Background: In the last decade, the clinician-patient relationship has become more of a partnership. There is growing interest in shared decision-making (SDM) in which the clinician and patient go through all phases of the decision-making process together, share treatment preferences, and reach an agreement on treatment choice. The purpose of this review is to determine the extent, quality, and consistency of the evidence about the effectiveness of SDM. Method: This is a systematic review of randomised controlled trials (RCTs) comparing SDM interventions with non-SDM interventions. Eleven RCTs met the required criteria, and were included in this review. Results: The methodological quality of the studies included in this review was high overall. Five RCTs showed no difference between SDM and control, one RCT showed no short-term effects but showed positive longer-term effects, and five RCTs reported a positive effect of SDM on outcome measures. The two studies included of people with mental healthcare problems reported a positive effect of SDM. Conclusions: Despite the considerable interest in applying SDM clinically, little research regarding its effectiveness has been done to date. It has been argued that SDM is particularly suitable for long-term decisions, especially in the context of a chronic illness, and when the intervention contains more than one session. Our results show that under such circumstances, SDM can be an effective method of reaching a treatment agreement. Evidence for the effectiveness of SDM in the context of other types of decisions, or in general, is still inconclusive. Future studies of SDM should probably focus on long-term decisions.

The aim of the present study was to evaluate the psychometric properties of the Dutch version of the Readiness to Change Questionnaire (RCQ-D). The subjects were 246 excessive drinkers admitted to an addiction treatment centre and 54 offenders convicted of an alcohol-related crime in The Netherlands. The factor structure of the RCQ-D for the two samples combined was found to be consistent with the three-factor structure established for the original RCQ. The reliability of the items for each scale was found to be satisfactory. Allocated stage of change showed significant differences between the different subsamples. As expected, the scale scores for adjacent stages of change showed significantly higher inter-correlations than the scale scores for non-adjacent stages. Additionally, the negatively formulated items from the pre-contemplation scale were reformulated positively and their internal consistency tested among the offender sample. The positively formulated pre-contemplation items showed a higher alpha value than the negatively formulated items. We therefore suggest that the positively formulated items should replace the negatively formulated ones.

BackgroundThe automatic tendency to attend to and focus on substance-related cues in the environment (attentional bias), has been found to contribute to the persistence of addiction. Attentional bias modification (ABM) interventions might, therefore, contribute to treatment outcome and the reduction of relapse rates. Based on some promising research findings, we designed a study to test the clinical relevance of ABM as an add-on component of regular intervention for alcohol and cannabis patients.Design/MethodsThe current protocol describes a study which will investigate the effectiveness and cost-effectiveness of a newly developed home-delivered, multi-session, internet-based ABM (iABM) intervention as an add-on to treatment as usual (TAU). TAU consists of cognitive behavioural therapy-based treatment according to the Dutch guidelines for the treatment of addiction. Participants (N = 213) will be outpatients from specialized addiction care institutions diagnosed with alcohol or cannabis dependency who will be randomly assigned to one of three conditions: TAU + iABM; TAU + placebo condition; TAU-only. Primary outcome measures are substance use, craving, and rates of relapse. Changes in attentional bias will be measured to investigate whether changes in primary outcome measures can be attributed to the modification of attentional bias. Indices of cost-effectiveness and secondary physical and psychological complaints (depression, anxiety, and stress) are assessed as secondary outcome measures.DiscussionThis randomized control trial will be the first to investigate whether a home-delivered, multi-session iABM intervention is (cost-) effective in reducing relapse rates in alcohol and cannabis dependency as an add-on to TAU, compared with an active and a waiting list control group. If proven effective, this ABM intervention could be easily implemented as a home-delivered component of current TAU.Trial registrationNetherlands Trial Register, NTR5497, registered on 18th September 2015.

PSG proves to be a rare phenomenon among adult scratchcard buyers in the Netherlands. Both incidence and prevalence of the DSM-IV diagnosis PSG were low. Stability of the DSM-IV diagnosis PSG, DSM-IV criteria and South Oaks Gambling Screening-S (SOGS-S) problems were low. Prevalence was stable over the time because incidence and recovery rates were very similar.

Scratchcards have a very low addiction potential among adults in the Netherlands. Given the specific characteristics of the unique PSG and the relatively small amount of money they spent, the appropriateness of DSM criteria for this particular form of gambling can be questioned.