(INCENTIVOS): Las actividades de la

The range of prevention programs in the Netherlands is diverse. The aim of an intervention can be to postpone the start of substance use or to reduce the level of (experimental) use. Besides the target groups and the goals of the interventions, the methods and settings within which the interventions take place differ. The measures the government takes can be

divided into measures aimed at the supply of the substances and the availability, the price, the age limits, and the marketing.

Universal prevention has a long history in the Netherlands.17 The relevant parties18 share their knowledge on alcohol use since 2005 in the Partnership Early detection Alcohol (Partnership Vroegsignalering Alcohol, PVA). The Partnership aims to improve the co-operation between addiction care facilities, specialized mental health care facilities, primary care, schools, leisure centers, community centers, youth centers, and local institutions. In its first phase from 2005 to 2007 the PVA developed a standard product and created support for this product from the primary care and the municipalities. In its second phase from 2007 to 2010 the PVA worked on implementing the developed product in the primary care. Moreover, in the secondary care pilot projects were executed. In the same period an early detection protocol for the youth was developed, and the project "Prevent alcohol-related harm in young people"19 was executed by the PVA. In its third and last phase from 2011 to 2013 the PVA will emphasize on implementing the developed products, especially the products focused on the secondary care.20

In 2013, the PVA will be terminated in order to prevent that it will become an institution that hinders innovations at a local level. The PVA will have achieved the goal that it was created for, namely improved co-operation between the important players. However, in the area of the youth care improvements can still be made. Here the co-operation between the field partners is still insufficient, and more activities are necessary. Therefore the PVA pleads for a Partnership Youth and Addiction21 (Van der Gaag 2011).

Stepped care

The prevention policy in the Netherlands is built on the principle of stepped care. According to this principle the prevention activity starts with the least intensive intervention and only steps to a more intensive intervention when necessary. The consecutive steps are: 1) information, 2) testing, 3) self-help, and 4) supported care.

17

http://www.nji.nl/nji/dossierDownloads/Watwerkt_middelengebruik.pdf. 18

These relevant parties are: the Dutch College of General Practitioners (NHG), The Dutch Institute for Healthcare Improvement CBO, The Scientific Institute for Quality of Healthcare of the UMC St Radboud (IQ Healthcare), Association of GGD’s (Community Health Services) in the Netherlands, The Trimbos Institute, Reinier de Graaf Gasthuis te Delft (polikliniek Jeugd en Alcohol), and the Foundation Knowledge Center Addiction “Scoring Results”.

19

Developed by the Reinier de Graaf Gasthuis. 20

www.vroegsignaleringalcohol.nl. 21

http://www.vroegsignaleringalcohol.nl/~/media/Themasites/PVA/Downloads/Themanummer%20Verslav ing%202011%20nr%203.ashx.

49 E-health

A wide variety of e-health interventions for alcohol and drug use have been developed along the line of stepped care by, or in co-operation with, the addiction care facilities. Some examples of these e-health interventions are the following:

• alcoholdebaas.nl, • alcoholenik.nl, • alcoholinfo.nl, • cannabisondercontrole.nl, • dealermee.nl, • drinktest.nl, • drugsinfo.nl, • drugsondercontrole.nl, • minderdrinken.nl, • testjeleefstijl.nu, • unity.nl, • watdrinkjij.nl, • watwiljijmetwiet.nl, • wietcheck.nl. School

The main universal prevention program in the Netherlands is given by the interactive school- based prevention program about alcohol, tobacco, and drugs named "The Healthy School and Drugs" (DGSG, see our former National Reports). The program has been developed for primary schools, secondary schools, and for intermediate vocational education. The DGSG- program consists of four parts: 1) education at school, 2) parent involvement, 3) identifying of problem use and support, and 4) rules and dealing with the rules. The existing E-learning modules are being adapted and improved regularly. The local Public Health Services and the addiction care support the schools in carrying out the program. In 2012, about one-third of the primary schools and 70 percent of the secondary schools were involved in this

program. From the 70 schools for intermediate vocational education, 26 schools were involved in the program (on 55 separate locations, personal communication, program Parenting and Education, Trimbos Institute).

