[Using transient elastography as a screening tool for liver fibrosis in addiction service]. / Utilisation de l'élastométrie hépatique comme outil de dépistage de la fibrose hépatique dans un service d'addictologie.

BACKGROUND: Most addictive behaviors are risk factors for chronic hepatitis. The level of liver fibrosis is the main prognostic factor of chronic hepatitis. Transient elastography is a valid and accessible tool for measuring the level of liver fibrosis. Its routine use in addiction service is however poorly documented. AIMS OF THE STUDY: To test the feasibility of a systematic use of transient elastography as a tool for screening and diagnosis of liver fibrosis in patients hospitalized in an addiction medicine ward and to determine the prevalence of hepatic fibrosis, its predictive factors and etiologies and appreciate its evolution during alcohol detoxification. PATIENTS AND METHODS: Two hundred and twenty-seven patients were included, hepatic elastography was measured by two operators according to the standards. Threshold of fibrosis (F1) was 8 kPa, threshold cirrhosis (F4) was 13 kPa. RESULTS: Hepatic elastography was performed in 208 (92%) patients. A body mass index greater than 30 was associated with the non-feasibility of transient elastography, anti-HCV positive serology was associated with a lower reproductibility of transient elastography. Of the 208 patients, 61 had liver stiffness ≥ 8 kPa (prevalence of fibrosis of 29%), 25 had liver stiffness ≥ 13 kPa, fibrosis was not known for 46 (75%) of the 61 patients with fibrosis. A fibrosis was independently associated with the following variables: time between last alcohol ingestion and transient elastography measurement< 8 days, GGT>65 UI/L and serum concentration of platelets< 150 × 10(9)/L. Thirty patients had a second transient elastography in a median of 21 days after the first measurement. The decrease in liver stiffness during detoxification was significant only for patients whose alcohol ingestion was recent. CONCLUSION: Our study confirmed that the measurement of liver stiffness by transient elastography was an efficient tool for the diagnosis and detection of liver fibrosis in patients with addictive behavior. The decrease in hepatic elastography during alcohol detoxification may serve as a motivational tool.

[Inpatient care in the treatment of alcohol use disorders]. / Place de l'hospitalisation dans la prise en charge des troubles de l'alcoolisation.

Inpatient treatment has long been considered the reference in the treatment of alcoholism. It may indeed have many conceptual advantages, but practically it is a method of treatment with high costs and long waiting period. Moreover, reviews of studies evaluating effectiveness of treatment settings for alcohol dependence suggest that no significant differences exist between inpatient and outpatient programs. Therefore, it seems useful to determine indications of inpatient detoxification programs. As we may see, the choice of inpatient detox should be primarily guided by the contra-indications of outpatient detox. However, it also depends very much on patients' preference, essential to success, since they are the lead actors. Some other situations require urgent residential care, regardless of readiness to change or type of alcohol disorder underlying.

[Maintaining abstinence after alcohol detoxification]. / Maintien de l'abstinence après le sevrage.

"To quit drinking" is not the panacea of alcohol dependence treatment; it is only its first step. Abstinence should be considered more as a mean than a purpose of the after-withdrawal cares. The frequent resistance of the alcoholic patient to undertake in a long term abstinence can be by-passed by suggesting to fix himself renewable terms for periods during which he feels rather confident to raise the bet of a "most accomplished possible" abstinence. To facilitate the realization and the preservation of this abstinence in the best conditions (potentiation of the profits and minimization of the difficulties), a "therapeutic menu" will be proposed to the patient besides a "minimum plan" containing a medical follow-up over one year, with variable frequency of visits according to the evolution and the prescription of one or two anti-craving drugs registered. Psychotherapies using different techniques as Cognitive Behavioural Therapy, group therapy or psychoanalysis could be proposed after a necessary clarification to the patients of the mechanism of action of each and the waited profits. In the final, two thirds of the patients with alcohol dependence fire in one year a profit of their treatments; the practitioner takes, actually, no risk and should propose systematically a project to the only 20% of them who come to consult him.

[Care network in addictive pathologies: where is it?]. / Réseaux de soins dans les conduites addictives: où en est-on?

Network practise is important in the care of addictive pathologies. It aims to fulfill patient needs on a social and health level, as part of a concertive approach from the different health workers. Co-ordinated practise seems to provide an adapted and proven response for more than twenty years now, but has only recently been recognised as such by the health authorities. It was originally initiated by militant care workers in response to a daily reality too complex to be managed alone. The bringing together of experience and competencies, an adapted response to the demands in a context of dependency, patient care facilitated by exchanges, complementarily and the sharing of competencies are the objectives of a rich and beneficial network. However, it seems necessary to supplement with financial, human and legal help in order maintain the continuity and improve this novel approach.