Details

Last Updated: 30 January 2024

The use of drugs and alcohol in Belgium

The use of psychoactive substances and addiction problems are a public health issue, since the use of these substances poses a risk to the individual health of the user, among other things. Affected individuals must be able to access quality care services without being stigmatised or facing discrimination. To address these issues, the federal government has initiated several projects in various sectors: 

• Care model for drug-using prisoners
• Tackling inappropriate use of psychopharmaceuticals
• Addressing substance abuse in hospitals
• Raising awareness among healthcare professionals

Below we take a closer look at some of these projects.  The goal of these projects is to counter the problems caused by drug use and promote the health and well-being of individuals. Through collaboration with various agencies and professionals, these projects strive to provide early identification and intervention, treatment, reintegration and social support for those facing drug-related problems. Through concerted efforts, the government seeks to reduce the harmful effects of drug use and promote a safer and healthier society.

Care model for drug-using prisoners Despite the daily efforts of care providers and the intense efforts of the FPS Justice, drug and medication use in Belgian prisons remains high. Drug use entails various health risks and can place significant pressure on prison security. A Belgian study[1] found that almost 60% of inmates used drugs before their incarceration, which is higher than the international average of 50%.[2]. As part of the penitentiary healthcare reform, the FPS Public Health, in collaboration with the FPS Justice, funded an adapted care model for incarcerated drug users through a pilot project in three prisons in 2017: Brussels Penitentiary Complex Hasselt Prison Lantin Prison

Three non-profit organisations specialising in providing assistance to drug users are receiving funding to provide additional training, expertise and staffing support to the three prisons.

In each of these prisons, additional care staff have been recruited and the existing care and prison staff have received additional training, so that prisoners with a drug problem can be given more personalised support. Furthermore, inmates are now systematically screened for drug use upon arrival, so that they can be guided to the right help more quickly if necessary. The relevant care workers inside and outside the prison walls are also in close contact with each other, which helps to ensure the continuity of care.

• In Belgium’s largest prison, Lantin, no fewer than 1,447 inmates were screened over a 12-month period, of whom 50.2% reported using drugs and 12.8% of these drug users were included in the pilot project.
• Hasselt is a smaller and more modern prison with a special drug-free ward where inmates who choose to stop using drugs can be admitted. In this prison, 303 inmates were screened and 184 (60.7%) of them reported using drugs from which 46.2% opted to participate in the project.
• We have similar data for Saint-Gilles, where 43.6% of those screened were found to use drugs and 109 inmates were followed for 12 months in the project. Inmates in Saint-Gilles are currently being transferred to Haren prison.

In total, this pilot project has already screened thousands of inmates and offered around 1,500 care pathways. In addition to its original tasks, the project will now focus on post-detention aftercare, the involvement of front-line psychologists and peer support.  In March 2023, the FPS Health launched a call to expand the pilot project to seven other prisons. The project will again be monitored by a group of scientific experts and an 18-month training course will be provided to support the prisons. This takes place on the initiative of the NIHDI. 

Tackling inappropriate use of psychopharmaceuticals

Belgium continues to have the largest population of users of psychopharmaceuticals. Psychopharmaceuticals are drugs used in the treatment of psychiatric disorders and psychological problems. These drugs can be classified into several groups: antipsychotics, antidepressants, narcotics and sedatives, and stimulants such as Rilatine.

In 2022, it was estimated that more than 3 million Belgians were taking at least one psychopharmaceutical. This is 1 belgian out of 4. Narcotics and sedatives are the most commonly used[3].

Psychotropic treatments are not always adapted to patients’ needs, are often unjustifiably prolonged, poorly monitored and rarely questioned. Psychotropic drugs may be necessary in some cases, but only at the right dose and for the right length of time. If possible, chronic use should be avoided, to prevent unnecessary side effects and, in the case of certain types of psychotropic drugs, dependence or addiction. It’s also crucial to stop taking them gradually if their value is no longer proven.

The Belgian Psychotropics Experts Platform (BELPEP) aims to promote the appropriate use of psychopharmaceuticals such as antidepressants, narcotics and sedatives in Belgium. This includes proper prescribing and follow-up of treatment. We note that some patients are prescribed psychopharmaceuticals when there may be non-drug alternatives, while others are not prescribed a psychopharmaceutical when one might be essential for optimal treatment of their condition.

More information about BELPEP: https://www.health.belgium.be/fr/sante/organisation-des-soins-de-sante/qualite-des-soins/bonnes-pratiques/belgian-psychotropics

An awareness campaign was launched by the FPS Public Health in September 2023, targeting general practitioners, pharmacists and psychologists. The goal of this campaign is to draw attention to the proper use of psychopharmaceuticals, where open dialogue with patients and information sharing among healthcare professionals are essential. Attention is being drawn again to resources such as clinical guidelines, training courses and an online handbook to facilitate this dialogue.

