IVO Addiction Research Institute

(1) Background: Ethnic minorities exhibit a higher prevalence of post-traumatic stress disorder (PTSD), while results for problematic substance use among ethnic groups remain mixed. PTSD and problematic substance use often co-occur; however, the impact of ethnicity on this association has not yet been investigated. (2) Methods: Self-report data on problematic alcohol/cannabis use (AUDIT/CUDIT) and presence of severe PTSD symptoms (PSS-SR) of N = 22,841 participants of Dutch (n = 4610), South-Asian Surinamese (n = 3306), African Surinamese (n = 4349), Ghanaian (n = 2389), Turkish (n = 3947), and Moroccan (n = 4240) origin were available from the HELIUS study. (3) Results: We found a positive association between the presence of severe PTSD symptoms and problematic alcohol and cannabis use. Ethnicity did not moderate the association between the presence of severe PTSD symptoms and problematic alcohol/cannabis use. (4) Conclusions: We demonstrated the relationship between the presence of severe PTSD symptoms and problematic alcohol/cannabis use in a multi-ethnic sample. The relationship between the presence of severe PTSD symptoms and problematic alcohol/cannabis use was similar between ethnic groups. We recommend screening for PTSD symptoms in those exhibiting problematic substance use and vice versa, regardless of ethnic background.

Introduction Legal spaces for street-based sex work are limited and appear to be diminishing. In the Netherlands, two of the once eight tippelzones (legal street sex work zone) remain after the “De Baan” in Utrecht closed in 2021. We examined how the closure has affected the lives and vulnerability of sex workers that worked there. Methods We performed a longitudinal qualitative study with sex workers using semi-structured interviews exploring their experiences. Participants were interviewed once before (n = 17) and once after (n = 13) the closure of the tippelzone in 2021. We thematically analyzed the interview transcripts. Results Before closure, most participants relied on income from the street zone, and their support needs varied. Post-closure, income loss led to financial strain, loneliness, and mental health issues for some. Plans for the future were disrupted, impacting participants’ ability to execute their plans, leaving many uncertain about their future paths. Conclusions The closure of the tippelzone led to increased financial strain, stress, and reduced social contacts. Stigma and the ambiguous nature of sex work seemed to hinder acceptance of and access to support, indicating complex and diverse experiences among sex workers. Policy Implications To effectively assist sex workers when closing legal street work zones, it is crucial to invest in building rapport early, address power imbalances, and provide long-term support tailored to individual needs, including financial assistance. Policymakers must consider the evolving vulnerabilities of sex workers to mitigate negative effects.

Introduction: The Stoptober House is part of the annual national Stoptober smoking cessation campaign in the Netherlands. During the first week of October, 48 volunteers resided in the tobacco-free Stoptober House for 5 days and received smoking cessation counseling. This pilot study explored how the Stoptober House may have facilitated smoking cessation among participants. Methods: We included 48 individuals who were selected for the Stoptober House (intervention group) and 67 individuals who were not selected (control group). Surveys were conducted at baseline, immediately after 2 and 8 weeks of post-intervention. We compared self-reported abstinence, psychosocial mediators related to smoking cessation, and perceived active elements of the Stoptober House between the intervention and control groups using t/χ2 tests and linear mixed model (LMM) analysis. Sixteen semi-structured qualitative interviews were conducted to explore participants' perspectives on the elements contributing to their success in quitting smoking. Results: At 8 weeks of follow-up, a higher proportion of participants in the intervention group (24/48 [50%]) reported being abstinent compared to the control group (5/67 [7%]; p < 0.001). Among participants who reported making a quit attempt, 22/38 (57.9%) in the intervention group remained abstinent compared to 4/17 (23.5%) in the control group (p = 0.022). The intervention group also exhibited higher self-efficacy to quit smoking throughout the follow-up period and higher social support immediately after the Stoptober House. No significant differences were observed in other psychosocial factors. The interviews highlighted several perceived elements of the Stoptober House that contributed to smoking cessation success, including restricted smoking opportunities, access to smoking cessation counselors, and peer support. Conclusion: This pilot study suggests that the Stoptober House provides support that can help people quit smoking. Further research is needed to confirm these findings and determine the cost-effectiveness of this intervention in promoting long-term abstinence among specific groups of smokers.

