Antoni Gual

Antoni Gual
Hospital Clínic de Barcelona · Servicio de Psiquiatría

MD, PhD.

About

432
Publications
53,826
Reads
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7,521
Citations
Introduction
Dr Antoni Gual is a psychiatrist, Head of the Addictions Unit at the Neurosciences Institute, Clinic Hospital, University of Barcelona, Spain; and also acts as Alcohol Consultant at the Health Department of Catalonia. He is Coordinator of several EU funded projects (Alice Rap, Odhin, Amphora, Leader, Twist) and has been involved in several european research projects in the areas of Public Health and clinical trials. He is Vicepresident of the International Network on Brief Interventions for Alcohol Problems (INEBRIA), past-President of the European Federation of Addiction Scientific Societies (EUFAS) and past president of the Spanish Scientific Society for the Study of Alcohol and Alcoholism.
Additional affiliations
January 2000 - present
IDIBAPS August Pi i Sunyer Biomedical Research Institute
Position
  • Researcher
January 1998 - January 2010
Collegi Oficial de Metges de Barcelona
Position
  • Co-Director of the Impaired Physicians Program (PAIMM)
Description
  • Program devoted to provide treatment to physicians with addictive or mental disorders.
January 1985 - present
Hospital Clínic de Barcelona
Position
  • Consultant

Publications

Publications (432)
Article
Full-text available
Background: Effective interventions exist for heavy drinking and depression but to date there has been limited translation into routine practice in global health systems. This evidence-to-practice gap is particularly evident in low- and middle-income countries. The international SCALA project (Scale-up of Prevention and Management of Alcohol Use Di...
Article
Full-text available
Background Initial results from the SCALA study demonstrated that training primary health care providers is an effective implementation strategy to increase alcohol screening in Colombia, Mexico and Peru, but did not show evidence of superior performance for the standard compared to the shorter training arm. This paper elaborates on those outcomes...
Article
Full-text available
Background Sodium oxybate (SMO) has been shown to be effective in the maintenance of abstinence (MoA) in alcohol-dependent patients in a series of small randomized controlled trials (RCTs). These results needed to be confirmed by a large trial investigating the treatment effect and its sustainability after medication discontinuation. Aims To confi...
Article
Purpose of review: The purpose of this update is to provide an overview of recent research publications (January 2020-January 2022) on real-time telemedicine solutions for the management of addictions (alcohol, tobacco, opioids, and other drugs). Recent findings: Motivational interviewing by real-time telemedicine showed effectiveness in youth a...
Article
The crisis caused by prescribed opioids and their related side effects are a public health problem worldwide. Most of these are prescribed for coping with chronic pain. The coexistence of opioid use disorder (OUD) in patients with chronic pain represents a complex challenge due to the need for managing both pain and OUD. The aim of this systematic...
Article
Full-text available
Issues: Numerous studies have examined the impact of the COVID-19 pandemic on alcohol use changes in Europe, with concerns raised regarding increased use and related harms. Approach: We synthesised observational studies published between 1 January 2020 and 31 September 2021 on self-reported changes in alcohol use associated with COVID-19. Electr...
Article
Full-text available
Psychological trauma is highly prevalent among psychiatric disorders, however, the relationship between trauma, neurobiology and psychopathology is not yet fully understood. The cerebellum has been recognized as a crucial structure for cognition and emotion, however, it has been relatively ignored in the literature of psychological trauma, as it is...
Article
Full-text available
Brief alcohol advice offered to patients was shown to be a clinically- and cost-effective intervention to prevent and manage alcohol-related health harm. However, this intervention is not yet optimally implemented in practice. A suggested strategy to improve the implementation of brief alcohol advice is through community actions which would enhance...
Article
Sodium oxybate (SMO) has been approved in Italy and Austria for the maintenance of abstinence in alcohol dependent (AD) patients. Although SMO is well tolerated in AD patients, cases of abuse and misuse have been reported outside the therapeutic setting. Here we report on a phase IIb double-blind, randomized, placebo-controlled trial for the mainte...
