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Virtuelle Medizin in der Behandlung von Sucht in den USA, Kanada und darüber hinaus

ZusammenfassungInsbesondere während der aktuellen Corona-Pandemie hat der Gebrauch virtueller Lösungen in der Medizin international stark zugenommen. Es gibt eine zunehmende Akzeptanz gerade auch in dem Bereich der hausärztlichen Versorgung, der Behandlung psychischer Störungen und der Abhängigkeitserkrankungen.Die Entwicklung ist international unterschiedlich, v. a, wenn man die USA und Kanada auf der einen Seite und Europa, insbesondere Deutschland, andererseits vergleicht. In Nordamerika hat bei dem Einsatz von moderner Technologie die Einführung von „Electronic Medical Record Systems“ eine dominierende Rolle gespielt. Diese ist insbesondere auf Abrechnung und Dokumentation zu Versicherungszwecken fokussiert. Daneben gibt es zunehmend Apps, die spezifische therapeutische Ansätze zu implementieren helfen. Die Anwendung virtueller Ansätze im Suchtbereich ist begrenzt, aber in Teilen sehr innovativ und auf deutsche Verhältnisse anwendbar. Wie in Europa gibt es auch in Nordamerika nur sehr begrenzte Forschungskapazitäten und prinzipiell Widerstand bei den medizinischen Berufsgruppen bezüglich der Anwendungsmöglichkeiten und der Rolle im Behandlungsprozess. Mehr Kooperation würde international zu einer Beschleunigung der Entwicklung und der Etablierung gemeinsamer Standards beitragen sowie die Behandlungssysteme bedeutend verbessern.

Internet Addiction – An Umbrella Construct

Problematic Internet Use or “Internet addiction” is generally considered as an inability to control the use of the Internet, which eventually involves psychological, social, academic, and/or professional problems in a person's life. Dysfunctional use of the Internet has been related to a variety of different activities such as cybersex, online gambling, online video game playing, or social network involvement, thereby emphasizing that this problematic behavior can take very different forms across individuals and should not be viewed as a homogeneous construct. Since its appearance in the psychiatric and clinical psychology literatures, Internet addiction has been almost systematically conceptualized within the framework of behavioral (nonchemical) addictions. Accordingly, the various criteria proposed to define an addiction to the Internet (and related screening tools) were transposed from those established for the diagnosis of substance abuse and disordered gambling. In 2013, the APA decided that evidence is too scarce to allow its inclusion as a new condition in the DSM-5. Indeed, the Internet addiction construct is challenged by both theoretical and empirical concerns. In this talk, I will review the existing evidence supporting the view that conceptualizing the Internet-related disorders as “behavioral addiction” is too restrictive and might result in the simplification of heterogeneous and multi-determined problematic behaviors. Theoretical and clinical implications of this position will be discussed. Finally, I will consider the risks associated with the “pathologization” of every day behaviors. Indeed, nowadays, many daily behaviors and leisure activities tend to be considered as new tentative behavioral addictions, which could eventually deserve the credibility of this important (but emergent) field of research.

Health-related quality of life of patients in opioid substitution treatment in Germany

Introduction: Health-related quality of life (HRQOL) is an important treatment outcome criterion in chronic diseases. While the fields of medicine and mental health have embraced HRQOL as a valuable source of information in treatment and research, the field of addiction is lagging behind in this respect. Research on HRQOL in drug users has only been emerging in the past 10 years and the systematic use of HRQOL measures in clinical practice is scarce. Opioid substitution treatment (OST), the standard treatment for opioid dependence, typically measures its quality and treatment success by means of objective parameters, such as mortality. With opioid dependence as a chronic, relapsing disease, a long-term approach to patient care is needed, focusing on improvements in treatment adherence and patient wellbeing. HRQOL lends itself as a useful tool in this respect, seen that it is a measure of subjective wellbeing and a predictor of remission and treatment adherence. As such, HRQOL could be used to monitor the patient and provide tailored support in treatment. While measures of HRQOL have been implemented in an increasing number of studies on opioid dependence, the objective was often to demonstrate the effectiveness of OST in improving patients' wellbeing upon entering treatment. Epidemiological data on the HRQOL of OST patients is limited, and lacking entirely for Germany. Such cross-sectional data is of interests, as it includes the large population of long-term OST patients, whose wellbeing is rarely captured in the literature. The aim is to examine the HRQOL of OST patients in Germany, and assess its relation to mental and physical health.

ENSH-Global Standards Review 2015: Why and How!

Introduction: The ENSH-Global Network for Tobacco Free Health Care Services is an international non-profit Association with the aim to strengthen the role of healthcare services in the implementation of the Framework Convention of Tobacco Control of the World Health Organisation. The ENSH-Global Concept is based on standards and a self-audit questionnaire and was developed on European level in 2002 and updated in 2007. The purpose of this concept and tools are to engage, motivate and support health services, independent of size, culture, and country legislation to effectively implement tobacco management policies within a healthcare setting. A European-wide evaluation in 2008 showed that all organisations who performed above the European median, were members of the ENSH network. To meet the changing demands in tobacco control and to integrate global experiences, ENSH-Global instigated a review and update of the standards in July 2014. Methods: Initially, all national and regional coordinators were invited to participate in this review process which commenced with written feedback using a standardized form. Ten national coordinators participated in the process and they each recruited a national team of experts to cover both 'tobacco' and 'quality' aspects. On-going review of feedback and suggestions and updating of the draft standards took place in the frame of one personal workshop and seven online meetings of the coordinating team. During the review timeframe, all members were invited to input by returning feedback on draft versions which were circulated at two key stages. The final version will be presented in the annual General Assembly of ENSH-Global in June 2015. The new edition of the standards will be piloted in the next ENSH Fold Forum Process 2015/6. Results: The updated Standards and experiences of the validation process will be presented with a focus on the core principles for implementation.