The Dutch schools (primary schools, secondary schools, and schools for intermediate vocational education) can call in the assistance of a multidisciplinary Care and Advice Team (ZAT, zorg- en adviesteam). A school can receive such assistance in case there are worries about a pupil who has complex problems. Until now, the addiction care has not been

involved yet in all teams and in all schools. The House of Representatives has paid attention to this issue, but a motion to change the situation has been rejected. The goal of the motion was that in every ZAT and on every school a youth addiction prevention worker had to be part of the team.22

22

Family

During the past years, much effort has been made to support parents while they are bringing up their children. Parents will have to teach their children that starting to drink alcohol, smoking, and using cannabis at an early age is not a wise thing to do. In the context of the 2011 lifestyle campaign "How do I help my child to say no against drinking alcohol, smoking and using cannabis"23 the Trimbos Institute and the National Centre on Tobacco Control (Stivoro) published a guideline for employees of the Public Health Services and the Addiction clinics. This guideline can be applied to organize the local provision of

interventions for parents about smoking, alcohol, and drugs. The guideline contains effective and well-documented interventions for parents about the educational topics alcohol,

smoking, cannabis, and hard drugs. Furthermore the guideline includes general advises about how to improve the recruitment and guidance of parents for parenting interventions. It also includes an overview of the regional pilots (implementing interventions) that took place in 2011.24

Community

The Drugs Information Line

For more than 15 years the Drugs Information Line (Drugs Infolijn) has been an important reliable source of information for the general public about drugs. The Drugs Information Line is not only a telephone line, but it also covers a chat service, an e-mail service, and it runs a twitter account for knowledge dissemination. It operates the evidence-based website

www.drugsinfo.nl, which information on drugs, drug treatment, the law, health, parental issues, and risks of drug use. The website also contains a question and answer section. Moreover, the Drugs Information Line manifests itself through other channels like forums and local and national media.

Over the years many help and information lines have seen a decline in the number of phone calls, and this also counts for the Drugs Information Line. People seem to focus more on digital information by means of e-mail and chat, information on the websites of the

Trimbos Institute, and specific drugs forums. Figure 3.1 reviews the reasons for contacting the Drugs Information Line in 2011.

23 www.hoepakjijdataan.nl. 24 http://www.trimbos.nl/webwinkel/productoverzicht-webwinkel/alcohol-en-drugs/af/af1118-roken- drinken-blowen-en-opvoeding.

51

Figure 3.1: Reasons for contacting the Drugs Information Line in 2011

Source: Drugs Information Line, Trimbos Institute.

In 2011, 42 percent of the persons who contacted the Drugs Information Line searched information related to their own substance use, and more than a quarter (28%) searched information for the substance use of somebody close by (family member, partner, or friend). Less than a fifth of the information searches were work-related (17%), and less than a tenth (7%) concerned educational matters or 'other' matters (6%).

Figure 3.2 gives the breakdown by substances for the information requests in 2011.

Figure 3.2: Information requests by substance at the Drugs Information Line in 2011

In 2011, about a quarter of the information seekers asked questions about cannabis (28%), and about a fifth wanted to know something about XTC (19%). About a quarter asked for more general information about drugs (24%). Less than a fifth of the information seekers was interested in information about cocaine (16%), and less than a tenth was interested in information about GHB (8%) or amphetamine (5%).

Addiction app

A relatively new addiction care facility Ready for change launched an Addiction app in October 2012. This app includes a self test, and a button "relapse prevention" with information about self help groups nearby to the user. The app also has an emergency button which immediately makes contact with a caregiver. For persons who have been addicted it contains a program which calculates the "clean time". This indicates for how many days and hours the former addicts have not taken drugs or alcohol. The app also encloses practical information, including information for partners, friends, and family. The app can be downloaded for free.

3.4 Selective and indicated prevention in at risk groups and settings

In the former National Report it has already been explained why in the Dutch situation the distinction between selective and indicated prevention is difficult to make (see National Report 2011 § 3.4). Therefore, in the following, these two types of prevention will be treated together.

