Low-threshold Care for Marginalised Hard Drug Users: Marginalisation and Socialisation in the Rotterdam Hard Drug Scene

Since the early 1990s several developments have taken place in the hard drug scene in the Netherlands. Key elements in these developments were harm reduction measures, introduction of crack, open drug scenes, police interventions, drug-related nuisance, low-threshold care facilities and the well-being of drug users. Drug policy and drug scenes have also changed in the past 15 years. The aim of this thesis is to provide insight into the role of low-threshold care facilities in the process of marginalisation and socialisation of drug users. Marginalisation entails that chronic hard drug users drift away from the core institutions of society, e.g. family and friends, the labour market and health care; socialisation is the opposite of marginalisation (Coumans, 2005). The roles that low-threshold care facilities can play are derived from this process. First, low-threshold care facilities can contribute to the discontinuation of marginalisation. Second, low-threshold care facilities can function as re-integration instruments. Both marginalisation and socialisation have their effects on individual drug users and on society in a broader perspective (in terms of public health and public safety). By understanding the role of low-threshold care facilities within a changing environment, these facilities can be utilised more effectively. First, this chapter outlines the concepts of ‘hard drug scenes and nuisance’ and ‘harm reduction and low-threshold care’. Then, Coumans’ theory of marginalisation and socialisation is presented and the six chapters of this thesis are introduced. Finally, the methodology and data used are presented

Differences in sociodemographic, drug use and health characteristics between never, former and current injecting, problematic hard-drug users in the Netherlands

BACKGROUND: Injecting drug users are at increased risk for harmful effects compared to non-injecting drug users. Some studies have focused on differences in characteristics between these two groups (e.g., housing, overall health). However, no study has investigated the specific Dutch situation which in the last years has seen a decrease in homelessness among problematic hard-drug users and an increasing focus on physical health in low-threshold addiction care. The purpose of this study was to determine differences in sociodemographic, drug use and health characteristics between never-injecting (NIDUs), former-injecting (FIDUs) and current-injecting drug users (IDUs) and describe injecting practices. METHODS: A total of 202 problematic hard-drug users (NIDU = 64; FIDU = 76; IDU = 62) were recruited from 22 low-threshold care facilities, including drug consumption rooms, methadone maintenance treatment, heroin-assisted therapy, day shelter and/or night shelter, supported housing and day activity centres. Data were collected on-site through structured face-to-face interviews. RESULTS: Results indicate that IDUs represented a separate group of problematic hard-drug users, with distinct sociodemographic and drug use characteristics. Overall, IDUs appeared to be the group with least favourable characteristics (unstable housing/homelessness, illegal activities, polydrug use) and NIDUs appeared to have the most favourable characteristics (stable housing, help with debts, less polydrug use). The FIDU group lies somewhere in between. The three groups did not differ significantly in terms of health. Regarding injecting practices, results showed that majority of IDUs had injected drugs for over 10 years and IDUs injected heroin, cocaine, amphetamine and/or methadone in the past 6 months. Sharing syringes was not common. A quarter reported public injecting. CONCLUSIONS: Unstable housing and homelessness are related to (former) injecting drug use, and stable housing is related to never-injecting drug use. Our study suggests that the number of ‘new’ IDUs is low. However, public injecting among IDUs is not uncommon and is associated with unstable housing. This emphasizes the potential of housing projects as a component of harm reduction measures. Therefore, prevention of (risks associated with) injecting drug use and supported housing programmes for problematic hard-drug users deserve the continuous attention of policymakers and professionals in low-threshold addiction care

Experiences of persons with executive dysfunction in disability care using a social robot to execute daily tasks and increase the feeling of independence:Multiple-case study

