[Psychological treatment in substance use disorders: focus for the future]. / Psychologische behandeling van verslaving: focus voor de toekomst.

BACKGROUND: Cognitive behavioural therapy and motivational interviewing are evidence-based treatments for substance use disorders (SUDs). However, treatment for SUDs is still at an early stage and patients are being deprived of many new forms of treatment from which they could benefit. Low treatment compliance and limited treatment success are also problems that need attention. AIM: To find out from the literature how these problems can be or are being tackled and to formulate suggestions for improvements. METHOD: We reviewed the literature, collecting and formulating suggestions about possible improvements in the treatment of SUD patients. We mention strategies to reduce the treatment gap, to improve treatment compliance and treatment results. RESULTS: According to the literature, clinics and hospital wards can introduce more structured screening for substance use disorders. Internet treatment has proven to lower the threshold for treatment. Patients reluctant to begin treatment can be motivated by their loved ones (via CRAFT) to join treatment programmes. E-health is a promising technique for enhancing patients' compliance with tasks that can be performed at home. The addition of contingency management can increase treatment compliance and encourage abstinence. Furthermore, the treatment of comorbid psychiatric disorders and the provision of continuing-care are strategies that are likely to optimise treatment results. CONCLUSION: A number of viable strategies are available or are being developed for improving the treatment of SUD patients. Dutch research has made an important contribution in this area.

Characterisation of bioactive glass coatings on titanium substrates produced using a CO2 laser.

Titanium and its alloys are widely used in load-bearing bioinert implants. Bioactive glasses (BAGs) form a chemical bond with bone, but they are not suitable for load-bearing applications. Creating a BAG coating on a titanium implant could combine the best properties of both materials. The results tend to be poor when conventional firing methods are applied to coat titanium with BAG. A local application of heat to melt the glass can be achieved by a CO2 laser. A new method is introduced to create BAG coatings on titanium locally in a controlled manner, with a focused CO2 laser beam. The coatings produced by this method precipitate calcium phosphate in vitro. Processing parameters (number of coated layers, laser power, and processing atmosphere) providing a firm attachment of the glass and good in vitro bioactivity were identified. XRD analysis showed no crystallisation of the glass due to processing with the laser. EDXA indicated the formation of a calcium phosphate layer, which FTIR suggested to be a hydroxyapatite. The results show CO2 laser processing to be a promising technique for the manufacture of 30-40 microm BAG coatings on titanium.

Implants coated with bioactive glass by CO2-laser, an in vivo study.

Due to ageing of the population, the number of revision operations is expected to increase. Thus good fixation of medical implants is crucial for successful treatment. In our previous studies, a method to coat titanium implants with bioactive glass (BAG) via CO2 laser treatment was introduced. It allows to localise the application of a bioactive coating, without heat treatment of the whole implant. In the present study, cylindrical titanium implants were used (BAG-coated, control group: NaOH-treated and grit-blasted Ti). Three implants were placed in each femoral epicondyle of six rabbits. After eight weeks the animals were sacrificed. Half of the implants were subjected to a torsional loading test. In the control groups, the failure occurred at the bone-implant interface, in the BAG group the failure occurred mainly in the reacted glass. The implants coated with BAG were integrated into host bone without a connective tissue capsule and were surrounded by significantly more bone than the control implants. The findings indicate clearly that the use of CO2 laser radiation to create BAG coatings did not inhibit the bioactive properties of the glass in terms of osteoconduction.

Subchondral bone and cartilage repair with bioactive glasses, hydroxyapatite, and hydroxyapatite-glass composite.

