The number of hard drug addicts in the Netherlands is stable and relatively low (cf. annex I). The average age of heroin addicts is over thirty and rising*. There is therefore no reason to assume that the policy on soft drugs has resulted in a large increase in hard drug addicts. The fact that according to various statistics, including those of the Amsterdam Municipal Health Service, young people in the Netherlands rarely start using hard drugs such as heroin or cocaine before the age of 20 rather suggests the opposite in fact*.
The fact that there are virtually no young people under 20 using heroin or cocaine in the Netherlands is extremely gratifying, especially as experience shows that the later in life a person starts using a drug the greater the chance of their overcoming their addiction at some stage.
Care providers are now facing new developments, however.
As already described above, the nuisance caused by some addicts has increased. Secondly, care workers are having to deal with an increasingly large variety of extremely problematic target groups, all of whom need to be approached in a different way. Examples include mentally disturbed addicts, addicts whose lifestyles involve a lot of crime and/or aggression, addicts who are homeless and young addicts with no fixed address, foreign addicts and multiple drug users. What links these groups is the fact that their addiction is not an isolated problem but often bound up with other problems, such as psychiatric disorders and problems of lifestyle and/or social deprivation. Diseases such as TB and certain forms of hepatitis are increasingly common among addicts. Many of the addicts in these target groups are in a poor physical and mental condition, partly as a result of the long-term use of drugs and their chance of recovery is therefore small*.
Dutch policy on hard drug addicts has for a long time been based on the principle that addicts should be treated as patients requiring treatment for their addiction, that treatment being geared to ensuring their abstinence from drugs in future. However, there are few scientifically sound, broad-based evaluations of the effectiveness of such treatment programmes in the somewhat longer term but what studies there are reveal that they have only a limited effect on the progress of the addiction process*,*.
Care aimed at limiting the damage caused while a person is addicted is reasonably successful, however. As a result, the health of Dutch addicts is relatively good, one current sign of which is the growing number of older addicts. Some Dutch addicts are also relatively well integrated in the community.
The disappointing results of some treatments aimed only at abstinence, and the emergence of new groups of addicts, whose addiction is only one component of a whole range of problems, mean that adjustments need to be made in the types of preventive work carried out and care provided. The government believes that the following innovations should have the highest priority:
The innovations involved concern the care provided to all drug addicts and the prevention work aimed at vulnerable groups who are at risk of addiction. At the same time, particular attention will be paid to problematic addicts, who are often those involved in crime.
Each of the above-mentioned priorities in the renewal of care is discussed briefly below.