Vision on addiction care: ‘Someone with an addiction is not to blame’

15 September 2025

Addiction occurs about as often as depression, yet receives far less attention. Mainly due to stigma: it's your own fault. That’s unjustified, says professor of Addiction Care Arnt Schellekens. And pointing fingers only backfires, he argues: ‘From causes to treatment, addiction is no different from other mental disorders.’

About ten percent of Dutch people struggle with substance addiction, mainly to nicotine, alcohol, and cannabis. The share of heroin has declined rapidly in recent years. GHB emerged around the turn of the century and has remained stable over the past decade. Meanwhile, stimulant drugs like 3MMC and prescription drug addiction seem to be on the rise. ‘We can see trends in addiction, but we don’t really know whether the total number of people with substance addiction has increased over the past decades’, says Arnt Schellekens. ‘One thing is certain: addiction has always been around.’

Responsibility

Schellekens improves addiction care in various ways. He works as an addiction psychiatrist and as the national rapporteur on addictions for the Ministry of Health, Welfare and Sport (VWS), where he contributes to national addiction policy. As a professor of Addiction Care, he and his team conduct research on many aspects of addiction: from epidemiology to the link between addiction and other mental disorders, neurobiological research, and new treatment methods.

With all that knowledge and experience, his motto is: someone with an addiction is not to blame. Research shows that addiction is 50 to 60 percent attributable to genetic factors and also linked to environmental factors. Schellekens: ‘Think of traumatic events or social surroundings. Moreover, addictive substances disrupt the functioning of brain areas needed to regulate yourself, your emotions, and impulses. That makes it increasingly difficult to regain control and stop using after long-term use.’

So, no blame, but there is responsibility. ‘You’re not responsible for having diabetes, but you can choose to eat less sugar and get support from a dietitian. That’s how I view addiction’, says Schellekens. ‘A blaming finger can be sensed from miles away by the patient. It’s better to say: “I’m not judging you. It’s a terrible condition you didn’t choose, but I do need you to work with me on your recovery.” That increases autonomy, allowing the patient to make better personal choices.’

Spectacular results

Good addiction care actually starts much earlier, with prevention and education. ‘We’ve seen spectacular results with smoking’, says Schellekens. ‘That’s due to tobacco products becoming more expensive and less accessible, and bans on smoking in hospitality venues and tobacco advertising. Smoking is no longer the norm—a huge cultural shift over the past twenty to thirty years. Something similar may happen with alcohol.’

Still, despite prevention, some people will always become addicted. In those cases, preventive measures can sometimes backfire. ‘If you make cigarettes extremely expensive, fewer people start smoking. But someone already addicted won’t necessarily quit, and may end up in financial trouble.’ That means national policy must consider both prevention and addiction treatment.

According to Schellekens, accessible insured care is crucial: ‘We only reimburse one quit attempt per year. It would be better to reimburse multiple attempts. And to make specialized addiction care available to people who struggle to quit. Currently, only primary care support is reimbursed.’

Higher risk with ADHD

More attention is also needed for co-occurring disorders (comorbidity). Addiction often goes hand in hand with other mental health issues. Schellekens already showed in 2018 that children with ADHD are at higher risk of addiction. Treating ADHD well reduces that risk. The same applies to adults with ADHD, addiction treatment outcomes improve when ADHD is effectively addressed. International guidelines have since been developed based on this.

Other mental disorders, such as depression or psychosis, are also linked to addiction. ‘However, care for these conditions is organized separately: within addiction care and general mental health care. We can achieve a lot with a more integrated approach to addiction and other psychological issues’, says Schellekens. ‘That requires care organized around the patient, rather than through separate care circuits.’

Treatment and tapering

For many addictions, effective treatment programs exist in the Netherlands, such as for alcohol or heroin addiction. ‘For other addictions, we need to develop new treatment methods.’ Schellekens’ team already developed a successful tapering protocol for GHB addiction in 2013, which is now widely used internationally. ‘Tapering is complex here: withdrawal is intense, and overdose can lead to coma. Our protocol makes detoxification much safer and reduces complications. Patients receive pharmaceutical-grade GHB, which is gradually tapered under supervision.’ The team of Schellekens is currently testing whether another substance, baclofen, can partially replace GHB.

The team also developed a so-called rotation protocol for treating addiction to strong (opioid) painkillers. Under supervision, patients switch to a different type of painkiller that is easier to taper off. Schellekens: ‘In 2012, a patient was hospitalized at Radboudumc for months with severe pain and physical complications, alongside serious psychological issues due to extreme opioid use. As a test, we started treatment with the opioid buprenorphine. It’s less addictive and provides better pain relief with fewer side effects than other opioids. This significantly improves quality of life, creating space to begin tapering. Within a week, the patient was much more stable—both in terms of craving opioids and regarding pain and psychological symptoms.’ This rotation protocol is now widely used, including internationally, to the satisfaction of patients. ‘They often send postcards from holiday destinations to thank us for the good care.’

Harm reduction

Despite good care, there is still a group that cannot overcome substance addiction. Schellekens believes much can still be improved for them: ‘Sometimes tapering doesn’t work, and we have to accept that someone continues to use. It’s important to better identify these individuals, reduce the harm caused by drug use, and improve their quality of life.’

One option is a distribution program, where people with persistent addiction receive the substance they’re addicted to from their care facility, without the goal of quitting. Research shows that people often end up using less and visiting emergency services less frequently. Social disruption caused by their addiction also decreases. Such programs already exist for opioids like heroin and methadone, but could also work for alcohol or cocaine.

A cup of coffee

Another option is providing user spaces. These are mainly found in larger cities, but their availability has been declining for years. ‘Here, people are allowed to use their own drugs. Social workers or nurses are present to offer a sandwich and a cup of coffee, have a chat, and provide health education. They often also offer clean needles. This reduces the risk of infections like hepatitis and HIV.’ Less harm for the individual, and less social disruption.

At Radboudumc itself, Schellekens also sees room for improvement: ‘Many patients come in with complications from addiction. We’re not always able to identify addiction as the root cause, discuss it, and treat it. The lifestyle desk and joint multidisciplinary consultations are great steps, but we can further integrate addiction care into our treatment programs and pathways. Within our university medical center, but also in primary care, our attitude toward people with addiction truly matters.’

Learn more

Motivational interviewing techniques were originally developed for addiction care but are also useful in other situations where behavior change is desired—such as lifestyle, therapy adherence, or school motivation. Senior lecturer in communication skills Marion Biermans teaches these techniques in advanced training programs for addiction physicians and general practitioners: ‘Motivational interviewing is a proven effective therapy for addiction, especially for tackling smoking, alcohol, and cannabis. As a caregiver, you don’t judge, don’t try to fix, and don’t tell someone what to do. You work from equality and compassion, and help the patient articulate why they might want to change and what they need to do so.’ Physiotherapist Miranda Jacobs is a trainer and coach in Motivational Interviewing and organizes training sessions for Radboudumc staff.
 

Talking about addiction

Radboud Reflects is organizing the debate evening Vaping, alcohol or pills. Innocent addiction? with Arnt Schellekens and Marion Biermans, on Monday, September 22, from 20:00–21:30 at LUX, Nijmegen (in Dutch). For tickets and more info click here.

 

Illustration: Monique Wijbrands. This article appeared in Radbode #4, 2025.

• Want to know more about these subjects? Click on the buttons below for more news.

  News homepage news & media