Proposals Dual Disorders

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1 Proposals Dual Disorders Substance use disorders and ADHD: a complex relationship chair Geurt, van de Glind, Trimbos-instituut and ICASA Foundation - NL - gglind@trimbos.nl J. Antoni, Ramos-Quiroga, Hospital Universitari Vall d'hebron. Universitat Autònoma de Barcelona - ES - jaramos@vhebron.net Screening and diagnosis of ADHD in SUD patients: new findings. Maija, Konstenius, Karolinska Institutet - SE - maija.seglekonstenius@sll.se Trauma in SUD patients with and without ADHD Katelijne, van Emmerik-van Oortmerssen, University of Amsterdam - NL - katelijnevo@hotmail.com Complexity of SUD in adults with ADHD Franz, Moggi, University Hospital of Psychiatry Berne. University of Fribourg - CH - franz.moggi@puk.unibe.ch The role of Borderline Personality Disorder in SUD Attention Deficit Hyperactivity Disorder (ADHD) is a highly comorbid disorder in patients with substance use disorders (SUD). Moreover, both SUD and ADHD are associated with various other comorbid conditions. Substance use disorders are reported to co-occur with a variety of other Axis I and Axis II disorders with mood and anxiety disorders, borderline personality disorder,(bpd), and antisocial personality disorder (ASPD) being the most frequently reported in the literature. The symposium will show the last results of the ICASA research group (International Collaboration on ADHD and Substance Abuse). First of all, the diagnosis of ADHD in patients with substance abuse will be review. The validation of new instruments to diagnosis ADHD in this population will be presented at this talk. After that, the results of the study about the presence of antecedents of trauma in ADHD patients with substance use disorder will be shared. Moreover, at the next presentation the complexity of substance use disorder in patients with ADHD will be addressed. Finally, the relationship between borderline personality disorder, ADHD and substance use disorders will be review. At the end of the symposium the assistants will achieve a compressive review of the most actual findings of ICASA focused on ADHD and substance abuse. 2 - The bipolar addiction comorbidity Chair: V Balanzá-Martínez (Spain) Speakers: F Kapczinski: Addictions and bipolar disorders from a staging model perspective JM Goikolea: Dual bipolar disorders a focus on prevention M Berk: Novel pharmacological treatments for dual bipolar disorders

2 3 - Convergence of addiction medicine and dual disorders (co-occurring disorders). Chairs: Gregory Bunt, M.D., Clinical Assistant Professor of Psychiatry NYU School of Medicine President-elect ISAM. Miguel Casas MD. PhD President Dual Pathology Foundation. Speakers Tarek Gawad, M.D., Immediate Past-President, ISAM. Nady El-Guebaly, MD. Founding President, ISAM Javier Didia Attas, M.D. Founding President ACAPI Nestor Szerman, M.D. Chair WPA Section on Dual Disorders/Pathology. SEPD President : Is it Possible to Treat the Psychopathology of Heroin Addicts Only with Agonist Opioid Treatment? chair Torrens, Marta, - ES - mtorrens@parcdesalutmar.cat chair Clausen, Thomas, - NO - thomas.clausen@medisin.uip.no Pani, Pier Paolo, - IT - pallolo@tin.it Does the prominent psychopathology of heroin addicts exist? Maremmani, Icro, - IT - maremman@med.unipi.it What is the specific psychopathology of Heroin Addicts at treatment entry? Maremmani, Angelo GI, - IT - angelogimaremmani@gmail.com Do methadone and buprenorphine have the same impact on psychopathological symptoms of heroin addicts? This workshop focuses on the prominent psychopathology of heroin addicts and on treatment using methadone or buprenorphine. There is recent research evidence that supports an antipsychotic, anxiolitic, antipanic, and mood stabilizing effect of opioid medications. The presenters will discuss three questions: 1.) Does the prominent psychopathology of heroin addicts exist? 2.) What is the specific psychopathology of heroin addicts at treatment entry? 3. Do methadone and buprenorphine have the same impact on psychopathological symptoms of heroin addicts? 5 - Suicidal and non-suicidal self-injurious behavior in patients with dual disorders Chair: Leo Sher (USA) Leo Sher Co-Chair: Zoltan Rihmer (Hungary) Speakers: Maria Dolores Picouto (Spain) "The role of HPA axis abnormalities in the pathophysiology of suicidal behavior in adolescents with dual disorders" Juan Jose Carballo (Spain) "Predictors of non-suicidal self-injury thoughts and behavior among adolescents. Results from the "ARCOS" study" Zoltan Rihmer (Hungary) "Mood disorders, smoking and suicide." Leo Sher (USA) "Prevention of suicidal behavior and non-suicidal self-injury in patients with dual disorders."

