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Samenvatting Middelenmisbruik-preventie en behandeling
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MIDDELENMISBRUIK1
,INHOUDSOPGAVE
1. VERSLAVING EN HERSTEL ............................................................................................................................................................. 7
1.1. Recente geschiedenis .................................................................................................................................................. 7
1.1.1. herstel in de geestelijke gezondheidszorg ..........................................................................................................................7
1.1.2. herstel in de verslavingszorg ......................................................................................................................................................8
1.2. Conceptualisering van herstel ..................................................................................................................................... 8
1.2.1. van der stel: 4 subprocessen van herstel ...................................................................................................................................9
1.2.2. chime-d leamy en stuart ..........................................................................................................................................................10
1.2.3. herstelkapitaal .........................................................................................................................................................................11
1.2.4. relationeel herstel ....................................................................................................................................................................11
1.3. Implicaties voor ondersteuning ................................................................................................................................. 12
1.3.1. verschuiving van de aanpak .....................................................................................................................................................12
1.3.2. verschillende wezgen naar herstel ...........................................................................................................................................12
1.3.3. pijlers voor herstelondersteunende hulpverlening ..................................................................................................................12
2. ALCOHOL, AN INCONVENIENT TRUTH ........................................................................................................................................... 13
2.1. Alcohol gerelateerde gezondheidsproblemen ........................................................................................................... 13
2.2. Impact van alcohol op gezondheid is complex .......................................................................................................... 13
2.3. Wat kunnen wij doen om de risico’s te beperken...................................................................................................... 14
2.4. Getuigenis alcoholverslaving..................................................................................................................................... 14
3. PERSONEN MET COMPLEXE ONDERSTEUNINGSNODEN: “DUBBELE DIAGNOSE” ~ CLARA .......................................................................... 16
3.1. Dubbele diagnose’: what’s in a name? ..................................................................................................................... 16
3.1.1. Personen met een dubbele diagnose.......................................................................................................................................16
3.1.2. Rol van gebruik ........................................................................................................................................................................16
3.1.3. Van ‘dubbele diagnose’ naar complexe ondersteuningsnoden ...............................................................................................16
3.2. Ondersteuning ........................................................................................................................................................... 17
3.2.1. Historische context ..................................................................................................................................................................17
3.2.2. Focus vnl. op symptoomreductie: medische kijk .....................................................................................................................17
3.3. Opzoek naar inspirerende praktijken ........................................................................................................................ 17
3.3.1. Mijn doctoraatsonderzoek .......................................................................................................................................................18
3.3.2. Villa Voortman .........................................................................................................................................................................18
3.3.3. Ondersteuningslandschappen .................................................................................................................................................20
3.4. Kritische reflectie ....................................................................................................................................................... 20
4. AMBULANTE VERSLAVINGSZORG ................................................................................................................................................. 21
4.1. Situering in het ruimere landschap ........................................................................................................................... 21
4.2. Overzicht voornaamste voorzieningen ...................................................................................................................... 21
4.2.1. msoc – Medisch sociaal opvang centrum ................................................................................................................................21
4.2.2. ambulante centra .....................................................................................................................................................................22
4.2.3. Centrum Geestelijke Gezondheidszorg ....................................................................................................................................22
4.2.4. Dagwerkingen ..........................................................................................................................................................................22
4.2.5. Dagbehandelingen ...................................................................................................................................................................22
4.2.6. Sociale werkplaats ...................................................................................................................................................................23
4.2.7. Varia: druglijn, internet, … .......................................................................................................................................................23
4.2.8. Herstelgericht werken? ............................................................................................................................................................23
4.2.9. Uitdagingen voor ambulante verslavingszorg ..........................................................................................................................23
4.3. Wat is verslaving ....................................................................................................................................................... 23
4.4. VISIE OP AMBULANTE VERSLAVINGSZORG VANUIT DE KIEM ................................................................................... 25
4.4.1. Hoe werken wij? ......................................................................................................................................................................25
4.4.2. Overzicht verschillende modules .............................................................................................................................................26
4.4.3. Herstelondersteundend werken binnen AC De Kiem? .............................................................................................................27
5. VISIE OP VERSLAVING EN HERSTEL BEPAALT ZORGVORM EN -INHOUD.................................................................................................. 28
5.1. verslaving als chronisch, recidiverende hersenziekte ................................................................................................ 28
5.2. Addiction: need for a shifting focus........................................................................................................................... 28
5.3. Implicaties voor behandeling .................................................................................................................................... 29
