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BACKGROUND: Leave is an essential part of treatment within the framework of the tbs measure (court ordered psychiatric treatment for offenders with a mental disorder). Traditionally, these leaves lead to concerns about safety.AIM: To study how often tbs-patients do not return from leave (on time) and how often they commit a crime during an unauthorized absence (UA). In addition, we investigate whether patient or offence characteristics can predict an UA.METHOD: All UA’s between 2009-2020 were examined. We also analysed the patient characteristics of 11,525 permit applications between 2010 and 2018 from the registration system of the Advisory Board for Permitting Leave TBS (AVT).RESULTS: 2.5% of the applications for leave between 2009 and 2020 involved an UA and 0.15% involved an UA with a recidivism. Patients with a cluster B personality disorder, substance use disorder, mood disorder, attention disorder, arson or a serious violent crime as an index offence had a significantly higher chance of having an UA. However, these associations were very weak. The risk factor violation of conditions (from the Dutch risk assessment tool, the HKT (Historical, Clinical, Future)) was also a significant but very weak predictor of UA.CONCLUSION: UA is a rare event. Despite the fact that some patient and offence characteristics were associated with an UA, this relationship is weak and predicting an UA is difficult.

To investigated the impact of the lockdown during the COVID-19 pandemic, since March 2020, on the occurrence and characteristics of recreational drug intoxications in the Emergency Department (ED), compared to previous years.Retrospective cohort study METHOD: Patients ≥ 18 years old who presented to the ED of OLVG hospital in Amsterdam with recreational drug intoxication(s), with or without alcohol, were divided into the pre-COVID-19-period (January 2017 to February 2020), and the COVID-19-period (March to December 2020). An intoxication was registered by the treating physician, or retrospectively by researchers. Subgroup analysis was performed for foreign tourists, Dutch tourists and Amsterdam residents, as for the four most common drugs used.A total of 3,881 patients (73.6% male, aged 32 (±12) years) were included, of whom 49.0% were tourists. During the COVID-19-period, a 53% decrease of intoxications was observed (1090.1 vs. 514.8 patients/year), with an 83% decrease of tourists (574 vs. 98.4 patients/year), 20% decrease in Dutch residents (516 vs. 416 patients/year) and 4,5% decrease in Amsterdam residents (354 vs.338 patients/year). Among Dutch patients, a significant decrease in cocaine (85.6 vs. 75.6 patients/years), MDMA (25.1 vs. 27.6 patients/year), and THC (108.6 vs. 76.8 patients/year) intoxications were observed. However, the amount of GHB/GBL related intoxications was comparable between groups (100.7 vs. 105.6 patients/year).During the COVID-19-period, drug-related intoxications decreased by 53%. Among Dutch residents this decrease was 20%, with a significant decrease in cocaine, MDMA and THC intoxications. However, the amount of GHB/GBL related intoxications was comparable with the pre-COVID-19 period.

To demonstrate the results of routine screening and treatment for psychiatric problems, psychosocial problems and substance use (PPS) among pregnant women in the Netherlands. This approach is advocated by the national program 'The first 1000 days', which focuses on a healthy start for (unborn) children in vulnerable situations.Secondary data analysis of a routine care dataset obtained from midwifery practices and hospitals throughout the Netherlands. All practices and hospitals applied systematic screening with Mind2Care.Each Mind2Care screening results in either a negative result (no risk), an alert and/or a treatment advice based on local care pathways. Anonymous data on detected risk factors and subsequent alerts/advices from 22.141 pregnant women were analyzed.Of all women, 24% had at least one PPS risk factor. Accumulation of risks was present in 10% of women. Thirty-one percent of all pregnant women received at least one specific advice (15% alerts, 24% treatment advices, including overlap).One in four pregnant women has psychiatric problems, psychosocial problems and/or substance use for which guideline care is available. Implementation of Mind2Care is demanding to the obstetrical system, and requires multidisciplinary care processes of medical and social caregivers. Despite the lack of a scientific evidence on the added value of systematic detection and treatment of PPS-risks in all pregnancies, this programmatic approach is increasingly acknowledged on the national attention level as the way forward to a healthy start for every child, even if born under vulnerable conditions.