3 6 - Symposium : Dual disorders in the neuroscience context Chair: Nestor Szerman MD. Chair WPA Section on Dual disorders/pathology Speakers : Nestor Szerman MD. Hospital Universitario Gregorio Marañon Madrid, Spain. Dual Disorders in the context on neuroscience. Maria Isabel Barrigon MD PhD. Fundación Jiménez Díaz, Madrid, Spain. U shaped curve of psychosis according drug use. Lola Peris MD PhD. CNP-Centre Neuchâtelois de Psychiatrie, Neuchâtel, Switzerland. Borderline Personality Disorder and addiction: so near and yet so far 7 - Forum debate: Dual pathology in the Maghreb Chair: Mehdi Paes, M.D., Professor of Psychiatry; Rabat,Morocco Discussants Jean-Pierre Daulouède, M.D., Psychiatrist, Director of Bizia, Bayonne, President of the European and International Congress on Addiction, Hepatite and Aids; Bayonne,France "Dual Pathology and harm reductio:collaborative projects" Haifa Zalila, M.D.,Professor of Psychiatry;Tunis Medical School, Tunisia "Dual Pathology and intravenous drug users in Tunisia" Soumia Berrada, M.D., Professor of Psychiatry;Casablanca, Morocco "Dual Pathology and cocaine" Fatima El Omari,M.D.,Professor of Psychiatry; Rabat-Salé, Morocco "Opiate substitution treatments and harm reduction" Nadir Bourbon, M.D., Professor of Psychiatry;Cheraga, Algiers, Algeria "Dual Pathology in Algeria" : Depression, addiction and hepatitis C infection: a gender approach chair Torrens, Marta, - ES - mtorrens@parcdesalutmar.cat Martin-Santos, Rocio, - ES - rmsantos@clinic.ub.es Depression and HCV treatment in females Gilchrist, Gail, - UK - gail.gilchrist@kcl.ac.uk The REDUCE intervention for VHC in female drug users Fischer, Gabriele, - ES - gabriele.fischer@meduniwien.ac.at Gender differences in co-morbidity of substance use disorder Worldwide, around 170 million people are infected with HCV; the majority are IDU. Being female is a predictor of HCV among IDU. Sharing injecting equipment poses the greatest risk of transmission among IDU. Depression among IDUs has been associated with injection-related risk and needle sharing. Also treatment for HVC is related to increase of depression. In this symposium, the s will reflect last dates about the relationship between depression, addiction and hepatitis C infection since a gender perspective. They will include epidemiological, clinical, and therapeutic and also group intervention to reduce HCV risk taking behaviours and increase HCV transmission knowledge among females.

4 9 - Behavioral Addictions and Mental health Chair: professor Nady el- Guebaly -Speaker 1 Echeburua Enrique (Spain) -Similarities and differences across chemical and behavioral addictions - Speaker 2 Pinhas Dannon (Israel). A personal status, legal, economic and psychiatric diagnosis of types of adult male gamblers: the comparison between gambling habits. Speaker 3 Nady el-guebaly N-(Canada) Towards an individualized treatment profile across behavioral addictions TOWARDS AN INDIVIDUALIZED TREATMENT PROFILE ACROSS BEHAVIORAL ADDICTIONS Nady el-guebaly, MD Professor & Head, Addiction Division, University of Calgary Research Director, Alberta Gambling Research Institute Calgary Alberta, Canada Objectives: An appreciation of the empirical body of evidence underpinning the biopsychological causes of various behavioral addictions leads to a proposed individualized profile for assessing treatment needs. Methods: This presentation is based on nine recent literature reviews submitted as part of the Textbook of Addiction Treatment: International Perspectives Section on Behavioral Addictions. It includes two parts. Results: In Part I, an outline of neurobiological data, e.g. frontostriatal findings, neurotransmitters and genetic results covers six types of behavior addictions. A summary of psychological underpinnings of these behaviors follows, involving impairment of control, craving, expectancies, motives and personality. In Part II, a synopsis of pharmacological trials to date as well as the comparatively more robust level of evidence surrounding psychosocial interventions along with potential cultural differences could provide a menu of treatment options against individualized needs. Conclusions: An ever-expanding spectrum of behaviors potentially leading to addiction calls for