5.3.1. Findings after 20 years of harm reduction in the UK ...............................................................................................................30
5.3.2. Ook in Nederland worden beperkingen erkend (Stollenga, 2014) ...........................................................................................30
5.4. Wat leren we uit onderzoek naar herstel .................................................................................................................. 30
2
, 5.4.1. 40 YEARS OF ADDICTION RESEARCH: WHAT do we know about treatment & RECOVERY? (SCOTT & DENNIS, 2003) ............32
5.4.2. Recovery Prevalence (Best et al., 2019) ...................................................................................................................................32
5.4.3. Recovery enablers (Humphreys and Lembke (2013) ...............................................................................................................33
5.4.1. De rol van alcohol- en drughulp verlening? .............................................................................................................................33
5.5. Recovery pathways ................................................................................................................................................... 34
5.6. Spontaan herstel ....................................................................................................................................................... 35
5.6.1. Natural recovery ......................................................................................................................................................................35
5.6.2. Tips and tricks of Recovery management (Dennis, Scott & Laudet, 2014) ..............................................................................36
6. RESIDENTIËLE BEHANDELING EN THERAPEUTISCHE GEMEENSCHAPPEN EN HUN ROL BINNEN HET ZORGCONTINUÜM ..................................... 37
6.1. residentiële behandeling ........................................................................................................................................... 37
6.1.1. ≠ Detox – behandeling .............................................................................................................................................................37
6.1.2. Residentieel vs. Ambulant........................................................................................................................................................38
6.1.3. Doel behandeling .....................................................................................................................................................................38
6.1.4. voordelen van resresidentiële behandeling volgens behandelaars? .......................................................................................38
6.1.5. Wat brengt residentiële behandeling op? ...............................................................................................................................39
6.2. gehanteerde methoden ............................................................................................................................................. 39
6.2.1. Minnesota model .....................................................................................................................................................................39
6.2.2. 12-stappen AA-Vlaanderen ......................................................................................................................................................40
6.3. Cognitieve gedragstherapie ...................................................................................................................................... 41
6.3.1. Werkt (residentiële) behandeling? ..........................................................................................................................................41
6.4. History and development of TCsµ ............................................................................................................................. 43
6.5. TCs and the evidence-base ........................................................................................................................................ 44
6.5.1. Evidence for effectiveness? .....................................................................................................................................................44
6.5.2. What to conclude from ‘the evidence’? ...................................................................................................................................45
6.6. Tcs in the network of services: supporting addiction recovery .................................................................................. 45
6.6.1. Coolmine Pathways through treatment (2015) .......................................................................................................................45
6.6.2. The role of Tcs in a network of drug services? .........................................................................................................................46
7. HARM REDUCTION – SPUITENRUIL............................................................................................................................................... 47
7.1. Harm reduction ......................................................................................................................................................... 47
7.1.1. HR Geschiedenis ......................................................................................................................................................................47
7.1.2. definitie Harm reduction ..........................................................................................................................................................48
7.1.3. Relevante vragen van een hulpverlener ..................................................................................................................................48
7.1.4. HR: EMCDDA ............................................................................................................................................................................49
7.1.5. UITGANGSPUNTEN HR .............................................................................................................................................................49
7.1.6. HR IS NIET.................................................................................................................................................................................49
7.1.7. ONTWIKKELING EUROPEES DRUGBELEID HR ...........................................................................................................................50
7.1.8. HR WERKT ................................................................................................................................................................................50
7.1.9. Harm reduction : bestaansrecht ..............................................................................................................................................50
7.2. Spuitenruil ................................................................................................................................................................. 51
7.3. µWaar en wanneer kan HR ....................................................................................................................................... 52
7.4. Harm reduction vs herstel ......................................................................................................................................... 52
7.4.1. Een brede invulling van herstel ................................................................................................................................................53
7.4.2. HR en herstel............................................................................................................................................................................53
7.5. Harm reduction in een nutchell ................................................................................................................................. 53
7.6. Spuitenruil ................................................................................................................................................................. 53
7.6.1. doelstelling ...............................................................................................................................................................................54
7.6.2. wettelijk kader .........................................................................................................................................................................54
7.6.3. regestratie ................................................................................................................................................................................55
7.6.4. Maatschappelijke kijk op harm reduction ................................................................................................................................56
8. OUDERSCHAP ONDER DRUK/DRUGS: RISICO EN PROTECTIEVE FACTOREN ............................................................................................. 57
