Formación en adicciones de los médicos residentes en psiquiatría en el conjunto de la Unión Europea. Ponencia presentada en Logroño el 13 de marzo del 2015, en el marco de las 42º Jornadas Nacionales de Socidrogalcohol

1. 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

2. 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

3. Índice
• Introducción
• EUFAS: La Federación de Sociedades
científicas de Adicciones de la Unión Europea
• Material y método
• Resultados
• Conclusiones

4. Índice
• Introducción
• EUFAS: La Federación de Sociedades
científicas de Adicciones de la Unión Europea
• Material y método
• Resultados
• Conclusiones

5. Introducción
• Las adicciones, un olvido de la psiquiatría
• Factores de cambio:
– La adicción como enfermedad del cerebro
– La eclosión de la patología dual

6. Índice
• Introducción
• EUFAS: La Federación de Sociedades
científicas de Adicciones de la Unión Europea
• Material y método
• Resultados
• Conclusiones

7. 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).

8. EUFAS

9. 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:
Société Française d'Alcoologie
Germany:
Deutsche Gesellschaft für Suchtforschung und Suchttherapie (German
Society for Addiction Research and Addiction Therapy, (DG-Sucht)
Deutsche Gesellschaft für Suchtmedizin (DGS)
Deutsche Gesellschaft für Suchtpsychologie (DG-SP)
Holland:
Dutch Society of Practitioners of Addiction Medicine (VVGN)
Hungary:
Hungarian Association on Addictions (HAA)
Italy:
Societa Italiana di Alcologia (SIA)
Società 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:
Associação Portuguesa de Medicina da Adicção, A.P.M.A., Alcoolismo e
Toxicodependências
Associação Portuguesa para o Estudo das Drogas e das Dependências -
(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)

10. 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.

11. Major Goals of EUFAS:
• Reinforce addiction research in Europe
• Improve and harmonise prevention and
treatment
• Suggest policies based on evidence

12. Índice
• Introducción
• EUFAS: La Federación de Sociedades
científicas de Adicciones de la Unión Europea.
• Material y método
• Resultados
• Conclusiones

13. 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)

14. 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?

15. Índice
• Introducción
• EUFAS: La Federación de Sociedades
científicas de Adicciones de la Unión Europea.
• Material y método
• Resultados
• Conclusiones

16. COUNTRIES
Belgium
Finland
France
Germany
Greece
Ireland
Italy
Lithuania
Luxembourg
Netherlands
Norway
Poland
Portugal
Russia
Spain
Sweden
Switzerland
UK
Response rate 18/21: 86%

17. Are addictions part of the training of
psychiatrists in your country?
70%
20%
10%
Yes
No
Optional

18. How many years lasts the residency in
psychiatry?
2 years
5%
4 years
30%
5 years
55%
6 years
10%

19. Approximately which percentage of
the training is devoted to addictions?
30%
20%
25%
25%
Not specified
5%
6-10%
10-15%

20. Months devoted to addictions during
psychiatry residency
29%
38%
14%
19%
Not specified
3 or less
4 to 6
more than 6

21. 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

22. Are addictions recognized as a
subspeciality of Psychiatry?
84%
16%
No
Yes

23. 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.

24. 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.

25. • 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?

26. 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

27. 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

28. Do you think there is a need for a
European harmonization in this area?
90%
5%
5%
Yes
No
I don't know

29. 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

30. Índice
• Introducción
• EUFAS: La Federación de Sociedades
científicas de Adicciones de la Unión Europea
• Material y método
• Resultados
• Conclusiones

31. 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

32. 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 !!!