a profile of common risk factors and an individualized assessment of needs. References: 1. el-guebaly N, Carra G, Galanter M. Textbook of Addiction Treatment: International Perspectives. Springer, to be published Leeman R, Potenza M. A Targeted Review of the Neurobiology and Genetics of Behavioural Addictions: An Emerging Area of Research. Can J Psychiatry 2013;58(5): : What about relationship between Post Traumatic Stress Disorder and Heroin? chair Dell'Osso, Liliana, - IT - ldelloss@med.unipi.it Carmassi, Claudia, - IT - ccarmassi@gmail.com Post traumatic stress spectrum and maladaptive behaviours (drug abuse included) after catastrophic events: L Aquila 2009 earthquake as case study Rugani, Fabio, - IT - fabruga@gmail.com Life events (loss and traumatic) and emotional responses to them in heroindependent patients before and after the dependence age of onset Maremmani, Icro, - IT - maremman@med.unipi.it Opiate addiction as spectrum of Post Traumatic Stress Disorder Epidemiological data show frequent associations between post-traumatic stress disorder (PTSD) and substance use disorders (SUD). This symposium, composted by 3 talks, tries to shed

5 light on the relationship of PTSD and SUD, specifically heroin addiction. First (1), we investigate the role of post traumatic stress spectrum and maladaptive behaviours in a population in a catastrophic event, such the earthquake was in Aquila population (IT) in We explore the role of degree of exposure (œdirect vs œindirect ), gender and age (> o =40) as potential risk factors for PTSD and the role of these same variables and of PTSD as potential risk factors for maladaptive behaviours in the same sample. Then (2), we move deeply into the relationship between PTSD and heroin addiction, assessing the life events (loss events and potentially traumatic events) of 82 heroin-dependent patients before and after the dependence age of onset (DAO) and their emotional, physical and cognitive responses to these events, within a trauma and loss spectrum, assessing, as well, personality traits at risk for PTSD. Finally (3), we studied if drug addiction can configure a clinical presentation belonging to a sort of PTSD spectrum, analysing potentially stressful events and emotional-affective consequences in heroin addicts Dual Disorders: Different problems and different treatment options? Chair: Professor Benyamina Amine (France). Speakers: Professor SamahJabr (Palestine) Cognitive Behavioral Therapy in the Treatment of Palestinian Patients with Comorbid Substance Use and Mental Disorders Professor Melamed Yuval (Israel). Smoking reduction among psychiatric inpatients. Dr. Shaul Lev-Ran (Israel). Buprenorphine/naloxone in the treatment of opiate addiction among individuals with co-morbid chronic pain and psychiatric disorders: a naturalistic 12 - Gambling behaviors and mental health Chair: Enrique Echeburua 1- Speaker: Enrique Echeburua. PhD. Similarities and differences across chemical and behavioral addictions. Implications for treatment. Professor of Clinical Psychology. University of the Basque Country. San Sebastián (Spain) 2- Speaker: Julio Angel Brizuela MD An integrated plain for training on Prevention, Assistance and Psychoeducation to the Community at Neuquén Province- Argentina. 3- Speaker: Hermano Tavares MD, PhD Associate Professor Department of Psychiatry, University of São Paulo, Brazil Development and validation of the Gambling Follow up Self-Report : PSYCHOPATOLOGY AND DUAL PATHOLOGY ASSOCIATED TO SMOKED AND INHALED COCAINE IN LATINAMERICA chair ELVIA, VELASQUEZ, - CO - chair Javier, Didia, ALAD - AR - ELVIA VELASQUEZ, VELASQUEZ, ALAD - CO - Overview of smokeable cocaines and consequens Coca Paste syndrome

