According to Belgium Country Drug Report, 10.1% of young adults aged between 15-34 have used cannabis, 0.8% MDMA, 0.5% Amphetamines, and 0.9% cocaine.
In Belgium, Cannabis accounts for 35% of all treatment entrants, with amphetamines accounting for 9%, cocaine 25%, heroin 19% and 13% other.
The drug policy in Belgium is defined by the Federal Drug Policy Note of 2001.
The goals of the policy are the prevention of drug use, intervention for those consuming substances, harm reduction and treatment.
Prevention and intervention are covered in both Flemish and French communities in Belgium.
Both the Flemish Centre of Expertise for Alcohol and Other Drugs (VAD) and the Commission of the French Community (COCOF) have introduced local and universal interventions to deal with substance dependency.
This includes school-based educational programmes that outline the risk of substances, life-skills education, peer prevention, and an increase in counselling services.
With regards to harm reduction, the Belgium government has introduced peer support groups into communities and needle and syringe programmes (NSP).
There has also been an emphasis on providing inpatient and outpatient treatment, which is available through local community medical services. (1)
This article will discuss drug and alcohol rehab in Belgium.
Admission to rehab in Belgium is available through community medical services.
There is a range of services available, such as outpatient or inpatient care.
Access to outpatient care is via consultation with a medical professional, such as a general practitioner (GP), or by contacting a local day-care centre or social care centre.
Outpatient treatment includes reintegration services, opioid substitution treatment (OST), and mental health and psychological services, such as therapy and counselling.
Inpatient treatment is also available through local medical services, such as specialised hospital units or local specialised intervention centres.
For access to an inpatient, residential programme, people are advised to contact their general practitioner. (2)
Alternatively, private rehabs are available but come at a cost. This can range from several hundred to several thousand Euros.
For admission to a private rehabilitation facility, people are advised to contact the facility for a consultation where they will be medically and psychologically assessed – this is to determine the best treatment.
A date for admission will then be given.
Addiction can be both physical and psychological.
Physical addiction refers to a physiological dependency upon a substance for the body to function correctly.
When an individual is physically addicted, they require the substance to avoid physiological withdrawal symptoms, such as fatigue, restlessness, and shakes.
When addiction affects an individual’s cognitive function, and when cognitive functions require a substance to operate properly, this is known as a psychological addiction.
This can be twofold: an individual needs a substance to achieve a desired emotional or mental state or an individual needs a substance to alleviate certain mental issues.
This can include mental health issues, such as depression or anxiety. (3)
The first step to overcoming physical or psychological addiction is detox. This is the process of the brain and body expelling addictive substances.
The process of detoxing can vary from person to person and substance to substance.
Some of the variables that influence the detox process, and how long it will last, are the type of substance, the period in which an individual has been taking it, and the method used to enter the substance into the bloodstream.
Heroin, for example, can be consumed in various ways – such as injection or inhalation.
Studies have found that injecting heroin can lead to addiction faster, and, therefore, require a longer period of detox.
Studies show that the time in which a substance takes to reach the brain can influence how quickly someone becomes addicted and the levels of tolerance someone builds for that drug.
The reason for this is that the quicker a substance enters the bloodstream, the quicker it reaches the brain.
Tolerance also impacts detox. The greater the tolerance, the more an individual will consume a substance.
Individuals that have a high tolerance might need longer to detox.
However, studies indicate that on average, people suffering from heroin dependency will experience withdrawal symptoms between 4-6 hours and can last up to seven days. (4)
For alcohol, withdrawal can occur between 6-14 hours and can last up to five days. (5)
Cocaine withdrawal begins between 8-12 hours after the last dose and can last up to seven days. (6)
Withdrawal symptoms for these substances can vary, and often range from mild to severe.
Mild heroin withdrawal symptoms include anxiety, stress, fatigue. Whereas severe symptoms include hyperthermia, hypertension, and breathing problems.
Mild alcohol symptoms include anxiety, nausea, and vomiting. Severe symptoms can be delirium and loss of mental functions.
For cocaine, mild symptoms can be restlessness and depression. Severe symptoms include fever and depression.
In Belgium, inpatient and outpatient treatment is available for those suffering from heroin, alcohol, or cocaine dependency.
For outpatient treatment, services include detox support, mental health support, and free counselling and therapy.
For those suffering from heroin dependency, opioid substitution treatment (OST) is available.
OST is available through general practitioners and specialised community facilities. Those wishing to enter OST will be offered methadone or buprenorphine.
For those suffering from alcohol dependency, certain medication is available to help with the detox process. This includes benzodiazepines, antidepressants, and anxiolytics.
Local hospitals and specialised centres also offer inpatient treatment for heroin, alcohol, and cocaine dependency.
When attending a residential treatment programme, individuals will receive twenty-four-hour medical care, which includes a supervised detox.
