day’s chairman: Niels Mulder
Reception and registration
Erik Masthoff, director, Fivoor, the Netherlands
ADHD and Addiction: Epidemiologu, Neurobiology and Treatment
Wim van den Brink, Professor of Psychiatry and Addiction, AMC Amsterdam, the Netherlands
ADHD and substance use disorders (SUDs) are highly comorbid with 20-25% of all SUD patients also meeting criteria for adult ADHD (van Emmerik-van Oortmerssen et al., 2012) and about 50% of the patients with childhood ADHD developing SUD (Manuzza et al., 2008). This high level of concurrent and prospective comorbidity is largely explained by genetic overlap (Derks et al., 2014; Abdellaoui et al., 2020). Moreover, prospective clinical and retrospective register studies suggest that early treatment of ADHD with robust doses of stimulants may prevent or postpone the development of SUD in children with ADHD (Groenman et al., 2013, 2019; Zheng Chang et al., 2014). Together these findings suggest that ADHD and SUD share neurobiological mechanisms.
In this presentation, we explore the neurobiological overlap between ADHD and SUD using data from cross-sectional and prospective neurocognitive and neuroimaging studies. The neurobiology of both ADHD and SUD can be summarized as a combination of an impaired motivational and reward system and a deficient cognitive control system, including impairments of delay discounting and error monitoring (Frodl, 2010; Moline & Pelham, 2014; Adisetiyo & Gray, 2017).
Patients with both disorders also show reduced dopamine transporter binding of methylphenidate (Crunelle et al., 2013) causing reduced efficacy of standard doses of stimulants for the treatment of ADHD patients with comorbid SUD explaining the need for high dose stimulant treatment in these comorbid patients (Carpentier & Levin, 2017; Levin et al., 2015; Konstenius et al., 2014). Finally, a recent paper showed better ADHD outcomes in comorbid SUD+ADHD patients treated with integrated cognitive behavior therapy (iCBT) (van Emmerik-van Oortmerssen et al., 2019).
Psychosocial treatment on dual diagnosis
Franz Moggi, head psychologist, University of Bern, Switzerland
Despite thirty years of treatment research, patients with dual diagnoses (i.e. patients with co-morbidity of a mental disorder such as depression, anxiety disorder, psychosis, personality disorder, ADHD, etc.) and substance-related addictive behaviors such as alcohol use disorder, cannabis use disorder etc., are still a great challenge in clinical practice and various treatment settings. The prevalence of co-morbidity is high, the degree of clinicians’ uncertainty in diagnostics and treatment indication is often high, and treatment of these patients is usually lengthy and difficult in terms of the choice of specific interventions. Moreover, patients have frequent relapses or exacerbation of symptoms and repeatedly need to be (re-) hospitalized despite great clinical efforts. Nevertheless, promising strategies are emerging in the psychosocial and psychotherapeutic treatment of comorbid patients, which have fortunately found their way more and more into the training of psychiatrists and psychotherapists and have become known under the term integrative treatment. The talk will present promising findings from psychotherapy research on various forms of comorbidity such as substance use disorder and comorbid psychosis, post-traumatic stress disorder, or ADHD and discuss the core ingredients of successful integrative treatment. The integrative treatment may be categorized into seven domains, which need be considered in varying intensity depending on patients’ individual problems and needs. These domains are a) use of crisis intervention to improve treatment adherence, b) providing an integrative treatment setting, c) recognition of phases of behavior change and use of motivational interviewing to promote change, d) application of comorbidity-specific cognitive behavioral interventions, e) inclusion of family and social resources, f) use of pharmacotherapy, and g) adoption of a long-term perspective. These seven treatment domains will be discussed in more detail.
Arnt Schellekens, Professor in Psychiatry and Addiction, Radboudumc, the Netherlands
14:00 - 15:00 Parallel session I
WS1.1 Workshop IDDT-Integrated Dual Disorder Treatment
Hella Schulte-Wefers, the Netherlands
In the Center for dual diagnoses (CDP) in The Hague/the Netherlands we have implemented Integrated Dual Diagnosis Treatment (IDDT). IDDT has a multidisciplinary approach and combines pharmacological (medication), psychological, educational, and social interventions to address the needs of service users and their family members. It is based on the transtheoretical model of behavior change from Prochaska en DiClemente. The model assesses an individual’s readiness to act on a new healthier behaviour, and provides strategies, or processes of change to guide the individual through the stages of change to Action and Maintenance. Treatment is adjusted to the phase of motivation the patient is in.
