[Drug use and treatment misuse: Key points on polydrug use]. / Usages de drogues et mésusages de médicaments : repères utiles sur la polyconsommation.

Problematic use of psychoactive drugs, be it legal, on prescription, or not, remains a broad phenomenon when taken as a whole, with an increasingly large spectrum of used products. The polysubstance drug use is an expanding new trend. Although its epidemiological analysis is complex, needing further research, certain patterns of drug combinations can be found, allowing to identify clusters of users associated to more specific medical and social risks. Managing polysubstance users involves assessing each drug use, but also the connections between drugs and the patient's expectations for each of them. Complications, as well as psychiatric and somatic comorbidities are to be taken into account. The therapeutic tools for polysubstance drug use, mainly pharmacological, are still often limited to the sum of specific tools for each product. Prevention is crucial but has to adapt to the identified use clusters, and the gender. Notably, a good knowledge of chronic pain management and prescribed drug dependency risks is required to prevent polysubstance drug use involving opioids.

Anxiety disorders are associated with early onset of heroin use and rapid transition to dependence in methadone maintained patients.

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.

[The baclofene saga and the paradigm shift in alcohol addiction treatment]. / La saga du baclofène et le changement de paradigme de la prise en charge de l'addiction à l'alcool.

Baclofen represented the hope of an effective treatment of addiction to alcohol, in a context where the therapeutic featuring agreement obtained modest results. The rise of baclofen has bypassed the usual academic procedures. There is a scientific rational prescription of baclofen. Its use opens up the prospect of using other agonists of GABAB to manage the craving.

[Opiates, harm reduction and polysubstance abuse]. / Opiacés, réduction des risques et polyconsommation.

Opioid dependence is a chronic metabolic brain disease and several individual, sociological and biological factors are implicated in its development. Program (needle exchange, low threshold access to treatment) prevent harms associated with opioid use (HIV, overdose…). Effective treatment involves a set of pharmacological and psychosocial interventions. The benefits of maintenance programmes increase as long as the person remains in treatment (many years). Relapse is a symptom of the disorder or a sign of abstinence failure. Treatment aims to improve quality of life in a comprehensive and individualised assessment.

[Environment and addictive behaviors]. / Conduites addictives et environnement.

Consumer society creates the emergence of addictive behaviors and environments of the subject "shape" the use of psychoactive substances. The family approach is to search out a guilt of members to understand family dynamics and enable young people to emancipate themselves from the family model. The social environment contributes to the marginalization of drug users "pathologizing" his conduct. Offer help without preconditions and a relationship based on a therapeutic alliance can contribute decisively to the recovery of an addict. The prison is a place of initiation of use and consumption of psychoactive substances despite the offer of specialized treatment. Measures of risk reduction of HCV/HIV infection and alternatives to incarceration should complete it. At workplace, consumption can be considered as a mean of doping to be more "efficient", but also as an attempt to withstand the stresses and changes in working conditions in the context of individualization and a loss of marks related to the new way of organizing work.

[Addictions and medicine]. / Addictions et médecine.

The qualifiers of alcoholic, drug addict have been abandoned because marked by the image of a person who uses toxic and violates the social prohibition to gradually give way to the representation of a sick person in a state of psychological distress, medical and social. Control systems of drug regulation should consider the damage to the individual, their potential to induce drug dependence and the effects on the family environment or society. Some emerging substances are excluded, others are demonized, thus limiting the scope of prevention messages. The theoretical model of addictions is much more complex for 20 years, while psychopathological references remained identical. There has been a proliferation of work neurobiological, cognitive-behavioral and sociological observations. Medical and psychosocial approaches are complementary to the understanding of a complex multifactorial phenomenon but also of its treatment whose goal is to enable the person to rebuild his life and not simply to be supported for curbing its substance use.

[Alcohol, an addiction like any other]. / L'alcool, une addiction comme les autres.

The current treatment available to people in difficulty with regard to their consumption of alcohol is not merely limited to forced abstinence. It benefits from the advances made in addictology and research into treatment based on the concept of controlled consumption. In the framework of a therapeutic alliance, multidisciplinary teams offer medication-based treatments and individualised and diversified psycho-social treatment.

Is smoking linked to positive symptoms in acutely ill psychiatric patients?

BACKGROUND: The self-medication hypothesis is commonly put forward to explain the high prevalence of smoking in psychiatric patients. However, studies supporting the self-medication hypothesis have most often been carried out on chronic patients stabilized by antipsychotics. AIM: Given that antipsychotics tend to erase psychiatric symptoms, the present study was undertaken on acutely ill patients usually receiving no medications, or on whom medications are ineffective. METHODS: Participants were 492 consecutively hospitalized patients. They were evaluated the day of their hospitalization with the Brief Psychiatric Rating Scale (BPRS, 18 items). Urinary cotinine and creatinine were measured the morning following their hospitalization. The urinary cotinine/creatinine ratio and the cotinine/creatinine/number of cigarettes smoked per day ratio (nicotine extraction index) were calculated for each patient. RESULTS: The positive symptoms subscale of the BPRS significantly correlated with smoking, whereas other BPRS subscales did not. In patients with mood disorder, the nicotine extraction index correlated with the positive symptoms, activation and hostility subscales, but not with the negative symptoms subscale. Analyses of individual BPRS items using the cotinine/creatinine ratio measure showed that smoking is positively associated with "unusual thought content" and "grandiosity" items and negatively associated with "guilt feeling", "depressed mood" and "motor retardation". Analyses of individual BPRS items using the nicotine extraction index showed a positive association only with "unusual thought content" and "grandiosity" items. Patients with schizophrenia extract more nicotine from cigarettes than other patients. CONCLUSION: In acutely ill psychiatric patients, smoking is linked with positive symptoms and not with negative symptoms.

Comparison of self-reports and biological measures for alcohol, tobacco, and illicit drugs consumption in psychiatric inpatients.

BACKGROUND: Asking psychiatric in-patients about their drug consumption is unlikely to yield reliable results, particularly where alcohol and illicit drug use is involved. The main aim of this study was to compare spontaneous self-reports of drug use in hospitalized psychiatric patients to biological measures of same. A secondary aim was to determine which personal factors were associated with the use of tobacco, alcohol, and illicit drugs as indicated by these biological measures. METHODS: The consumption of substances was investigated using biological measures (urine cotinine, cannabis, opiates, cocaine, amphetamines and barbiturates; blood carbohydrate-deficient transferrin [CDT] and gamma-glutamyl transferase [GGT]) in 486 consecutively admitted psychiatric patients, one day following their hospitalization. Patients' self-reports of alcohol, tobacco and illicit drugs consumption were recorded. Socio-professional and familial data were also recorded. RESULTS: The results show a low correlation between biological measures and self-reported consumption of alcohol and illicit drugs. Fifty-two percent of the patients under-reported their consumption of illicit drugs (kappa=.47). Patients with schizophrenia and personality disorders were more likely to disclose their illicit drug consumption relative to patients suffering from mood disorders and alcohol dependence. Fifty-six percent of patients underreported alcohol use, as evaluated by CDT (kappa=.2), and 37% underreported when using the CDT+GGT measure as an indicator. Smoking appeared to be reported adequately. In the study we observed a strong negative correlation between cannabis use and age, a strong correlation between tobacco and cannabis use, and correlations between tobacco, cannabis and alcohol consumption. CONCLUSION: This study is the first to compare self-reports and biological measures of alcohol, tobacco and illicit drug uses in a large sample of inpatients suffering from various categories of psychiatric illnesses, allowing for cross-diagnosis comparisons.