Treatment at the Clínic

The Child and Youth Psychiatry and Psychology Department at Hospital Clínic has had an Adolescents Addictive Behaviours Programme (UNICA-A) since November 2005. Currently, the programme involves a part-time psychiatrist (Daniel Ilzarbe), a psychologist (Rosa Díaz) and a social worker (Laura Higueras). It also receives occasional support from nursing staff and social educators. The programme offers advice and intervention in highly complex cases referred to or treated within the department. Screen use related problems (e.g., with video games, social networks, sports betting and online shopping) are identified and given specific, intensive intervention. 

Professionals in the programme address “Internet addiction” in a cross-disciplinary manner and collaborate with: 

• The community programme, Konsulta’m, which provides school-based counselling, early detection and occasional guidance.
• The Child and Adolescent Mental Health Centre (CSMIJ) in Eixample which offers consultancy and support to the centre’s professionals in cases requiring specific intervention for addiction-related problems.
• The Intensive Dual Diagnosis Outpatient Programme, which treats complex cases referred from the area’s CSMIJs that require intensive visits, frequent coordination with schools and other social resources (in cases of severe absenteeism and legal offences, for example), as well as full or partial hospitalisation when psychiatric symptoms need to be assessed or serious crises require containment.

37%-43% of patients treated in the UNICA-A Programme (2021–2024) sought a consultation for problematic Internet or video game use. Comorbidity with other psychiatric disorders among these patients ranged from 60% to 96%. Most of the care provided for these children and adolescents and their families takes place in outpatient consultations. They accounted for 22% of the population treated in the high-intensity dual diagnosis programme and about 1% of all hospitalisations in the Department.

The treatment plan offered by UNICA-A consists of an interdisciplinary intervention that provides integrated care for addictive behaviour, comorbid disorders and other contributing factors - whether causes or consequences of the addiction - tailored to the individual needs and characteristics of the patient and their family; this is delivered in close coordination with community resources. 

1. The initial interview is usually conducted with the patient’s parents only, when a complete clinical history is taken, including medical, psychiatric, psychobiographical and family background as well as other information.
2. Subsequent interviews are held with the patient using motivational techniques to facilitate engagement and raise awareness of problems related to Internet use.
3. This is followed by a combination of individual and joint sessions with the parents to work on family agreements, as well as develop parenting and socio-emotional skills in both parents and children.

Parents also take part in psychoeducational sessions with other parents, whenever possible. When necessary, home or community visits are also made to strengthen the bond with the patient and observe any family dynamics that may be perpetuating problems. Patients are also frequently accompanied when returning to school or encouraged to take part in recreational and social activities. Coordination with schools, social services and child and adolescent care teams, among others, is also very frequent, with the aim of unifying objectives and planning strategies, facilitating school attendance or identifying resources for the family, among other goals.

The treatment of more complex cases must take into account the need to consolidate progress and prevent possible relapses; therefore, the follow-up period is usually extended for one or two years, during which visits are progressively less frequent.

When patients reach adulthood, efforts are made to establish a link with the corresponding adult service. We have a specific transition programme with the Adult Addictions Unit and Adult Mental Health Centre in the hospital for patients in the Esquerra de l'Eixample area. This includes joint visits with professionals from both services and family sessions with parents and children to facilitate the transition between the two units.