Some of this WP’s results have been reached by now:

• An EU wide Systematic review on the availability of EU addiction training opportunities.
• the partners explored all available national educational courses including vocational and online short courses that have potential to increase physicians’ skills in identifying and managing patients whose medical problems are caused or may be exacerbated by illicit drug use disorders.

 

The following results were reached through focus groups with professions health care professionals organized by all partners in their countries:

• Six National Reports defining the gaps and shortages in practical and forward-looking skills in the illicit drug addiction health care industry at regional level as discussed with health care professionals and patients themselves.

In reaching Result 2.2, Focus groups were organised in all partner countries and they addressed important issues related to the situation of the existing training courses offered to professionals dealing with drug users, as well as the various aspects involved in the approach and intervention processes.

 

Focus group organized by Klaipėdos Ernesto Galvanausko Profesinio Mokymo Centras in Lithuania

In relation to the Erasmus+ project CARE4SUD, surveys of doctors, psychiatrists working with people addicted to illegal drugs, and healthcare specialists were held at the Republican Centre for Addictive Disorders, Klaipėda branch. Unfortunately, we could not arrange groups interviews for doctors due to busy schedules. Therefore, doctors were interviewed individually using the individual interview method. Healthcare professionals were interviewed in a group using a focus group discussion method.

10 doctors, psychiatrists working with people addicted to narcotic substances and 10 healthcare specialists (nurses, nursing assistants, social workers, psychologists) were interviewed during May-June months.

Most of the specialists who took part in the survey indicated that they received theoretical knowledge during their bachelor’s and master’s studies, but they lacked practical knowledge and had to seek additional training and information independently. Knowledge provided was focused more on general assistance to a person in risk situations, thus a holistic approach being emphasized, which, according to the participants of the survey, corresponds to the specialization in working with addicted people, yet there was a lack of specificity when discussing various addictions.

The participants in the interviews highlighted the following important points and needs within competence development in the area of addiction:

• University and non-university institutions (universities and colleges) do not include enough training on addictions in the preparation of healthcare professionals; furthermore, insufficient information is provided in social and psychological fields.
• A certain stigma and lack of knowledge about addiction diseases exists even among specialists (psychiatrists). Due to stigmatization and negative attitude in the society, addicted people do not always receive adequate help; it is difficult to get information in a way that is accessible to them.
• Lack of skills and knowledge: The participants of the survey indicated that specialists providing counselling services to those addicted to illegal narcotic substances should have the following skills and knowledge: communication and cooperation skills, ability to work in a team, ability to build a safe and respectful relationship with the patient, understand and be able to manage the disease of addiction, be able to work with manipulative people, be aware and manage to recognize narcotic substances, especially the new ones, and their effect; be able to involve relatives to help their addicted person, be honest, empathetic, and tolerant, to constantly improve professional competencies, practical skills, and etc.
• Little attention is paid to preventive measures in the field of treatment and management of people addicted to illegal narcotic substances.
• Healthcare institutions working with people suffering from addictions should consistently prepare a qualification improvement plan for their specialists who also expressed the need to improve their competencies when working with people addicted to narcotic substances.
• Proposals for future action: Training should be based on reliable sources, theoretical material supported with evidence and in combination with practice (case presentations, group work, etc.). Furthermore, training should be conducted by experienced specialists, held offline, provide practical situations based on other countries’ experience, and information gained from addicted people who have been in remission for a certain period, and share one’s success stories.

Focus group organized by Institut Za Raziskave In Razvoj Utrip Zavod in Slovenia

UTRIP conducted a focus group in person in Ljubljana on May 29th, 2023 aiming to collect data and investigate the knowledge and skills gaps and shortages in the field of substance (drug) addiction in healthcare and other addiction-related sector at the national level. It also aimed to explore the education and training needs of professionals in this area. 10 individuals took part in the focus group: 6 health and social worker in addiction field and 4 public health workers (responsible for addiction field from different perspective, such as policy and research) in public institutions, such as the National Institute of Public Health and the Ministry of Health.

An important conclusion was that there is a real knowledge and skills gap in the field of substance (drug) addiction related education and training in Slovenia and that healthcare and other addiction-related professionals do not have an adequate and special knowledge and skills on the issues besides working experience and learning from that.

The participants proposed several topics which have to be included in (online) education and training courses for addiction-related professionals, which are as follows:

• Pharmacology, toxicology and forensics in the field of drugs;
• Anthropology of drugs (e.g., use of drugs for ritual purposes in indigenous communities);
• Public health and drugs (e.g., nursing, epidemiology with special emphasis on drugs);
• Political economy of drugs (alcohol, tobacco and cannabis industry, whose products and advertising aim is to create a consumer-addict) and related lobbying, advocacy and other challenges when trying to change public health related policies;
• Recovery of people who use drugs (e.g., social work, welfare state, community approach, work with particularly vulnerable groups etc.);
• Treatment and harm reduction measures in the field of drugs (e.g., exchange of sterile equipment, drug testing, drug consumption facilities, mobile units, substitution therapy etc.);
• Prevention (e.g., science of prevention, theoretical background, effective and ineffective/harmful approaches);
• New psychoactive substances (warning and analysis systems, response and international cooperation and regulatory challenges, new ways of using drugs, chemsex, etc.);
• Risk and protective factors related to different addictions and risky behaviors;
• Evidence-based approaches to work with vulnerable populations (e.g., youth, women, people with substance use or other mental health disorders, homeless people etc.).

