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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).
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%
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?
• 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 !!!