6 Javier, Didia Attas, ACAPI - AR - Dual Pathology in Latinamerican with special reference to coca Paste Paco Rafael, Navarro, ALAD - CO - Comorbidity on Coca Paste and Cocaine Experience of a center treatment Saúl, Pacurucu, ALAD President - CO - Context of Drug Abuse and Alcohol in Latinamerica That participants understand different psychopathology and consequens of drug administration ways as: smoked, inhaled (sniffing) and injected cocaines and resulting syndrome of smoked basic Cocaines as PBC, Cocaine Basic Paste (PBC), crack, paco, etc. Methodology 4 s, based on relevant literature review and experience, compare and take conclusions on consequens by regions Importance The cocaine use, abuse and addiction, is one of the most widespread drugs abuse causing major problems worldwide. Literature do not make difference between impact of smoked vs Inhaled Cocaines what is crucial for appropriate clinical and preventive manage Results The smoked Cocaines are most dangerous than inhaled cocaines for its more rapid absorption through the lungs increasing the effects and the mixtures in its composition. The main forms are Î PBC in Latin America made from coca leaves Î Crack made from Cocaine Hydrochloride Î Paco (Cono Sur) and Oxi (Brasil) smoked cocaines have spread recently and have different composition mixtures that changes and increases consequens. This use started in Andean countries Per* and Bolivia in the years after quickly spread to Chile Colombia Ecuador, Brazil, and after 2000 had increased in Argentina, Uruguay, Paraguay (Paco) represents high percentages of patients in treatment centers Conclusions Use of smoked basic cocaines is more dangerous than inhaled cocaine, it is spreading to different countries in Latin America, USA and Europe. For prevention we need actions, studies, prevention and more treatment. Bibliography 3. Pasta B*sica de Coca*na. Cuatro dôcadas de historia, actualidad y desaf*os. UNODC. De Vida Peru : Adicci?n y Patolog?a Dual: Psicoterapia y Psicopatolog?a desde un enfoque Contructivista Post Racionalista chair Guajardo S?inz, Humberto, Universidad de Santiago de Chile - CL Ramirez Lopez, Juan, - ES La relaci?n entre Patolog?a Dual y Adicciones Guajardo S?inz, Humberto, Universidad de Santiago de Chile - CL Psicopatolog?a Dual y Adicciones Modelo Contructivista Kushner Lanis, Diana, CIAD (Centro de Investigación y Asistencia a Drogodependencias - CL Psicoterapia Postrracionalista en Patolog?a Dual y Adicciones El enfoque Psicopatol?gico de las adicciones se ha realizado tradicionalmente desde diferentes enfoques de corrientes psicol?gicas basadas en una epistemolog?a racionalista. Es as? como se han aplicado terapias de diferentes enfoques como Conductuales, Cognitivas, Sist?micas o Psicoanal?ticas, todas ellas bas?ndose en la noci?n de que es el terapeuta el que define lo que ocurre con el sujeto y buscando eliminar la adicci?n como una forma inapropiada de la

7 conducta del sujeto.la aparici?n de los planteamientos epistemol?gicos constructivistas a partir de autores como Humberto Maturana, Vittorio Guidano, Guillem Feixas, Michael Mahoney, Juan Balbi entre otros, junto al dise?o de un M?todo de Terapia Cognitiva Post Racionalista nos ha permitido a los autores aplicar estos planteamientos al proceso adictivo y al desarrollo de la Patolog?a Dual.Desde hace varios a?os estamos trabajando en la l?nea de establecer que la Organizaci?n de Sentido Personal del individuo que se desarrolla desde las primeras etapas del desarrollo evolutivo y que pensamos puede ser influ?da desde temprano por trastornos ligados a una Patolog?a Dual, es fundamental para explicar el desarrollo de una adicci?n.la adicci?n surge a partir de una discrepancia cognitivo afectiva entre las vivencias actuales y la Organizaci?n de Sentido Personal que se produce en un momento de la vida del individuo, que no logra ser resuelta y que encuentra en la droga de consumo una forma de resolver al menos transitoriamente esta discrepancia : GUIDELINES FOR PHARMACOLOGICAL AND PSYCHOLOGICAL TREATMENT OF ADULT PATIENTS WITH A PSYCHIATRIC DISORDER AND A COMORBID SUBSTANCE USE (DUAL DIAGNOSIS PATIENTS) chair San, Luis, - ES chair Bernardo, Miguel, - ES San, Luis, - ES PRESENTATION OF THE GUIDELINES FOR PHARMACOLOGICAL AND PSYCHOLOGICAL TREATMENT OF ADULT PATIENTS WITH A PSYCHIATRIC DISORDER AND A COMORBID SUBSTANCE USE (DUAL DIAGNOSIS PATIENTS) Bernardo, Miguel, PRESENTATION OF THE GUIDELINES FOR PHARMACOLOGICAL AND PSYCHOLOGICAL TREATMENT OF ADULT PATIENTS WITH A PSYCHIATRIC DISORDER AND A COMORBID SUBSTANCE USE (DUAL DIAGNOSIS PATIENTS) Arrojo, Manuel, - ES - PRESENTATION OF THE GUIDELINES FOR PHARMACOLOGICAL AND PSYCHOLOGICAL TREATMENT OF ADULT PATIENTS WITH A PSYCHIATRIC DISORDER AND A COMORBID SUBSTANCE USE (DUAL DIAGNOSIS PATIENTS) For