Background Social distancing measures during the COVID‐19 pandemic forced an abrupt transformation of treatment delivery for mental health care. In mid‐March 2020, nearly all in‐person contact was replaced with video conferencing. The pandemic thus offered a natural experiment and a unique opportunity to conduct an observational study of whether alcohol use disorder treatment through video conferencing is non‐inferior to in‐person treatment. Methods In a large urban substance use disorder treatment center in the Netherlands, treatment evaluation is routine practice. Outcome data are regularly collected to support shared decision making and monitor patient progress. For this study, pre‐test and post‐test data on alcohol use (Measurements in the Addictions for Triage and Evaluation), psychopathology (Depression Anxiety Stress Scales), and quality of life (Manchester Short Assessment of Quality of Life) were used to compare outcomes of cognitive behavioral therapy treatment for three cohorts: patients who received treatment for a primary alcohol use disorder performed prior to (n = 628), partially during (n = 557), and entirely during (n = 653) the COVID‐19 lockdown. Results Outcome was similar across the three cohorts: No inferior outcomes were found for treatments that were conducted predominantly through video conferencing during lockdown or treatments that started in‐person, but were continued through video conferencing, compared to in‐person treatments that were conducted prior to COVID‐19. The number of drop‐outs were also similar between cohorts. However, there was a difference in average treatment intensity between cohorts, with treatment partially or fully conducted during the COVID‐19 pandemic lasting longer. Conclusions Treatment for a primary alcohol use disorder, provided partially or predominantly through video conferencing during the COVID‐19 pandemic resulted in abstinence rates and secondary outcomes similar to traditional in‐person care, in spite of the potentially negative effects of the COVID‐related lockdown measures themselves. These results from everyday clinical practice corroborate findings of randomized controlled studies and meta‐analyses in which video conferencing appeared non‐inferior to in‐person care in clinical effectiveness.

Gambling disorder was reclassified as a first behavioral addiction in the DSM-5 in 2013. In 2018, gaming disorder was included in the ICD-11. In this presentation, research findings regarding the psychological and neurobiological mechanisms in gambling disorder and other behavioral addictions are highlighted. Specifically, neural and behavioral responses regarding reward expectation, reward outcomes, and the role of specific mechanisms in gambling like near wins, and in gaming, like lootboxes are highlighted. Besides the recognition of gambling disorder, the broader perspective of gambling harms is highlighted and related to psychosocial, financial, and health consequences. The perspective of interaction between human design factors (e.g. psychological and neurobiological mechanisms, such as decision making, reward processing) and gambling design factors (e.g. near wins, multiline betting) is reviewed. Evidence with regard to psychological and pharmacological interventions are discussed and future directions for research perspectives are discussed. Disclosure of Interest A. Goudriaan Grant / Research support from: Anna Goudriaan received grants from the Dutch Foundation for Scientific Research (NWO and ZonMw) and from VCVGZ Foundation

Purpose To explore the impact of having relatives with addiction problems on students’ health, substance use, social life, and cognitive functioning, and to establish possible contributions of the participants’ gender, type of relationship, and type of addiction of the relative(s). Methods A qualitative, cross-sectional study of semi-structured interviews with thirty students from a University of Applied Sciences in the Netherlands who had relatives with addiction problems. Results Nine major themes were identified: (1) violence; (2) death, illness, and accidents of relatives; (3) informal care; (4) perception of addiction; (5) ill health, use of alcohol and illegal drugs; (6) financial problems; (7) pressured social life; (8) affected cognitive functioning, and (9) disclosure. Conclusions Having relatives with addiction problems severely affected the life and health of participants. Women were more likely to be informal carers, to experience physical violence, and to choose a partner with addiction problems than men. Conversely, men more often struggled with their own substance use. Participants who did not share their experiences reported more severe health complaints. It was impossible to make comparisons based on the type of relationship or type of addiction because participants had more than one relative or addiction in the family.

