RESUMEN

This work aimed at creating a psychosocial intervention based on growth mindset theory and implementation intention strategies, in order to reduce alcohol consumption among users in the general population, and the clinical population of individuals with alcohol use disorder. A mixed method approach was used, combining qualitative and quantitative research methods among both populations. Four focus groups were first conducted to extract arguments in favor of a malleable view of alcohol consumption (study 1A), situations that trigger the desire to drink alcohol, as well as strategies used by people to counteract this need (study 1B). Data were analyzed using reflective thematic analysis in line with the scientific literature on alcohol consumption. The results were used to create a questionnaire scoring the relevance of each argument, situation and strategy (study 2). The 20 best scored arguments, situations and strategies were selected to create the intervention. The created intervention consisted in a popularized scientific article describing alcohol consumption as malleable, including the selected arguments and followed by two internalization exercises. Then, a volitional help sheet included the selected situations and solutions was presented, allowing forming up to three plans. The discussion focused on the added value of the created material compared to pre-existing tools in the literature, and presents plans to test the intervention in a future study.

Asunto(s)

RESUMEN

How to manage adult attention deficit hyperactivity disorder in patients with substance use disorders? Adult attention deficit hyperactivity disorder (ADHD) frequently occurs with anxiety disorders, mood disorders and above all addictive comorbidities. Its evaluation must be systematic during an addictology consultation. ADHD is a neurodevelopmental disorder characterized by a complex clinical picture combining cognitive, affective and behavioral dimensions that frequently underlies addictive disorder. Substance misuse frequently begins as an over-the-counter medication. The multidimensional diagnostic approach makes it possible to detect these complex interactions. The motivational therapeutic approach involving the comorbidity issue is crucial to support the patient in his change towards a control of his addictions.

Comment prendre en charge le trouble déficit de l'attention/ hyperactivité de l'adulte en addictologie ? Le trouble déficit de l'attention/hyperactivité de l'adulte se présente fréquemment a vec des comorbidités anxieuses, thymiques et surtout addictives. Qu'il soit connu dès l'enfance ou non, traité ou non, son exploration doit être systématique en consultation d'addictologie. Pathologie développementale à l'expression clinique complexe mêlant les dimensions cognitive, affective et comportementale, ce trouble constitue un facteur de risque significatif pour les troubles addictifs. La prise de substances correspond fréquemment à des stratégies d'automédication. L'approche diagnostique multidimensionnelle permet de détecter ces interactions parfois complexes. L'approche thérapeutique motivationnelle et la prise en compte de cette comorbidité permettent d'accompagner le patient dans son changement vers un contrôle de ses addictions.

Asunto(s)

RESUMEN

Repetitive negative thinking (RNT), the most studied forms of which are depressive ruminations and anxious worry, is a unique transdiagnostic process responsible for the development and maintenance of many mental disorders. Over the past decade, studies have shown that RNT could be involved in the development and maintenance of alcohol use disorder (AUD). However, to date, little is known about the factors that can influence this relationship, even though some theoretical and empirical arguments suggest that variables such as gender or metacognitive beliefs may determine the role of RNT in the onset of symptoms. The aim of the present study was to test the moderation effect of metacognitive beliefs and gender in the relationship between RNT and AUD. Eighty-one AUD patients were administered measures of AUD severity, RNT, metacognitive beliefs about thinking and alcohol use, anxiety, and depression. Results indicated that the 'capture mental resources' factor of RNT is a significant predictor of AUD severity, independent from anxiety and depression, and that this effect is moderated by metacognitive beliefs and gender. RNT is a significant predictor of AUD severity only for people with high negative beliefs about thoughts regarding uncontrollability and danger. Furthermore, RNT was found to predict AUD severity only for men with high beliefs about the need to control thoughts and for men with high positive beliefs about emotional self-regulation. Treatments that reduce attentional impairments caused by RNT and modify dysfunctional metacognitive beliefs could be promising for some patients with AUD.

Asunto(s)

RESUMEN

The concept of addiction emerged subsequent to the moral approaches of the end ofthe 19th century as a pathological behaviour. The manuals which classify mental disorders, together with the notion of substance-related disorders, enable them to be approached with a medical vision. The subject of numerous, often heated or divisive debates, addictology requires a clinical approach. The treatment of addiction must involve professionals from the medical, nursing, psychological and social fields. This multi-disciplinarity encourages each player to consider their own nursing identity while taking into account that of each other.

