Psiquiatría y adicciones: Encuentros y desencuentros desde una

perspectiva Europea

Antoni Gual Presidente de EUFAS (European Federation of Addiction Societies)

Unidad de Conductas Adictivas. IDIBAPS. Hospital Clínic. Barcelona

Red de trastornos Adictivos

Conflicts of interest

Interest Name of organisation

Current roles and affiliations

Addictions Unit, Psychiatry Dept, Neurosciences Institute, Hospital Clinic, University of Barcelona; IDIBAPS; RTA; Vice President of INEBRIA, President of EUFAS

Grants Lundbeck, D&A Pharma, FP7, SANCO

Honoraria Lundbeck, D&A Pharma, Servier, Lilly, Abbvie

Advisory board/consultant

Lundbeck, D&A Pharma, Socidrogalcohol (Alcohol Clinical Guidelines) 2013

Índice

• Introducción

• EUFAS: La Federación de Sociedades científicas de Adicciones de la Unión Europea

• Material y método

• Resultados

• Conclusiones

Índice

• Introducción

• EUFAS: La Federación de Sociedades científicas de Adicciones de la Unión Europea

• Material y método

• Resultados

• Conclusiones

Introducción

• Las adicciones, un olvido de la psiquiatría

• Factores de cambio:

– La adicción como enfermedad del cerebro

– La eclosión de la patología dual

Índice

• Introducción

• EUFAS: La Federación de Sociedades científicas de Adicciones de la Unión Europea

• Material y método

• Resultados

• Conclusiones

Mission & Aims of EUFAS

• The purpose of the Federation is to promote education and the attainment of the highest level of knowledge and understanding in the field of addiction in all European countries.

• Addiction disorders comprise all mental disorders related to the use of psychoactive substances and non-substance-related disorders related manifestations (such as gambling).

EUFAS

Member societies of EUFAS Austria:

Austrian Society for Addiction Research and Addiction Therapy

Belgium:

Association for Alcohol and other Drug Problems

Czech Republic:

Czech Society of Addiction Medicine of the Czech Medical Society J.E.

Purkyne

Denmark:

Danish Psychiatric Association

Finland:

Finnish Society of Addiction Medicine

Flanders:

Flemisch Society for Psychiatry,

Section on addiction psychiatry (chaired by Dr. Hendrik Peuskens)

France:

Societe Francaise d'Alcoologie

Germany:

Deutsche Gesellschaft fur Suchtforschung und Suchttherapie (German

Society for Addiction Research and Addiction Therapy, (DG-Sucht)

Deutsche Gesellschaft fur Suchtmedizin (DGS)

Deutsche Gesellschaft fur Suchtpsychologie (DG-SP)

Holland:

Dutch Society of Practitioners of Addiction Medicine (VVGN)

Hungary:

Hungarian Association on Addictions (HAA)

Italy:

Societa Italiana di Alcologia (SIA)

Societa Italiana Psichiatria delle Dipendenze)

Ireland:

St. Patricks University Hospital

Lithuania:

National Tobacco and Alcohol Coalition

Lithuanian Association of Addiction Psychiatry

Norway:

Norwegian Association of Addiction Medicine (NFRAM)

Poland:

Polish Society for Addiction Research Medical University of Warsaw,

Poland

Portugal:

Associacao Portuguesa de Medicina da Adiccao, A.P.M.A., Alcoolismo e

Toxicodependencias

Associacao Portuguesa para o Estudo das Drogas e das Dependencias -

(APA-APEDD)

Romania:

(Alliance against alcohol and drug addiction) ALIAT

Russia:

Russian Society for Addiction Medicine

Spain:

Socidrogalcohol

Switzerland:

Swiss Society for Addiction Medicine

United Kingdom:

Society for the Study of Addiction (SSA)

Clinical Addiction Network

Europe

European Society for Biomedical Research on Alcoholism (ESBRA)

European Association of Substance Abuse Research (EASAR)

Specifically EUFAS intends to:

• Improve addiction care in European countries,

• Improve prevention measures both on a national as

well as a European level,

• Support those European countries whose prevention

and treatment systems may be less developed,

• Influence the allocation of financial resources for

addiction research on a national as well as a

European level.

Major Goals of EUFAS:

• Reinforce addiction research in Europe

• Improve and harmonise prevention and

treatment

• Suggest policies based on evidence

Índice

• Introducción

• EUFAS: La Federación de Sociedades científicas de Adicciones de la Unión Europea.

• Material y método

• Resultados

• Conclusiones

Methods

• Online questionnaire sent to all Presidents of EUFAS member societies

• Mix of questions on qualitative & quantitative aspects of training on addictions delivered to resident psychiatrists

• Easy to answer (less than 10 minutes)

Questionnaire • Are addictions part of the training of psychiatrists in your country?

