Education and Training in Addiction Medicine and Psychology across Europe: A EUFAS Survey.

INTRODUCTION: Training in addiction medicine and addiction psychology is essential to ensure the quality of treatment for patients with substance use disorders. Some earlier research has shown varying training between countries, but no comprehensive study of addiction training across Europe has been performed. The present study by the European Federation for Addiction Societies (EUFAS) aimed to fill this gap. METHODS: A Delphi process was used to develop a questionnaire on specialist training in addiction treatment in 24 European countries. The final questionnaire consisted of 14 questions on either addiction medicine or addiction psychology, covering the nature and content of the training and institutional approval, the number of academic professorial positions, and the estimated number of specialists in each country. RESULTS: Information was not received from all countries, but six (Belgium, Denmark, Ireland, Italy, Poland, and Romania) reported no specialized addiction medicine training, while 17 countries did. Seven countries (Belgium, France, Ireland, Italy, Russia, Switzerland, and the Netherlands) reported no specialized addiction psychology training, while 14 countries did. Training content and evaluation methods varied. Approval was given either by governments, universities, or professional societies. Eighteen countries reported having professorships in addiction medicine and 12 in addiction psychology. The number of specialists in addiction medicine or psychology varied considerably across the countries. DISCUSSION: The survey revealed a large heterogeneity in training in addiction medicine and addiction psychology across Europe. Several countries lacked formal training, and where formal training was present, there was a large variation in the length of the training. Harmonization of training, as is currently the case for other medical and psychology specializations, is warranted to ensure optimal treatment for this under-served patient group.

Psychometric properties of CAST for early detection of problematic cannabis use in Spanish adolescents.

The high prevalence rates of cannabis use in adolescents and its early onset constitutes a major public health problem, raising the need for its early detection. The availability of validated tools to analyze early cannabis use is essential to detect problematic use at an early age. The Cannabis Abuse Screening Test (CAST) (Legleye et al., 2007) is widely applied in Europe; however, the CAST cut-off scores vary according to the setting, the screening objective, and the correction version (CAST-f or CAST-b), creating therefore confusion in its application. Moreover, the psychometric properties of the CAST as a tool for detecting problematic cannabis use are understudied. To fill this gap, such psychometric properties have been analyzed in a sample of Spanish adolescents while using different cut-off scores for CAST-f and CAST-b. Based on our findings, the optimal cut-off scores are 2 points for CAST-b and 4 points for CAST-f. The internal reliability of CAST-f (α = 0.83) and CAST-b (KR-20 = 0.80) are satisfactory. Factorial analysis suggested the assumption of a one-dimension model. The CAST seems to be a valid and reliable tool for early screening of problematic cannabis use in Spanish adolescents.

[SBIRT model as a prevention strategy against addiction with and without substance in teenagers.] / El modelo SBIRT como estrategia de prevención de las adicciones con y sin sustancia en adolescentes.

A high prevalence of adolescent substance use, risky consumption patterns and the decrease in the age of initiation, together with the growth of non-substance addictions, represent a huge challenge for Public Health. This suggests the need for a change of focus in the work of the primary care settings, which must be more proactive in the early detection and intervention. Although there are some previous experiences in Spain, we do not have a duly standardised system, based on clinical practice and validated in consulting rooms, which could be used in a general, simple, and guaranteed manner. The SBIRT (Screening, Brief Intervention and Referral to Treatment) model, developed in the United States and conceived from a Public Health perspective, might represent such a paradigm shift. The aim of this paper was to provide researchers and professionals with a review of the available evidence in different countries, with a view to implementing it in Spain, where SBIRT remains a challenge. In addition, theoretical and technical foundations, and potential of the SBIRT are described. Not only its possible benefits and opportunities are put on the table, but also the shortcomings, limitations and needs that must be overcome for SBIRT implementation to be possible.

La alta prevalencia del consumo de sustancias entre los adolescentes, los preocupantes patrones de consumo y el descenso de las edades de inicio, junto al crecimiento de las adicciones sin sustancia, suponen uno de los grandes desafíos actuales en materia de Salud Pública. Ello sugiere la necesidad de un cambio de enfoque en la labor de los dispositivos de Atención Primaria (AP), que han de ser más proactivos en la detección e intervención precoz. Aunque en España existen algunas experiencias previas, no disponemos de una sistemática debidamente protocolizada, fundamentada clínicamente y validada en las consultas, que pueda ser utilizada de forma generalizada, sencilla y con garantías por los profesionales. El modelo SBIRT (Screening, Brief Intervention and Referral to Treatment), desarrollado en Estados Unidos y concebido desde un enfoque de Salud Púbica, representa ese cambio de paradigma. El objetivo de este trabajo, además de dar a conocer los fundamentos teóricos, técnicos y potencialidades del SBIRT, fue poner a disposición de investigadores y profesionales una revisión de la evidencia disponible en diferentes países, de cara a su posible implantación en España, donde a pesar de la existencia de experiencias precedentes puntuales, constituye todavía una cuenta pendiente. Se ponen sobre la mesa no sólo los posibles beneficios y oportunidades, sino también las carencias, limitaciones y necesidades que han de superarse para que la implementación del SBIRT sea posible.