Substance use disorder (SUD) is common among youths with attention-deficit/hyperactivity disorder (ADHD). Co-morbid ADHD and SUD in youths complicates screening, diagnosis, and treatment of both disorders and is associated with worse treatment prognosis. Limited research in youths with SUD and co-morbid ADHD provides insufficient basis for firm recommendations. To offer clinicians some guidance on this topic, we present the results of an international consensus procedure.To summarize an international consensus on diagnosis and treatment of young people with comorbid ADHD and SUD.In a modified Delphi-study, a multidisciplinary, international group of 55 experts strived to reach consensus on 37 recommendations.Consensus was reached on 36 recommendations. Routine screening of ADHD and/or SUD is important. For the treatment of co-morbid SUD and ADHD in youths, both psychosocial and pharmacological treatment should be considered. Psychosocial treatment should preferably consist of psychoeducation, motivational interviewing (MI), and cognitive behavioral therapy (CBT) focused on SUD or both disorders. Long-acting stimulants are recommended as first choice pharmacotherapy, preferably embedded in psychosocial treatment. Experts did not agree on the precondition that patients need to be abstinent before starting stimulant treatment.Clinicians and youths with co-morbid SUD and ADHD can use this international consensus to choose the best possible treatment.

Long-term usage of benzodiazepines for anxiety and sleeping disorders results in a decline in effectiveness and an increase in the risk of dependence and side-effects over time. For this reason, in 2009, benzodiazepines for anxiety and sleeping disorders were disinvested (i.e. reimbursement was discontinued) in the Netherlands. Several factors contributed to disinvestment: the broad support from involved actors for disinvestment, the possibility to keep reimbursing benzodiazepines for patients groups for whom long-term use is indicated, patient groups that were not well organized, and the fact that long-term benzodiazepine use for anxiety and sleeping disorders is not medically necessary as well as ineffective. In the first year following disinvestment, the usage of benzodiazepines decreased with 15%. In subsequent years, usage stabilized, after which it decreased again.

Negative life events in childhood can have tremendous sequalae in adulthood. Parental death in childhood is associated with reaching lower socioeconomic status, delinquency, and premature death as an adult. Exposure to four or more adverse childhood experiences, (i.e. child abuse, exposure to domestic violence, parental drug addiction, mental disorder or imprisonment) is associated with an increased risk on chronic disease in adulthood, including diabetes, mental illness, alcoholism, cancer, and cardiovascular disease. Identification of children exposed to ongoing adverse experiences is important to offer them support or help them escape. It could be helpful to ask adults if they were exposed to these experiences. If so, this could provide the possibility to offer them help when they still are hampered by these experiences. Maybe intervention could benefit them by preventing lifelong sequalae with chronic use of health care, incapacity for work, and use of medication.

Although mental health care for prisoners with mental health problems during and after detention improves re-integration and reduces criminal recidivism, prisoners with psychiatric problems seem to have difficulties connecting to regular mental health care after detention. AIM: To describe referrals from Flemish prisons to psychiatric hospitals or external therapeutic settings in the year 2019. METHOD: All prisoners with mental health problems that were referred from a Flemish prison to mental health care in 2019 were studied (n = 577) , using data collected by the Flemish initiative TANDEM. RESULTS: The vast majority of referrals were prisoners with a substance use disorder. In total, 1 in 5 prisoners with mental health problems directly had access to ambulatory or residential mental health care. 30% of these ultimately did not appear to start with the planned treatment.Continuity of mental health care after detention is recommended and also has a social benefit. Improving cooperation between justice and external mental health care, taking into account the needs of the prisoner, is essential in the development of succesful treatment plans.

Tobacco use disorder is a major contributor to morbidity and mortality worldwide. Yet, in contrast to other substance use disorders, tobacco use disorder is often considered as an unhealthy lifestyle. In this article we argue that tobacco use disorder should be considered similar to other addictive disorders, and summarize supporting arguments from genetics, neuroscience, as well as treatment perspective. Considering Tobacco Use Disorder as an addictive disorder will facilitate awareness among health professionals that patients with this condition should receive proper treatment that should be reimbursed by health insurance. This will reduce the health burden of tobacco use disorder, improve quality of life of individual patients and reduce societal health care costs.

