Research project DR/25 (Research action DR)
Background and objective
Substance abuse is often a long lasting and complex problem and is associated with other problems such as unemployment, relational, psychological and physical problems, judicial and/or financial problems. The range of services for persons with alcohol- or other substance related problems consists of various treatment modalities, such as early intervention, substitution therapy, detoxification, drug free treatment, aftercare, psychiatric treatment, housing, … Because of the lack of evaluation research in alcohol and drug treatment in Belgium, there is little or no information available about the effectiveness of these treatment modalities. In the international literature though, a lot of scientific research has been published about the effectiveness of certain interventions. As a consequence, there is some and even sufficient evidence available concerning the effectiveness of specific treatment modalities for alcohol- and other substance related disorders.
In the international literature, there is an increasing attention for the implementation of more evidence-based practice. The same tendency can be noticed in Belgium. Especially the diversity concerning the implementation of certain interventions and the unclearness about their effects demand unambiguous evidence-based guidelines and protocols. This way, a more original implementation of certain interventions can be realized, which appears to be associated with more positive treatment outcomes. The cost-effectiveness of the implementation of evidence-based guidelines is often a decisive factor.
In various countries, evidence based guidelines have already been developed. In the United States, the ‘Drug Abuse Treatment Toolkit’ was developed by UNODC and the guidelines for substance related disorders of the American Psychiatric Association (APA) are expected in 2006 (APA Practice Guidelines). Recently, manuals for the development of guidelines were published in the Netherlands and guidelines were developed for different kinds of disorders. In the United Kingdom too, recommendations for guideline development were formulated by the Royal College of Psychiatrists (1994). In 2002, ‘The Department of Health’ developed guidelines for the treatment of substance related disorders.
In Belgium, almost no evidence-based guidelines are available for the treatment of substance related disorders. The objective of this research is to verify which evidence based guidelines and protocols exist in substance abuse treatment and to which extent field workers are familiar with these guidelines and protocols and implement them in daily practice. The final objective is the formulation of consensus guidelines for the field of substance treatment that are applicable in the Belgian context.
Methodology
STAGE 1. Literature study
A literature study will be carried out about existing evidence based protocols and guidelines for the treatment of substance related disorders. For the literature search, databases such as Medline, PubMed, Cochrane library, PsycINFO, Web of Science, relevant internetsites,... will be used. The emphasis will be put on reviews and existing guidelines and protocols.
The next step is in selecting, evaluating and grading the literature as to the degree of evidence. The quality of the selected literature can be evaluated by criteria that were defined earlier. The degree of evidence will be deducted from this evaluation. At the end of this stage, an overview will be made of the evidence based treatment protocols that are supported by a sufficient amount of evidence.
STAGE 2. Interviews in treatment facilities
A first step is the composition of a representative sample. Different types of treatment facilities (psychiatric hospitals, psychiatric departments of general hospitals, crisis intervention centres or emergency psychiatric departments of general hospitals, long term residential group programmes with a RIZIV-convention and outpatient centres with/without a RIZIV-convention) and different treatment modalities (detoxification, maintenance, drug free treatment and aftercare) will be represented in the sample. In 50 treatment facilities respondents will be interviewed, proportionally divided between Flanders, Wallonia and Brussels.
The second step is the development of a semi-structured interview based on the evidence-based guidelines and protocols that were found through the literature study. The knowledge and implementation of these different guidelines will be assessed.
Problems, opinions and remarks concerning the implementation of these protocols or elements of these protocols, will be discussed. The respondents are people within the treatment facilities who are responsible for the treatment of clients with a substance related disorder.
STAGE 3. Suggestions for evidence based treatment protocols that are applicable in Belgium. (in close cooperation with the substance abuse treatment sector)
In this stage, concept guidelines will be developed, based on the literature review and the interviews in the treatment facilities. Then focus groups will be organized to come to final guidelines.
Scientific experts as well as some respondents of the semi-structured interviews will participate in these groups. During the meetings, they will, in different steps, try to reach a consensus concerning the concept guidelines. The Delphi-method will be used to further refine the concept guidelines.
STAGE 4. Recommendations for implementation.
To formulate recommendations for implementation, the available literature concerning the implementation of guidelines as well as knowledge of field workers will be considered. The implementation of guidelines and protocols will also be discussed and elaborated during the focus groups and the semi- structured interviews.
STAGE 5. Report
The findings concerning the different stages of this research will be published in a final report.
Evidence-based werken in de verslavingszorg : een stand van zaken = Les pratiques "evidence based" dans l'aide aux toxicomanes : un état des lieux
Autrique, Mieke - Vanderplasschen, Wouter - Van Ham, Sophie ... et al Gent : Academia Press, 2007 (PB6188)
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Evidence-based werken in de verslavingszorg : een stand van zaken : samenvatting
Brussel : Federaal Wetenschapsbeleid, 2007 (SP1724)
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Les pratiques 'evidenced based' dans l'aide aux toxicomanes: Un état des lieux : résumé
Bruxelles : Politique scientifique fédérale, 2007 (SP1725)
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Evidence-based practise in substance abuse treatment in Belgium : a state of the art : summary
Brussels : Federal Science Policy, 2007 (SP1726)
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