8.1. Toenemende aandacht voor KOAP-Problematiek ..................................................................................................... 57
8.2. Ouderschap en middelenafhankelijkheid .................................................................................................................. 57
8.2.1. risicofactoren ouders ...............................................................................................................................................................58
8.2.2. Protectieve factoren ouders ....................................................................................................................................................59
8.2.3. goed (genoeg) ouderschap ......................................................................................................................................................59
8.2.4. basisvoorwaarden voor ondersteuning KOAP in de thuissituatie ............................................................................................59
8.3. Kinderen van ouders met een verslavingsproblematiek ........................................................................................... 59
3
, 8.3.1. prenatale periode ....................................................................................................................................................................59
8.3.2. risico’s bij pasgeborenen .........................................................................................................................................................60
8.3.3. Het foetaal alcoholsyndroom FAS ............................................................................................................................................60
8.3.4. Risico’s bij jonge kinderen (2 tot 6jaar) ....................................................................................................................................61
8.3.5. risico’s bij schoolgaande kinderen van ouders met een verslavingsproblematiek ..................................................................61
8.3.6. Plaatsing ...................................................................................................................................................................................62
8.3.7. veerkracht (resilience) .............................................................................................................................................................62
8.3.8. Intergenerationele afhankelijkheid ..........................................................................................................................................63
8.3.9. Realistisch beeld ......................................................................................................................................................................63
8.4. Implicaties voor de hulpverlening ............................................................................................................................. 63
8.5. Aanbevelingen........................................................................................................................................................... 64
8.5.1. Methodieken voor opvoedingsondersteuning .........................................................................................................................65
8.5.2. netwerkvorming .......................................................................................................................................................................65
8.6. Aiden’s verhaal .......................................................................................................................................................... 65
9. DRUGS EN DRUGBELEID IN DE GEVANGENISSEN .............................................................................................................................. 66
9.1. Introductie ................................................................................................................................................................. 66
9.2. Relevantie.................................................................................................................................................................. 66
9.3. Monitoring drugs in Belgische gevangenissen .......................................................................................................... 66
9.3.1. Druggebruik onder de gevangenispopulatie ............................................................................................................................67
9.3.2. Gezondheid van druggebruikende gevangenen ......................................................................................................................69
9.3.3. Redennen van gebruik in de gevangenis ..................................................................................................................................69
9.4. Drugbeleid in de gevangenissen - historiek ............................................................................................................... 70
9.4.1. Penitentiair drugbeleid: anno 2021 .........................................................................................................................................70
10. ZELFHULPGROEPEN – EMPOWERMENT IN HERSTEL ......................................................................................................................... 72
10.1. Probleemstelling........................................................................................................................................................ 72
10.2. ZELFHULP .................................................................................................................................................................. 73
10.2.1. Hoe werken zelfhulpgroepen .............................................................................................................................................73
10.2.2. Buddy systeem....................................................................................................................................................................74
10.2.3. Zelfhulpgroepen als sociale steun ......................................................................................................................................74
10.2.4. STIGMA EN SCHAAMTE.......................................................................................................................................................74
10.2.5. Actieve participatie .............................................................................................................................................................74
10.2.6. Empowerment ....................................................................................................................................................................75
10.2.7. Meerwaarde zelfhulp voor herstelproces...........................................................................................................................75
11. ERVARINGSKENNIS EN MIDDELENMISBRUIK ................................................................................................................................... 76
11.1.1. praktijkonderzoek en cocreatie in beeld ............................................................................................................................76
11.2. Centrale vragen ......................................................................................................................................................... 76
11.2.1. DEFINIERING CENTRALE BEGRIPPEN...................................................................................................................................76
11.2.2. DRIE POSITIES VAN ERVARINGSKENNIS ..............................................................................................................................76
11.2.3. ERVARINGSDESKUNDIGHEID ..............................................................................................................................................76
11.3. Waarom is ervaringskennis belangrijk ...................................................................................................................... 77
11.3.1. historische voedingsbodem ................................................................................................................................................77
11.4. Ervaringsdeskundigen als beeldvormer in “de media” .............................................................................................. 78
11.5. CGZ/ verslavingszorg & herstel ................................................................................................................................. 78
11.6. Breeder vraagstuk ..................................................................................................................................................... 78
11.7. Hoe in te zetten ......................................................................................................................................................... 79
11.7.1. evenwaardige positie ..........................................................................................................................................................79