Article
Full-text available
Background: There is considerable unexplained variability in alcohol abstinence rates (AR) in the placebo groups of randomized controlled trials (RCTs) for alcohol dependence (AD). This is of particular interest because placebo responses correlate negatively with treatment effect size. Recent evidence suggests that the placebo response is lower in...
Article
Full-text available
Background: Cannabis is the third most consumed drug worldwide. Thus, healthcare providers should be able to identify users who are in need for an intervention. This study aims to explore the relationship of acute, chronic, and early exposure (AE, CE, and EE) to cannabis with cognitive and behavioral harms (CBH), as a first step toward defining ris...
Article
Full-text available
Introduction Implementation of evidence-based care for heavy drinking and depression remains low in global health systems. We tested the impact of providing community support, training, and clinical packages of varied intensity on depression screening and management for heavy drinking patients in Latin American primary healthcare. Materials and me...
Article
Full-text available
Background Brief interventions (BI) for risky drinkers in primary healthcare have been demonstrated to be cost-effective but they are still poorly implemented. Digital BI seems to be a complementary strategy to overcome some barriers to implementation but there is a scarcity of studies in clinical environments. We present the results of a randomize...
Article
Aims: Cognitive impairment in patients with alcohol use disorder (AUD) is highly prevalent, and it negatively impacts treatment outcome. However, this condition is neither systematically assessed nor treated. Thus, we aimed to explore the usability of a virtual reality-based protocol ('Rehabilitation Gaming System', RGS) for patients with AUD. Me...
Article
Full-text available
Liver transplantation is a complex procedure that requires multiple evaluations, including abstinence monitorization. While literature assessing the impact of different variables on relapse, survival, and graft loss exists, little is known about the predictive capacity of direct alcohol biomarkers. The primary aim of this study was to evaluate the...
Article
Background Primary care (PC) is crucial in the care of substance use disorder (SUD) patients. However, the relationship between PC and addiction settings is complex and collaboration issues stand out. Available evidence suggests that integration of SUD and PC services can improve physical and mental health of SUD patients and reduce health expenses...
Article
Full-text available
Aims To investigate changes in alcohol consumption during the first months of the COVID-19 pandemic in Europe as well as its associations with income and experiences of distress related to the pandemic. Design Cross-sectional on-line survey conducted between 24 April and 22 July 2020. Setting Twenty-one European countries. Participants A total o...
Article
Full-text available
The present study is part of a larger multi-site clinical trial aiming to test the efficacy of Virtual Reality-Cue Exposure Therapy (VR-CET) in patients diagnosed with alcohol use disorder (AUD) considered resistant to treatment as usual (TAU). In this study, we focused on exploring alcohol craving, anxiety, and attentional bias as indicators of th...
Article
Full-text available
The identification of variables that can modulate the efficacy of cue exposure using virtual reality (VR) is crucial. This study aimed to explore determinant variables of cue-elicited alcohol craving and perceived realism (PR) of environments and alcoholic beverages during a VR cue-exposure session among alcohol use disorder (AUD) outpatients. A pr...
Article
Full-text available
The standardization of cannabis doses is a priority for research, policy-making, clinical and harm-reduction interventions and consumer security. Scientists have called for standard units of dosing for cannabis, similar to those used for alcohol. A Standard Joint Unit (SJU) would facilitate preventive and intervention models in ways similar to the...
Article
Background: Cannabis is one of the most used drugs worldwide. There is no gold standard treatment for cannabis use disorder (CUD). Motivational interviewing (MI) has shown efficacy in some substance use disorders. Therefore, a systematic review was conducted to assess the effectiveness of MI in CUD. Methods: Randomized controlled trials or open-...
