Conference report Europad 2014

The 11th Europad congress took place in Glasgow (Scotland) last May, 23-25th as planned.

As usual, the congress was structured in different thematic symposia, dealing with features of available treatment options, needs and strategies in special populations, prevention and handling of complications and comorbidities, and the configuration of treatment in special settings, such as custody and general practice.

Introduction speeches proposed viewpoints about the unmet needs in opiate addiction treatment, with the aim to reach some level of agreement upon the definition of outcome measures, socially shared goals and options for improvement of healthcare standards.

Selected lectures gave a synopsis of the different approaches to addiction treatment. Some conceptual and communicative differences seem to exist, such as the enduring use of such terms as “substitution” or “detoxification” with regard to agonist treatment, which we hope will soon be officially and systematically discharged. On one hand, some authors tried to investigated in the outcome of patients who accomplished successful longer-term agonist opiate treatment, with regard to those who remained abstinent after shorter-term interventions, in order to clarify whether, apart from the relapse-prevention perspective, quality of life, psychopathology and social adjustment are rather influenced by enduring abstinence or ongoing treatment. On the other hand, others showed greater attention towards single treatment modes, and the optimization of transition from one treatment to another, though not always consistently with the retention and response expectancy, so that shifting to treatment itself for previous responders or those who had not been treated properly by methadone treatment may just result in longer term failure.

The issue of psychopathology of addiction was thoroughly dealt with, beyond the categorial approach of dual diagnosis. A model of substance-induced psychopatological profiles, as persistent post-withdrawal syndromes, was discussed and typified. the optimization of patient-treatment matching strategies was also proposed.

An accent was put on the concept of “difficult patient”, with a double implication. On one side, the need to build up specific strategies to maintain difficult patient in treatment, algorhytms for the approach to complex situation and hierarchical views of intervention strategies. On the other, the need to avoid of turning a simple addicted patient to a non-responders, by calling up non-existent personal resources against the patient's own symptoms, or mistaking severity for a negative attitude towards treatment. The clinical knowledge underlying the interaction between patients and the healthcare system should be referred to as a basis to avoid the paradox of presumed resistant patients who have actually undergone no attempt of potentially effective treatment.

Such general themes were treated both by oral reviews, presentation of original data and conceptual speeches. Room was not subtracted to usual thematic symposia about pain treatment, infective diseases with special regard to hcv, side effects of agonist treatment, newer treatment options such as implantable naltrexone and buprenorphine-naloxone.

On the whole, we are glad to witness the will of different nations to give original and active contributions to the increase and improvement of knowledge about heroin addiction, on both biological and trans-cultural grounds, which has always been one main aim of the Association itself.