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Maciej Kopera,1 Kirk J Brower,2 Hubert Suszek,3 Andrzej Jakubczyk,1 Sylwia Fudalej,1 Aleksandra Krasowska,1 Anna Klimkiewicz,1 Marcin Wojnar1,2 1Department of Psychiatry, Medical University of Warsaw, Warsaw, Poland; 2Department of Psychiatry, Addiction Research Center, University of Michigan, Ann Arbor, MI, USA; 3Department of Psychology, University of Warsaw, Warsaw, Poland Purpose: Chronic pain is a significant comorbidity in individuals with alcohol dependence (AD). Emotional processing deficits are a substantial component of both AD and chronic pain. The aim of this study was to analyze the interrelations between components of emotional intelligence and self-reported pain severity in AD patients. Patients and methods: A sample of 103 participants was recruited from an alcohol treatment center in Warsaw, Poland. Information concerning pain level in the last 4 weeks, demographics, severity of current anxiety and depressive symptoms, as well as neuroticism was obtained. The study sample was divided into “mild or no pain” and “moderate or greater pain” groups. Results: In the logistic regression model, across a set of sociodemographic, psychological, and clinical factors, higher emotion regulation and higher education predicted lower severity, whereas increased levels of anxiety predicted higher severity of self-reported pain during the previous 4 weeks. When the mediation models looking at the association between current severity of anxiety and depressive symptoms and pain severity with the mediating role of emotion regulation were tested, emotion regulation appeared to fully mediate the relationship between depression severity and pain, and partially the relationship between anxiety severity and pain. Conclusion: The current findings extend previous results indicating that emotion regulation deficits are related to self-reported pain in AD subjects. Comprehensive strategies focusing on the improvement of mood regulation skills might be effective in the treatment of AD patients with comorbid pain symptoms. Keywords: mood regulation, pain, alcoholism, emotional regulation

Background:The coronavirus disease 2019 (COVID-19) pandemic has impacted people with substance use disorders (SUDs) worldwide, and healthcare systems have reorganized their services in response to the pandemic.Methods:One week after the announcement of the COVID-19 as a pandemic, in a global survey, 177 addiction medicine professionals described COVID-19-related health responses in their own 77 countries in terms of SUD treatment and harm reduction services. The health responses were categorized around (1) managerial measures and systems, (2) logistics, (3) service providers, and (4) vulnerable groups.Results:Respondents from over 88% of countries reported that core medical and psychiatric care for SUDs had continued; however, only 56% of countries reported having had any business continuity plan, and 37.5% of countries reported shortages of methadone or buprenorphine supplies. Participants of 41% of countries reported partial discontinuation of harm-reduction services such as needle and syringe programs and condom distribution. Fifty-seven percent of overdose prevention interventions and 81% of outreach services were also negatively impacted.Conclusions:Participants reported that SUD treatment and harm-reduction services had been significantly impacted globally early during the COVID-19 pandemic. Based on our findings, we highlight several issues and complications resulting from the pandemic concerning people with SUDs that should be tackled more efficiently during the future waves or similar pandemics. The issues and potential strategies comprise the following: (1) helping policymakers to generate business continuity plans, (2) maintaining the use of evidence-based interventions for people with SUDs, (3) being prepared for adequate medication supplies, (4) integrating harm reduction programs with other treatment modalities, and (5) having specific considerations for vulnerable groups such as immigrants and refugees.

Aims To analyze the current paradigm and clinical practice for dealing with alcohol use disorders (AUD) in primary health care. Methods Analyses of guidelines and recommendations, reviews and meta-analyses. Results Many recommendations or guidelines for interventions for people with alcohol use problems in primary health care, from hazardous drinking to AUD, can be summarized in the SBIRT principle: s creening for alcohol use and alcohol-related problems, b rief i nterventions for hazardous and in some cases harmful drinking, r eferral to specialized t reatment for people with AUD. However, while there is some evidence that these procedures are effective in reducing drinking levels, they are rarely applied in clinical practice in primary health care, and no interventions are initiated, even if the primary care physician had detected problems or AUD. Rather than asking primary health care physicians to conduct interventions which are not typical for medical doctors, we recommend treatment initiation for AUD at the primary health care level. AUD should be treated like hypertension, i.e. with regular checks for alcohol consumption, advice for behavioral interventions in case of consumption exceeding thresholds, and pharmaceutical assistance in case the behavioral interventions were not successful. Minimally, alcohol consumption should be screened for in all situations where there is a co-morbidity with alcohol being a potential cause (such as hypertension, insomnia, depression or anxiety disorders). Conclusions A paradigm shift is proposed for dealing with problematic alcohol consumption in primary health care, where initiation for treatment for AUD is seen as the central element.