Homeless people have more complex problems, poorer health and shorter life expectancy (14- 16 years) than others. They often stay in an unsafe environment. Loneliness and avoidance of care reinforce their health problems. One third has an intellectual disability. Doctors should tackle these problems together with non-medics. This requires: - Knowledge of their biography: you don't know what you (don't) see; - Alertness to previously (psychological and physical) trauma, sexual abuse and (partner-- related) violence, especially among women; - Integrated approach to substance abuse, debt and deviant behaviour to break a downward spiral; - Reporting when someone is uninsured, so that financing of care, an address and health insurance can be arranged; - Care beds to enable (1) care around operations and extreme underweight, and (2) arranging Identity Card, address, income and insurance; - Secondary prevention: cooperation between doctors and social work, addiction treatment and curator; - Fewer rules so that right of insurance, right of residence and care can advance the health of the homeless.

Nitrous oxide (N2O) is increasingly used as a recreational drug, and is presumed relatively safe and innocent. The risks for neurological complications are often known, however the risks of serious thromboembolic events are not. We describe three cases of acute thromboembolic events resulting in serious cardiovascular complications after N2O abuse: one case of myocardial infarction that resulted in a reduced ejection fraction, one case of peripheral arterial occlusion that led to limb amputation and one case of pulmonary embolism that resulted in hemodynamic instability requiring extracorporeal membrane oxygenation (ECMO) and surgical removal. All patients were young adults with a low cardiovascular risk profile. N2O inactivates vitamin B12, leading to vitamin B12 deficiency and subsequent to hyperhomocysteinemia, which is associated with the formation of fibrinolysis-resistant blood thrombi. In conclusion, we contest the safety and innocence of recreational N2O (ab)use. Our three cases illustrate that, next to previously described neurological complications, the use of nitrous oxide is associated with thromboembolic cardiovascular complications, presumably mediated by hyperhomocysteinemia.

Most substance use disorders (SUD) emerge in adolescence and early adulthood. Early interventions in young people may reduce the risk and severity of SUD and other psychiatric disorders.br/AIM: To provide suggestions for proactive psychiatry in addiction.br/METHOD: Literature review.br/RESULTS: Comorbidity, cumulative risks and self-regulation skills each play an important role in proactive psychiatry. Early universal prevention and intervention targeted at improving self-regulation reduces the risk of a broad array of psychiatric and social problems, including addiction.br/CONCLUSION: In terms of broad prevention, much can be gained by widespread, consistent implementation and normalization of universal prevention at the pre- and elementary school level. Tijdschrift voor Psychiatrie 63(2021)2, 125-128.

Sexual abuse in individuals with (above) average iq is associated with a wide range of behavioural and psychological clinical characteristics, including characteristics regarding body experience. However, research on the clinical characteristics of sexually abused individuals with borderline intellectual functioning or mild intellectual disability (bif-mid) is scarce. OBJECTIVE To provide an overview of the literature on the clinical characteristics of sexually abused individuals with bif-mid.br/METHOD: PubMed, Embase, PsycInfo, cinahl, Cochrane Library and Web of Science were searched for relevant publications using terms related to 'intellectual disability' and 'sexual abuse'.br/RESULTS: Seven studies were included. The studies in question mostly reported behavioural and psychological characteristics such as challenging behaviour, sexualised behaviour or posttraumatic stress, anxiety or depressive symptoms associated with sexual abuse in individuals with bif-mid. None of the studies reported problems regarding body experience. CONCLUSIONS Sexual abuse in individuals with bif-mid is associated with a broad range of behavioural and psychological characteristics similar to that of individuals with (above) average iq. Whether sexually abused individuals with bif-mid have similar problems in body experience as sexually abused individuals with (higher than) average iq needs to be investigated.

Patients with a co-occurring substance use disorder and other mental disorder (dual diagnosis) are at increased risk of victimization: to become victims of for instance physical abuse, sexual abuse, and property crimes.br/AIM: To examine the effectiveness of the sos training: a new group-based intervention to improve resilience of dual diagnosis patients and thereby reduce their risk of victimization.br/METHOD: A randomized controlled trial was conducted in dual diagnosis patients, with a 14-month follow-up period. Patients were randomized to receive either care as usual (n = 125), or care as usual plus sos training (n =125). The primary outcome measure was defined as treatment response for victimization (yes/no), with 'yes' defined as at least a 50% reduction in the number of past-year victimization incidents at 14-month follow-up compared to baseline.br/RESULTS: Significantly more participants in the experimental group achieved positive treatment response for victimization (68%) compared to the control group (54%).br/CONCLUSION: Adding sos training to care as usual in dual diagnosis patients is more effective in reducing victimization compared to care as usual alone. The sos training can be implemented in addiction-psychiatry services to prevent future victimization in these patients.