The repair of an osteochondral defect in rabbit femur was studied with three kinds of bioactive glasses (BG), hydroxyapatite (HA), and hydroxyapatite-glass (HAG) composite. Seventy-two osteochondral defects were created in 18 rabbits. Sixty-four cylinders were implanted and eight defects were left empty as controls. Histomorphometry, scanning electron microscopy (SEM) and energy dispersive X-ray analysis (EDXA) were used for evaluation. Small osteochondral defects in rabbit femur found to heal themselves by regeneration. The three BGs, HA, and HAG led to direct lamellar bone repair of subchondral bone and restoration of articular surfaces mostly with hyalinelike cartilage in 12 weeks. However, the composition of the materials affects their behavior. Chondrogenesis took place earlier with the BGs than with HA. HAG degraded too much, glass 14 was too reactive and brittle, and the high alumina content in glass 11 disturbed its bone-bonding ability. Glass 7 and HA were the most balanced in the repair process. A special preparation method was used to retain soft tissues fairly unchanged and enable them to the observed together with hard tissues in SEM analysis.

Titanium and bioactive glass-ceramic coated titanium as materials for keratoprosthesis.

The current problem with keratoprosthesis is the ingrowth of corneal or conjunctival epithelium into the anterior chamber. This may lead to infections and extrusion of the prosthesis as well as to the development of retroprosthetic membrane and secondary glaucoma. Glass-ceramic coated and uncoated titanium has been tested as material for the keratoprosthesis to prevent epithelial ingrowth. Twenty-two Supra-Descemet's membrane keratoprostheses were inserted in the eyes of 22 rabbits for 1, 2, 4, 8, or 12 months. The prosthesis had an optic part made of polymethylmetacrylate (PMMA). The support for the optic part and the flange of the prosthesis were made of titanium. Eleven of the prostheses were coated with glass-ceramic. The histological sections of the enucleated eyes were prepared through the central part of the cornea and the prosthesis using a cutting-grinding method. The histological analysis was made on both halves of the implants separately giving two analysis areas in each eye. All 11 titanium prostheses were retained for the time period planned. Two glass-ceramic coated prostheses were lost at 2 and 4 weeks, respectively. This was caused by difficulties at surgery due to a thick coating. These eyes were excluded from the histological analysis. No significant ingrowth of epithelium was seen in 15/18 (83%) and in 16/22 (73%) of the analysed areas of the glass-ceramic coated and titanium prostheses, respectively. Titanium appears to be a suitable material for the keratoprosthesis. The ingrowth of the epithelium may be hindered further by coating the titanium with bioactive glass-ceramic.

Dissolution and scanning electron microscopic studies of Ca,P particle-containing bioactive glasses.

Calcium phosphate (Ca,P) precipitation behavior on the surface of two bioactive glasses and four bioactive glass composites--two with hydroxylapatite (Ca10(PO4)6 (OH)2) and two with rhenanite (CaNaPO4)--were studied in simulated body fluid (SBF) and in Tris-Buffer at 5, 8, 16, 24, 48, 72, and 144 h. The weight loss of the materials was measured and the amount of precipitation was estimated using scanning electron microscopy with electrochemical detection (SEM-EDX) analysis. The test was repeated for one glass and its respective rhenanite composite every 3 h until 60 h and thereafter every 10 h until 150 h in SBF. Atomic absorption spectroscopy, spectrophotometry, SEM-EDX analysis, and pH measurements were performed on these samples. It is shown that in vitro the composite materials have a higher capacity for Ca,P precipitation than the glasses. Weight losses of the materials correlate well with their composition. Both the glass and Ca,P phases influence the precipitation mechanism and rate. Precipitation begins preferably from the glass phase. Ca,P particles clearly influence the time of onset and rate of precipitation. Cross-sectional EDX analysis of the samples revealed an absence of a clear Si-rich layer in glass A0B0 (SiO2 53.9 mol %, Na2O 27.5, CaO 12.4, P2O5 6.2, Al2O3 0.0 and B2O3 0.0) composites. This was attributed to the presence of extra calcium and phosphate ions on the surface of the material. The ion-concentration and pH change curves offered insight into the mechanism of precipitation. A connection was established between SEM-EDX results and the release curves. Formation of an Si,Ca,Na film was observed that seemed to initiate the Ca,P precipitation.(ABSTRACT TRUNCATED AT 250 WORDS)