KLINISCHE ORTHOPEDAGOGIEK:
MIDDELENMISBRUIK
Noor Desutter
SAMENVATTING MM 2023-2024
,INHOUDSOPGAVE
Les 1 en 2: productinformatie .................................................................................................................................. 4
Overview: ..................................................................................................................................................................... 4
Definiëring en contextschets ........................................................................................................................................ 5
Drugs ........................................................................................................................................................................ 5
Druggebruik:............................................................................................................................................................. 5
Afhankelijkheid (dependence) ................................................................................................................................. 6
Klassificaties (indelingen, groepen) .............................................................................................................................. 7
Pyshcoleptica................................................................................................................................................................ 9
GHB .......................................................................................................................................................................... 9
Gassen en vluchtige oplosmiddelen ....................................................................................................................... 11
Narcotica ................................................................................................................................................................ 12
Psychoanaleptica ....................................................................................................................................................... 15
Cocaïne ................................................................................................................................................................... 15
Psychodysleptica ........................................................................................................................................................ 20
Cannabis ................................................................................................................................................................. 20
Mescaline en psyclocibine (peyotl en psylootjes) .................................................................................................. 23
LSD.......................................................................................................................................................................... 23
Dissociatieven: ketamine ....................................................................................................................................... 24
Synthetische cannabinoïden .................................................................................................................................. 25
Producnten met een meervoudig werkingspatroon ................................................................................................... 26
3,4- methyleendioxyamfetamines (XTC, Mdma, mda ............................................................................................ 26
Para-methoxyamfetamines .................................................................................................................................... 28
Afgeleiden van benzofulraan: 6-APB (benzoFury) ................................................................................................. 28
Cathinonen: mephedrone… ................................................................................................................................... 28
Besluit ......................................................................................................................................................................... 29
Les 3: Het belgisch drugsbeleid .............................................................................................................................. 30
Het drugsfenomeen .................................................................................................................................................... 30
Multidemensionaal (domein) ................................................................................................................................. 30
Multi-level (niveaus) .............................................................................................................................................. 31
Het internationaal kader ............................................................................................................................................ 32
VN: Internationale verdragen ................................................................................................................................ 32
EU: Europese unie .................................................................................................................................................. 33
Historiek van het Belgisch drugsbeleid ....................................................................................................................... 34
Drugswet van 1921 ................................................................................................................................................ 34
Ontwikkelingen 1921-1975 .................................................................................................................................... 34
Jaren ’90: een effectief drugsbeleid ....................................................................................................................... 35
De voornemens van het Belgisch drugsbeleid ............................................................................................................ 36
In welke mate geïmplementeerd? .............................................................................................................................. 38
1
,Les 4: alcohol- en drughulpverlening in Vlaanderen: organisatie, feiten en tendensen .......................................... 42
Inleiding ...................................................................................................................................................................... 42
Middelenmisbruik, afhankelijkheid en verslaving ...................................................................................................... 42
Middelenmisbruik (DSM IV) ................................................................................................................................... 42
Substance use and addictive disorders (DSM V) .................................................................................................... 43
Middelengerelateerde problemen ......................................................................................................................... 43
Ontstaan + organisatie drughulpverlening ................................................................................................................ 44
Ontstaan ................................................................................................................................................................. 44
Een aantal vaststellingen ....................................................................................................................................... 45
Onderscheiden hulpverleningsvormen ....................................................................................................................... 46
1. Drugvrije behandeling .................................................................................................................................... 46
2. Ontwenningsbehandeling .............................................................................................................................. 46
3. Substitutietherapie......................................................................................................................................... 47
4. Harm reduction .............................................................................................................................................. 47
5. Geïntegreerde behandeling ........................................................................................................................... 47
6. Reïntegratie en nazorg (zeer belangrijk) ........................................................................................................ 48
VIDEO: A new kid on the block: private behandeling ............................................................................................ 48
Onderzoeksbevindingen mbt behandeliing middelenafhankelijkheid ........................................................................ 49
Zorggebruik ............................................................................................................................................................ 49
Effectiviteit van (residentiële) behandeling? ......................................................................................................... 49
Benchmark-onderzoek alcholbehandeling 2007 ........................................................................................................ 49
Recente evoluties mbt drughulverlening ............................................................................................................... 50