In the former years there has been a growing need for a form of prevention that fills the gap between universal and indicated prevention. Therefore, the attention has shifted more and more to selective prevention. The high-risk approach of selective prevention serves as a bridge between the two forms of prevention. Providing preventive services to groups of people with more than one risk factor appears to be a promising strategy. This strategy is promising in terms of improving the health of individuals in a specific risk group and lowering the risk that their problems will become chronic.25

In the following text, some examples of selective and indicated prevention activities in the Netherlands will be described.

Open and Alert

The program Open and Alert offers alcohol- and drug prevention in risk settings and aims to prevent (problematic) use of alcohol and drugs by juveniles at these settings. It also aims to support them in the best possible way. It covers projects in the residential child care, youth work, youth custodial institutions, and facilities for people with mild or borderline intellectual disabilities. These are risk settings because problematic alcohol and drug use often occur in these settings. This kind of problematic use worsens the problems of juveniles and

grownups in these setting. Due to problematic use, their chances to marginalize increase, and juveniles and grownups in these setting often get socially excluded from the healthcare.

The program has resulted in five factsheets to inform health insurers, municipalities, caregivers, and managers about alcohol and drug prevention in the risk settings mentioned

25

Preventie van chronische ziekten in risicogroepen (http://www.rivm.nl/bibliotheek/rapporten/ 260221004.pdf).

53 above. Next to that course material, (implementation) manuals, and work books have been developed for caregivers in the different settings.

The Drugs Information and Monitoring System (DIMS)

Twenty years ago the Ministry of Health, Welfare, and Sport (VWS) founded the Drugs

Information and Monitoring System (DIMS). The DIMS explores the chemical content of

drugs, the health risks, and monitors trends. The drugs are collected by means of those users who bring their drugs for control to an organisation affiliated with the DIMS. These organisations have weekly office hours. This method of collecting drugs brings along the possibility to exchange information between the personnel at the testing facilities and the users. The user is informed about the composition of the delivered drugs and is warned about the risks. The data that are collected this way are used for education, prevention, and drug policy. Next to this, the data are used to inform the network of organisations

participating in the DIMS.

Acute health risks for users can occur, for example in case extra harmful substances are detected in the drugs. In case of such acute health risks, the DIMS will start a national or a regional warning campaign, a Red Alert. In 2011, the DIMS warned two times at a national level. The first national warning targeted the risks of using ecstasy pills contaminated with PMMA, and the second national warning targeted pills with a high dose of MDMA. During the first six months of 2012, about 4,000 people visited the consulting hours of the DIMS-

facilities, about 160 people every week. In total 4,421 samples were delivered, about 176 samples weekly (DIMS 2012) (see also § 10.3).

At the request of the present Cabinet, the DIMS has increased its tasks with regard to the "Reporting Desk New Drugs" (Meldpunt Nieuwe Drugs, MND). The MND monitors the new psychoactive drugs which appear frequently on the market, like mephedrone, 4-MEC, or MDPV. These new drugs raise questions about who are the users and about the (health) risks. At a special website (www.meldpuntnd.nl/) the users can report new drugs

anonymously and eventually can describe their experiences with these drugs.

The Monitor Drug-related Emergencies

In addition to the Drugs Information and Monitoring System (DIMS), the "Monitor drug- related emergencies" (Monitor drugsincidenten) has been established since 2009. By means of this monitor current data are gathered about the nature and extent of drug-related health incidents in the Netherlands. The data are collected on the special website

www.drugsincidenten.nl by a number of health-care organizations like hospitals, ambulance services, police medical-services, and first-aid services, in different regions of the country. This website enables the exchange of information and supports the professional level of health workers concerning interventions targeting these incidents. In 2011 a total of 3,652 incidents were registered. Between 2009 and 2011 the notification came in 48 percent of the cases from ambulance services, in 32 percent of the cases from the first aid stations on parties, in 14 percent of the cases from the Emergency Departments of the hospitals and in 8 percent of the cases from police doctors (Monitor drugsincidenten Factsheet 2011).

Nightlife / going out

In August 2012, the Trimbos Institute, in co-operation with STI Aids Nederland and the Centre Media & Health, launched the internet film "SndBites".26 This internet film is about going out and the sensible use of alcohol, safe sex, and the prevention of hearing loss. The film is intended for juveniles between 15 and 18 years receiving Lower and Intermediate Vocational Education.