BACKGROUND: Executive functions are essential for independently navigating nearly all of our daily activities. Executive dysfunction often occurs as a result of a neurodevelopmental disorder. Persons with executive dysfunction experience challenges regarding independent execution of daily tasks. Social robots might support persons with executive dysfunction to execute daily tasks and promote their feeling of independence. OBJECTIVE: This study aimed to study the impact of interacting with social robot Tessa on goal attainment in the execution of daily tasks and perceived independence of persons with executive dysfunction. METHODS: In this multiple-case study, 18 participant–caregiver couples were followed up while using Tessa in the home environment for 3 months. Goal attainment on independently performing a self-determined goal was measured by the Goal Attainment Scale, and participant–caregiver couples were interviewed about their experience with their interaction with Tessa and how they perceived Tessa’s impact on their independence. RESULTS: In total, 11 (61%) participants reached their goal after 6 weeks and maintained their goal after 3 months. During the study period, 2 participant–caregiver couples withdrew because of mismatch with Tessa. Participants set goals in the following domains: execution of household tasks; intake of food, water, or medication; being ready in time for an appointment; going to bed or getting out of bed on time; personal care; and exercise. Participants perceived that Tessa increased the feeling of independence by generating more structure, stimulation, and self-direction. Participant–caregiver couples reported that the auditive information provided by Tessa was more effective in coping with executive dysfunction compared to their initial approaches using visual information, and the use of Tessa had a positive impact on their relationship. CONCLUSIONS: This study paid ample time and attention to the implementation of a social robot in daily care practice. The encouraging findings support the use of social robot Tessa for the execution of daily tasks and increasing independence of persons with executive dysfunction in disability care

Het Minnesota model

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Depressieproblematiek gemeten in Nederland : wat verschillende databronnen zeggen over het vóórkomen van depressieproblematiek

Voor het Meerjarenprogramma Depressiepreventie is een inventarisatie gedaan naar databronnen met gegevens over het vóórkomen (de prevalentie) van depressieproblematiek in de algemene bevolking in Nederland. Er zijn 43 landelijke, regionale en lokale databronnen gevonden, en hun kenmerken worden beschreven. Daarbij wordt een overzicht gegeven van reeds gepubliceerde prevalentiecijfers uit 22 van de databronnen. De inventarisatie maakt duidelijk welke prevalentiegegevens beschikbaar zijn voor welke groepen in de algemene bevolking op welk schaalniveau (landelijk, regionaal of lokaal). Deze informatie is bijvoorbeeld bruikbaar om te monitoren of de ambitie van het Meerjarenprogramma Depressiepreventie wordt gerealiseerd: een forse verlaging van het aantal mensen met een depressieve stoornis in het komende decennium. Daarnaast brengt de inventarisatie belangrijke gegevenslacunes in kaart. Zo ontbreekt het vooralsnog aan landelijke representatieve gegevens over de prevalentie van depressieve en aanverwante stoornissen bij jongeren tot 18 jaar en oudere personen van 65 jaar of ouder

Experiences of persons with executive dysfunction in disability care using a social robot to execute daily tasks and increase the feeling of independence: Multiple-case study

Background: Executive functions are essential for independently navigating nearly all of our daily activities. Executive dysfunction often occurs as a result of a neurodevelopmental disorder. Persons with executive dysfunction experience challenges regarding independent execution of daily tasks. Social robots might support persons with executive dysfunction to execute daily tasks and promote their feeling of independence. Objective: This study aimed to study the impact of interacting with social robot Tessa on goal attainment in the execution of daily tasks and perceived independence of persons with executive dysfunction. Methods: In this multiple-case study, 18 participant–caregiver couples were followed up while using Tessa in the home environment for 3 months. Goal attainment on independently performing a self-determined goal was measured by the Goal Attainment Scale, and participant–caregiver couples were interviewed about their experience with their interaction with Tessa and how they perceived Tessa’s impact on their independence. Results: In total, 11 (61%) participants reached their goal after 6 weeks and maintained their goal after 3 months. During the study period, 2 participant–caregiver couples withdrew because of mismatch with Tessa. Participants set goals in the following domains: execution of household tasks; intake of food, water, or medication; being ready in time for an appointment; going to bed or getting out of bed on time; personal care; and exercise. Participants perceived that Tessa increased the feeling of independence by generating more structure, stimulation, and self-direction. Participant–caregiver couples reported that the auditive information provided by Tessa was more effective in coping with executive dysfunction compared to their initial approaches using visual information, and the use of Tessa had a positive impact on their relationship. Conclusions: This study paid ample time and attention to the implementation of a social robot in daily care practice. The encouraging findings support the use of social robot Tessa for the execution of daily tasks and increasing independence of persons with executive dysfunction in disability care