Toenemende aandacht voor herstel ...................................................................................................................... 50
→ naar meer kwaliteit van zorg ............................................................................................................................. 50
Les 5: residentiële behandeling en drugvrije behandeling in therapeutische gemeenschappen ............................. 51
The third generation of therapeutic communities ..................................................................................................... 51
First generation TG’s .............................................................................................................................................. 51
Second generation TG’s ......................................................................................................................................... 52
Third generations TG’s ........................................................................................................................................... 53
Interconnections: interconnections between first European TC’s and American TC’ (vbn. TG’s) ............................... 53
Alfa house (’68) ...................................................................................................................................................... 53
Aebi Hüs (’73) ......................................................................................................................................................... 53
Daytop Germany (’72) ............................................................................................................................................ 53
Daytop Sweden ...................................................................................................................................................... 54
Emiliehoeve (’72), Essenlaan & Breeweestee ........................................................................................................ 54
De sleutel (’74) ....................................................................................................................................................... 54
Kritiek op traditionele aanpak dus er was een nieuwe aanpak nodig ........................................................................ 54
De Kiem (’76) .......................................................................................................................................................... 54
Trempoline (’78) ..................................................................................................................................................... 54
De spiegel (’79)....................................................................................................................................................... 54
European identity ....................................................................................................................................................... 55
Discussie: adaptation of American models into own culture (in Europa) .............................................................. 55
2
, The drug-free therapeutic community ....................................................................................................................... 56
definitie van the drug-free therapeutic community .............................................................................................. 56
Fundamentele principes......................................................................................................................................... 56
Nieuwe TG’s ............................................................................................................................................................... 57
De filosofie van nieuwe TG’s .................................................................................................................................. 57
De bewoners .......................................................................................................................................................... 58
Fasen van behandeling............................................................................................................................................... 58
Crisis intervention .................................................................................................................................................. 58
Ambulantory level .................................................................................................................................................. 58
Reception ............................................................................................................................................................... 58
Induction ................................................................................................................................................................ 59
Treatment .............................................................................................................................................................. 59
Social (re)integration .............................................................................................................................................. 59
Principes van de behandeling ..................................................................................................................................... 60
Veiligheid en acceptatie (veilige omgeving) ........................................................................................................... 60
Hiërarchische structuur .......................................................................................................................................... 60
Mondelinge berispingen en leerervaringen ........................................................................................................... 60
Ontmoeting (=encounter) (hart van de TG) .......................................................................................................... 61
Familie werk ........................................................................................................................................................... 61
Integrated treatment systems.................................................................................................................................... 62
Introductie van geïntegreerde behandelingssystemen ......................................................................................... 62
Definitie van geïntegreerde behandelsystemen .................................................................................................... 62
Linken met democratische TG en drugsvrije TG .................................................................................................... 63
Les 6: Samenwerken en lokale netwerken in de jeugdhulp .................................................................................... 64
Samenwerking en lokale netwerken .......................................................................................................................... 64
Case study van Brugge(n) voor jongeren ................................................................................................................... 64
Historiek ................................................................................................................................................................. 64
Methodologie ......................................................................................................................................................... 65
Resultaten .............................................................................................................................................................. 66
Discussie en aanbevelingen ................................................................................................................................... 70
Les 7: alcohol en drugpreventie in de praktijk ........................................................................................................ 72
Evolutie van preventie ................................................................................................................................................ 73
Klassieke indeling van preventie: ziektedenken .................................................................................................... 73
Informatiegerichte benaderingen → vroeger!!! .................................................................................................... 74
Epidemiologie ............................................................................................................................................................. 77
benaderingen ............................................................................................................................................................. 83
Informatiegerichte preventie benaderingen ......................................................................................................... 83
Sociale invloed benaderingen ................................................................................................................................ 83
Individuele benaderingen ...................................................................................................................................... 83
Omgevingsgerichte benaderingen ......................................................................................................................... 83
implementatie ............................................................................................................................................................ 84