• How many years lasts the residency in psychiatry?

• Approximately which percentage of the training is devoted to addictions?

• Do you have an approximate idea of how many months are devoted to

addictions?

• Can you briefly describe in which settings does training take place?

• Are addictions recognized as a subspecialty of Psychiatry?

• Could you briefly describe the strengths and weaknesses of the addiction

training program for psychiatry residents in your country?

• Which changes would you suggest to improve the actual situation?

• In general how would you rate the level of competence in addiction

psychiatry a resident has at the end of his/her training (from 1 not

competent at all, to 5 extremely competent)

• Do you think there is a need for a European harmonization in this area? If

yes, what should be the main principles that should guide it?

• Would you like to make any other considerations?

Índice

• Introducción

• EUFAS: La Federación de Sociedades científicas de Adicciones de la Unión Europea.

• Material y método

• Resultados

• Conclusiones

COUNTRIES Belgium Finland France Germany Greece Ireland Italy Lithuania Luxembourg Netherlands Norway Poland Portugal Russia Spain Sweden Switzerland UK

Response rate 18/21: 86%

Are addictions part of the training of psychiatrists in your country?

70%

20%

10%

Yes

No

Optional

How many years lasts the residency in psychiatry?

2 years 5%

4 years 30%

5 years 55%

6 years 10%

Approximately which percentage of the training is devoted to addictions?

30%

20% 25%

25%

Not specified

5%

6-10%

10-15%

Months devoted to addictions during psychiatry residency

29%

38%

14%

19%

Not specified

3 or less

4 to 6

more than 6

Can you briefly describe in which settings does training take place?

• In most countries a combination of inpatient, outpatient and day hospital settings

• Usually inpatient settings take precedence

• Settings are located both in general Psychiatric facilities and in specialized Addiction services.

• In most countries the length of stay in each setting is not fix

Are addictions recognized as a subspeciality of Psychiatry?

84%

16%

No

Yes

Are addictions recognized as a subspeciality of Psychiatry?

• Germany, Latvia and Russia do recognize Addictions as a subspeciality

• France, Finland, Switzerland and Netherlands offer specialization in Addictions open to a variety of professionals

• In the UK Addictions are recognized by the Royal College of Psychiatrists but not by the Health Deptartment

• There are Chairs in Addictions in various countries.

Strengths of addiction training programs for psychiatry residents in your country?

• Training schemes, clinical placements, CV and competencies defined (UK)

• The program is both theory and competency oriented and there is a serious exam and practice evaluation (NL)

• At some places well developed and integrated in standard training (B)

• Regular part of psychiatric training.

• Too short

• Not compulsory

• Large variety within institutions

• Not evidence based

• Not well structured

• Lack of training skills (in addictions) in some psychiatric institutions

Weaknesses of addiction training programs for psychiatry residents in your country?

Which changes would you suggest to improve the actual situation?

• Recognition of Addiction as a speciality (53%)

• Improve training pathways for non psychiatrists

• To extend length and content of training (1 year)

• Expand the training on addiction at undergraduate level

• Making training compulsory within psychiatric rotations

Level of competence in addictions that a psychiatry resident has at the end of his/her training

5%

20%

40%

25%

5% 5%

Very good

Quite good

Fair

Not too good

Bad

I don't know

Do you think there is a need for a European harmonization in this area?

90%

5% 5%

Yes

No

I don't know

What are the main principles that should guide harmonization?

• Every resident needs to get a clinical placement in addiction psychiatry, in both and inpatient and outpatient setting, including dual diagnosis training.

• We should aim at the comparable level of training and competence to enable interchangeability in employment of doctors in the EU.

• To standardize what a psychiatrist in EU should know about addictions,

• To aim at EU wide competencies for specialists in addiction psychiatry.

• EU guidelines for a training program, including exchanges and development of a shared core CV.

• To develop EU modules of training materials. • European meetings for psychiatry residents in this area, i.e.,

summer schools or intensive courses

Índice

• Introducción

• EUFAS: La Federación de Sociedades científicas de Adicciones de la Unión Europea

• Material y método

• Resultados

• Conclusiones

Summary

• Addictions are part of the compulsory psychiatric training in 70% of countries

• Addictions training is around 5-10% of the residency time (2-6 months) and in a variety of settings

• Just 25% of respondents think that residents training is good or very good.

• 90% think EU harmonization is needed

• Harmonization should be achieved through: – EU guidelines for a training program

– Development of a shared core CV

Psiquiatría y adicciones: Encuentros y desencuentros desde una

perspectiva Europea

Antoni Gual Presidente de EUFAS (European Federation of Addiction Societies)

Unidad de Conductas Adictivas. IDIBAPS. Hospital Clínic. Barcelona

Red de trastornos Adictivos

Muchas gracias !!!