More information:  https://www.usagepsychotropes.be

Alcohol care pathway in general hospitals

Alcohol consumption poses risks to both the physical and psychosocial health of users. It can cause various diseases as well as accidents. According to Sciensano’s Health Survey in 2018, alcohol consumption is a potential hazard for 14% of the Belgian population^[4].

It is recommended to limit alcohol consumption to no more than 10 standard units per week (1 standard glass = 1 unit = 10 grams of pure alcohol) and not to consume alcohol daily. It is estimated that about 20% of all patients admitted to general hospitals exhibit harmful or risky alcohol use.

In 2009, the pilot project ‘Tools & alcohol care pathway’ was launched in general hospitals on the basis of the observation that alcohol-related problems were still under-recognised in general hospitals. The goal of this project is to improve the detection and treatment of people with alcohol-related problems through training and awareness of healthcare personnel and by developing an alcohol care pathway that strengthens collaboration.

The benefits for the hospitals where the project has been implemented are numerous. Healthcare providers are paying more attention to alcohol use in their daily practice, thanks in part to many resources such as brochures, guidelines, posters, care pathways, abstinence scales, and so on. Patients are referred more quickly and treatment of alcohol-related withdrawal symptoms is more effective. On the basis of the positive results, the project has been expanded to 15 general hospitals.

Learn more:  https://www.health.belgium.be/fr/sante/organisation-des-soins-de-sante/hopitaux/projets-specifiques/dispositif-alcool

^{[1]Favril, L., & Laenen, F. V. (2018). Predictors of drug use during detention: data from 1,326 inmates from 15 prisons in Flanders. PANOPTICON, 39(4), 296–312. https://biblio.ugent.be/publication/8577366}

^{[2]Mundt, A. P., Baranyi, G., Gabrysch, C., & Fazel, S. (2018). Substance use during imprisonment in Low- and Middle-Income countries. Epidemiologic Reviews, 40(1), 70–81. https://doi.org/10.1093/epirev/mxx016.}

^{[3]Source: IQVIA Belgium Le Marché Pharmaceutique Belge- National Sell In Audit for the period 2018-2023; and Regional Sell Out Patient data for the period 2022}

^{[4]L. Gisle, S. Demarest, S. Drieskens. Health Survey 2018: Alcohol use. Brussels: Sciensano. Accessed on 1 October 2023, from www.gezondheidsenquete.be}

Details

Last Updated: 30 January 2024

New policy initiatives

The Interministerial Conference on Public Health (IMC) agreed on December 14 2022, to develop a transversal care model of eating disorders as an example of integrated care. This model is based on the specific proposals of the Committee on the New Mental Health Policy for Children and Youth (COMMHCY). It clearly states that there is a need in Belgium for a population-orientated care organisation.  This should, on the one hand, support children and adolescents so that mental problems – and, more specifically, eating disorders – can be prevented.  On the other hand, early detection mechanisms are also best developed for the first signs of eating disorders and quality and accessible care is tailored when needed.

Such care organisation leads to more health gains, greater well-being, less suffering and lower social costs.

To achieve this objective, a care pathway will be developed for children and adolescents with eating disorders. As a complement to the initiatives within the states, this involves:

• Training of primary care providers around eating disorders so that they learn to recognise signs of an eating disorder, dare to intervene or to enable them to refer.
• Further development of specialised psychological and dietetic care for adolescents with eating disorders, preferably as part of a multidisciplinary collaboration with general practitioners, psychologists and psychiatrists. Cooperation and consultation will be actively encouraged in this regard.
• Support for outpatient care with expertise through multidisciplinary outpatient support teams, known as MAST teams. Their job will be to support outpatient providers so that young people can be supervised and treated in their own environment for as long as possible. If needed, they can provide specific training and peer supervision to assistance providers. In difficult pathways, they will be responsible for care coordination and may also take steps to address gaps in care provision in terms of policy, as well as helping to look for solutions within the framework of the mental health networks.
• Increasing the flexibility of intensive offerings and having more options and variations of assistance forms developed to provide better tailored care. This mainly involves various forms of part-time treatment and (intensive) multi-family therapy (MFT and iMFT)

The new care pathways for children and adolescents with eating disorders will be implemented from 2024.

^{[1]Sixth COVID-19 Health Survey. First results (2021). Brussels: Sciensano. Filing number/2021/14,440/29. Accessed 1 October 2023, from  https://doi.org/10.25608/r4f5-1365}

^{[2]IIn 2020, we saw a decrease because of COVID-19 pandemic measures and because of the temporary suspension of registration of diagnoses in Minimal Psychiatric Data (MPD).}