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Prognosis value from an integrative model of vulnerability based on a French and Dutch adaptation of ASAM criteria in the choice of treatment method for drug addicts

Research project DR/04 (Research action DR)

Persons :

Description :

A. Introduction

Drug addiction is a major Public Health problem. Drugs and Alcohol abuse are among the main causes of impairment and mortality, but consequences at the human and social levels are numerous and quite deleterious: poverty, lack of professional formation, difficulties in reaching the work market, criminality, marginalization, AIDS.
The major characteristic in drug addiction is the heterogeneity among drug users in terms of psychological patterns and of used products leading to specific effects. Moreover the biomedical status, motivation and familial or social supports of the patients are also different. This complexity of the addiction problem leads to difficulties in handling both prevention and cares.

The aim of our research work is to:

1. adapt an integrative model of vulnerability in the case of substance-dependent persons;
2. validate the model in order to highlight subsequently the links between diagnoses and therapeutic choices.

Such an approach to the problem will lead to a better comprehension of the heterogeneity which characterizes the drug addicts population. As far as Health policy is concerned, such a model aims to a better adequacy between diagnosis and therapeutics.
The construction of an integrative model aiming to a better orientation of drugs users is a complex issue. At the same time, such a method is difficult to validate. The aim of those criteria is to promote a multidimensional approach in direction of patients suffering from a drug abuse disorders in order to lead them to the most appropriate level of care.
As objective as possible, this dispatching to Health resources should be based on a system (Placement Matching) which includes 6 dimensions:

a) acute state of intoxication and/or risk of withdrawal,
b) biomedical status,
c) psychiatric co-morbidity,
d) treatment acceptance/resistance,
e) relapse risk,
f) social environment.

Because of the number and the complexity of the rules influencing patients dispatching after assessment, with respect to ASAM criteria, a decisional tree was drawn and then computerized in order to obtain standardization between the different users.

B. Methodology

1. French and Dutch translations and adaptations, and computerisation

Translation work will be conducted in accordance with the forward-backward translation method. The adaptation takes into account available care offer within the areas concerned. Translations in the original tool will be in English.

2. Naturalistic validity study

The validity of the French / Dutch adaptation will be studied by mean of a naturalistic comparison of addicted patients receiving an initial treatment according or not to the type of treatment advised by the French / Dutch adaptation of the ASAM criteria.
Sample sizes cover 100 subjects from each linguistic community who meet DSM-IV dependency criteria for at least one psychoactive substance (illegal drug) and are spread across two groups (in agreement, or in divergence, with ASAM recommendations). Patients will be re-assessed after one and six months in terms of their clinical evolution and general status.

Documentation :

Adaptation française et néerlandaise des critères de l’ASAM dans le choix du mode de prise en charge des toxicomanes : résumé    Bruxelles : Politique scientifique fédérale, 2004 (SP1280)
[To download

Aanpassing en validering van de ASAM PPC-2R criteria aan Frans- en Nederlandstalige Belgische drugsverslaafden : samenvatting    Brussel :Federaal Wetenschapsbeleid, 2004 (SP1281)
[To download

Adaptation and validation of the ASAM PPC-2R criteria in French and Dutch speaking Belgian drug-addicts : summary    Brussels : Federal Science Policy, 2004 (SP1282)
[To download

Adaptation française et néerlandaise des critères de l’ASAM dans le choix du mode de prise en charge des toxicomanes : rapport final    Bruxelles : Politique scientifique fédérale, 2004 (SP1393)
[To download

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