Understandings of drug addiction recovery are still being debated. Research on perspectives from first-hand experiences with recovery is rare and often contains short-term experiences in the context of a treatment setting. We aim to gain further understanding of recovery by analyzing autobiographical data from persons in different stages of drug addiction recovery who are not linked to any specific treatment service. We conducted 30 in-depth qualitative interviews with participants from various parts of the Netherlands. Participants self-identified as being "in recovery" or "recovered" from drug addiction for at least 3 months. Men and women are equally represented, and the sample consists of an equal number of participants in early (<1 year, n = 10), sustained (1-5 years, n = 10), and stable (>5 years, n = 10) recovery. We undertook a data-driven thematic analysis. Participants described that recovery is a broad process of change because addiction is interwoven with everything (theme 1); that recovery is reconsidering identity, seeing things in a new light (theme 2); that recovery is a staged long-term process (theme 3); and that universal life processes are part of recovery (theme 4). Thus, Drug addiction recovery is experienced as an interwoven long-term process, including identity change and common or universal life processes. Policy and clinical practice should therefore be aimed at supporting long-term tailored recovery goals and disseminating first-hand recovery experiences to enhance long-term outcomes and reduce stigmatization.

The concept of recovery has emerged as a prominent paradigm to understand processes of change in individuals with substance use problems. To date, most studies have focused on personal recovery as the key driving force of recovery journeys, generally individualizing the often-disabling social realities that persons in recovery face. To counterbalance this bias, this paper focuses on the contextual dynamics at stake during recovery processes, based on the lived experiences of 30 persons in drug addiction recovery in Flanders (Belgium). A Lifeline Interview method was applied to elicit recovery narratives, which were thematically analysed. We found that interpersonal relationships, enabling and disabling places, and socio-economic factors facilitate or impede recovery in meaningful ways. The findings also show how these diverse contextual dimensions are interrelated and ambiguous. Researchers, policymakers, and treatment providers should acknowledge the relational nature of recovery and the invalidating impact of stigma across the three identified contextual levels.

Although support by experiential peers for individuals with criminal behaviour is increasing, an empirical basis for its effectiveness is lacking. The purpose of this review was to investigate outcomes, mechanisms, and contextual factors of individual support by experiential peers for individuals who display criminal behaviour. We conducted a systematic realist literature review to test and refine our initial programme theory, which included seven mechanisms that may play a role in the desistance-supportive outcomes of experiential peer support. We screened 6,530 scientific papers and eventually included 25 articles focusing on asymmetrical one-on-one support for and by individuals with criminal behaviour. The findings suggest that experiential peers show empathy and have a non-judgmental approach, are considered role models, establish a trusting relationship with clients, offer hope, connect clients to other services, and have a recovery perspective on desistance. We found results indicative of act-desistance, positive personal development and improvements in mental health and personal circumstances, although study results were not consistent. The information on contextual factors was too limited for a robust analysis. Future research should not only focus on objective measures (e.g. absence of criminal behaviour), but also on subjective measures (e.g. hope, self-esteem) and investigate long-term effects.

Addiction problems impact not only the persons with these problems but also family members. This study aims to examine the impact of the COVID-19 pandemic on stress, strain on health, study experiences, coping strategies, and access to support of students with relatives with addiction problems. Thirty students, aged 18-30 years, from a University of Applied Sciences in the Netherlands participated in a three-year qualitative longitudinal interview study. One round of individual semi-structured interviews was conducted before the COVID-19 pandemic, and three during the COVID-19 pandemic. Directed Content Analysis was applied, using the Stress-Strain-Information-Coping-Support-model. Four major themes were identified: (1) Increase in stress and strain; (2) Decrease in stress and strain; (3) Coping strategies, and (4) Access to social, professional, and educational support. Before the pandemic, most participants had health problems, especially mental health problems, including problems with their own substance use. Some had study delay. Analysis revealed that during the pandemic, most participants experienced an increase in these problems. This appeared to be related to their living situation: An increase in violence and relapse of relatives increased stress, especially for those living with their relatives. The coping strategies 'standing up' or 'putting up', and a decrease in support-social, professional, and educational-also contributed to stress. A few participants experienced less health problems and study problems. This was related to diminishing addiction problems of relatives, less social pressure, available help, and the coping strategy 'withdrawing'. Withdrawing was much easier for participants who did not live with their relatives with addiction problems. It is recommended to keep schools and universities open during pandemics, offering a safe haven for students at risk in the home situation.