Article
Full-text available
Objectives: This contribution provides insights into the methodology of a pan-European population-based online survey, performed without external funding during the COVID-19 pandemic. We present the impact of different dissemination strategies to collect data from a non-probabilistic convenience sample and outline post-stratification weighting sch...
Article
Background Individuals with Substance Use Disorders (SUD), are vulnerable to the psychological consequences of the COVID-19 pandemic. This is the first study to assess risk factors of adverse mental health outcomes during lockdown in a SUD population. Methods This was a cross-sectional study, conducted through an online survey that was completed b...
Article
Full-text available
Background SARS-CoV-2 reached Europe in early 2020 and disrupted the private and public life of its citizens, with potential implications for substance use. The objective of this study was to describe possible changes in substance use in the first months of the SARS-CoV-2 pandemic in Europe. Methods Data were obtained from a cross-sectional online...
Article
Full-text available
Background: Screening for unhealthy alcohol use in routine consultations can aid primary health care (PHC) providers in detecting patients with hazardous or harmful consumption and providing them with appropriate care. As part of larger trial testing strategies to improve implementation of alcohol screening in PHC, this study investigated the motiv...
Article
Background and importance: SBIRT programs (Screening Brief Intervention and Referral to Treatment) for at-risk drinkers in emergency departments (ED) have shown to be effective, particularly at short term. In this article, we report mid and long-term follow-up results of a specialized SBIRT program. A short-term follow-up after 1.5 months showed e...
Article
Full-text available
Background: Patients with alcohol use disorder (AUD) are likely to suffer disproportionate harms related to the COVID-19 pandemic and related policy measures. While many surveys have been conducted, most are focused on drinking changes in the general population and validation with biological markers is lacking. Method: We performed a retrospecti...
Article
Full-text available
Aims : Attentional bias (AB), alcohol craving, and anxiety have important implications in the development and maintenance of alcohol use disorder (AUD). The current study aims to test the effectiveness of a Virtual Reality Cue-Exposure Therapy (VR-CET) to reduce levels of alcohol craving and anxiety and prompt changes in AB toward alcohol content....
Chapter
Background: This study is part of a larger project aiming to develop a virtual reality (VR) software to be implemented as a clinical tool for patients diagnosed with alcohol use disorder (AUD). The study is based on previous research in which we identified factors that elicit craving for alcohol in a sample of AUD patients, and which led to the dev...
Article
Full-text available
Background Providing alcohol screening and brief advice (SBA) in primary health care (PHC) can be an effective measure to reduce alcohol consumption. To aid successful implementation in an upper middle-income country context, this study investigates the perceived appropriateness of the programme and the perceived barriers to its implementation in P...
Article
Full-text available
Purpose We aimed to test the effects of providing municipal support and training to primary health care providers compared to both training alone and to care as usual on the proportion of adult patients having their alcohol consumption measured. Methods We undertook a quasi-experimental study reporting on a 5-month implementation period in 58 prim...
Preprint
Full-text available
Background: SARS-CoV-2 reached Europe in early 2020 and disrupted the private and public life of its citizens, with potential implications for substance use. The objective of this study was to describe possible changes in substance use in the first months of the SARS-CoV-2 pandemic in Europe. Methods: Data were obtained from a cross-sectional onlin...
Preprint
Full-text available
Aims: The aim of this project was to investigate changes in alcohol consumption during the first months of the pandemic in Europe as well as its associations with income and experiences of distress related to the COVID-19 pandemic. Design: Cross-sectional online survey conducted between April 24 and July 22 of 2020. Setting: 21 European countries....
Preprint
Full-text available
Aims: The aim of this project was to investigate changes in alcohol consumption during the first months of the pandemic in Europe as well as its associations with income and experiences of distress related to the COVID-19 pandemic. Design: Cross-sectional online survey conducted between April 24 and July 22 of 2020. Setting: 21 European countries....