11.8. Concreet .................................................................................................................................................................... 80
11.9. Besluit ........................................................................................................................................................................ 80
12. GENDER EN VERSLAVING ........................................................................................................................................................... 81
12.1. Invloed van gender op ............................................................................................................................................... 81
12.1.1. Extra drempels voor vrouwen ............................................................................................................................................82
12.1.2. Gender sensitieve preventie ...............................................................................................................................................82
12.1.3. Laatste decennia .................................................................................................................................................................83
12.2. Gen Star initiatief ...................................................................................................................................................... 83
12.2.1. Gender-responsieve preventie initiatieven ........................................................................................................................84
12.2.2. Gender-responsieve ambulante initiatieven ......................................................................................................................84
12.2.3. Gender-responsieve residentiële initiatieven .....................................................................................................................84
4
,13. PROBLEEMGEBRUIK EN HERSTELKAPITAAL BIJ MENSEN MET MIGRATIEACHTERGROND ............................................................................ 86
13.1. What’s in a name ...................................................................................................................................................... 86
13.1.1. migranten en etische minderheden (MEM) .......................................................................................................................86
13.1.2. Middelenmisbruik en herstelkapitaal .................................................................................................................................86
13.1.3. Methodologie .....................................................................................................................................................................86
13.2. Herstelkapitaal onder druk bij MEM ......................................................................................................................... 87
13.2.1. Persoonlijk HK : fysiek + menselijk kapitaal ........................................................................................................................87
13.2.2. Sociaal kapitaal ...................................................................................................................................................................87
13.2.3. Gemeenschaps- & cultureel kapitaal ..................................................................................................................................87
13.2.4. triple stigma ........................................................................................................................................................................88
13.2.5. intersectionaal en meervoudig stigma ...............................................................................................................................88
13.2.6. barrières naar/in hulpverlening ..........................................................................................................................................89
13.2.7. culturele competentie als “holy grail” ................................................................................................................................89
13.3. Herstelkapitaal bij MEM ........................................................................................................................................... 89
13.3.1. persoonlijk herstelkapitaal .................................................................................................................................................89
13.3.2. Sociaal herstelkapitaal ........................................................................................................................................................90
13.3.3. Gemeenschapskapitaal .......................................................................................................................................................90
13.3.4. cultureel kapitaal ................................................................................................................................................................90
13.4. Conclusie en aanbevelingen ...................................................................................................................................... 90
14. SUBSTITUTIEBEHANDELING: METHADON, BUPRENORFINE EN HEROÏNE .......................................................................... 92
14.1. Opiaatafhankelijkheid en hulpverlening ................................................................................................................... 92
14.1.1. Ervaren drempels t.o.v. hulpverlening ................................................................................................................................92
14.2. Evolutie substitutiebehandeling in België ................................................................................................................. 92
14.3. Substitutiebehandeling ............................................................................................................................................. 93
14.3.1. Abstinentieverschijnselen bij stoppen opiaatgebruik .........................................................................................................93
14.3.2. Voordelen substitutiebehandeling .....................................................................................................................................94
14.3.3. En wat met buprenorphine? ...............................................................................................................................................94
14.3.4. Indicaties en contra-indicaties ............................................................................................................................................94
14.3.5. Substitutiebehandeling .......................................................................................................................................................94
14.4. Verschil methadon – heroïne .................................................................................................................................... 95
14.4.1. Substitutiebehandeling .......................................................................................................................................................95
14.5. Medisch-sociale opvangcentra.................................................................................................................................. 95
14.6. Methadonbehandeling in de praktijk ........................................................................................................................ 95
14.6.1. Procedures ..........................................................................................................................................................................96
14.6.2. Onderhoudsfase .................................................................................................................................................................96
14.6.3. Herstarten na onderbreking ...............................................................................................................................................96
14.6.4. Beleid bij bijgebruik ............................................................................................................................................................97
14.6.5. Afbouw ...............................................................................................................................................................................97
14.6.6. Toediening… .......................................................................................................................................................................97
14.7. evidentie voor effectiviteit!? ..................................................................................................................................... 97
14.8. Wat na substitutiebehandeling ................................................................................................................................. 97
14.8.1. Onderzoeksmethodologie ..................................................................................................................................................98