Unlabelled: The Netherlands plans to ban tobacco sales in supermarkets in 2024. In a comprehensive policy evaluation, we aim to examine: 1) the impact of the policy on the number and types of tobacco outlets, 2) the impact on attitudes and behaviors of smoking adults and non-smoking youth, and 3) the influence of the tobacco industry on the policy process and the retail environment. In addition, our study focusses on differential effects in disadvantaged neighborhoods, where both smoking rates and tobacco outlet density are typically highest. This study brings together economic, psychological, and journalistic research methods. We investigate the impact of the new legislation on the number and type of tobacco outlets, and on the number of smokers by using routinely collected population monitoring data. We examine the impact of the legislation on smoking susceptibility of non-smoking youth and on impulse tobacco purchases by smoking adults with yearly quantitative surveys and with qualitative interviews and discussion sessions. We describe whether these impacts differ for disadvantaged versus non-disadvantaged neighborhoods. We investigate what strategies the tobacco industry uses to influence the new legislation, policy processes, and the tobacco retail environment by performing a journalistic investigation, by means of documents obtained by Freedom of Information Act (FOIA) requests, (possibly) leaked documents from insider meetings, and interviews with insiders. The methods of our evaluation can be used as a model for other comprehensive public policy evaluations. Registration: Clinical Trials ID NCT05554120, Protocol ID KWF140282021-2. Abbreviations: FOIA: Freedom of Information Act. SES-WOA: socioeconomic scores of private households. MCID: minimal clinically important difference.

Introduction: Randomized controlled trials have demonstrated the effectiveness of workplace smoking cessation programs. However, with low participation rates reported, it is important to understand the barriers and facilitators for the reach and participation of employees in workplace smoking cessation programs. The objective of the present study is to uncover the needs of employees regarding reach and participation when implementing a workplace program to address smoking cessation. Methods: We carried out 19 semi-structured qualitative interviews in 2019 based on the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) Framework with current and former smoking employees of organizations with ≥100 employees in the Netherlands. Some of the interviewees had experience with a cessation program. Data were analyzed using the Framework method. Results: The main barriers according to employees were insufficient promotion of the cessation program, completing the program in the employee’s own time and working night shifts and peak hours. Facilitators included being actively approached to participate by a colleague, positive reactions from colleagues about employee’s participation in the program, providing the program on location and integrating the program as part of the organization’s vitality policy. Conclusions: Effective workplace programs for smoking cessation can stimulate cessation but implementers often experience low participation rates. Our study presents recommendations to improve the recruitment and participation of employees in a workplace smoking cessation program, such as using active communication strategies, training managers to stimulate smoking employees to participate and making the program as accessible as possible by reimbursing time spent and offering the program at the workplace or nearby. Integrating the smoking cessation program into wider company vitality policy will also aid continued provision of the program.

Aims: Research over many years indicates that individuals with problematic alcohol or drug use or gambling disorders can cause considerable burden on family members. And yet, affected family members (AFMs) are largely neglected in research, health and social care policy and provision. To address the needs of AFMs of people struggling with a substance use or gambling disorder, the 5-Step Method was developed. Methods: The goal of this study is to evaluate the routinely delivered 5-Step Method in the Netherlands using measures at baseline (N = 145), and end-of-treatment (N = 102). In addition, a subsample at three-month post intervention (N = 70) was included. The intervention was delivered via video-conferencing to half (47.6%) of the participants. Findings: Participants reported significantly lower rates of Total Family Burden after completing the 5-Step Method, when comparing measurements at baseline and end-of-treatment (d = 0.56), and measurements at baseline and three-month post intervention (d = 0.85). In addition, participants following the intervention via video-conferencing (N = 69) performed equally well or better compared to participants following the intervention face-to-face (N = 76). Conclusions: Following the 5-Step Method for AFMs results in lower Total Family Burden. In accordance with the Stress-Strain-Information-Coping-Support (SSICS) model, the effectiveness of the intervention could be improved by finding new ways of increasing support for AFMs.