After psychedelics were banned in 1968, the flourishing research on the use of psychedelics in patients with a mental disorder stopped abruptly. Recently, we see a renaissance of this research.br/AIM: To present an overview of what is known about the treatment of addiction and psychosis with psychedelics.br/METHOD: Literature study based on Medline en PubMed publications till December 2019.br/RESULTS: Studies on the effectiveness of psychedelics in the treatment of addiction and psychosis is still very limited in size and methodological quality. Nevertheless, most studies show positive effects of both classical and atypical psychedelics in a variety of addictions on motivation, craving, reduced consumption, and abstinence often following a single dose and with long-lasting benefits (3-24 months). Use of ketamine in patients with a psychosis stabilized on an antipsychotic might reduce negative symptoms.br/CONCLUSION: Before psychedelics can be used in standard clinical practice for the treatment of patients with an addiction or a psychosis, larger and methodologically better studies are needed. The use of psychedelics also creates an opportunity to better understand the shared underlying pathology of many different mental disorders.

lsd and other hallucinogens or psychedelics have been therapeutically used in psychiatry in the period between the Second World War and the late 1980s. In the past years renewed interest in the medical sciences for research and therapeutic use of these substances has evolved.br/AIM: A discussion of contemporary lsd research in the context of earlier research.br/METHOD: A systematic survey of the literature on the psychiatric use of lsd and the reactions towards lsd use in society.br/RESULTS: Since 1947 lsd has been therapeutically used in the treatment of anxiety, depression, addiction, post traumatic disorders, and other conditions. Since the early 1960s this use has been criticized because of the danger of evoking psychoses in patients, and because of the rise of a widespread non-medical use. However, there is no consolidated evidence-base for either the positive or the negative outcomes of lsd therapy.br/CONCLUSION: At this moment it is unpredictable whether lsd will make a comeback in psychiatry. Contemporary research attempts to evade all public controversy and to build up a solid evidence-base. Nevertheless it demonstrates a direct continuity with earlier research.

In recent years there was a renewed interest in psychedelic substances.br/AIM: To present an overview of what is known about the use of classic psychedelic drugs and 'atypical' psychedelic drugs (i.e. entactogen/empathogenic drugs like mdma and dissociative drugs such as ketamine) in the Netherlands.br/METHOD: Data from a Dutch adult general population survey from 2016 and 2018 and other surveys - mainly among nightlife attendees - were used to provide prevalence estimates and user characteristics. In addition to that, data from several Dutch monitoring systems were included for information on problematic psychedelic drug use, health emergencies and psychedelic drug markets.br/RESULTS: The last year prevalence of ecstasy among Dutch adults was 2.9%, making it the most used psychedelic in the general population. For hallucinogenic mushrooms/truffles, lsd, 2C-B and ketamine, the last year prevalence estimate ranged between 0.2 and 0.6%. For all psychedelic substances, higher use rates were found among men, young adults between 20-29 years old, adults with higher education, and inhabitants of urban areas. In different groups of nightlife attendees, psychedelic substance use prevalence was greater than that of the general population. Data from various sources suggested an increase in the number of ketamine users.br/CONCLUSION: Apart from ecstasy, the use of psychedelic substances is relatively low in the general population. In subgroups of the Dutch population, ketamine use increased in recent years. Further research is needed to gain a better understanding of the use of psychedelics in the Netherlands, particularly in subpopulations.

Individuals with a mild intellectual disability or borderline intellectual functioning (mbid) are at risk for psychiatric disorders, including addictive disorders. Treatment of these disorders is often complicated by co-morbidity, as well as caregiver's and practitioner's struggle to effectively help.br/AIM: To provide guidelines for psychiatrists to organize and deliver treatment to patients with mbid and addiction.br/METHOD: Based on a case study, we describe obstacles in the care for patients with mbid and addiction, and provide guidelines to overcome these.br/RESULTS: The Netherlands are leading in providing proper care for patients with mbid and addiction. However, available treatment protocols are not widely implemented.br/CONCLUSION: Staff needs to be trained in working with patients with mbid and addiction, and interagency collaboration needs to be put in place. This is a collective responsibility of addiction medicine, general psychiatry, and disability services.