14.8.2. Componenten van een “goed leven” ..................................................................................................................................98
14.8.3. Conclusies ...........................................................................................................................................................................99
14.8.4. Klinische implicaties ............................................................................................................................................................99
14.9. Gecontroleerde heroineversterking ......................................................................................................................... 100
14.9.1. Behandeling met behulp van heroïne ...............................................................................................................................100
14.9.2. Ethische vragen.................................................................................................................................................................100
14.9.3. Gecontroleerde heroïneverstrekking in Zwitserland ........................................................................................................100
15. PLENAIRE SESSIE – EUROPA ASI................................................................................................................................................ 101
15.1. Algemeen ................................................................................................................................................................ 101
15.1.1. Geschiedenis .....................................................................................................................................................................101
15.1.2. voordelen..........................................................................................................................................................................102
15.1.3. nadelen .............................................................................................................................................................................102
15.2. Structuur van de EUROP-ASI ................................................................................................................................... 103
15.3. Scoring van de EUROP-ASI....................................................................................................................................... 103
15.3.1. zelfbeoordeling cliënt .......................................................................................................................................................104
5
, 15.4. Ernst score ............................................................................................................................................................... 104
15.4.1. stap 1 : ERnstproces..........................................................................................................................................................105
15.4.2. stap 2: zelf-beoordeling cl.................................................................................................................................................106
15.5. De eerste drie levensdomeinen ............................................................................................................................... 106
15.5.1. Lichamelijke gezondheid...................................................................................................................................................108
15.5.2. arbeid, opleiding en inkomen ...........................................................................................................................................109
15.5.3. Alcohol en druggebruik .....................................................................................................................................................110
15.6. Feedback formulier ................................................................................................................................................. 113
15.6.1. Voordelen: ........................................................................................................................................................................114
15.6.2. Positieve negatieve aspecten ...........................................................................................................................................114
15.6.3. Ernstscore .........................................................................................................................................................................114
15.6.4. motivatie ernstscore .........................................................................................................................................................114
16. OPDRACHT LES 2 ................................................................................................................................................................... 115
17. PLENAIRE SESSIE 2: MOTIVERENDE GESPREKSVOERING .................................................................................................................. 116
17.1. Basisideeën.............................................................................................................................................................. 116
17.1.1. Continuüm van communicatiestijlen: ...............................................................................................................................116
17.2. Doelen ..................................................................................................................................................................... 117
17.3. Basisbegrippen ........................................................................................................................................................ 117
17.3.1. motivatie...........................................................................................................................................................................117
17.3.2. ambivalentie .....................................................................................................................................................................119
17.3.3. wrijving .............................................................................................................................................................................121
17.4. Stadia van verandering ........................................................................................................................................... 121
17.5. Stadia van verandering ........................................................................................................................................... 122
17.5.1. persoonlijke zones voor verandering ................................................................................................................................123
17.6. Gedragsverandering ................................................................................................................................................ 123
17.7. Definitie Motiverende gespreksvoering .................................................................................................................. 123
17.8. Werkcollege Motiverende gespreksvoering ............................................................................................................ 124
17.8.1. DOORHEEN DE STADIA VAN VERANDERING .....................................................................................................................124
17.8.2. basisprincipes ...................................................................................................................................................................127
17.8.3. oefeningen ........................................................................................................................................................................128
18. EXAMEN ............................................................................................................................................................................ 130
6
,1. Verslaving en herstel
Oxycodon = grootste doodsoorzaak amerika, meer dan ongevallen
Schriftelijk examen met openvragen, 10 punten, 5 punten op Openvragen en 5 punten op een mondelinge
vraag. 10 punten op oefeningen waarvan 5punten op een oefening op het examen en 5punten op een paper
over de EuropASI.
( eerste deel van de les = kijken in andere SV want heb hier niet teveel bijgeschreven over de prevalentie
zeker half uur van de les)
1.1. Recente geschiedenis
1.1.1. HERSTEL IN DE GEESTELIJKE GEZONDHEIDSZORG
’60: antipsychiatrie (Rissmiller & Rissmiller, 2006)
→ Foucault (Frankrijk), Basaglia (Italië), Laing (UK), Szasz (USA)
→ Kritiek: macht van totalitaire instituten, medische framing van psychische problemen en eindeloos
karakter van opnames
’70: Amerikaanse survivor movement (Morrison, 2013)
→ Kritiek: inhumane omstandigheden, sociale ongelijkheid,…
→ Weg van de medisch klinische enge kijk naar een ondersteuningsdenken
→ Heel erg bottom-up
→ Opkomen voor de rechten van patiënten
→ Gaat heel er sterk
Deïnstitutionalisering = een verschuiving van de instituten meer naar de samenleving.
