Illicit drug addiction stands as a pressing concern affecting millions across the European Union (EU) and worldwide. The European Drug Report 2023 highlights that approximately 83 million adults in the EU, constituting 28.9% of the adult population, have experimented with illicit drugs at least once in their lifetimes. Drug addiction is a sensible issue that demands a comprehensive approach encompassing prevention, treatment, and professional capacity building. The European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) emphasizes the need to enhance the professionalism of the drug prevention workforce across Europe. This imperative is also underscored in the EU Drugs Action Plan (2021-2025), which aims to mitigate the proliferation of drug use within EU Member States. Nevertheless, numerous challenges persist, including inadequate curricula on addiction medicine and vocational education and training (VET) programmes and a shortage of trained professionals.

While it is widely recognized that VET plays a crucial role in equipping the general workforce with practical skills and knowledge (Brockmann, Clarke & Winch, 2008), its application and effectiveness vary from country to country, and this variability extends to the work developed with individuals with substance use disorder (SUD). Across diverse healthcare systems, there has been a resounding call to enlarge local, non-stigmatizing services to meet better the needs of individuals grappling with substance use disorders (Triliva et al., 2020).   This encompasses information dissemination, service organization, staff attitudes, significant others' involvement, and personal disposition (Gilchrist et al., 2014). Several studies have emphasized the imperative of enhancing psychosocial interventions and customizing them to cater to diverse risk groups (Molina et al., 2020; Schäfer et al., 2023), but methodological challenges persist considering the psychosocial treatments for substance misuse (Luty, 2015; Hunt et al., 2019; Sulaman, Hartley & Elvins, 2023). Healthcare workers frequently report feeling ill-equipped to address the complex needs of SUDs, exacerbating the stigma surrounding drug addiction. The World Health Organization (WHO) has identified deficits in global training programmes for SUDs, emphasizing the imperative of building workforce capacity to achieve sustainable development goals related to health and well-being (SDG 3). Moreover, the prevalent stigma associated with drug addiction delays prevention and treatment efforts, hindering access to care for affected individuals. COVID-19 has further exposed vulnerabilities in the EU healthcare system, particularly in addressing the comorbidities of SUDs among patients.

To address these challenges, the CARE4SUD project “Vocational training in illicit drug addiction: equipping health care practitioners with addiction treatment competencies and techniques” (2022-1-LT01-KA220-VET-000086077) emerges as an important initiative. Developed by Klaipėdos Ernesto Galvanausko Profesinio Mokymo Centras (Lithuania) in partnership with Inštitut za raziskave in razvoj Utrip (Slovenia), Sosu Ostjylland (Denmark),  University do Porto (CIIE/FPCEUP, Portugal), Direcția de Asistență Socială și Medicală Cluj-Napoca (Romania) and Institute of Social Solidarity and Wellbeing: Social Mind (Greece), this project aims to enhance the professionalism of healthcare practitioners in the field of illicit drug addiction, both nationally and across Europe. The target participants of the CARE4SUD project include healthcare practitioners in the primary health sector, addiction professionals, VET educators, and policymakers. By empowering healthcare practitioners with the essential knowledge and skills, CARE4SUD aims to improve the standard of care provided to individuals with illicit drug addiction by creating a VET programme. Drawing upon evidence-based practices and collaborative partnerships (Mulder, 2017), this programme seeks to bridge existing professional training and service delivery gaps, ultimately striving for improved health outcomes and social well-being within affected communities. Through a holistic approach informed by research, the CARE4SUD project aims to promote a more inclusive and competent healthcare workforce capable of effectively addressing the complexities of illicit drug addiction in contemporary society.

Building on the CARE4SUD project - which aims to provide healthcare practitioners an opportunity to enter the addiction field and enhance the knowledge and skills required for their further professional development - and informed by a qualitative approach (Bryman, 2001; Lewin & Glenton, 2018), our research procedures consist, mainly, of conducting interviews (Burton et al., 2014; Cohen et al., 2000) and focus group discussions (Krueger & Casey, 2009). In this sense, and to clarify the lack and requirements in healthcare training connected to illicit drug addiction, we conducted interviews with individuals who have a history of or are currently engaged in illicit drug use. A total of 27 individuals were interviewed, comprising seven women and 20 men aged between 24 and 67 years old, from Portugal (n=4), Greece (n=5), Slovenia (n=5), Lithuania (n=5), Romania (n=5) and Denmark (n=3). These interviews aimed to identify the needs and gaps within the practical context and the prospective skills required for addiction health training across the six participating countries. Furthermore, we conducted focus group discussions comprising ten addictologists and ten healthcare professionals from each partner country, a total of 120 participants. These focus groups included a diverse range of healthcare workers with expertise in the illicit drug addiction field, such as psychiatrists, nurses, general practitioners, psychologists, social workers, and addiction counselors. The overarching aim of these focus groups was to gather insights concerning drug use from several perspectives and identify knowledge gaps in drug prevention and treatment education. We aimed to develop a core set of competencies tailored to address the specific needs of healthcare professionals. The data collected was analyzed through thematic content analysis (Bardin, 2011). In all the cases, participants were above 18, participated voluntarily, and provided informed consent before involvement.

Data analysis revealed a knowledge gap in illicit drug addiction education and training across the six different countries. Besides the prominent focus of all participants on the importance of promoting health services that are non-stigmatizing, aiming to address better the needs of individuals coping with SUD (Triliva et al., 2020), the data uncovered several needs concerning professional training in this area, namely: (a) the absence of targeted training courses in university studies, with existing ones often outdated; (b) insufficient promotion and adaptation of existing courses to meet the practical needs of people with drug addiction; and (c) the necessity for models of best practice and collaboration among professionals in the field. Proposed areas for inclusion in an illicit drug addiction VET programme include fundamental knowledge of psychopathology, pharmacology, and psychotherapeutic techniques, particularly family therapy in addiction contexts. The curriculum should also cover motivational interviewing, screening tools for addiction assessment, mental health first aid, referrals to primary illicit drug addiction services, enhancement of communication skills, and ethical and legal considerations. To address these challenges and develop a comprehensive VET training program, it is imperative to integrate a thorough examination of the social, psychological, and physiological ramifications of drug addiction, incorporating detailed insights into addiction pharmacology and neurobiology. Collaborative efforts involving key stakeholders—such as healthcare professionals, educators, policymakers, and individuals with lived experiences of addiction—can help to identify potential obstacles and formulate strategies to overcome them, resulting in more impactful and practical training for healthcare professionals working with illicit drug addiction. Including experts with lived experiences in the programme development process is also crucial, as their insights can enrich its effectiveness and offer a deeper understanding of the specifics of addiction and recovery.

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