Jessica De Maeyer

Impact of addiction severity and psychiatric comorbidity on the quality of life of alcohol-, drug- and dual-dependent persons in residential treatment.

Background: Substance users’ quality of life (QoL) is influenced by several variables, including psychiatric comorbidity and addiction severity. Thus far, the impact of the type of dependence (alcohol, drug or dual dependence) remains unclear. Therefore, the objectives of the study were to evaluate QoL in a clinical sample of alcohol-, drug- and dual-dependent patients and to assess the independent impact of psychiatric comorbidity, addiction severity and type of dependence on QoL. Methods: Face-to-face interviews with 274 patients admitted to residential substance abuse treatment were conducted using the European Addiction Severity Index (EuropASI), the Mini-International Neuropsychiatric Interview and the Assessment of Personality Disorders self-report questionnaire. Results: Multivariate analyses showed that anxiety, mood or personality disorder, employment status and the severity rating on the EuropASI domain alcohol use were associated with overall QoL. Gender, anxiety disorder and the severity ratings on the EuropASI domains alcohol use, drug use, physical health and emotional and psychological health were associated with overall perception of health. Conclusion: Addiction severity and psychiatric comorbidity explained the greatest amount of QoL variance, whereas the type of dependence did not play a central role.

Prevalence and Determinants of Personality Disorders in a Clinical Sample of Alcohol-, Drug-, and Dual-Dependent Patients

The present study compares the prevalence rates of 12 personality disorders (PDs) among patients with alcohol, drug, and dual dependence through chi-square tests and analyses of variance. It further investigates possible predictors of these PDs through multiple linear regression analyses. Data were gathered in 2007–2008 among 274 patients admitted to intensive, residential substance abuse treatment programs in Belgium, using the ADP-IV (Assessment of DSM-IV Personality Disorders), the EuropASI (European version of the Addiction Severity Index), and the MINI (Mini International Neuropsychiatric Interview). The analyses showed that drug- and dual-dependent patients have higher PD prevalence rates than alcohol-dependent patients. The severity, but not the nature of the dependence, appears as an important predictor for personality pathology.

Villa Voortman: carte blanche or not?

Purpose – Influenced by evolutions in mental health, a meeting house, “Villa Voortman”, was recently developed. It is based on an integration of therapeutic community (TC) and psychoanalytical Lacanian thinking. The purpose of this paper is to investigate the position of Villa Voortman in the treatment continuum for dually diagnosed clients. Two research questions are addressed: how does Villa Voortman operate ? and how do clients perceive the Villa? Design/methodology/approach – The first question was tackled by a personal account of the founders of Villa Voortman. The second question was addressed by a qualitative study using video-material of 19 visitors’ personal accounts. Findings – The visitors mentioned three themes: social inclusion, personal development and equality. These aspects are further refined into sub-themes including the provision of “asylum”; the instalment of a warm and welcoming atmosphere; the focus on real human encounter; a permissive, supportive and “waiting” environment; a minima...

Treatment satisfaction and quality of support in outpatient substitution treatment: opiate users’ experiences and perspectives

Abstract Aims: Patient-reported outcomes have become an important source of information to guide service provision. Although opiate substitution treatment (OST) is an evidence-based and widely available intervention for opiate dependent individuals, evaluation studies have primarily focused on objective outcome indicators rather than on clients’ perspectives and personal experiences. This study aims to assess opiate users’ satisfaction with various aspects of substitution treatment and their subjective experiences and expectations regarding the provision of psychosocial support. Methods: The study sample consisted of 77 opiate-dependent individuals who had been involved in OST for at least three months in some cities in Belgium. Qualitative interviews were used to explore clients’ subjective experiences, in addition to some quantitative measures. Findings: About half of the respondents recently received some form of psychosocial support and they were generally satisfied about these services. However, the number of persons who wanted psychosocial support clearly outnumbered those actually receiving these services. Respondents stressed the importance of building trusting relationships with OST staff. Also, the need for more flexible and individualised support was emphasised. Conclusions: Compared with other stakeholders’ perspectives or traditional outcome indicators, service users’ subjective experiences shed an alternative light on the impact of opiate dependence and OST on individuals’ daily lives. This information should be incorporated in individual treatment planning and when designing and evaluating OST services.

Substance use among individuals with intellectual disabilities living independently in Flanders