Substance use disorders (SUD) and attention-deficit/hyperactivity disorder (ADHD) often co-occur in adults. Together, they complicate diagnosis and can negatively influence treatment outcome.br/AIM: To develop a practical guide to assist professionals with the screening, diagnosis and treatment of adult patients with SUD and ADHD.br/METHOD: A literature search and a consensus procedure between several international scientific and clinical experts. This manuscript is an adapted and summarized Dutch version of the International consensus statement on screening, diagnosis and treatment of patients with SUD and comorbid ADHD.br/RESULTS: The routine use of adequate screening tools enables ADHD to be detected earlier in adults with SUD. The diagnostic process for ADHD should be initiated as soon as possible in patients with SUD. Integrated treatment, involving a combination of pharmacotherapy and psychotherapy, is preferred. Long-acting stimulants with up-titration to higher dosages may be considered.br/CONCLUSION: Early detection of ADHD in patients with SUD is essential for adequate diagnosis and more effective treatment and follow-up for these patients.

background The ability to predict the level of care (care burden) on the basis of patient characteristics is important for both the indication for treatment and the funding of mental healthcare. Within the framework of an administrative agreement in mental healthcare, a care demand intensity model 1.0 was developed. However, since the predictive power of this model is rather limited it remains controversial. aim To ascertain whether prediction of the level of care using the care demand intensity model can be improved by using more and more precise patient characteristics. method Comparison between the care burden estimate based on patient characteristics at intake into an addiction care institute and the care burden estimate determined by the indicators in the care demand intensity model. results Taking into account both the increasing number and more precise patient characteristics at intake in addiction care explained a considerably larger proportion of the variance in care consumption than the care demand intensity model 1.0.br/CONCLUSION: The estimate of the consumption of care can be greatly improved but remains an insufficient tool upon which to base funding.

Few data are available on predictors for the transition of individuals with mental illness to more independent forms of housing.br/AIM: To analyse which variables predict the transition of individuals with severe mental illness from supported housing within the Dutch community housing programs (CHP) to more independent ways of living.br/METHOD: Data of 1569 participants were analysed using Cox regression analysis.br/RESULTS: Individuals with a personality disorder, current alcohol misuse or who received ambulant care prior to admission in CHP had the highest probability of moving to a more independent way of living. Individuals who received clinical care prior to admission in CHP, individuals with admission in Supported Housing, and individuals with a history of substance dependency had the highest probability of clinical relapse.br/CONCLUSION: The predictors found in this study can be used as a starting point both for hypotheses for additional aetiological research and for guidelines covering specific interventions.

Dual diagnosis (substance use disorder combined with a comorbid mental illness) is a common problem. One of the methods to treat this is integrated dual diagnosis treatment (IDDT). IDDT consists of the simultaneous, integrated application of different treatment components. Their efficacy, however, has only been studied separately. As a result, the effectiveness of the IDDT program as a whole remains unclear.To evaluate the scientific evidence relevant to the effectiveness of IDDT in dual diagnosis patients.A systematic literature review using MEDLINE, Embase and PsycINFO (Prisma guideline).Six studies were found: a randomised controlled study (RCT), two non-randomised controlled studies, and three uncontrolled pre-post studies . There was a notably large diversity in outcome measures. The results differed significantly, including some studies concluding a significant (additional) effect, while others concluded that there was no indication of a significant effect of IDDT.In clinical practice, IDDT is recommended and chosen frequently as the treatment for patients with dual diagnosis. However, it is remarkable how limited and unthorough the research is pertaining to the effects of the full IDDT program on dual diagnosis.

Although there is a great need for staging and profiling in psychiatry, no-one has so far devised a staging and profiling model to aid diagnosis and treatment.To devise a basic staging and profiling strategy that can be used to treat patients suffering from both substance abuse disorder and a psychiatric disorder.On the basis of existing staging model for addiction, we explore how staging could also be useful for the treatment of comorbidity in psychiatry.Since there is hardly any evidence of the use of staging for this kind of comorbidity, we present a staging model that might help to provide a solution. To the described stages we add a recommended treatment setting or treatment intensity.Further research is needed to ascertain whether the staging model that we have presented will lead to improvements in the prognosis and treatment of patients with dual disorders referred to Dutch psychiatrists.