Background: The COVID-19 pandemic and measures have placed various burdens on societies and individuals. Emerging evidence suggests that people in drug addiction recovery were negatively affected. This study investigates whether risk and protective factors associated with return to problematic substance use differed between the periods before and during the pandemic for those in recovery. Methods: A convenience sample of persons in drug addiction recovery for at least three months completed an assessment at baseline before the pandemic (T0, N = 367) and at two consecutive follow-ups 12 months apart (T1, N = 311; T2, N = 246). The final follow-up took place during the pandemic (2020-2021). We analyzed rates and predictors of problematic substance use in both periods, and whether relations between predictors and problematic use differed between the periods. Results: Rates of problematic use did not differ significantly before and during the pandemic for those who were followed-up. However, the relationship between problematic use and commitment to sobriety differed between both periods (OR = 3.24, P = 0.010), as higher commitment was only associated with lower odds of problematic use during (OR = 0.27, P < 0.001), but not before, the pandemic (OR = 0.93, P = 0.762). In both periods, persons who were engaged in psychosocial support had lower odds of problematic use. Conclusions: The COVID-19 pandemic was not followed by significant return to problematic substance use in a cohort of people who were already in drug addiction recovery for some time before the pandemic. However, with restricted access to environmental resources, they may have been more dependent on internal motivations. Targeting personal recovery resources with interventions could therefore reduce the chances of return to problematic substance use during a pandemic.

Background: Given the increased use of smart devices and the advantages of individual behavioral monitoring and assessment over time, wearable sensor-based mobile health apps are expected to become an important part of future (forensic) mental health care. For successful implementation in clinical practice, consideration of barriers and facilitators is of utmost importance. Objective: The aim of this study was to provide insight into the perspectives of both psychiatric outpatients and therapists in a forensic setting on the use and implementation of the Sense-IT biocueing app in aggression regulation therapy. Methods: A combination of qualitative methods was used. First, we assessed the perspectives of forensic outpatients on the use of the Sense-IT biocueing app using semistructured interviews. Next, 2 focus groups with forensic therapists were conducted to gain a more in-depth understanding of their perspectives on facilitators of and barriers to implementation. Results: Forensic outpatients (n=21) and therapists (n=15) showed a primarily positive attitude toward the addition of the biocueing intervention to therapy, with increased interoceptive and emotional awareness as the most frequently mentioned advantage in both groups. In the semistructured interviews, patients mainly reported barriers related to technical or innovation problems (ie, connection and notification issues, perceived inaccuracy of the feedback, and limitations in the ability to personalize settings). In the focus groups with therapists, 92 facilitator and barrier codes were identified and categorized into technical or innovation level (n=13, 14%), individual therapist level (n=28, 30%), individual patient level (n=33, 36%), and environmental and organizational level (n=18, 20%). The predominant barriers were limitations in usability of the app, patients' motivation, and both therapists' and patients' knowledge and skills. Integration into treatment, expertise within the therapists' team, and provision of time and materials were identified as facilitators. Conclusions: The chances of successful implementation and continued use of sensor-based mobile health interventions such as the Sense-IT biocueing app can be increased by considering the barriers and facilitators from patients' and therapists' perspectives. Technical or innovation-related barriers such as usability issues should be addressed first. At the therapist level, increasing integration into daily routines and enhancing affinity with the intervention are highly recommended for successful implementation. Future research is expected to be focused on further development and personalization of biocueing interventions considering what works for whom at what time in line with the trend toward personalizing treatment interventions in mental health care.

