Máté Kapitány-Fövény

Given the multifaceted nature of addiction, a multidisciplinary and comprehensive therapeutic approach is essential. Art therapy has therefore become an important complementary intervention in both inpatient and outpatient treatment settings. Numerous studies support its applicability and effectiveness among individuals with addiction. Art therapy can be particularly beneficial in reducing pervasive feelings of shame and anxiety, as well as in facilitating the processing of traumatic experiences - phenomena that are common among people with substance use disorder (SUD) and are often difficult to articulate verbally. The study examines the use of art therapy with clients with SUD, with a specific focus on the therapeutic factors that emerge through clinical practice. The analysis is grounded in three interrelated theoretical frameworks that help explain potential mechanisms of change in art therapy: trauma theory, mentalization-based approaches, and neurobiological and reward-related models. The case studies draw on two closed art therapy groups, consisting of 8 and 12 sessions respectively, at a drug outpatient treatment centre. Each group comprised eight adult participants with SUD. Most participants presented with comorbid conditions. Findings from the case studies suggest that the therapeutic factors associated with art therapy play a meaningful role in clients’ recovery processes. Evidence of recovery is reflected in the artworks produced during therapy, which offer insight into clients’ personalities, emerging behavioural and emotional patterns, and ongoing personal transformation. These visual expressions reflect clients’ current level of self-awareness and may highlight obstacles that may hinder recovery. In this way, the artworks function as visual narratives that both document and support the therapeutic process. The findings provide practical implications for clinicians seeking to integrate art therapy into addiction treatment. They also contribute to a deeper understanding of the therapeutic potential of the arts in supporting recovery among individuals with SUD. Given the high prevalence of comorbid personality disorders and trauma histories among individuals with SUD, art therapy serves as a uniquely adaptable modality that complements both verbal psychotherapy and pharmacological interventions. Art therapy is also a valuable tool for status assessment, offering insight into personality traits and emotional states.

This commentary evaluates Lakatos et al.'s qualitative study on nasal spray addiction within rhinitis medicamentosa (RM), applying Griffiths' addiction component model. While evidence remains insufficient for formal diagnostic inclusion, the study identifies behavioral and psychological features paralleling core addiction criteria. Case reports and user narratives provide additional support, though counter-evidence persists. Conceptual and methodological challenges highlight the need for research addressing clinical relevance, theoretical embedding, and taxonomic plausibility. Despite limited empirical validation, the significant distress and functional impairment reported by affected individuals underscore the importance of recognizing and addressing this emerging issue.

Background: Religiousness has been positively associated with better mental health and stronger self-control, including in patients with substance use disorders (SUDs) or attention deficit/hyperactivity disorder (ADHD). However, data on religiousness in patients with SUD and comorbid ADHD are lacking. Objectives: This study aims to test in patients with SUD and comorbid ADHD whether (1) religiousness is negatively associated with SUD and ADHD symptom severity, and (2) self-control mediates the assumed negative association of religiousness with SUD and ADHD symptom severity. Method: In an international cohort study, baseline religiousness, self-control, SUD and ADHD symptom severity, and craving were assessed with self-report questionnaires and structured clinical interviews in 578 treatment-seeking SUD patients with comorbid adult ADHD (SUD + ADHD). Data were analyzed using structural equation modeling (SEM). Results: Stronger self-control wad associated with lower severity of both ADHD and SUD, but higher religiousness was only associated with lower severity of ADHD. This association was not mediated by self-control. Conclusion: Religiousness may have a salutary relationship with ADHD severity, but not with SUD severity. While self-control was associated with lower symptom severity for both co-occurring conditions, it may not be involved in the potentially salutary effects of religiousness in patients with SUD + ADHD.