BACKGROUND Over the past decades, there has been increased scientific and clinical interest in substance use among individuals with intellectual disabilities (ID). Despite raised interest and awareness in the topic, lack of supportive data on prevalence and risk factors highlights the need for ongoing research. The aims of this cross-sectional multicenter study were to examine the nature and extent of substance use in individuals with ID living independently, to investigate group differences in substance use and related problems, and to explore the role of substance-related knowledge and attitudes in substance use behaviors. METHOD Participants were 123 individuals with mild to moderate ID receiving support from independent living services. Data were gathered by means of a structured interview strategy (i.e. the Substance Use and Misuse in Intellectual Disability-Questionnaire; SumID-Q). RESULTS Findings revealed that rates of lifetime use of licit and illicit substances were higher than those found in earlier studies among individuals with ID and the general population. While cannabis use was the only illicit substance reported, current tobacco and alcohol use were shown to be highly prevalent (48%-45.5%). Rates for the latter were similar to earlier studies among community samples of individuals with ID. In contrast to our hypotheses, few group differences in substance use behaviors were observed. Male gender was associated with age of onset of alcohol and tobacco use and tobacco use-related problems, while younger age was found to be associated with lifetime use of cannabis. No evidence was found regarding the role of knowledge; however, smokers and alcohol users rated tobacco and alcohol use more positively. CONCLUSION This study demonstrated that individuals with ID living independently use a wide range of licit and illicit substances and present divergent levels and patterns of substance use. Notwithstanding the role of personal choice in substance use, more research is needed to better understand the nature and extent of substance use and related problems, as well as the role of substance-related knowledge and attitudes in individuals with ID.

Keep an eye on your friends, even when you don’t know them”: Drug use and harm reduction in the Goa trance scene in Belgium

Aims: The use of illegal drugs is well documented in some alternative, underground music scenes, like the Goa trance scene. The aim of this article is to explore harm reduction practices employed by attendees of the Goa trance scene in order to identify potential pathways for targeted interventions in (underground) music scenes, such as Goa trance. Methods: Following pilot observations at Goa parties, in-depth interviews were conducted with 19 Goa party attendees in Belgium. Respondents were recruited using snowball sampling methods. Findings: Participants reported that solidarity is apparent in the Goa trance scene and is an important variable in minimising drug-related harm, particularly with respect to providing help and support to people in need (communitarian values). On the other hand, personal controls on drug consumption were also employed to minimise harm, such as buying drugs from trusted people, trying to keep drug use limited to weekends and adhering to ones own limits (neo-liberal values). Conclusions: A combination of communitarian and neo-liberal values were employed by drug users in the Goa trance scene in Belgium, and this offers several options for new harm reduction efforts. Approaching drug users as active citizens and enabling resources is a useful way of informing the development of innovative harm reduction strategies. Evaluating enabling resources in settings where drug use occurs will provide additional pathways to harm reduction policies and programs.

Reflections on a Service User Perspective in Supporting Persons with Dual Diagnosis: the Case of Villa Voortman

Inclusive citizenship is an important concept in today’s mental health care. Still, persons with co-occurring substance use problems and psychiatric problems seem to fall through the cracks of existing (community) treatment services. At the same time, they are the persons least asked for their opinions as service users. This commentary sheds light on Villa Voortman, an innovative community-based outpatient treatment service for persons with dual diagnosis in Ghent (Belgium) that gives a central position to user perspectives in its daily practice.

Human rights, the capability approach and Quality of Life: an integrated paradigm of support in the quest for social justice

Purpose This paper highlights the integrative character of orthopedagogics. Quality of Life (QoL), as guiding the normative framework in orthopedagogics is explicitly connected with the framework of human rights and the capability approach (CA) in the quest for social justice and human dignity. The purpose of this paper is to question that how these three specific frameworks can cross-fertilize each other and result in the development of an integrated normative foundation for supporting people living in socially vulnerable situations. Design/methodology/approach This paper reflects on the question on how the human rights framework, the CA and the framework of QoL can be integrated in the support of people who find themselves in a socially vulnerable situation. Findings The core features of each framework are described. Originality/value To conclude the paper, commonalities and the added value of integrating these three frameworks are explored. By integrating these three frameworks, they could function as a shared agenda that gives direction to the daily actions of professionals, with attention for aspects at the micro, meso and macro levels. Each framework and their interrelatedness urge for an integrative approach of orthopedagogics where the strengths of different frameworks are recognized and used in order to support people in socially vulnerable situations to achieve a life worth living.

Quality of Life in Therapeutic Communities for Addictions: A Positive Search for Wellbeing and Happiness

ABSTRACT Although addiction is increasingly considered as a chronic problem, only a limited number of studies have addressed quality of life (QoL) in therapeutic communities (TCs) for addictions. This reflective conceptual article assesses the history, philosophy, and background of the TC movement as modern concept, with roots in existentialism and phenomenology, as well as the QoL approach as a “postmodern” concept, with a positive vision on wellbeing and happiness, grounded in Aristotelian rationalism. The exploration of the QoL concept situated in the context of TC values, facts, and subjects leads to the finding that both visions can go alternatively together and fertilize each other.

Disability Policy Evaluation: Combining Logic Models and Systems Thinking

Policy evaluation focuses on the assessment of policy-related personal, family, and societal changes or benefits that follow as a result of the interventions, services, and supports provided to those persons to whom the policy is directed. This article describes a systematic approach to policy evaluation based on an evaluation framework and an evaluation process that combine the use of logic models and systems thinking. The article also includes an example of how the framework and process have recently been used in policy development and evaluation in Flanders (Belgium), as well as four policy evaluation guidelines based on relevant published literature.