3
MIDDELENMISBRUIK
Noor Desutter
SAMENVATTING MM 2023-2024
,INHOUDSOPGAVE
Les 1 en 2: productinformatie .................................................................................................................................. 4
Overview: ..................................................................................................................................................................... 4
Definiëring en contextschets ........................................................................................................................................ 5
Drugs ........................................................................................................................................................................ 5
Druggebruik:............................................................................................................................................................. 5
Afhankelijkheid (dependence) ................................................................................................................................. 6
Klassificaties (indelingen, groepen) .............................................................................................................................. 7
Pyshcoleptica................................................................................................................................................................ 9
GHB .......................................................................................................................................................................... 9
Gassen en vluchtige oplosmiddelen ....................................................................................................................... 11
Narcotica ................................................................................................................................................................ 12
Psychoanaleptica ....................................................................................................................................................... 15
Cocaïne ................................................................................................................................................................... 15
Psychodysleptica ........................................................................................................................................................ 20
Cannabis ................................................................................................................................................................. 20
Mescaline en psyclocibine (peyotl en psylootjes) .................................................................................................. 23
LSD.......................................................................................................................................................................... 23
Dissociatieven: ketamine ....................................................................................................................................... 24
Synthetische cannabinoïden .................................................................................................................................. 25
Producnten met een meervoudig werkingspatroon ................................................................................................... 26
3,4- methyleendioxyamfetamines (XTC, Mdma, mda ............................................................................................ 26
Para-methoxyamfetamines .................................................................................................................................... 28
Afgeleiden van benzofulraan: 6-APB (benzoFury) ................................................................................................. 28
Cathinonen: mephedrone… ................................................................................................................................... 28
Besluit ......................................................................................................................................................................... 29
Les 3: Het belgisch drugsbeleid .............................................................................................................................. 30
Het drugsfenomeen .................................................................................................................................................... 30
Multidemensionaal (domein) ................................................................................................................................. 30
Multi-level (niveaus) .............................................................................................................................................. 31
Het internationaal kader ............................................................................................................................................ 32
VN: Internationale verdragen ................................................................................................................................ 32
EU: Europese unie .................................................................................................................................................. 33
Historiek van het Belgisch drugsbeleid ....................................................................................................................... 34
Drugswet van 1921 ................................................................................................................................................ 34
Ontwikkelingen 1921-1975 .................................................................................................................................... 34
Jaren ’90: een effectief drugsbeleid ....................................................................................................................... 35
De voornemens van het Belgisch drugsbeleid ............................................................................................................ 36
In welke mate geïmplementeerd? .............................................................................................................................. 38
1
,Les 4: alcohol- en drughulpverlening in Vlaanderen: organisatie, feiten en tendensen .......................................... 42
Inleiding ...................................................................................................................................................................... 42
Middelenmisbruik, afhankelijkheid en verslaving ...................................................................................................... 42
Middelenmisbruik (DSM IV) ................................................................................................................................... 42
Substance use and addictive disorders (DSM V) .................................................................................................... 43
Middelengerelateerde problemen ......................................................................................................................... 43
Ontstaan + organisatie drughulpverlening ................................................................................................................ 44
Ontstaan ................................................................................................................................................................. 44
Een aantal vaststellingen ....................................................................................................................................... 45
Onderscheiden hulpverleningsvormen ....................................................................................................................... 46
1. Drugvrije behandeling .................................................................................................................................... 46
2. Ontwenningsbehandeling .............................................................................................................................. 46
3. Substitutietherapie......................................................................................................................................... 47
4. Harm reduction .............................................................................................................................................. 47
5. Geïntegreerde behandeling ........................................................................................................................... 47
6. Reïntegratie en nazorg (zeer belangrijk) ........................................................................................................ 48
VIDEO: A new kid on the block: private behandeling ............................................................................................ 48
Onderzoeksbevindingen mbt behandeliing middelenafhankelijkheid ........................................................................ 49
Zorggebruik ............................................................................................................................................................ 49
Effectiviteit van (residentiële) behandeling? ......................................................................................................... 49
Benchmark-onderzoek alcholbehandeling 2007 ........................................................................................................ 49
Recente evoluties mbt drughulverlening ............................................................................................................... 50
