‘Evidence-based’-werken in de verslavingszorg: geen evidentie?

Abstract

De laatste jaren wordt de term 'evidence-based' steeds vaker in de mond genomen en verschijnen er tal van publicaties die het belang van 'evidence-based practice' (EBP) en 'evidence-based'-richtlijnen (EBR) in de verslavingszorg benadrukken. De kloof tussen theorie en praktijk is echter een welbekend probleem en op de werkvloer lijkt men vrij terughoudend te staan tegenover deze nieuwe tendens. In dit artikel wordt daarom bekeken wat de kennis is van praktijkwerkers over EBP en EBR, welke houding zij tegenover deze ontwikkeling aannemen en in welke mate zij de methoden en richtlijnen toepassen. Dit gebeurt aan de hand van de resultaten van een bevraging in de Belgische verslavingszorg, waarbij sleutelfiguren uit zestig verschillende voorzieningen in België geïnterviewd werden. Op basis van de resultaten worden aanbevelingen geformuleerd voor de praktijk. InleidingDe laatste jaren wordt de term 'evidence-based' steeds vaker in de mond genomen en verschijnen er met de regelmaat van de klok publicaties die de noodzaak van het toepassen van 'evidence-based'-methoden en -richtlijnen in de verslavingszorg benadrukken. Deze terminologie is afgeleid van het begrip 'evidence-based medicine' (EBM), dat in 1992 voor het eerst gelanceerd werd door Sackett en collega's in het befaamde tijdschrift

‘The Human Prerogative’: A Critical Analysis of Evidence-Based and Other Paradigms of Care in Substance Abuse Treatment

“…Such concerns were also expressed by clinicians, treatment providers and researchers at various national and international conferences in Brussels (Belgian Federal Science Policy, March 27, 2007), Thessaloniki ( . Similar reactions were observed during a study we made concerning the implementation and application of evidence-based interventions and guidelines in Belgian substance abuse treatment [10]. Strikingly, in the French-speaking part of Belgium (the Walloon provinces), which has a strong psychodynamic treatment tradition and is more closely oriented to the Latin tradition and the Southern European countries, the opposition towards the evidence-based paradigm is much stronger than in the Dutch-speaking part of the country (Flanders).…”

Practitioners’ Attitudes concerning Evidence-Based Guidelines in Belgian Substance Abuse Treatment

“…Moreover, in Flanders the AngloSaxon, empirical-analytical orientation is more commonly accepted, while the Latin-French tradition and the application of the psychodynamic theory is more widespread in the Walloon region. The fact that there is not much evidence yet for the effectiveness of the psychodynamic approach in treating substance abuse problems [29] could also explain the less positive attitude.…”

“…As in Germany, Italy and Spain [31] , guidelines in Belgium are on the rise in medical sciences [32] . For substance abuse treatment, almost no evidence-based guidelines have been developed yet in Belgium [29] . However, it is debatable whether each national organization in Europe needs to produce its own guidelines, since the evidence underlying guideline recommendations is usually of an international nature [33] .…”

“…In various countries such as the United States, Canada, Australia, New Zealand, the UK, the Netherlands and Sweden, evidence-based guidelines have been developed for substance abuse treatment by national organisations, universities and research centres [20,[24][25][26][27][28][29] . In France, some evidence-based guidelines have also been developed for pharmacotherapeutic interventions in substance abuse treatment [30] .…”

Multi‐context versus context‐specific qualitative evidence syntheses: combining the best of both

“…In addition, and where possible, we used a methodological filter on qualitative research. The QES eventually included eight articles reporting on perspectives from different target groups working in the Belgian health care and political context (Van Driel et al 2003;Hannes et al, 2005;Heymans et al, 2006;Autrique et al, 2007;Hannes et al, 2007;Hannes et al, 2008;Hannes et al, 2009;Hannes et al, 2010).…”