequate matching procedures
necessary
bull RESCueH projects will contribute to
new and applicable knowledge
1022013
23
Success
Also available
MATE-Outcomes for treatment outcome
measurements
MATE-Crimi targeted for criminal and
addictive behaviours
MATE-Youth targeted for 12-23 year
Developed and tested in the Netherlands
and Germany
Dutch English German and Italian versions
available
1022013
24
Drinkerrsquos Check-Up
Dutch version (1994)
Drinkerrsquos Check-Up is a proven
effective two-session brief
motivational intervention
developed by W R Miller (1988)
Providing assessment and
personalized non-judgmental
feedback and motivating advice
(Screening and) Brief Interventions
bull Agenda
bull Advice
bull Assess
bull Assist
bull Arrange
bull Introduce the topic
bull Inform and advice
bull Assess use and problems
bull Inform about support in
behavior change
bull Guide and refer
One
session
2-4
sessions
Treatment gt 4 sessions
1022013
20
Disease Management Model
Recquires adequate measurement of
patient characteristics
Measurement of Addictions for
Triage and Evaluation
New general up-to-date assessment instrument for
patieumlnt characteristics in substance abuse treatment
ndash European alternative
Designed for treatment allocation (triage) in a disease
management model
1022013
21
Disease Management Model
Staging and profiling chronic ill
patients to match to proper level and
kinds of care
Model developed inspired by the
staging and profiling of cancer
treatment
Van den Brink amp Schippers (2012) Stageing and profiling in substance
abuse treatment
TNM System Analogy
Van den Brink amp Schippers (2012) Staging and profiling in substance
abuse treatment
ONCOLOGY
bull T = Tumor size
bull N = Nodes
bull M = Metastasis
bull G = Grade
bull R = Resection
bull c = clinical inform
bull p = pathologist inform
bull y = adjuvant therapy
ADDICTION
bull Stage of the disorder
bull Psychiatricsomatic comorbidity
bull Social dysfunctioning
bull Addictive Substance
bull Reaction on former treatment
bull Clinical (fenotypical) information
bull Endofenotypicalgenetic information
bull Combination treatment
1022013
22
Testing Allocation Algorithm
Concluding Remarks
bull Ample evidence available for effective
alcohol treatment
bull Implementation of evidence-based
treatments in routine practice
insufficient
bull Due to the course of the disorder
adequate matching procedures
necessary
bull RESCueH projects will contribute to
new and applicable knowledge
1022013
23
Success
Also available
MATE-Outcomes for treatment outcome
measurements
MATE-Crimi targeted for criminal and
addictive behaviours
MATE-Youth targeted for 12-23 year
Developed and tested in the Netherlands
and Germany
Dutch English German and Italian versions
available
1022013
24
Drinkerrsquos Check-Up
Dutch version (1994)
Drinkerrsquos Check-Up is a proven
effective two-session brief
motivational intervention
developed by W R Miller (1988)
Providing assessment and
personalized non-judgmental
feedback and motivating advice
(Screening and) Brief Interventions
bull Agenda
bull Advice
bull Assess
bull Assist
bull Arrange
bull Introduce the topic
bull Inform and advice
bull Assess use and problems
bull Inform about support in
behavior change
bull Guide and refer
One
session
2-4
sessions
Treatment gt 4 sessions
1022013
21
Disease Management Model
Staging and profiling chronic ill
patients to match to proper level and
kinds of care
Model developed inspired by the
staging and profiling of cancer
treatment
Van den Brink amp Schippers (2012) Stageing and profiling in substance
abuse treatment
TNM System Analogy
Van den Brink amp Schippers (2012) Staging and profiling in substance
abuse treatment
ONCOLOGY
bull T = Tumor size
bull N = Nodes
bull M = Metastasis
bull G = Grade
bull R = Resection
bull c = clinical inform
bull p = pathologist inform
bull y = adjuvant therapy
ADDICTION
bull Stage of the disorder
bull Psychiatricsomatic comorbidity