Toenemende aandacht voor herstel ...................................................................................................................... 50
→ naar meer kwaliteit van zorg ............................................................................................................................. 50
Les 5: residentiële behandeling en drugvrije behandeling in therapeutische gemeenschappen ............................. 51
The third generation of therapeutic communities ..................................................................................................... 51
First generation TG’s .............................................................................................................................................. 51
Second generation TG’s ......................................................................................................................................... 52
Third generations TG’s ........................................................................................................................................... 53
Interconnections: interconnections between first European TC’s and American TC’ (vbn. TG’s) ............................... 53
Alfa house (’68) ...................................................................................................................................................... 53
Aebi Hüs (’73) ......................................................................................................................................................... 53
Daytop Germany (’72) ............................................................................................................................................ 53
Daytop Sweden ...................................................................................................................................................... 54
Emiliehoeve (’72), Essenlaan & Breeweestee ........................................................................................................ 54
De sleutel (’74) ....................................................................................................................................................... 54
Kritiek op traditionele aanpak dus er was een nieuwe aanpak nodig ........................................................................ 54
De Kiem (’76) .......................................................................................................................................................... 54
Trempoline (’78) ..................................................................................................................................................... 54
De spiegel (’79)....................................................................................................................................................... 54
European identity ....................................................................................................................................................... 55
Discussie: adaptation of American models into own culture (in Europa) .............................................................. 55
2
, The drug-free therapeutic community ....................................................................................................................... 56
definitie van the drug-free therapeutic community .............................................................................................. 56
Fundamentele principes......................................................................................................................................... 56
Nieuwe TG’s ............................................................................................................................................................... 57
De filosofie van nieuwe TG’s .................................................................................................................................. 57
De bewoners .......................................................................................................................................................... 58
Fasen van behandeling............................................................................................................................................... 58
Crisis intervention .................................................................................................................................................. 58
Ambulantory level .................................................................................................................................................. 58
Reception ............................................................................................................................................................... 58
Induction ................................................................................................................................................................ 59
Treatment .............................................................................................................................................................. 59
Social (re)integration .............................................................................................................................................. 59
Principes van de behandeling ..................................................................................................................................... 60
Veiligheid en acceptatie (veilige omgeving) ........................................................................................................... 60
Hiërarchische structuur .......................................................................................................................................... 60
Mondelinge berispingen en leerervaringen ........................................................................................................... 60
Ontmoeting (=encounter) (hart van de TG) .......................................................................................................... 61
Familie werk ........................................................................................................................................................... 61
Integrated treatment systems.................................................................................................................................... 62
Introductie van geïntegreerde behandelingssystemen ......................................................................................... 62
Definitie van geïntegreerde behandelsystemen .................................................................................................... 62
Linken met democratische TG en drugsvrije TG .................................................................................................... 63
Les 6: Samenwerken en lokale netwerken in de jeugdhulp .................................................................................... 64
Samenwerking en lokale netwerken .......................................................................................................................... 64
Case study van Brugge(n) voor jongeren ................................................................................................................... 64
Historiek ................................................................................................................................................................. 64
Methodologie ......................................................................................................................................................... 65
Resultaten .............................................................................................................................................................. 66
Discussie en aanbevelingen ................................................................................................................................... 70
Les 7: alcohol en drugpreventie in de praktijk ........................................................................................................ 72
Evolutie van preventie ................................................................................................................................................ 73
Klassieke indeling van preventie: ziektedenken .................................................................................................... 73
Informatiegerichte benaderingen → vroeger!!! .................................................................................................... 74
Epidemiologie ............................................................................................................................................................. 77
benaderingen ............................................................................................................................................................. 83
Informatiegerichte preventie benaderingen ......................................................................................................... 83
Sociale invloed benaderingen ................................................................................................................................ 83
Individuele benaderingen ...................................................................................................................................... 83
Omgevingsgerichte benaderingen ......................................................................................................................... 83
implementatie ............................................................................................................................................................ 84
3
