title: State of Training, Clinical Services, and Research on Dual Disorders Across France, India, Israel, and Spain.
abstract: This article overviews training, clinical services, and research on dual disorders across four countries: France, India, Israel, and Spain.
  
  
  
  The current dual disorders systems in each of the four countries were reviewed, with a focus on strengths and limitations of each.
  
  
  
  In France, psychiatric care occurs within the public health care system and involves little training of medical graduates for managing dual disorders. Special courses and forums for specialists have recently started to meet the growing interest of physicians in learning how to manage dual disorders. The Indian health care system grapples with a large treatment gap for mental disorders, and while some treatment services for dual disorders exist, specific research and training efforts on dual disorders are just beginning. Israel has both public- and private sector services for patients with dual disorders, with specialized inpatient and emergency care for the acutely ill as well as day care and therapeutic communities for long-term management. Interest by researchers is growing, but training and education efforts in dual disorders are, however, minimal. Similar to the other countries, addiction and psychiatry disciplines are governed by separate divisions within the National Health System in Spain. There are some dual disorders services available, but they are limited in scope. While medical professionals clearly recognize the importance of dual disorders, there is no such recognition by the national and regional governing bodies.
  
  
  
  The common thread in various aspects of dual disorder management in each of these four countries is that there is a lower-than-desirable level of attention to dual disorders in terms of care, policy, research, and training. There are growing opportunities for training and continuing education in dual disorders management. We suggest that nations could learn from each other's experiences on how to address the issue of dual disorders.
authors: a Department of Psychiatry and National Drug Dependence Treatment Centre , WHO Collaborating Centre on Substance Abuse, All India Institute of Medical Sciences , New Delhi , India.|b International Programme in Addiction Studies, Master of Science in Addiction Studies, King's College London , United Kingdom.|c University of Adelaide , Adelaide , South Australia , Australia.|d Virginia Commonwealth University , Richmond , Virginia , USA.
authors: Yatan Pal Singh
authors: YP
authors: Balhara
authors: e Addiction Medicine and Dual Disorders Services, Department of Psychiatry , Sheba Medical Center , Tel-Hashomer , Israel.|f Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv , Israel.
authors: Shaul
authors: S
authors: Lev-Ran
authors: g Unidad Docente de Psiquiatría y Psicología Medica, Hospital Universitario Dr. Peset y Universidad de Valencia, & Universidad CEU-UCH , Valencia , Spain.
authors: José
authors: J
authors: Martínez-Raga
authors: h National Institute for Medical Research, University Paris-Sud, Hôpital Universitaire Paul Brousse , Villejuif , France.
authors: Amine
authors: A
authors: Benyamina
authors: a Department of Psychiatry and National Drug Dependence Treatment Centre , WHO Collaborating Centre on Substance Abuse, All India Institute of Medical Sciences , New Delhi , India.
authors: Shalini
authors: S
authors: Singh
authors: h National Institute for Medical Research, University Paris-Sud, Hôpital Universitaire Paul Brousse , Villejuif , France.
authors: Lisa
authors: L
authors: Blecha
authors: i Departamento de Psiquiatría , Hospital Universitario Gregorio Marañón, Calle Doctor Esquerdo , Madrid , Spain.
authors: Nestor
authors: N
authors: Szerman
mesh_terms: D002983:Clinical Competence; D003695:Delivery of Health Care; D019468:Disease Management; D005602:France; D006291:Health Policy; D006297:Health Services Accessibility; D006801:Humans; D007194:India; D007557:Israel; D001523:Mental Disorders / Q000628:therapy; D008605:Mental Health Services; D020380:Needs Assessment; D012106:Research; D013030:Spain; D019966:Substance-Related Disorders / Q000628:therapy
keywords: Dual disorders; France; India; Italy; Spain; co-occurring disorders; comorbidity; dual diagnosis; training