The Integrated Dual Disorder Treatment (IDDT) model is an evidence-based practice that improves the quality of life for people with co-occurring severe mental illness and substance use disorders by combining substance abuse services with mental health services.
In this workshop the model and the practical implementation in the CDP will be illustrated. The participants have the possibility to train with casuistics or their own case histories.
Victor Mids, illusionist and doctor (not practicing)
Victor Mids is both illusionist and a doctor (not practicing).
Through this combination he brings illusion and science together in a unique way. Let him take you to his world, where nothing is what it seems. Mindf*ck is a popular scientific magic show, that eliminates the classical image of glittercurtains and sawn orphan girls. In this magic show, known and unknown Dutch people will be confronted with impossible illusions. The viewer gets insight in the underlying psychological principles like distraction, nonverbal communication and the influence of the subconscious.
16:15 - 17:15 Parallel session II
P2.1 Family in therapie
Michel Stemkens, the Netherlands
The presentation of the NBR will be carried out by a representative. Regarding the family therapy topic, I would like to point out the importance of inviting relatives for intakes, not only to provide information about treatment options, but also in order to clarify mutual expectations. Secondly, I would like to talk about partner relation therapy and family therapy and finally I would like to address the informative family meetings with a different focus, e.g. providing information. Psychological education, for instance the relation between addiction and mental disorders and peer (or fellow suffers contact) as a form of family support..
day’s chairman: Stefan Bogaerts
Opening by the day’s chairman
Stefan Bogaerts, professor, Tilburg School of Social and Behavioral Sciences, the Netherlands
Geert Dom, Medical Director Psychiatric Center Multiversum, Belgium
Beating the stigma of substance use disorder
Patrick Corrigan, Distinguished Professor of Psychology, Illinois Institute of Technology, USA
Unlike other behavioral health conditions, the stigma of substance use disorder (SUD) may be especially resilient to change because it is socially and legally sanctioned. After a brief overview addressing the “What” of SUD stigma, I consider measures on “How” to change it. I summarize what research shows about methods that seem to have little effect or actually may make stigma worse; e.g., educate the public that SUD is a brain disorder. I then describe one effective approach to stigma change: promoting contact between people with SUD and the general public. This requires strategic disclosure of SUD experiences for this approach to go big scale.
Integrated Dual Disorder Treatment: Looking Forward After Twenty Years of Implementation
Patrick Boyle, Consulting Director, Center for Evidence Based Practices, USA
Integrated Dual Disorder Treatment (IDDT) was researched and developed during the 1990’s and implemented as an integrated clinical practice to help people with co-occurring mental illness and substance use disorders live full lives in an evolving recovery process (Drake, Goldman, et al 2001). While such evidence based practices have become more widely implemented across the world during the past twenty years, people with these two co-occurring disorders are still at risk of not receiving fully integrated care services for many reasons.
Looking to the future, an ongoing focus, expectation, and effort is required to: 1) rule out substance use disorders for people having mental disorders in all practice settings; 2) recruit, train and supervise all practitioners to properly detect, assess, and treat both disorders in an integrated manner, as well as other co-occurring disorders and conditions such as trauma; 3) support continuous quality improvement strategies in all practice settings to evaluate integrated practice implementation and supervision in an effective and routine manner; 4) make adjustments to services as indicated by such evaluations; 5) fully develop housing, employment, and primary health care systems to support these essential foundations to a full life for all.
Evidence Based Practices clinical interventions needed for full IDDT implementation initially included Motivational Interviewing (and its implied responsibility that all practitioners help people develop the motivation to change), Cognitive Behavioral Treatment, Substance Abuse Treatment (including tobacco cessation), Family educational interventions, Self-help 12-Step support, Pharmacological Treatment for all disorders and practices such as intensive case management, competitive employment, illness self-management recovery and leisure activities, all delivered with a stage-wise person-centered approach to care through multi-disciplinary teams (R. Drake, G. Bond, et al., 2002).
Since the inception of IDDT, additional attention is now necessarily being paid to Trauma Informed Care, using EDMR and numerous psychoeducational interventions, as well as the integration of primary health care.
Essential indicators still relevant for sustaining any EBP implementation include a top-down philosophy of integrated care that appreciates addiction as a condition for intervention vs an issue of willpower, staff education, guidance (supervision) and training, and a routine quality improvement process to measure and monitor a range of relevant client outcomes.
