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

3. (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…

4. 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.

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

6. Expectation

7. Vs reality

8. 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)

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

10. Specialist -> non-specialist

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

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

13. Mobile health and self-management

14. 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Unpublished data: 64 apps (32 USA; 16 EU; rest of the world) Mostly information-related apps Consumption trackers/ diaries: 11 Addiction-related information with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)

15. Thank you