“[Recovery is] a process, a way of life, an attitude, and a way of approaching the day’s challenges. It is not
a perfectly linear process. […] The need is to meet the challenge of the disability and to re-establish a new
and valued sense of integrity and purpose within and beyond the limits of the disability; the aspiration is to
live, work, and love in a community in which one makes a significant contribution.” Patricia Deegan
Recovery in de jaren 80 voor het eerst beschreven, door een lid van de survivor movement, herstel is
geen eindpunt.
‘90: professionele adoptie van hersteldenken
→ Eerst in USA, later ook in Europa (Chow, Ajaz & Priebe, 2018; Kidd, McKenzie & Virdee, 2014)
→ Veel aandacht voor holistisch kijken op het hersteldenken, vooral ook vanuit de top down,
professionele wereld.
→ Cf. definitie Anthony (1993)
“[Recovery is] a deeply personal, unique process of changing one’s attitudes, values, feelings, goals,
skills and/or roles. It is a way of living a satisfying, hopeful, and contributing life, even with limitations
caused by illness. Recovery involves the development of new meaning and purpose in one’s life as one
grows beyond the catastrophic effects of mental illness.”
2009: Artikel 107 van de Ziekenhuiswet
→ Hervorming van de Belgische geestelijke gezondheidszorg
7
, → Ontstaan nieuwe initiatieven: outreachende hulpverlening, community-based initiatieven Vb.
beschut wonen, villa voortman…
→ Herstel als richtinggevend kader
1.1.2. HERSTEL IN DE VERSLAVINGSZORG
18e-19e eeuw: ontstaan verslavingszorg in USA
→ Ervaringsdeskundigen, mutual aid, therapeutische gemeenschappen, NA & AA
→ Verschillende invullingen van herstel (Best et al., 2016), abstinentie als beginpunt van herstel, is
niet overal de startpunt van herstel wel bij AA, Als je een verslaving hebt dan is het een eeuwig
durend proces, er is geen eindpunt. = veel verschillende invullingen, kan ook zijn dat herstel eindig
is in de tijd. Herstel wordt anders opgevat naargelang verschillende initiatieven.
‘60-’70:
→ ‘Ex-verslaafden’ als paraprofessional
’70-’80: professionalisering van de drughulpverlening (White, 2012)
→ Evolutie richting acute zorginterventies + aandacht voor klinische functies
→ Paraprofessional → klinisch professional (screenen, diagnosticeren, behandelen)
‘80: hiv-crisis
→ Aandacht voor schadebeperking: methadon-substitutie
→ Voorkomen en verminderen van gezondheidsproblemen en risico’s
Maar…
→ Beperkingen van acuut zorgmodel en harm reduction-initiatieven
→ Hoge drop-out en herval (Laudet et al., 2007; McKeganey, 2006)
Recent
→ Aandacht voor herstel op lange termijn → verschillende wegen naar herstel
→ ‘Sustained recovery’ + VEEL MEER GENUANCEERD HERSTEL, focus meer op het proces,
contextgerichter en verschillende persoonlijke invullingen voor herstel
Zesde staatshervoming = Verschuiving bevoegdheden m.b.t. verslavingszorg naar Vlaamse overheid,
Focus op persoonlijk herstel, individu niet los van de context,…
Visietekst: zorg aangepast aan noden van het individu, aandacht voor (vroeg)interventie, oog voor context,
ondersteuning zo regionaal en lokaal als mogelijk,…
“Herstel van verslavingsgedrag en eraan gerelateerde problemen is een individueel proces van positieve
verandering, op vlak van gezondheid, dagelijks functioneren, maatschappelijke participatie en
persoonlijke ontwikkeling.” (Vandeurzen, 2015
1.2. Conceptualisering van herstel
Consensus over persoonlijk herstel…
→ Procesmatig karakter eerder dan ‘mijlpaal’
→ Idiosyncratisch karakter
8
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