the last 18 months, the Spanish Society of Biological Psychiatry has been elaborating the Guidelines for Pharmacological and Psychological Treatment of Dual Diagnosis Patients. Our aim is to provide helpful and pragmatic guidelines for clini*cians, such as psychiatrists and GPs, involved in treating peo*ple with psychiatric disorders and substance use. However, these guidelines should also be of interest to other practitioners in the substance misuse field, nonspecialists, patients and their families.dual diagnosis is traditionally defined as the cooccurrence of substance use disorder in patients with severe mental illness. About 50*f patients with severe mental illness have substance use and viceversa. Mental health professionals frequently find the treatment of dually diagnosed patients challenging and difficult. This GRADE approach was the instrument used to elaborate the Guidelines. The GRADE approach considers the quality of evidence, the evidence for each outcome and the magnitude of the effect. It also ensures a systematic and transparent process. The following steps were followed: PICO questions, choosing outcomes, Gradeing the evidence (participants and studies, relative and absolute effects), and quality of the evidence. Evidence obtained is presented in summary of findings (SoF) tables which give the key findings from the systematic review. Finally, recommendations for the optimal treatment of Dual Diagnosis patients are

8 given Simposio Portugues :Primeiro episódio psicótico no doente adito first psychotic episode in adicted patient Moderador: Professor Doutor António Palha, Porto Esquizofrenia e adição: processos neurobiológicos. Schizophrenia and addiction: neurobiological processes. Professor Doutor João Relvas, psiquiatra. Serviço de Psiquiatria, Centro Hospitalar Universitário de Coimbra Fatores de vulnerabilidade em esquizofrenia e adição: adolescência e juventude. Vulnerability factors in schizophrenia and addiction: adolescence and youth. Dra Eva Mendes, Médica interna de psiquiatria Serviço de Psiquiatria, Centro Hospitalar Universitário de Coimbra Psicose induzida por substâncias: estabilidade diagnóstica. Substances induced psychoses: diagnostic stability. Dra. Célia Franco, psiquiatra. Serviço de Psiquiatria, Centro Hospitalar Universitário de Coimbra. Doentes adictos numa unidade de primeiro episódio psicótico. Addicted patients in a first psychotic episode unit. Dra. Joana Maia, psiquiatra. Serviço de Psiquiatria, Centro Hospitalar Pombal-Leiria Simposio Portugues patologia dual em populações especiais dual pathology in special populations. Moderador: Dr. Luís Patrício, psiquiatra. Patologia dual na população prisioneira. Dual pathology in population in jail Enfermeira Cândida Henriques. Estabelecimento Prisional de Coimbra. Patologia dual e população em de situação sem-abrigo. Dual pathology and homeless population. Dra. Vera Martins, psiquiatra Serviço de Psiquiatria, Centro Hospitalar Universitário de Coimbra. PHDA e patologia dual: questões clínicas. HDAD and dual pathology, clinical i ssues. Dra. José Temótio, psiquiatra. Serviço de Psiquiatria, Centro Hospitalar Universitário de Coimbra Symposio Portugues: organização de serviços no tratamento do doente dual services organization in treatment of dual patient Moderador: Dr. António Reis Marques, psiquiatra Diretor doserviço de Psiquiatria do Centro Hospitalar Universitário de Coimbra Rede de referenciação para os comportamentos aditivos e dependências, a experiência de Coimbra Referral network for addictive behavioursand dependencies, the experience of Coimbra. Dra. Célia Franco, psiquiatra Serviço de Psiquiatria, Centro Hospitalar Universitário de Coimbra A experiência da Unidade de Patologia Dual de Coimbra.The experience of Dual Unit Pathology from Coimbra Dra.Carla Silva, psiquiatra. Serviço de Psiquiatria, Centro Hospitalar Universitário de Coimbra.Hospital de Dia no tratamento do doente dual Day Hospital in Dual Patient treatment