Chapter
Alcohol-related disorders are common, expensive in their entire course, and often underdiagnosed. To facilitate early diagnosis and therapy of alcohol-related disorders and thus prevent later complications, questionnaires and biomarkers are useful. Indirect state markers such as gamma-glutamyl transpeptidase (GGT), mean corpuscular volume (MCV), an...
Conference Paper
Objetivos: Evaluar el impacto de la COVID-19 y el confinamiento domicliario en las tasas de recaída de pacientes con trastorno por uso de alcohol (TUA). A diferencia de estudios previos hechos mediante encuestas, nos centramos en datos más fiables, como son las alcoholurias realizadas con etilglucurónido. Método: estudio de cohorte retrospectivo en...
Article
Background: Alcohol is associated with all-cause mortality increase. However, when this increase takes place has not been clearly established. The objective of this study was to establish the levels of alcohol consumption that can be considered low risk for overall mortality. Methods: Systematic review of cohort studies published since 2014 that...
Article
Full-text available
Alcohol is a major risk factor for burden of disease. However, there are known effective and cost-effective alcohol control policies that could reduce this burden. Based on reviews, international documents, and contributions to this special issue of International Journal of Environmental Research and Public Health (IJERPH), this article gives an ov...
Article
Full-text available
Background/objective: Determining the predictive variables associated with levels of alcohol craving can ease the identification of patients who can benefit from treatments. This study aimed to describe changes (improvement or no change/deterioration) in alcohol craving levels and explore the predictors of these changes from admission to discharge...
Article
Full-text available
Liver transplantation remains an essential procedure for many patients suffering from alcoholic liver disease. Alcohol use monitoring remains paramount all through the stages of this complex process. Direct alcohol biomarkers, with improved specificity and sensibility, should replace traditional indirect markers. Phosphatidylethanol (PEth) has been...
Method
Full-text available
Study protocol for the Alcohol Use and COVID-19 Survey, available online on the DEEP SEAS website: https://www.deep-seas.eu/wp-content/uploads/2020/10/Study-protocol-COVALC_Sept.20_DEEPSEAS.pdf
Article
Alcohol-related cognitive impairment (ARCI) is highly prevalent among patients with alcohol dependence. Although it negatively influences treatment outcome, this condition is underdiagnosed and undertreated. The aim of this systematic review is to investigate the existing evidence regarding both cognitive and pharmacological interventions for ARCI....
Article
Full-text available
Tobacco use is more prevalent among alcohol liver disease (ALD) transplant patients and exerts harmful effects to the patient and to the graft. The aims of this study were to examine the impact of smoking status (nonsmoker, ex-smoker, active smoker) on patient survival and clinical outcomes, and to assess risk factors for active smoking before and...
Article
Full-text available
There is great potential for scaling up the delivery of brief interventions for alcohol and illicit drug use, given the increasing coverage of mobile devices and technologies for digital interventions, including apps for smartphones and tablets. However, while the number of digital interventions is increasing rapidly, the involvement of brief-inter...
Article
Objectives: There are sex differences in the pattern of alcohol consumption and in the complications of alcohol use disorder (AUD). We aimed to identify sex-specific differences in the factors associated with alcohol withdrawal syndrome (AWS) among patients that requested a first treatment for AUD. Methods: We enrolled 313 patients (75% men) with...
Article
Full-text available
Background: Citizens affected by substance use disorders are high-risk populations for both SARS-CoV-2 infection and COVID-19-related mortality. Relevant vulnerabilities to COVID-19 in people who suffer substance use disorders are described in previous communications. The COVID-19 pandemic offers a unique opportunity to reshape and update addictio...
Preprint
Full-text available
UNSTRUCTURED There is great potential for scaling up the delivery of brief interventions for alcohol and illicit drug use, given the increasing coverage of mobile devices and technologies for digital interventions, including apps for smartphones and tablets. However, while the number of digital interventions is increasing rapidly, the involvement o...