bull Social dysfunctioning
bull Addictive Substance
bull Reaction on former treatment
bull Clinical (fenotypical) information
bull Endofenotypicalgenetic information
bull Combination treatment
1022013
22
Testing Allocation Algorithm
Concluding Remarks
bull Ample evidence available for effective
alcohol treatment
bull Implementation of evidence-based
treatments in routine practice
insufficient
bull Due to the course of the disorder
adequate matching procedures
necessary
bull RESCueH projects will contribute to
new and applicable knowledge
1022013
23
Success
Also available
MATE-Outcomes for treatment outcome
measurements
MATE-Crimi targeted for criminal and
addictive behaviours
MATE-Youth targeted for 12-23 year
Developed and tested in the Netherlands
and Germany
Dutch English German and Italian versions
available
1022013
24
Drinkerrsquos Check-Up
Dutch version (1994)
Drinkerrsquos Check-Up is a proven
effective two-session brief
motivational intervention
developed by W R Miller (1988)
Providing assessment and
personalized non-judgmental
feedback and motivating advice
(Screening and) Brief Interventions
bull Agenda
bull Advice
bull Assess
bull Assist
bull Arrange
bull Introduce the topic
bull Inform and advice
bull Assess use and problems
bull Inform about support in
behavior change
bull Guide and refer
One
session
2-4
sessions
Treatment gt 4 sessions
1022013
22
Testing Allocation Algorithm
Concluding Remarks
bull Ample evidence available for effective
alcohol treatment
bull Implementation of evidence-based
treatments in routine practice
insufficient
bull Due to the course of the disorder
adequate matching procedures
necessary
bull RESCueH projects will contribute to
new and applicable knowledge
1022013
23
Success
Also available
MATE-Outcomes for treatment outcome
measurements
MATE-Crimi targeted for criminal and
addictive behaviours
MATE-Youth targeted for 12-23 year
Developed and tested in the Netherlands
and Germany
Dutch English German and Italian versions
available
1022013
24
Drinkerrsquos Check-Up
Dutch version (1994)
Drinkerrsquos Check-Up is a proven
effective two-session brief
motivational intervention
developed by W R Miller (1988)
Providing assessment and
personalized non-judgmental
feedback and motivating advice
(Screening and) Brief Interventions
bull Agenda
bull Advice
bull Assess
bull Assist
bull Arrange
bull Introduce the topic
bull Inform and advice
bull Assess use and problems
bull Inform about support in
behavior change
bull Guide and refer
One
session
2-4
sessions
Treatment gt 4 sessions
1022013
23
Success
Also available
MATE-Outcomes for treatment outcome
measurements
MATE-Crimi targeted for criminal and
addictive behaviours
MATE-Youth targeted for 12-23 year
Developed and tested in the Netherlands
and Germany
Dutch English German and Italian versions
available
1022013
24
Drinkerrsquos Check-Up
Dutch version (1994)
Drinkerrsquos Check-Up is a proven
effective two-session brief
motivational intervention
developed by W R Miller (1988)
Providing assessment and
personalized non-judgmental
feedback and motivating advice
(Screening and) Brief Interventions
bull Agenda
bull Advice
bull Assess
bull Assist
bull Arrange
bull Introduce the topic
bull Inform and advice
bull Assess use and problems
bull Inform about support in
behavior change
bull Guide and refer
One
session
2-4
sessions
Treatment gt 4 sessions
1022013
24
Drinkerrsquos Check-Up
Dutch version (1994)
Drinkerrsquos Check-Up is a proven
effective two-session brief
motivational intervention
developed by W R Miller (1988)
Providing assessment and
personalized non-judgmental
feedback and motivating advice
(Screening and) Brief Interventions
bull Agenda
bull Advice
bull Assess
bull Assist
bull Arrange
bull Introduce the topic
bull Inform and advice
bull Assess use and problems
bull Inform about support in
behavior change
bull Guide and refer
One
session
2-4
sessions
Treatment gt 4 sessions