Going Out: Alcohol and Drugs

Contracted by the Ministry of Health, Welfare, and Sport (VWS), the Trimbos Institute, in co- operation with several parties in the field of addiction care, runs the program "Going Out: Alcohol and Drugs". This program was started in 1998, and deals predominantly with the prevention of harmful drug use in recreational settings, especially by young people from 16 up to including 26 years. A variety of interventions and preventive instruments has been developed during this project. Some examples are a quick-scan for detecting drug problems, First Aid courses for personnel in recreational settings, factsheets, and a help desk.

Stakeholders in the program are, for instance, municipalities, municipal health services, coffee shops, and institutes for addiction care (Croes and Van Gageldonk, 2009, see also several former national reports).

Since 2008, a website has been installed that provides information for people who participate in the nightlife. The website contains information about the effects of drugs and alcohol, the risks that are involved, advices for less risky use, tests for the knowledge about drugs, tests for the level of use, advices for going out safely, advices for first aid per drug type, tips for obtaining general advice, information about drug testing, and links to general information.

In a letter to the House of Representatives the Minister of Health, Welfare, and Sport (VWS) and the Minister of Security and Justice (VenJ) have pledged the grant until 2014 for "Going Out: Alcohol and Drugs". After 2014 the activities of this program must be included in other programs or must be picked up on a regional level.27

A complicating factor is the cutting in the budgets for addiction prevention at the level of the municipalities. This has implications for peer-education projects like, for example, Unity. This is a youth-participation project that works with volunteers who are recruited at the entertainment scene. These volunteers are trained by the staff of Unity to become peer educators. Unity aims as much as possible to reduce the risks of the use of recreational drugs. It works in co-operation with the addiction care facilities Jellinek Preventie, Context (part of Parnassia Bavo Groep), Novadic-Kentron, Centrum Maliebaan, Brijder, and Iriszorg. Because of the cuts on the budgets for prevention, Bouman GGZ (region Rotterdam) has finished the activities per 2012 as regards Unity per 2012. Novadic-Kentron has halved the activities for the same reason.

The Centre Safe and Healthy Nightlife (Centrum Veilig en Gezond Uitgaan, CVGU) is part of the program “Going Out: Alcohol and Drugs”. This centre was initiated by the Dutch

Centre for Crime Prevention & Safety (Centrum voor Criminaliteitspreventie en Veiligheid,

CCV) and the Trimbos Institute. The aim of the CVGU is to offer support to municipalities for constructing a local policy (a mix of measures) to increase the safety in recreational settings by reducing drug and alcohol use. The CVGU is also a centre of expertise for evidence- based interventions and practice- or experience-based activities in this domain. It

disseminates newsletters, info sheets, and it organizes thematic meetings. On the 21st of

26

http://www.sndbites.nl/. 27

55 November 2012, for example, a meeting was scheduled about how to influence the risk behavior of juveniles in the nightlife. The meeting was meant for professionals working in the health and security domain. Recently two factsheets were published entitled "Health

incidents caused by alcohol and drugs, first aid in nightlife facilities and during events" and "Risky use of alcohol and drugs in the nightlife, facts, figures and trends".

The CVGU now aims to monitor the health- and security effects of different closure times in the nightlife. Therefore, the CVGU is now investigating municipalities that have planned to change the closure times.

Youth and Safety Guide

The Youth and Safety Guide (Wegwijzer Jeugd en Veiligheid) is an initiative of the Ministry of Security and Justice (VenJ), the Ministry of the Interior and Kingdom Relations (BZK), the Association of Dutch Municipalities (VNG), and the Dutch Centre for Crime Prevention & Safety (CCV). The Youth and Safety Guide informs stakeholders about the activities of the government and the municipalities with regard to youth and safety. An overview of these activities is given on the website www.wegwijzerjeugdenveiligheid.nl. Apart from an overview of national and local policies, this website also offers research findings and best practices. To further support the stakeholders during the policymaking process, a roadmap is also available.

App for (care) professionals

In July 2012, the prevention department of the institute for addiction care IrisZorg launched a new App for (care) professionals entitled "From alcohol to ecstasy". This App contains easy accessible current information about drug use, the characteristics of different drugs, the risks