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Quality standards have been recognized as an important tool for improving the quality of drug use prevention, treatment, and harm reduction services and for bridging the gap between science and practice. The aim of this paper is to describe the state of implementation of quality standards in drug demand reduction in the European Union and to identify barriers, needs, and challenges to implementation and future pathways. Between June and November 2021, an online survey (n = 91) and follow-up interviews (n = 26) were conducted with key informants - experts in drug demand reduction and quality assurance. Data were analyzed using descriptive statistics and thematic analysis. The survey showed that most countries have implemented the European Drug Prevention Quality Standards (EDPQS) in the prevention domain and the Minimum Quality Standards (MQS) in drug demand reduction. A variety of standards are applied in the treatment area and the EQUS minimum quality standards are widely known. The application of quality standards is least reported in the harm reduction service area. Mentioned challenges and barriers to implementation included lack of funding, unrecognized importance of evaluation, professional competencies, and system fragmentation. Mentioned supportive factors included appropriate materials and training, as well as political support and professional networks. The study shows that quality standards are inconsistently implemented in all areas of drug demand reduction. According to respondents, implementation could be improved by advocating for the need to implement quality standards, ensuring sustainable funding for interventions, and providing education and training.

Integrated treatments are often recommended for adolescents with substance use disorders (SUD) and comorbid pathologies. This study aims to compare the effectiveness of two different intervention programs (integrated and parallel) and to investigate treatment outcome predictors. Seventy-five adolescents (13-17 years old) with substance use and comorbid disorders referred to our outpatient program were randomized to integrated (n = 33) or parallel (n = 32) treatment groups. Their sociodemographic variables, psychopathology, substance use problems, and global functioning were assessed at baseline and 12 months after treatment initiation. Both treatments were associated with positive pre-post changes in several outcome variables (severity of school, family, and psychiatric problems; global functioning; and stage of change). Integrated treatment showed better outcome on adherence (χ2 = 14.328; p > .001) and a composite global measure based on the severity of drug-related problems (χ2 = 8.833, p = .003). Following an adaptive treatment strategy, we offered patients who dropped out of parallel treatment (n = 12) the possibility of entering integrated treatment. Eleven of them accepted and constituted a third comparison group (parallel-to-integrated). Multivariate logistic regression analysis showed that the likelihood of a positive global treatment outcome increased with integrated or parallel-to-integrated treatment, internalizing or mixed comorbid disorders, older age, and fewer legal issues. Integrated treatment showed better adherence and global treatment outcomes than parallel treatment in adolescent patients with dual disorders. Older age and fewer legal issues were also related to a positive global treatment outcome.

Alexithymia is related with propensity towards impulsive behavioral responses, rather than cognitive regulation of stressful events. Youth is a particularly vulnerable time for the confluence of these variables, which may impact the severity of gambling disorders (GD). However, sex differences have hardly been explored. This study aimed, firstly, to explore the frequency of GD among young people, as well as the presence of GD with other comorbid addictions. Secondly, latent classes were examined on the basis of gambling risk and their relationship to other addictive behaviors, alexithymia and stressful life events. Thirdly, we analyzed whether class membership was predicted by sex and age. The sample was composed of 360 participants between the ages of 18 and 35, the majority female. The results obtained revealed that alcohol abuse was the most prevalent addictive behavior both for problem and non-problem gamblers of both sexes. Group membership analyses showed the presence of two latent classes based on gambling risk. One of them was characterized by gambling risk, comorbidity, alexithymia, and stressful life events, and mainly predicted by being male. The other model was characterized by no gambling risk, lower levels of stressful life events and alexithymia, and mainly predicted by being female. This second profile presents a risk of alcohol abuse and compulsive buying. We highlight the need to introduce a gender perspective both in the interpretation of research findings and in the clinical application of treatments.

Therapeutic Communities (TC) are residential settings that provide psychosocial rehabilitation for substance-using individuals. In general, TCs have been proven effective, although a large part of the evidence is from studies with methodological shortcomings. Therefore, the aim of this systematic review was to evaluate the effectiveness of TCs in terms of relapse rates. The search used EBSCO, PubMed, and Web of Science up to July 29, 2021 and was based on the international Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Of the 94 studies, eight met selection criteria including a total of 2,064 participants from 40 TCs. Of the eight studies, seven were cohort studies and one was a randomized controlled trial (RCT). Findings reveal that TCs were effective in reducing substance use, although some uncertainty remains regarding the long-term persistence of the improvements. Thus, further research is necessary to compare relapse rates in TC programs for substance-related disorders.

Alcohol consumption among Spanish undergraduates during their university time has increased exponentially in recent years. In addition, this lifestyle change is associated with abandoning the Mediterranean diet, increasing the risk of suffering some kind of injury and affecting their quality of life. The study was carried out with a sample of 1,057 Spanish university students, 12.1% (n = 127) of them women and 87.9% (n= 930) men. The SF-36 questionnaire was used to measure health-related quality of life, the MEDAS test to check adherence to the Mediterranean diet, and the AUDIT test to measure alcohol consumption. The results show an inverse relationship between injury and quality of life (β= -0.020) and adherence to the Mediterranean diet (β= -0.042) among students who have suffered some kind of injury. On the other hand, there was a positive relationship with alcohol consumption (β= -0.046). The main conclusion is that lower alcohol consumption and higher adherence to the Mediterranean diet was associated with a better quality of life and a reduced risk of injury in undergraduates in southern Spain.

