There are many occupational stress management programmes available which are designed to prevent and cure the negative aspects of job-stress. The focus of the programmes can be directed towards the individual worker, the working group, the organization of the work or the organization as a whole. Moreover, programmes show a considerable variation with respect to the type of interventions they promote and their underlying assumptions, as well as their duration and costs. In this paper, effect studies of occupational stress programmes published between 1987 and 1994 are reviewed. The aim is to give a practical overview of the variety in occupational stress programmes, their scope, applicability and the evidence of their effectiveness. The paper updates the review by DeFrank and Cooper published in 1989.

Trust and the need for trust vary with the character and severity of ill health. Studies on trust in doctor-patient relationships are more worthwhile if they are directed at specific groups and situations.

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During the 1970s, the Methadone Dispensing Circuit (MDC) was initiated by the municipality of Amsterdam in order to cope with the heroin addiction epidemic that afflicted the city. In the MDC, methadone is dispensed to opiate addicts on a maintenance basis in low-threshold public health programmes, as well as in high-threshold treatment programmes. The MDC is an essential part of the local drug policy in the city. It is designed to get in touch with all opiate addicts who are not able to manage their lives in a proper way, and to stimulate them to regulate their addiction. This paper describes the genesis of the MDC as a result of a historical and political process. Determining factors in this process proved to be the urgency of the drug problem, the widespread consensus among local politicians, most of the general practitioners (GPs) and alternative relief institutions about the low-threshold dispensing, and finally its success, particularly the lower rate of drug-related death and less disruption of public order. In the second part of the paper, data on the functioning and effectiveness of the MDC are presented. It is concluded that the effectiveness of the MDC could be improved by better management and the application of more sensible diagnostic methods. The transferability of the 'Amsterdam model' to other places is discussed; besides the burden of the drug problem, it depends on the acceptance of the underlying value orientation.