Article
Background: There is huge potential for scaling up the delivery of brief interventions for alcohol and illicit drug use, given the increasing coverage and technologies of e-digital interventions, including applications for smartphones and tablets. However, while the quantity of digital interventions is increasing rapidly, the involvement of brief-i...
Article
Objective To evaluate if cannabis dose recorded as standard joint unit (SJU) consumed before admission and other related factors have an influence on psychiatric inpatient's symptom severity and clinical outcomes. Methods Cross-sectional study in an acute psychiatric inpatient unit including 106 individuals. Quantity of cannabis was measured as SJ...
Article
Full-text available
Objective: Due to the high economic and morbimortality burden associated to alcohol use, in the last decades, public health services have developed several programs to detect and to intervene on at risk drinkers in primary care settings and emergency departments (ED). The aim of this study is to determine the proportion of detected and registered...
Article
Full-text available
Cannabis is the third most used psychoactive substance worldwide. The legal status of cannabis is changing in many Western countries, while we have very limited knowledge of the public health impact of cannabis-related harms. There is a need for a summary of the evidence of harms and risks attributed to cannabis use, in order to inform the definiti...
Preprint
Full-text available
Monitoring mental health outcomes has traditionally been based on heuristic decisions often based on scarce, subjective evidence, making the clinical decisions made by professionals, as well as the monitoring of these diseases, subject to flaws. However, the "digital phenotype", which refers to the analysis of data collected by measuring human beha...
Preprint
Full-text available
Monitoring mental health outcomes has traditionally been based on heuristic decisions often based on scarce, subjective evidence, making the clinical decisions made by professionals, as well as the monitoring of these diseases, subject to flaws. However, the "digital phenotype", which refers to the analysis of data collected by measuring human beha...
Preprint
Full-text available
Background : While primary health care-based prevention and management of heavy drinking is clinically effective and cost-effective, it remains poorly implemented in routine practice. Systematic reviews and multi-country studies have demonstrated the ability of training and support programmes for healthcare professionals to increase primary health...
Conference Paper
Objetivo: Evaluar la influencia de las percepciones, actitudes y prácticas del personal asistencial que trabaja en unidades de hospitalización de salud mental de adultos respecto a intervenciones sobre el consumo de tabaco en pacientes ingresados. Material y métodos: Estudio transversal. Se incluyen unidades de hospitalización de Agudos (UA), Patol...
Article
Fundamentos: El consumo excesivo de alcohol es uno de los factores de riesgo de morbimortalidad más importantes en nuestro entorno, por lo que en los últimos años se han desarrollado múltiples programas para la detección e intervención sobre los consumidores de riesgo en los centros de atención primaria y de Urgencias. El objetivo de este estudio f...
Article
Introduction: Reduced drinking has been debated as a treatment goal for heavy drinking alcohol dependent patients, in whom treatment based on abstinence is not always an option. Nalmefene was the first drug approved by the European Medicines Agency (2013) with the indication of reduced drinking in high drinking risk level alcohol dependent patients...
Preprint
BACKGROUND In the EU, approximately 165 million people suffer from mental health disorders, namely anxiety, mood disorders, and substance abuse. These mental health disorders have resulted in both direct and indirect global economic costs estimated at US $2.5 trillion in 2010, with the indirect costs (USD $ 1.7 trillion) being significantly higher...
Article
Full-text available
Background: Monitoring mental health outcomes has traditionally been based on heuristic decisions, often based on scarce, subjective evidence, making the clinical decisions made by professionals, as well as the monitoring of these diseases, subject to flaws. However, the digital phenotype, which refers to the analysis of data collected by measurin...
Presentation
Attentional bias (AB) and alcohol craving are heavily involved in the development and maintenance of alcohol drinking patterns and may facilitate relapse even after many years of abstinence. To address the recent interest in novel technologies applied in the assessment and treatment of alcohol use disorder (AUD), the “ALCO-VR” project aims to devel...