Some organizations continue to seek Integrated Treatment services implementation technical assistance in 2020 as if it were a new system of care. Perhaps it is THEY who are “new”, yet appreciably enthusiastic! Workforce capability and capacity are challenged in some places by practitioner turnover into retirement and movement into other professions due to inadequate financial compensation and psychological support while delivering this array of services with complicated people in need.
The importance of pragmatism, curiosity, self-reflection, and optimism (hope) is essential for success. We are disseminating “hope” for and with people as we continue to add to our knowledge base of integrated disorder treatment implementation.
Key-note lecture VIII
14:45 - 15:45 Parallel session III
W3.1 Wings of Care
Marc Haerkens, the Netherlands
15:45 - 16:45 Parallel session IV
P4.1 Self-harming behaviour and addiction: similarities, differences and possibilities for treatment using EMDR
Nienke Kool and Mariska van Kampen, the Netherlands
Is self-harming behaviour an addiction? Some say it is and some say it is not. In literature, differences but also similarities between these two kinds of behaviour are found. As self-harm is difficult to treat, there is a need for effective treatment. Therefore, we used the similarities between self-harm and addiction and investigated the “protocol imaginary execution of self-damaging behavior” as a potential treatment for self-harm. This protocol is based on EMDR. With this protocol, the patient is asked to imagine that he / she is performing the undesirable behaviour and at the same time a distracting task is offered, with which the working memory is double burdened. The purpose of this technique is to reduce the patient’s unwanted, harmful behaviour.
In our PIT-study (Protocol Imaginary execuTion of self-injury), we use a single-case experimental design, aiming to investigate whether there is a functional relationship between the treatment, the urge to self-harm and the frequency and seriousness of the self-harm.
In this workshop, we will present an overview of the similarities and differences between self-harm and addiction. Next, the PIT-study will be presented and the results will be discussed with the audience.
day’s chairman: Henk Nijman
Opening by the day’s chairman
Henk Nijman, professor Forensic psychology, Radboudumc, The Netherlands
10:15 - 11:15 Parallel session V
W5.1 Treating trauma and addiction: the effect of seeking-safety on PTSD and substance abuse
Annette Bonebakker and M. Dankmeijer, the Netherlands
Trauma in combination with addiction is an underestimated problem, while these patients often suffer from severe symptoms and severe psycho-social problems. Patients with these dual disorders are either treated in addiction health care, or in psychiatric health care. As a consequence their disorders are treated separately while there is compelling scientific evidence that these disorders overlap. Drawing a hard line between psychiatric health and addiction is therefore, not realistic (Kok e.a. 2015).
Dual disorders (i.e. psychiatry and addiction) treated at the same time as co-occuring psychopathology leads to better treatment outcome (Neven e.a. 2018).
Seeking Safety is the first evidence based integrated treatment for trauma and addiction. (Najavits e.a. 2005; Najavits e.a. 2010). At the centre for Dual Disorders in The Hague, we study the effect of seeking safety on PTSD and on substance abuse in dual disorder patients. We are especially interested in the treatment outcome of seeking safety as a group treatment. We plan to include 40 patients in this study.
In this workshop, we will present the treatment programme en we will discuss the study design.
Nicotine Addiction, Mental Health and Substance Abuse; Management in clinical practice
Renee Bittoun, professor, University of Sydney, Australia
Patient profiles and network structures in the treatment of SUD, with a focus on dual diagnosis
Stefan Boogaerts, professor, Tilburg School of Social and Behavioral Sciences, the Netherlands
The group of forensic patients with substance use disorder (SUD) is a very heterogeneous group with complex relationships between SUDs, comorbid mental health problems and criminal recidivism. Gaining more understanding of this heterogeneity can be obtained by developing refined patient profiles, (e.g., based on diagnoses, type of drugs, type of crime and risk and protective factors). These group profiles can be seen as anchor points to direct treatment of the individual patient. Firstly, in this lecture, we explain patient profiles within a large group of forensic patients with a primary SUD diagnosis. Secondly, we will discuss and unravel (reciprocal) associations between crime related factors (e.g., diagnoses, single risk and protective factors, type of drugs) in SUD patients. These associations are underexposed in research and clinical practice. As scientists and clinicians, our default mindset is often linear and therefore, we fail determining how factors are interrelated, which factors are central in treatment at a specific moment, and how factors are connected to other factors. These insights are important for science and treatment and monitoring changes in associations and in centrality of factors should be integrated into a treatment process.
Closing by all chairs
End of the conference
Take away lunch