Aim: To provide a description of patients receiving alcohol treatment in eight different European countries, including the level of comorbidities and functional limitations. Methods: Drinking behaviours, DSM-IV alcohol use disorder (AUD), mental and somatic comorbidities, disability and health services utilization of 1767 patients from various specialized treatment settings were assessed as representative for regions of eight European countries. Severity of alcohol dependence (AD) in terms of drinking level was compared with a large representative US sample. Alcohol and Alcoholism, 2015, 1–9 doi: 10.1093/alcalc/agv009 Article © The Author 2015. Medical Council on Alcohol and Oxford University Press. All rights reserved 1 Alcohol and Alcoholism Advance Access published February 25, 2015 Downloaded from by guest on February 25, 2015 Results: Patients in specialized care for AUDs showed high levels of consumption [average level of daily ethanol intake: 141.1 g, standard deviation (SD): 116.0 g], comorbidity [e.g. liver problems: 19.6%, 95% confidence interval (CI): 17.5–21.6%; depression: 43.2%, 95% CI: 40.7–45.8%; anxiety: 50.3%, 95% CI: 47.8–52.9%], disability and health services utilization (average number of nights spent in hospital(s) during the last 6 months: 8.8, SD: 19.5 nights). Severity of AD was similar to the US sample, but European men consumed on average more alcohol daily. Conclusions: High levels of consumption, somatic and mental comorbidities, disability and functional losses were found in this representative treatment sample, indicating that treatment was initiated only at severe stages of AUDs. Earlier initiation of treatment could help avoid some of the health and social burden.

Detecció d'alcoholèmia; Intervenció breu; Actitud del personal sanitari Detección de alcoholemia; Intervención breve; Actitud del personal sanitario Alcoholism detection; Brief intervention; Attitude of Health Personnel Aims: To determine the relation between existing levels of alcohol screening and brief interventionrates infive European jurisdictions and role security and therapeutic commitment by the participat-ing primary healthcare professionals. Methods: Health care professionals consisting of, 409 GPs, 282 nurses and 55 other staff including psy-chologists, social workers and nurse aids from 120 primary health care centres participated in a cross-sectional 4-week survey. The participants registered all screening and brief intervention activities aspart of their normal routine. The participants also completed the Shortened Alcohol and Alcohol Pro-blems Perception Questionnaire (SAAPPQ), which measure role security and therapeutic commitment. Results: The only significant but small relationship was found between role security and screeningrate in a multilevel logistic regression analysis adjusted for occupation of the provider, number ofeligible patients and the random effects of jurisdictions and primary health care units (PHCU). Nosignificant relationship was found between role security and brief intervention rate nor betweentherapeutic commitment and screening rate/brief intervention rate. The proportion of patientsscreened varied across jurisdictions between 2 and 10%. Conclusion: Thefindings show that the studied factors (role security and therapeutic commitment)are not of great importance for alcohol screening and BI rates. Given the fact that screening and briefintervention implementation rate has not changed much in the last decade in spite of increased pol-icy emphasis, training initiatives and more research being published, this raises a question aboutwhat else is needed to enhance implementation. Radboud university medical centre received co-funding from The NetherlandsOrganization for Health Research and Development (ZonMW, Prevention Pro-gramme), under Grant Agreement n° 200310017—ODHIN—Optimizing de-livery of healthcare interventions in the Netherlands, according to Art.II.17 ofthe FP7 EC Grant Agreement. Pomeranian Medical University in Szczecin re-ceived co-funding regarding presented research from the Polish sciencefinancialresources in the years 2012–2014 allocated to conduct the international co-funded project ODHIN.

BackgroundAlcohol use disorders (AUDs) are highly prevalent in Europe, but only a minority of those affected receive treatment. It is therefore important to identify factors that predict treatment in order to reframe strategies aimed at improving treatment rates.MethodsRepresentative cross-sectional study with patients aged 18–64 from primary health care (PC, six European countries, n = 8476, data collection 01/13–01/14) and from specialized health care (SC, eight European countries, n = 1762, data collection 01/13–03/14). For descriptive purposes, six groups were distinguished, based on type of DSM-IV AUD and treatment setting. Treatment status (yes/no) for any treatment (model 1), and for SC treatment (model 2) were main outcome measures in logistic regression models.ResultsAUDs were prevalent in PC (12-month prevalence: 11.8%, 95% confidence interval (CI): 11.2–12.5%), with 17.6% receiving current treatment (95%CI: 15.3–19.9%). There were clear differences between the six groups regarding key variables from all five predictor domains. Prediction of any treatment (model 1) or SC treatment (model 2) was successful with high overall accuracy (both models: 95%), sufficient sensitivity (model 1: 79%/model 2: 76%) and high specificity (both models: 98%). The most predictive single variables were daily drinking level, anxiety, severity of mental distress, and number of inpatient nights during the last 6 months.ConclusionsVariables from four domains were highly predictive in identifying treatment for AUD, with SC treatment groups showing very high levels of social disintegration, drinking, comorbidity and functional losses. Earlier intervention and formal treatment for AUD in PC should be implemented to reduce these high levels of adverse outcomes.