The objective of this work was to assess changes during pregnancy and after childbirth in diet, consumption of tobacco, electronic cigarettes, cannabis, alcohol use and exposure to environmental tobacco smoke depending on the mother's educational level.A cross-sectional study was carried out whose target population was 18,822 Galician women aged 18-49 who gave birth between September 2015 and August 2016, and their 19,204 live-born children. A descriptive analysis was performed, and the prevalence of different behaviors was estimated at three time points - pre-pregnancy, pregnancy and after childbirth - depending on the mother's educational level. Percentages of change were calculated.Information was obtained from 6,436 women. Regardless of the educational level, during pregnancy there was an improvement in the different lifestyles. In the first months after childbirth, lifestyles worsened, except for exposure to environmental tobacco smoke and the use of electronic cigarettes. Most of the risk behaviors showed a gradient depending on the educational level; thus, the lower the educational level, the higher the prevalence of risk behaviors.In general, during pregnancy all women adopted healthier lifestyles that they abandoned in the months following childbirth. Women with a lower level of education showed a higher prevalence of risk behaviors, both in the period prior to pregnancy, as well as during pregnancy and after childbirth.

Cannabis is the most widely consumed illegal drug in Spain, with consumption concentrated mainly in adolescence and early adulthood. The objectives were to estimate the prevalence of cannabis use, cannabis use disorder (CUD) and dependent use in the Galician population aged 16 years and over, and to characterize cannabis users and cannabis dependent users. Data are from two cross-sectional studies from the Risk Behavior Information System conducted in 2017 (n = 7,841) and 2018 (n = 7,853). The Cannabis Abuse Screening Test (CAST) was used to identify users with CUD and/or dependent use. Prevalences were estimated and regression models were fitted to identify variables associated with cannabis use and dependent use. In 2017-2018, 2.7% (95% CI: 2.5-3.0) of the Galician population aged 16 years and over consumed cannabis at the time of the survey, with this prevalence being 9% in the 16-24 years age group. Prevalence decreased with age and was higher in males in all age groups. The prevalence of CUD in users was 69.5% (95% CI 61.1-78.1) and of dependent use it was 49.2% (95% CI 46.6-53.9). Tobacco use was the major determinant of being a cannabis user [OR = 19.8 (95% CI 13.8-28.4)] and daily cannabis use of being a dependent user [OR = 5.5 (95% CI 3.2-9.5)]. Cannabis use among the Galician population is high, especially among young people aged 16-24 years, who show the highest probability of dependent use. Prevention measures should be aimed especially at the younger population aged 16 years to curb its use and the development of consequences such as CUD and dependent use.

The objective of this study is to describe how mental health professionals in training (residents) apply the brief intervention (5As) on the tobacco and alcohol consumption to their patients, and if this is related to the training received and/or their own consumption. This is a cross-sectional study in which a self-reported questionnaire was administered to first-year residents of mental health professionals in Catalonia (2016-2019) (psychiatrists, psychologists and nurses). We performed a descriptive analysis of the variables and we applied a chi-square test for the comparison of proportions. 154 professionals completed the questionnaire. Half of them had not received any university training on intervention in smoking (46.8%) or in alcohol consumption (53.2%). Those who had received it, advised, assessed and helped their patients to quit smoking more frequently (p = 0.008, p = 0.037 and p = 0.039; respectively). Those who had received training in alcohol intervention gave advice, performed assessments and offered help to quit/reduce alcohol among their patients more frequently (p < 0,001; p = 0,001; y p < 0,001; respectively). Residents usually helped more to quit or reduce alcohol than to quit tobacco (p < 0,001). 60.1% of them never or rarely helped their patients to stop smoking and 34.6% rarely helped in the case of alcohol. In general, nurses did more intervention for tobacco than alcohol use, regardless of the training received. The lack of training of professionals in tobacco and alcohol intervention at university is related to a lack of intervention on patients in their professional practice, regardless of their own consumption.

Introduction: During periods of isolation, people with substance use disorders may reduce tension, stress, uncertainty and possible distress by increasing the use of substances or practices that they have abused. The objective of this study was to evaluate the impact of the pandemic on emergency care and continuity of care for patients with substance use disorders.

Method: Study carried out in the only psychiatric emergency service in the province at the Hospital Universitario Santa María de Lérida, which cares for 431,183 people. Sociodemographic, clinical and evolutionary variables were collected from all the patients treated during a period prior to lockdown (January 13, 2020, until March 14, 2020) and during the first (March 15, 2020 until June 20, 2020) and second states of emergency (from October 25, 2020 to May 9, 2021).

Results: 908 patients attended with substance use disorder, representing 23.8% of all visits. During the first state of emergency, visits increased (p < 0,001) with a decrease in the average age (p = 0.0023). During the second state of emergency, there was an increase in the use of alcohol with respect to the rest of toxic substances (p < 0,001) and an increase in the visits of patients without prior follow-up (p = 0.005).

Conclusions: Substance use disorder consultations increased in the first state of emergency, with patients being younger and attending for reasons related to outpatient discontinuity, while in the second state of emergency, alcohol use increased in people without prior follow-up and with small social networks. Admissions in the first state of emergency were shorter, with no subsequent link to other detoxification treatment centers and with an earlier return to the emergency room, especially in female users.