Substance dependence is a chronic disorder that is difficult to treat. Non-invasive stimulation techniques may have beneficial effects on the course of the illness.To provide an overview of studies that evaluate the clinical effects that transcranial magnetic stimulation (tMS) and transcranial direct current stimulation (tDCS) have on patients with substance use disorders.We performed an extensive search of the literature, using PubMed.Most studies showed that both tMS and tDCS have a beneficial effect on clinical outcomes. However, the effects seemed to wear off over time, even if tMS and tDCS had been administered to patients over several sessions.In terms of efficacy, we award a level B qualification to both tMS and tDCS, which means that we regard both techniques as 'very probably efficient'.

Very little information is available regarding the number of compulsory admissions (ca) from psychiatric wards and ae wards. Nevertheless, the incidence of such admissions seems to be increasing.To estimate the incidence of ca and identify the underlying diagnoses of patients in the Psychiatric ward and the ae ward of the Imelda Hospital in Bonheiden over a 10-year period.We studied the records of all patients who were compulsorily referred from the psychiatric ward and the ae ward over the period 2005-2014.There was an increase in the number of ca from both the the psychiatric and the ae ward. The procedure for ca was instituted slightly more often for men than for women. Patients in the ae ward suffered mainly from psychotic disorders and disorders related to substance abuse. Patients in the psychiatric ward had mainly mood and psychotic disorders.The results closely resemble the data from comparable studies. It was very unusual for patients admitted compulsory from the Psychiatric ward to be suffering from substance-related disorders.

Healthcare professionals are crucial in the identification and accessibility to treatment for people with substance use disorders.Objective of this literature review is to assess health professionals' attitudes towards patients with substance use disorders and to examine the consequences of these attitudes on healthcare delivery for these patients.PubMed, Psycinfo and Embase were systematically searched for articles published between 2000-2011. Reviews, commentaries and letters were excluded, as were studies originating from non-Western countries. The search process yielded 1562 citations. After selection and quality assessment 28 studies were included.Health professionals generally have negative attitudes towards patients with substance use disorders. They perceive violence, manipulation, and poor motivation as impeding factors in the healthcare delivery for these patients. Health professionals also lack adequate education, training and support structures in working with this patient group. Negative attitudes of health professionals diminish patients' feelings of empowerment and subsequently treatment outcomes. Health professionals have a more task-oriented approach (e.g. less personal engagement and diminished empathy) in the delivery of healthcare for these patients.This review indicates that negative attitudes of health professionals towards patients with substance use disorders are common and contribute to suboptimal health care for these patients. However, few studies have evaluated the consequences of health professionals' negative attitudes towards patients with substance use disorders.

A large number of interventions are available for the treatment of addiction. Professionals need to know about the effectiveness and cost-effectiveness of interventions so they can prioritise appropriate interventions for the treatment of addiction.To provide an overview of the scientific literature on the cost-effectiveness of addiction treatment for alcohol- and drug-abusers.We searched the databases Medline and Centre for Reviews and Dissemination. To be relevant for our study, articles had to focus on interventions in the health-care setting, have a Western context and have a health-related outcome measure such as quality adjusted life years (QALY). Twenty-nine studies met our inclusion criteria: 15 for alcohol and 14 for drugs.The studies on alcohol addiction related mainly to brief interventions. They proved to be cost-saving or had a favourable incremental cost-effectiveness ratio (ICER), remaining below the threshold of € 20,000 per QALY. The studies on drug addiction all involved pharmacotherapeutic interventions. In the case of 10 out of 14 interventions, the ICER was less than € 20,000 per QALY.Almost all of the interventions studied were cost-saving or cost-effective. Many studies consider only health-care costs. Additional research, for instance using a social cost-benefit analysis, could provide more details about the costs of addiction and about the impact that an intervention could have in these/the costs.