Elméleti háttér: Akut vagy krónikusan elnyúló fenyegetések esetén veleszületett, automatikusan aktiválódó védekezési reakciók jelennek meg: ezek között kiemelhető a harcolás, a menekülés és a lefagyás védekezési mechanizmusa. Ennek ellenére korábban nem volt elérhető magyar nyelven olyan mérőeszköz, amely specifikusan ezeket a reakciókat vizsgálta volna. Cél: A jelen vizsgálat célja a Fight, Flight, Freeze Questionnaire (FFFQ) magyarra történő adaptációja és a mérőeszköz pszichometriai jellemzőinek vizsgálata. Módszerek: A vizsgálatban kevert klinikai (183 szorongásos vagy hangulatzavarral diagnosztizált személy) és non-klinikai (311 egyetemi hallgató kontrollcsoportja) mintán konfirmatív faktorelemzéssel (CFA) vizsgáltuk meg az FFFQ–HU faktorszerkezetét. A mérőeszköz konvergens validitásának vizsgálata érdekében a résztvevők további, szorongást (Spielberger-féle Állapot- és Vonásszorongás Kérdőív Vonásszorongás Skála), depressziót (9 itemes Beck Depresszió Kérdőív), impulzivitást (Barratt Impulzivitás Skála módosított, 21 itemes magyar változata), viselkedésgátlást és aktivációt (Viselkedéses Gátló és Aktiváló Rendszer Skálák), valamint megküzdési módokat (Konfliktusmegoldó Kérdőív) mérő validált skálákat töltöttek ki. Eredmények: A CFA megfelelő modellilleszkedés mellett (RMSEA = 0,06; CFI = 0,96; TLI = 0,95) erősítette meg az FFFQ–HU elméleti, háromfaktoros szerkezetét. A konvergens validitás tekintetében a harcolás elsősorban az impulzivitással [r_S(417) = 0,32; p < 0,001], a viselkedésaktiváció szórakozáskeresés dimenziójával [r_S(417) = 0,26; p < 0,001], valamint a feszültségredukció [r_S(417) = 0,46; p < 0,001] megküzdési módjával mutatott összefüggést. A menekülés elsődleges korrelátumai a depresszió [r_S(417) = 0,64; p < 0,001], a viselkedésgátlás [r_S(417) = 0,25; p < 0,001], valamint a feszültségredukció [r_S(417) = 0,32; p < 0,001] voltak. A lefagyás leginkább a szorongással [r_S(417) = 0,47; p < 0,001], a viselkedésgátlással [r_S(417) = 0,52; p < 0,001], és a passzív megküzdéssel [r_S(417) = 0,23; p < 0,001] mutatott jelentősebb együttjárást. A lineáris regresszió elemzések eredményei alapján a harcolás egyedüli szignifikáns és negatív magyarázó változója az iskolai végzettség volt (β = –0,19; p < 0,001), míg a menekülés és a lefagyás esetén a klinikai csoporttagság pozitív (β = 0,27; p < 0,001; β = 0,28; p < 0,001), míg az életkor negatív (β = –0,15; p < 0,01; β = –0,10; p = 0,04) prediktora volt a magasabb faktorátlagoknak. Következtetések: Az FFFQ– HU megfelelő pszichometriai jellemzői lehetővé teszik a mérőeszköz alkalmazását mind a kutatás, mind a klinikai gyakorlat területén. Az FFFQ–HU által mért védekezési reakciók fontos, potenciálisan a terápiás folyamatot is meghatározó információkat hordoznak.

Background and aim: Based on national annual statistical data, estimates can be made on the number of the clients entered treatment. However, these data provide information on the addiction treatment’s capacity rather than on the real number of people with substance use disorders. A lot of international research found that many clients do not access addiction treatment due to personal, social and structural factors. In Hungary, research on entering treatment’s barriers is more limited – our aim is to analyse the gaps in the substance use disorder treatment. Method: Qualitative method was applied. The target group consisted of national professionals who have been working in treatment for several years at health care system or social service providers in Budapest. 11 interviews were conducted. Verbatim transcriptions were analysed using qualitative thematic analysis. Result and conclusion: Several structural, organisational, and personal barriers of accessibility to substance use treatment have been explored. No change in the last 5-10 years has been found regarding the funding and unpredictability of funding in the field; the political interests of decision making that ignore experts’ opinion; the unpredictable legal environment with administrative burdens; the attitudes of society towards drug use; the lack of qualified workforce. National and international research also suggests that there are deep, systemic problems in substance use treatment, which can be addressed through social sensitisation programmes, evidence-based decision-making involving experts, prevention, a more predictable legal and financial environment, capacity expansion and meaningful information.

Non-medical opioid use is a major public health concern causing high mortality. While opioid agonist maintenance treatment (OMT) is a key life-saving intervention, there is (a) no international consensus on opioid treatment outcomes and (b) few opioid treatment outcome studies include key (public) health outcomes, such as overdose or HIV/hepatitis C. We report the rationale and study protocol for, and preliminary results of, an ongoing international OMT outcomes consensus study that aims to address this double gap (n = 110 collaborating experts from 32 countries, plus a n = 477 Delphi evaluation panel from 26 of those countries: 58% male–41% female; 47% OMT patients–53% OMT professionals). We present a first draft of a patient interview guide (including a ‘clinical form’) to monitor OMT outcomes in six domains. The form appears to be well accepted and feasible in early testing. Through this, we aim to enhance the quality of and access to OMT, and improve the survival, health and quality of life of people who use opioids, while promoting non-stigmatising patient-physician relationships.