Aims There is evidence that child maltreatment is associated with problematic alcohol use later in life. However, previous epidemiological studies that have examined the link between child maltreatment and adult problematic alcohol use have not considered ethnic differences. Therefore, the purpose of the current study was to investigate the relationship between child maltreatment and adult problematic alcohol use among six ethnic groups in the Netherlands, in a large, urban sample. Methods This study used baseline data from the Healthy Life in an Urban Setting (HELIUS) study: a large-scale, multi-ethnic prospective cohort study conducted in Amsterdam, the Netherlands. Child maltreatment, current problematic alcohol use and several potential confounders (e.g. parental alcohol use) were assessed in participants ( N = 23 356) of Dutch, South-Asian Surinamese, African Surinamese, Ghanaian, Turkish and Moroccan origin. With logistic regression analyses, we examined effect modification by ethnicity on the association between child maltreatment and problematic alcohol use. Furthermore, we explored effect modification by ethnicity for specific types of child maltreatment, namely: physical, sexual and psychological abuse and emotional neglect. Results Effect modification by ethnicity was present. Stronger associations between child maltreatment and problematic alcohol use were found in all ethnic minority groups compared to the Dutch reference group. Particularly strong associations between all four types of child maltreatment and alcohol use problems were found for the Moroccan origin group. Conclusions This study adds to a growing body of evidence that child maltreatment is associated with problematic alcohol use in adulthood. In addition, our findings indicate that ethnicity impacts this relationship. Although problematic alcohol use was more prevalent in the Dutch origin group, associations with child maltreatment were stronger in ethnic minority groups. Future studies on child maltreatment and alcohol use problems should also examine ethnic disparities and should further unravel how these disparities can be explained.

Specific approaches are needed to reach and support people with a lower socioeconomic position (SEP) to achieve healthier eating behaviours. There is a growing body of evidence suggesting that digital health tools exhibit potential to address these needs because of its specific features that enable application of various behaviour change techniques (BCTs). The aim of this scoping review is to identify the BCTs that are used in diet-related digital interventions targeted at people with a low SEP, and which of these BCTs coincide with improved eating behaviour. The systematic search was performed in 3 databases, using terms related to e/m-health, diet quality and socioeconomic position. A total of 17 full text papers were included. The average number of BCTs per intervention was 6.9 (ranged 3–15). BCTs from the cluster ‘ Goals and planning ’ were applied most often (25x), followed by the clusters ‘ Shaping knowledge ’ (18x) and ‘ Natural consequences ’ (18x). Other frequently applied BCT clusters were ‘ Feedback and monitoring’ (15x) and ‘ Comparison of behaviour ’ (13x). Whereas some BCTs were frequently applied, such as goal setting, others were rarely used, such as social support. Most studies ( n = 13) observed a positive effect of the intervention on eating behaviour (e.g. having breakfast) in the low SEP group, but this was not clearly associated with the number or type of applied BCTs. In conclusion, more intervention studies focused on people with a low SEP are needed to draw firm conclusions as to which BCTs are effective in improving their diet quality. Also, further research should investigate combinations of BCTs, the intervention design and context, and the use of multicomponent approaches. We encourage intervention developers and researchers to describe interventions more thoroughly, following the systematics of a behaviour change taxonomy, and to select BCTs knowingly.

The aim of this cross-sectional study is (1) to describe the socio-demographic characteristics of students with relatives with problematic substance use and to examine differences between students with and without relatives with problematic substance use in (2) health, (3) substance use and (4) study success. We analyzed these differences in bivariate analyses between 881 (15.6%) students in a Dutch university population with relatives with problematic substance use (referred to as Affected Family Members (AFMs) and 4,781 students without such relatives. AFMs reported poorer health and used more substances, especially cannabis, than did non-AFM students and drank more often alone than did their peers. AFMs had more frequently study delay and missed class more often because of drug use. AFMs with more than one relative with problematic substance use had poorer health than AFMs with only one relative. Effect sizes were small to moderate. Health and educational professionals should provide support to deal with difficult life circumstances, for example, trauma-informed care programs.