BACKGROUND: A large number of interventions are available for the treatment of addiction. Professionals need to know about the effectiveness and cost-effectiveness of interventions so they can prioritise appropriate interventions for the treatment of addiction. AIM: To provide an overview of the scientific literature on the cost-effectiveness of addiction treatment for alcohol- and drug-abusers. METHOD: We searched the databases Medline and Centre for Reviews and Dissemination. To be relevant for our study, articles had to focus on interventions in the health-care setting, have a Western context and have a health-related outcome measure such as quality adjusted life years (QALY). Twenty-nine studies met our inclusion criteria: 15 for alcohol and 14 for drugs. RESULTS: The studies on alcohol addiction related mainly to brief interventions. They proved to be cost-saving or had a favourable incremental cost-effectiveness ratio (ICER), remaining below the threshold of € 20,000 per QALY. The studies on drug addiction all involved pharmacotherapeutic interventions. In the case of 10 out of 14 interventions, the ICER was less than € 20,000 per QALY. CONCLUSION: Almost all of the interventions studied were cost-saving or cost-effective. Many studies consider only health-care costs. Additional research, for instance using a social cost-benefit analysis, could provide more details about the costs of addiction and about the impact that an intervention could have in these/the costs.

The hallucinogen-induced persistent perception disorder (hppd) is a disturbing complication resulting from the use of hallucinogens. We report on a case-study in which an artist suffering from visual, auditory and olfactory hallucinations also experienced chromatic-phonemic synesthesias that had persisted for two years after he had stopped using lysergic acid diethylamide (lsd). The case described demonstrates that individuals suffering from hppd can also experience synesthesias that may in fact differ phenomenologically from 'coloured hearing', which is a symptom known to occur in the context of substance abuse.

The 5th edition of the DSM was published in May, 2013. The new edition incorporates important changes in the classification of addiction.To compare the classification of addictive behaviours presented in DSM-IV with the classification presented in DSM-5 and to comment on the changes introduced into the new version.First of all, the historical developments of the concept of addiction and the classification of addictive behaviours up to DSM-IV are summarised. Then the changes that have been incorporated into DSM-5 are described.The main changes are: (1) DSM-IV substance related disorders and DSM-IV pathological gambling have been combined into one new DSM-5 category, namely 'Substance Related and Addictive Disorders'; (2) DSM-IV abuse and dependence have been combined into one new DSM-5 diagnosis, namely 'Substance Use Disorder'; (2a) the DSM-IV abuse criterion 'recurrent substance-related legal problems' and the DSM-5 criterion 'craving' has been introduced; and (2b) the criteria for (partial) remission have been sharpened.DSM-5 is an improvement on DSM-IV, but for the diagnosis of a psychiatric disorder and the treatment of a psychiatric patient, classification needs to be complemented with staging and profiling.

The externalising disorders conduct disorder (CD) and ADHD occur frequently in patients suffering from substance use disorders. These disorders play an important role in the onset and development of addiction.To examine the influence of CD and ADHD on the current problems and the psychiatric comorbidity of patients with a chronic addiction.A group of 193 opiate-addicted patients receiving methadone maintenance treatment were evaluated extensively in the following areas: functioning, quality of life, psychiatric comorbidity (including CD and ADHD) and comorbid addictions. Standardised interviews were used to check for the presence of CD and ADHD.A history of CD was demonstrated in the majority of participants (60.1%). Persistent ADHD was ascertained in 24.9%. Participants with CD and/or ADHD had a more severe addiction, characterised by more psychiatric comorbidity, more serious dysfunctioning and reduced quality of life. A history of CD predisposed patients particularly to antisocial behaviour and personality disorders. ADHD increased the risk of psychiatric comorbidity.Psychiatric comorbidity is part and parcel of addiction and reduces the quality of life of addicted patients. Behaviour problems in childhood play a major role in the development of severe addictions. Although CD is the biggest risk factor, the combination of ADHD with CD increases this risk, possibly through increased vulnerability to further psychiatric comorbidity.

