Country Profile - Belgium

Belgium is a federal state. In this summary we only focus upon the situation in the Flemish speaking part of the country.

Problems in the treatment of alcoholism.

Several problems and short-comings are frequently encountered:

Late diagnosis

Usually, treatment only starts when the patient suffers from serious medical problems or when he begins to behave in a psychosocially disturbed way. The prognosis is better if diagnosis and treatment occur in the early stages of addiction. Early diagnosis and motivation for treatment are important tasks for both general practitioners and physicians.

Treatment focuses on the symptoms

Because alcoholics only ask for treatment when the symptoms are advanced, the secondary problems tend to be dealt with first. Other components of the complex background are often ignored, for example the psychological and social factors that play a rôle on in the development of alcoholism.

Fragmentary help

Since treatment of alcoholism merely focuses on the symptoms it usually remains temporary and restricted to just one aspect of the problem. Too little attention is paid to all the primary aspects of the problem and insufficient efforts are made to keep patients in continuous treatment.

Insufficient inter-disciplinary co-operation

Strictly medical interventions are often of vital importance in the recovery of the alcoholic, but usually they are insufficient in providing long term stability. Because of the complexity of alcoholism, there is a greater need for more co-operation between the different disciplines, for example, liaison-psychiatry and networking between medical and psychosocial disciplines.

Lack of practical experience

A survey proved that the theoretical medical knowledge of our doctors is very good, but that there is a need for more practical training and experience in the field of early detection, assessment, motivation, orientation and referral, and how to deal with dual diagnosis.

The situation in Belgium:

Medical education is organised at university level. The length of study depends on the speciality. For general practitioners it is 7 years, for specialists (psychiatrists, hepatologists) an additional 5 years. There are four universities where the courses are conducted in Flemish: Antwerp, Brussels, Ghent and, Louvain.

Theoretical and practical instruction mainly focuses on alcohol-related disorders. This material is discussed in all kinds of traditional medical courses (e.g. hepatology, pharmacology, psychiatry). Only in psychiatry, however, is more attention being paid to the development of a wider biopsychosocial vision.

No separate specialised course on the treatment of alcohol dependence exists. More specific issues of addiction are dealt with in several kinds of postgraduate courses. Therefore general practitioners strongly feel the need to follow postgraduate medical education.

Positive perspective.

The above mentioned problems and shortcomings in teaching and practice are clearly recognised by many experts involved with practical medical education. During the last few years more attention has been paid to these aspects in the traditional clinical courses. At present more efforts are being made to offer a better education and training of general practitioners.

On the other hand, no university has yet taken the initiative in organising a specific basic course on this subject, despite its importance. As a result of a wider reorganisation of the teaching at one university, there is an option to approach the sub-aspects of alcoholism in a more integrated system involving different specialists. At another university there used to be a specific post-graduate multi-disciplinary programme for addiction and its treatment. This merely focused on the drug problem and was more orientated to non-medical professionals.

Many local initiatives exist in the context of postgraduate education of general practitioners: lectures, seminars, work-groups where much attention is paid to therapeutical problems. There is also a continuing project, sponsored by the WHO, for a more systematic implementation of the AUDIT in primary care, connected to local awareness training. The feedback seems to be very positive. The VAD, the Flemish umbrella-organisation for the prevention and treatment of substance abuse, is also preparing a specific programme for general practitioners.

Conclusions

Permanent training courses are very important, but at the present only those interested take part and benefit. Before quality in the care of alcoholics and in their environment can be established, basic education at universities must improve.

Dr S. Ansoms