Once finishing the detox, individuals will undergo specialised therapy and counselling, create a relapse prevention plan, and enter an aftercare programme. (7)
When an individual has both mental health issues and a substance dependency it is called dual diagnosis.
Studies have found that both mental health issues and substance dependency interact in various ways, such as one leading to the other, or by perpetuating associated symptoms.
Research indicates that substance dependency can lead to various mental health issues, such as depression and anxiety.
Heroin, for example, has been found to interact with chemicals in the brain that leads to depression – even in individuals that have never previously suffered from it.
Many peoples also use substances to help deal with mental health issues.
Substances such as alcohol, cannabis, and cocaine, are commonly used to achieve desired emotional and mental states.
However, prolonged use of a substance increases the likelihood of addiction. (8)
Several factors can influence how long an individual will spend in rehab.
This includes the type of substance that the individual is dependent upon and the duration of the dependency. These factors will be used to determine the best treatment options.
Commonly, treatment will last between several months to one year. However, this can be extended based on the patient’s needs.
Conversely, much shorter stays in rehab are possible. This might include staying for the detox process and then moving to an outpatient programme that provides additional support services. (9)
When entering rehab, as part of the process of overcoming substance dependency, individuals will undergo therapy and counselling.
This can be wide-ranging, but most therapies have the same goal: to help understand why substance dependency has occurred, how it can be overcome, and how to avoid a relapse in the future.
Each rehab is different, and it is most likely that individuals will receive therapy that is tailored to their own needs and goals.
However, there are several common therapies that rehabs employ.
The most common is psychoanalysis – mostly referred to as talk therapy. This will involve a one-on-one session with a qualified professional.
They will likely delve into an individual’s past, looking to uncover traumatic experiences, past and current relationships, and things that might have led to addiction.
Another common therapy is Cognitive Behavioural Therapy (CBT). CBT, as the name suggests, looks at how cognition influences behaviours, and vice versa. (10)
Research has found that changing negative thoughts into positive ones will often lead to positive behaviour changes.
In turn, the more an individual makes positive behaviour changes, the more likely they are to think positively.
CBT also involves sitting with a professional, who will ask various questions about thoughts individuals have and behaviours they enact.
Individuals will then learn effective tools that can be employed to help change negative thought patterns, such as cognitive reappraisal.
Individuals might also receive Dialectical Behaviour Therapy (DBT). DBT is very similar to CBT but focuses on moods and emotions.
DBT is often a more long-term therapy, and teaches skills such as mood management, how to control emotions and reappraisal. (11)
Some rehabs expose patients to Contingency Management (CM). This is a behaviour-based therapy that uses a reward system to encourage positive behaviours.
When an individual behaves positively, they are rewarded with a gift – this could be money or a small present. When individuals behave negatively, the gift is withheld as a punishment. (12)
One of the most common forms of therapy at rehab is group therapy. This involves sitting in a group setting with several peers and a professional.
People take turns to discuss their experiences, problems, and challenges with sobriety.
Often, the group will give feedback, offer support, and provide accountability.
Studies have found that group therapy is particularly helpful in maintaining sobriety, providing a support network, and removing feelings of isolation related to substance dependency.
The basic premise of the 12-step approach to recovery is the recognition that individuals that are suffering from substance dependency need something greater to focus on – 12-steps refer to this as a higher power.
Originally, this higher power was the Christian God. However, most 12-step programmes now provide secular programmes.
The higher power can be anything from nature to a connection with something spiritual.
The 12-step approach requires induvial to submit to the higher power, use it for accountability, create a positive moral framework, reflect upon wrongdoings, and commit to repairing damaged relationships, if possible. (13)
For more information on the 12-step programme, please follow this link: 12-step programme.
An important part of rehab is relapse prevention and aftercare.
According to Belgium Country Drug Report and Belgium drug policies, both outpatient and inpatient treatment programmes offer this.
This will involve speaking with a medical professional to discuss potential triggers and how these can be avoided.
Counselling will be provided to help individuals develop important social and coping tools that can be implemented when leaving rehab, such as stress management, how to express emotions and communicate healthily, and how to avoid certain social situations and environments.
With regards to aftercare, many communities in Belgium offer harm reduction services, continued therapy, and peer support initiatives.
Individuals will be guided to these services when leaving rehab but can also speak with their general practitioner for more information and a referral.
In addition, both Alcoholic Anonymous and Narcotics Anonymous are available in Belgium. Both offer group therapy, the 12-step programme, and support networks. (14)
(3) Johnson, B., 2003. Psychological Addiction, Physical Addiction, Addictive Character, and Addictive Personality Disorder: A Nosology of Addictive Di. Canadian Journal of psychoanalysis, 11(1), pp.135-160.
(6) Wallace, B.C., 1987. Cocaine dependence treatment on an inpatient detoxification unit. Journal of Substance Abuse Treatment, 4(2), pp.85-92.