Little is known about the prevalence and the consequences of attention-deficit hyperactivity disorder (ADHD) among adults in the general Dutch population.To ascertain the prevalence of ADHD in childhood and adulthood, to investigate characteristics associated with the prevalence and persistency of ADHD and to draw a number of comparisons: to compare the functioning of adults with ADHD with that of people with a different mental disorder and to compare the extent to which these groups make use of treatment facilities.Data were derived from the Netherlands Mental Health Survey and Incidence Study-2 (NEMESIS-2), in which the occurrence of ADHD was determined in a representative sample of the Dutch population (n = 3,309; aged 18-44).2.9% of the respondents had had ADHD in childhood, 70.0% of them still had the disorder in adulthood. An anxiety disorder before the age of 16 increased the risk of ADHD persistency, whereas an impulse-control disorder decreased this risk. ADHD in adulthood was associated with lower socio-economic status, mental disorders, poor functioning and increased use of treatment facilities. ADHD adults and adults with an anxiety or substance use disorder showed very similar functional limitations and used treatment facilities to approximately the same extent.More than two-thirds of the adults who had had childhood ADHD still had the disorder in adulthood. The consequences of this in terms of functioning and use of treatment facilities are substantial.

Substance use regularly co-occurs with many types of criminality, including violent behaviour.To review the relationships between substance abuse and criminality, which can involve violent behaviour.We searched the literature for meta-analyses, reviews and empirical articles about relationships between the problematic use of and addiction to psychoactive substances on the one hand and antisocial and aggressive behaviour and recidivism on the other hand.In the case of both men and women there are significant relationships between substance abuse and criminal behavior. The majority of substance users, however, are not criminals and most of the offences they commit can be termed 'acquisitive offences'. The relationship between alcohol and violence is stronger than the relationship between substance abuse and violence. Furthermore, it is only in cocaine users that we find indications that psychopharmacological effects stimulate violent behaviour. A number of factors, particularly interactions, determine whether substance abusers are criminal and are violent. Violent behaviour can result from interactions between the severity of illness caused by substance abuse, individual psychological, social and neurobiological characteristics, situational factors and expectancies regarding the psychopharmacological effects of a particular substance.Substance abuse, particularly the combination of alcohol and drugs, is a predictor of criminality and criminal recidivism.

Cognitive behavioural therapy and motivational interviewing are evidence-based treatments for substance use disorders (SUDs). However, treatment for SUDs is still at an early stage and patients are being deprived of many new forms of treatment from which they could benefit. Low treatment compliance and limited treatment success are also problems that need attention.To find out from the literature how these problems can be or are being tackled and to formulate suggestions for improvements.We reviewed the literature, collecting and formulating suggestions about possible improvements in the treatment of SUD patients. We mention strategies to reduce the treatment gap, to improve treatment compliance and treatment results.According to the literature, clinics and hospital wards can introduce more structured screening for substance use disorders. Internet treatment has proven to lower the threshold for treatment. Patients reluctant to begin treatment can be motivated by their loved ones (via CRAFT) to join treatment programmes. E-health is a promising technique for enhancing patients' compliance with tasks that can be performed at home. The addition of contingency management can increase treatment compliance and encourage abstinence. Furthermore, the treatment of comorbid psychiatric disorders and the provision of continuing-care are strategies that are likely to optimise treatment results.A number of viable strategies are available or are being developed for improving the treatment of SUD patients. Dutch research has made an important contribution in this area.

In recent years several neuromodulation techniques have been introduced as interventions for addiction.To review and discuss studies that have investigated the effects of treating addiction by means of electroencephalography (EEG) neurofeedback, real-time functional magnetic resonance imaging (rt-fMRI) neurofeedback, transcranial magnetic stimulation/transcranial direct current stimulation (TMS/tDCS) and deep brain stimulation (DBS).We reviewed the literature, focusing on Dutch studies in particular.Studies using EEG neurofeedback were shown to have positive effects on drug use, treatment compliance, and cue reactivity in patients with cocaine and alcohol dependence. A pilot study investigating the effects of rt-fMRI neurofeedback on nicotine dependent patients showed that modulation of the anterior cingulate cortex can decrease smokers' craving for nicotine. In several studies decreased craving was found in alcohol dependent patients after TMS or tDCS stimulation of the anterior cingulate cortex or the dorsolateral prefrontal cortex. The first DBS pilot studies suggest that the nucleus accumbens is a promising target region for the treatment of alcohol and heroin dependence.Neuromodulation provides us with a unique opportunity to directly apply neuroscientific knowledge to the treatment of addiction. However, more research is needed to ensure the efficacy, safety and feasibility of the various neuromodulation techniques that are now available.