9 Enfermeira Carla Torres. Hospitalar Universitário de Coimbra : Intervention Strategies On Drug Users Severe Mental Disorders (Schizophrenia, Bipolar Disorder And Personality Disorder) From A Longitudinal Perspective In The Province Of Huelva chair Juan Jose, Manche?o Barba, Director de la Unidad de Gestion de Salud Mental del Area Hospitalaria Juan Ramon Jimenez de Huelva - ES Mercedes, Guzman Llorente, Area Hospitalaria Juan Ram?n Jim?nez The acute phase of the first mental disorder episode related with drug use Juan, Ramirez Lopez, Psiquiatra Coordinador del Centro Ambulatorio de Drogodependencias - ES The midle phase of the disease Maria Luisa, Gutierrez Lopez, Area hospitalaria Juan Ramon Jimenez - ES The chronic phase of the disease María, Ramirez Dominguez, Area hospitalaria Juan Ramón Jimenez - ES An experience of how to address severe mental disorders affecting drugs users in the Psychiatric Prison. GOAL In response to the difficulty of the approach to the treatment and monitoring of drug users* severe mental disorders, this symposium outlines the intervention strategies of the different stages of the illness conducted in the province of Huelva.We use in this province the model on a parallel basis upon the network of Mental Health and other one of Addictive Disorders, with the intention of obtaining an integrated approach aimed at the intervention of both the addictive and the severe mental disorder. SPECIFIC OBJECTIVES AND METHODOLOGY FIRST INTERVENTION - The objective of this first part is to reflect upon the most appropriate way of addressing the acute phase of the first episodes, related with drug use, in Emergency care and Acute Unit of Mental Health. SECOND INTERVENTION - The aim is to analize the midle phase of the disease, when the follow up and outpatient treatment is performed. The aproach of drug users with several mental disorderes, is carried out in the Mental Health Community Units and Addictive Disorders Centers. In both facilities, a Individualized Treatment Plan is applied. THIRD INTERVENTION - The goal is to work on different considerations in the intervention of the chronic phase of these patients, when they are under care, in residential resources of Social Support devices in our province. FOURTH INTERVENTION ì In this case we will discuss about an experience of how to address severe mental disorders affecting drugs users in the Psychiatric Prison Psicosis Dual, el huevo o la Gallina? Chair: Dr Carlos Roncero. Servicio de Psiquiatría. Hospital Universitario Vall Hebron. Psychiatry Departament. Universidad Autónoma de Barcelona. Barcelona (Spain) Speakers: Nelson Feldman Cannabis and Psychosis : Update and knowledge from Psychiatry. Centro Addictologie Geneva University Hospitals, Geneva, (Switzerlan).

10 Dr. Carlos Roncero Barcelona Cocaine-Induced Psychosis Dr Rodrigo Cordova (Colombia) Grupo CISNE, Universidad de Bogota, Bogotá (Colombia). APAL president electo Schizophrenia and adolescente drug abuse : INTERNET INFLUENCE IN THE 21sth CENTURY ADDICTIONS chair Francisco, Ferre, Hospital universitario Gregorio Mara?on - ES Javier, Correas, - ES Pathological gambling on the internet Javier, Quintero, - ES Patterns of Misuse and Abuse of Information and Comunication Technologies. Helen, Dolengevich, - ES Drugs on the Internet: new substances with unknown risks. Pathological gambling show us that under the model of addiction we should consider the concept of behavioral addictions or addiction whithout substance. With the widening and spread of the Internet and Information and Communication Technologies (ICTs), this pattern of behavior have changed until the point of being of risk. Online gambling became accessible from anywhere, hampering limited-access therapeutic strategies. But the Internet and ICTs have also influenced other risks, like patterns of unhealthy uses, that lead us to develop the concept of addiction to the internet or to smart phones, whith special vulnerability by youngsters. Finally, this symposium will address the issue of accessibility to "new" substances on line, some of them under the guise of harmless, but mantaining unknown risks Tobacco and Dual Disorders. Tabaco y Patologia Dual. Chair: Dr. Serebrisky Deborah(Argentina) Speakers: Dr. Serebrisky Deborah (Smoking and psychiatric co-occurring disorders in Argentina. Dr. Müller Fernando(Argentina) Smoking and mental health professionals in Argentina. Dr. Waisman Campos Marcela. Cognitive deterioration associated to the use of psychoactive substances. Tobacco also?