Focus groups organized by SOSU Ostjylland in Denmark

Two focus group interviews with health professional/pedagogical staff have been conducted in Denmark in order to define knowledge gaps and wishes for content in a future competence development course/educational offer. It was difficult to get participants to the interviews.

A focus group interview was conducted in a counseling center for addicts. Another focus group interview was conducted at a homeless home (for current and former addicts).

The participants in the focus group interviews gave the following important points and needs within competence development in the area of addiction:

• Lack of continuing education: Participants pointed out that there is no specific continuing education for doctors, health or social professionals in the field of addiction. There is a clear need for formalised, quality-assured and specialised training opportunities as well as certification requirements.
• Failure to update legal requirements and recommendations: There is a need to update legal requirements and recommendations within addiction treatment. Examples of off-label treatments based on recent research findings were cited.
• Lack of holistic approach: Participants pointed to the need for a more holistic approach to patients’ health. There is a lack of closer cooperation between psychiatry, addiction doctors, general practitioners and other parts of the health service. An optimization corresponding to cancer package courses was desired.
• Lack of skills and knowledge: Participants expressed that they do not feel adequately equipped for the tasks in the field of addiction on the basis of their initial training. The need for more tools and skills such as communication and motivational skills, knowledge of treatment options, activity analysis and collaboration with addiction therapists and other cross-sectoral partners was identified.
• Lack of competency validation and research: Participants pointed to the importance of pooling and validating competencies in a unit that can develop and implement education and training, as well as a higher degree of use of research to promote evidence-based interventions in the field.
• Economic challenges: Lack of sufficient funds for skills development was identified as the main barrier.
• Proposals for future action: Diploma courses, joint courses independent of basic training and counsellor training with theoretical and practical courses were proposed. In addition, important areas such as communication, compensation for abuse, treatment options and referrals to local activities were highlighted.

Focus group organized by Universidade do Porto in Portugal

In Portugal, two online group meetings occurred in June 2023 as part of the “CARE4SUD: Vocational training in illicit drug addiction: Equipping health care practitioners with addiction treatment competencies and techniques” project. The main aim of these meetings, involving health professionals working in this area – such as psychologists, psychiatrists, social workers, and addiction counsellors – sought to understand in-depth qualitative information on ideas and perceptions of the importance of illicit drug addiction training and facilitate the identification of the skill-based competencies needed for such activity.

Based on these participants’ perceptions, several dimensions must be deconstructed and deepened when considering training in this area. One of the main one’s concerns stigma, attitudes, and lack of awareness since existing training programs might not have adequately addressed the importance of reducing stigma and raising awareness about the complex nature of addiction. Overcoming stigma and negative attitudes towards addiction can be a significant challenge, mainly due to “the need for people to start to see addiction as a mental health problem and that stigma isn’t just in society in general, it comes mainly from the professionals who work directly in this area,” as one of the psychologists mentioned. Healthcare workers might have preconceived notions about individuals with addiction, affecting their willingness to engage in training and their approach to patient care. Consequently, healthcare workers might not fully understand the extent and complexity of illicit drug addiction and its associated challenges. Designing a program that raises awareness about the impact of addiction and the importance of effective treatment is crucial. Along the same line, and since Portugal is culturally diverse, with unique cultural and socio-economic contexts, addiction experiences can vary among different populations and regions. Drug addiction affects individuals from diverse backgrounds and communities, which may lead to disparities in access to quality treatment. Hence, training programs should address inclusivity and diversity in their curriculum and be culturally sensitive by tackling the unique needs of different communities.

Another critical point refers to the fact that there is limited integration of addiction-related training into mainstream medical and healthcare education. One of the psychiatrists states that “doctors generally don’t know much about drugs. I see in my patients that they often have horrible experiences when they go to the emergency room; some of them even often hide that they are on drug substitution programs, for example, to avoid being treated differently”. Healthcare professionals, including doctors and nurses, receive inadequate training in addiction medicine and treatment, leading to challenges in recognizing and addressing addiction issues. On top of that, effective addiction treatment also requires a multidisciplinary approach involving medical professionals, psychologists, social workers, addiction counsellors, and more. There are gaps in training to promote collaboration and communication between these professionals that must be addressed. Additionally, achieving the right balance between theoretical knowledge and practical skills is essential in addiction training. Designing a program that provides conceptual understanding and hands-on techniques can be challenging but is needed.

