Etiology of substance use: implications for treatment A. Pirona Lisbon Addictions

(Spooner) Findings –Aetiology of ‘abuse’ Genetic factors Gender Attitudes and personality traits Family factors Traumatic life events Ethnicity Socio-economic status Macro-environmental factors Mental health Knowledge Stress and coping/support mechanism Peer factors School factors Anti-social behaviour and delinquency Age of first use Etc…

Planning treatment interventions Attachments can be positive or negative and can be with other adolescents, the family, workers and so on. Skills include competencies that help people succeed in life (for example, leadership) and coping strategies such as skills in assertiveness, problem solving and relaxation. Resources are anything that can help towards physical and emotional needs being met and can be internal (for example, intelligence) or external (for example, family, adolescent workers). Each of these factors have been addressed in the above review. The essence of the model is that, when planning interventions, we are trying to reduce the risk factors and build up the protective factors.

Roll out… Interventions that focus more on these models (< risk factors; > protective factors) Structured, evidence-based, manual-based programmes Recommendations, training, competence building, evaluation

Expectation

Vs reality

Reality Small teams Under-funded; under-staffed, over-worked Limited room to manoeuvre, innovate, implement new methods, new (end existing) evidence Limited availability outside urban areas Mostly heroin (or high risk drug use)-oriented services Limited formal/established coordination and collaboration (mostly informal)

Outside the box… 2 examples (among many) Primary health care E-health & M-health

Specialist -> non-specialist

MDMA Potent ‘SSRI’ 2.3 million young adults (15-34) used MDMA last year 1000 entered treatment in 2015 145 < 15y 589 - 15-<19

availability of competent services availability of young age mental health screenings primary health care involvement in early drug treatment and mental health management

Mobile health and self-management

M-health in the drugs field Unpublished data: 64 apps (32 USA; 16 EU; rest of the world) Mostly information-related apps Consumption trackers/ diaries: 11 Addiction-related information with connection to treatment services (personalised feedback): 11 Self-help applications: 16 (2 from EU, 13 USA)

Thank you