Asunto(s)

Asunto(s)

Asunto(s)

Asunto(s)

RESUMEN

Alcoholic disease in women, what specificities? Alcoholic disease in women has long been neglected. Taboo, culturally, it has also probably been so in the field of research and on clinical practice. But this has changed since the recent publication of some very relevant studies that attracted particular attention from a part of the public opinion who came in support of professionals alarmed by the inaction on this subject. Based on a specific clinical experience and from epidemiological studies, clinical data and the complications due to alcohol misuse by women, this article demonstrates the need to focus more on this pathology as it is serious for the patients as well as for their entourage. Indeed, complications seem to be able to develop from the first drink: they are somatic, psychiatric, but also social. There are specificities of this disease in women both through the factors of vulnerability but also by the clinical presentation or by its consequences. Women are more vulnerable than men to alcohol. The lack of knowledge from which this disease suffers leads to longer delays before consultation of patients and insidiously installs complications that are heavier than those of men. In fact, care requires a specific approach in relation to a request and a still particular status attributed to women. It is important to increase the information work in order to encourage patients to consult but also to better legislate on the promotion that mainly targets women and young people, and this in the framework of a more rigorous and efficient prevention.

Maladie alcoolique chez la femme, quelles spécificités ? La maladie alcoolique chez les femmes est restée longtemps négligée. Taboue sur le plan culturel, elle l'était probablement aussi encore dans le domaine de la recherche et de la clinique. Mais cela change depuis certaines études récentes très éloquentes qui ont éveillé l'intérêt d'une partie de l'opinion publique venue en soutien aux professionnels qui s'alarmaient de l'immobilisme à ce sujet. Sur la base d'une expérience clinique particulière et à partir d'études consacrées à l'épidémiologie, la clinique et les complications du mésusage d'alcool chez les femmes, cet article montre la nécessité de se pencher davantage sur cette pathologie tant elle est grave pour les patientes ainsi que pour leur entourage. En effet, les complications semblent pouvoir se développer dès le premier verre : elles sont somatiques, psychiatriques mais aussi sociales. Il existe des spécificités de cette maladie chez les femmes à la fois à travers les facteurs de vulnérabilité mais aussi par le tableau clinique ou encore par ses conséquences. Les femmes sont plus fragiles que les hommes face à l'alcool. Le manque de connaissance dont pâtit cette maladie rallonge le délai de consultation des patientes et installe insidieusement les complications qui sont plus lourdes que chez les hommes. De fait, la prise en charge nécessite une approche spécifique en lien avec une demande et un statut encore particulier attribué aux femmes. Il est important d'accentuer le travail d'information afin d'inciter les patientes à consulter mais aussi de mieux légiférer sur la promotion qui vise principalement la cible des femmes et les jeunes, et cela dans le cadre d'une prévention plus rigoureuse et plus efficace.

Asunto(s)

RESUMEN

Psychiatric disorders are common among patients with alcohol dependence. Symptoms of alcohol intoxication or withdrawal need to be disentangled from symptoms of psychiatric disorders. Alcohol dependence could induce psychiatric disorders, in particular depressive disorders and anxiety disorders. Patients with psychiatric disorders may self-medicate with alcohol use. There may be common factors promoting both alcohol dependence and psychiatric disorders: about 40% of patients with alcohol dependence present personality disorders. Alcohol dependence and psychiatric disorders worsen each other. Integrated approaches to treatment for patients presenting with co-occurring alcohol dependence and psychiatric disorders are recommended, including simultaneous treatments of alcohol dependence and treatments of psychiatric disorders.

Asunto(s)

RESUMEN

Excessive alcohol consumption is the second leading preventable cause of death in France (49,000/year), after tobacco consumption. Several recent studies found that the alcohol-related negative health consequences may occurs with small amounts of alcohol, in particular cancers. Therefore, the risk thresholds for alcohol consumption have been recently recommended not to be higher than 100g/week. Early age of onset of alcohol use is a strong predictor of alcohol use disorders and alcohol-related negative health outcomes. Subjects with alcohol use disorders are underdiagnosed and undertreated, with less than 10-15% of patients with severe alcohol use disorders per DSM-5 criteria receiving treatment. Early treatment of patients with alcohol use disorders decreases the alcohol-related negative health outcomes.

Asunto(s)

RESUMEN

General principles of treatment in addictology. Among all mental disorders, addictive pathologies are serious disorders. Their prognosis is severe. Their management is complex. It requires the evaluation of the addictive disorder, the psychiatric pathologies and the motivation. The follow-up must be adapted to the patient's motivation. By medications, it is traditional to oppose substitution and withdrawal strategies and risk reduction. Psychiatric comorbidities, frequent, are factors of aggravation of the dependency. They need parallel and integrated cares between addiction and mental health care systems. The place of hospitalization is reduced, support for families is essential.