While Portugal is known for its progressive drug policy, emphasis on harm reduction, and a public health-oriented approach to drug use and addiction, the available training programs might not adequately cover harm reduction strategies and updated treatment methods. Addiction treatment is rapidly evolving, with new evidence-based practices and treatment models emerging regularly. If training programs were not updated frequently, healthcare practitioners might have lacked knowledge about the most effective treatment and harm reduction strategies. This fact is directly related to the insufficient continuing education in this field since “the search for further or continuing training is centered on self-investment or the person’s mission to keep up to date in this area”, as mentioned by an addiction counselor. Healthcare practitioners face challenges accessing ongoing education and training opportunities to keep their addiction treatment knowledge and skills current.

Designing an illicit drug addiction training program for healthcare workers in Portugal, or any other country, can be a complex endeavor that involves several challenges. Through these meetings, it was acknowledged that equipping health professionals with drug treatment skills and techniques includes providing a training program that should enhance their knowledge, understanding, and practical skills to address the complex challenges of drug addiction.

To address these challenges and create a new training program, it’s crucial:

• To integrate an in-depth overview of the social, psychological, and physical impacts of drug addiction, including specific knowledge of the pharmacology and neurobiology of addiction.
• To involve key stakeholders, including healthcare professionals, educators, policymakers, and individuals with lived experiences of addiction. Collaborative efforts can help identify potential barriers and develop strategies to overcome them, resulting in a more effective and impactful training program for healthcare workers dealing with illicit drug addiction.
• To integrate mental health care in its relationship with addiction treatment, as many individuals with substance use disorders also have co-occurring mental health conditions. Healthcare professionals need training to diagnose and treat both disorders simultaneously effectively.
• To involve experts by experience in the training program elaboration since it can enhance its effectiveness and provide a more well-rounded understanding of the challenges and complexities of addiction and recovery.
• To improve healthcare workers’ communication skills by helping them learn how to engage with patients empathetically. Effective communication is crucial for discussing sensitive topics like substance use, so healthcare professionals should be trained in building trust, active listening, and using non-judgmental language.

The U.Porto team is deeply grateful to all the participants for the insights they shared and to ANtídoto Association and CLEANIC for their willingness to participate and be involved in this project.

Focus group organized by Direcția de Asistență Socială și Medicală in Romania

The focus group organized by the DASM On June 14th, 2023within the project was held online with 22 professionals dealing with addiction issues, representatives of institutions such as the Philanthropic Medical-Christian Association “Christiana”, Cluj Branch – St. Dimitrie Basarabov Program, Preventis Association, Center for Prevention, Evaluation and Antidrug Counseling Cluj, student medical offices, individual psychology offices, etc.

The questions and discussions revealed many needs related to the training of professionals, to the number and format of training courses in this field, such as: the fact that there are no training courses addressed to certain categories of professionals in university studies, and that some of the existing ones are not updated; that the existing courses are not sufficiently promoted or are not sufficiently adapted and practical enough according to the needs of the addicts; the need for models of good practice and collaboration between professionals in this field.

All information obtained in the focus groups will be processed by the project team and used to create a free online course to support professionals in the field of illicit drug addiction.

Focus group organized by Institute of Social Solidarity and Wellbeing in Greece

On 24th & 25th of May 2023, the Institute of Social Solidarity and Well- Being: Social-Mind conducted two online focus groups within the Erasmus+ project: Vocational Training in Illicit Drug Addiction: Equipping Health Professionals with Addiction Treatment Skills and Techniques (CARE4SUD).

The main aim of the focus groups was to collect data and investigate the skill gaps and shortages in practical and forward-looking skills in the illicit drug addiction health care industry at national level and explore the training needs of professionals in the area.

A range of health care workers with experience in the illicit drug addiction field, took part from across Greece, including psychiatrists, nurses, General practitioners, psychologists, social-workers etc. What became clear throughout the groups was that there is a real knowledge gap in the illicit drug addiction education and training in the country, and that health care professionals do not possess specialized knowledge on the issue unless they work in the field.

Areas proposed to be covered in the online Illicit drug addiction training programme under development would include: 

• Basic knowledge of psychopathology
• Basic knowledge of pharmacology
• Basic knowledge and techniques of psychotherapy, mainly family therapy in addiction
• Motivational interviews
• Screening questionnaires to assess the level of addiction
• Mental health first aid
• Referrals to main illicit drug addiction services in the country.

The Improvement of communication skills, ethical and legal aspects as well as minimization of preconceptions, were also issues proposed to be tackled in the new course.

We really thank Virginia Kalodiki, MD Psychiatrist as well as Ms. Maria Lapatsani, MSc Addiction Psychologist, with long working experience in the field of treatment of drug addicted individuals, who coordinated and facilitated the discussions.

 

 

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