Principes généraux de la prise en charge en addictologie. Parmi l'ensemble des troubles mentaux, les pathologies addictives sont des troubles graves. Leur pronostic est sévère. Leur prise en charge est complexe et nécessite l'évaluation du trouble addictif, des troubles psychiatriques associés et de la motivation. Le suivi au long cours doit s'adapter à la motivation du patient. Sur le plan médicamenteux, il est classique d'opposer les stratégies de substitution et de sevrage et la réduction des risques. Les comorbidités psychiatriques, habituellement résistantes, sont des facteurs de gravité. Elles nécessitent une prise en charge parallèle et intégrée entre les systèmes de soins en addictologie et en santé mentale. La place de l'hospitalisation est réduite, le soutien aux familles indispensable.

Asunto(s)

Asunto(s)

RESUMEN

ABCB1 polymorphisms are known to modify drug pharmacokinetics but have yet to be studied for their role in generating and maintaining cannabis dependence. The objective of this study is to determine if ABCB1 C3435T (rs1045642) polymorphism may modulate Δ9-Tetrahydrocannabinol (THC) blood levels in a sample of heavy cannabis users. The study sample includes 39 Caucasian individuals, recruited in two French addictology centres, with isolated cannabis dependence and heavy use (defined as ≥ 7 joints per week). Each underwent clinical evaluation, cannabis blood metabolite dosage (THC, 11-OH-THC, and THC-COOH) and genotyping of ABCB1 C3435T polymorphism. In this population (males: 74.4%, average age 29.5 +/- 9), average cannabis use was 21 joints per week (median 12; range 7 - 80). T carriers (TT/CT) had significantly lower plasma THC levels (ng/ml) versus non T carriers (8 vs 15.70, significant), controlling for level of weekly use, 11-OH-THC and THC-COOH levels. Our results show that ABCB1 C3435T polymorphism may modulate serum THC levels in chronic heavy cannabis users. The exact mechanisms and roles that this may play in cannabis dependence genesis and evolution remain to be elucidated. These results should be controlled in a replication study using a larger population.

Asunto(s)

RESUMEN

INTRODUCTION: Broadly defined behavioral addiction is a conceptual framework including behaviors characterized by loss of control and continuation despite significant negative consequences. Broadly defined behavioral addictions share many similarities with substance use disorders. As naltrexone is one of the most studied treatment for substance use disorders, we conducted a meta-analysis of randomized placebo-controlled trials (RCT) assessing the effectiveness of naltrexone in the treatment of broadly defined behavioral addictions. METHOD: We conducted a literature search and selection, up to January 1, 2017, according to previously set inclusion criteria. The selected trials underwent a quality assessment before data extraction and statistical analysis, which used fixed and random effects models. Standardized mean differences (SMD) were calculated using Hedge's adjusted g. RESULTS: A total of 6 RCTs (n = 356) were included. Of these, 3 assessed naltrexone effectiveness in the treatment of pathological gambling, and 3 tested its benefits in broadly defined behavioral addictions other than pathological gambling (kleptomania, trichotillomania, and impulsive compulsive disorders). The meta-analysis of the whole sample resulted in a statistically significant score improvement under naltrexone versus placebo (fixed effect model: SMD = -0.27, 95% CI [-0.51 to -0.03], z = 2.23; p = 0.025). CONCLUSION: The results of our meta-analysis suggest a beneficial effect of naltrexone in the treatment of broadly defined behavioral addictions.

Asunto(s)

Asunto(s)

RESUMEN

Thiamine deficiency (vitamin B1) is common in patients with alcohol dependence. Cognitive impairments may be an early consequence of thiamine deficiency. Wernicke's encephalopathy is underdiagnosed and undertreated. In patients with established Wernicke's encephalopathy, parenteral thiamine 200-500mg three times a day should be given for 3-5 days, followed by oral thiamine 250-1000mg/day. In patients with suspected Wernicke's encephalopathy, parenteral thiamine 250-300mg should be given two times a day for 3-5 days, followed by oral thiamine 250-300mg/day. In patients at high risk of thiamine deficiency, parenteral thiamine 250-500mg/day should be given for 3-5 days, followed by oral thiamine 250-300mg/day. In patients at low risk (with uncomplicated alcohol dependence), oral thiamine 250-500mg/day should be given for 3-5 days, followed by oral thiamine 100-250mg/day.

Asunto(s)

RESUMEN

Early onset of heroin use is a severity marker of heroin use disorder. We studied the interaction between early onset and rapid transition to heroin dependence recorded with retrospective interviews in 213 patients with severe heroin dependence and history of methadone maintenance treatment. General linear models were used to identify independent factors associated with early onset, factors associated with rapid transition to dependence, and a multivariate model was used to study the interaction of those two dimensions. Lifetime history of anxiety disorders and age at onset of cannabis use are shared common risk factors and are associated with the interaction.

Asunto(s)

Asunto(s)

Asunto(s)

Asunto(s)