Creating a psychosocial intervention combining growth mindset and implementation intentions (GMII) to reduce alcohol consumption: A mixed method approach

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.

Toward a better understanding of the influence of repetitive negative thinking in alcohol use disorder: An examination of moderation effect of metacognitive beliefs and gender

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.

[Problematic gambling and criminal responsibility]

OBJECTIVES

In total, 14% to 30 % of individuals with gambling disorder engage in illegal acts to finance such behavior. This clinical situation could be explained by higher gambling severity, associated substance use disorder, antisocial personality disorder and economic factors (debts, financial problems). The present work focuses, more broadly, on criminal responsibility of problematic gamblers.

METHODS

We will discuss this question through different typical situations that medical experts of criminal responsibility may have to face. We will address each of the following cases: 1) isolated problematic gambling; 2) problematic gambling associated with antisocial personality disorder; 3) problematic gambling associated with a manic episode; 4) problematic gambling associated with substance use disorders; and 5) problematic gambling associated wiht dopamine agonist treatment.

RESULTS

Isolated problematic gambling, (not associated with any psychiatric or addictive disorder): it seems consensual that individuals committing infractions in this case are criminally responsible. However, impeded ability to action control and possible sentence attenuation could be discussed in case of severe gambling disorder. Problematic gambling associated with antisocial personality disorder: if the penal offence reports solely to personality disorder, criminal responsibility would be attributed. However, if illegal or violent acting is directly linked to co-cocurrent delusional symptoms, it could be a cause of criminal non-responsibility. Problematic gambling associated with manic episode: manic episode related offence could lead to negation of criminal responsibility, while a hypomanic episode may provide grounds for sentence reduction. Problematic gambling associated with substance use disorders: in France, addiction is not considered to remove nor to impede a person's ability to understand or control his actions and is excluded from criminal non-responsibility causes. However, substance induced delusional or confusional episodes could abolish a subject's discernment or his ability to control his actions yielding to penal non-responsibility. Problematic gambling associated with dopamine agonist treatment: Criminal responsibility for dopamine agonist induced gambling related illegal acts is still controversial. Nevertheless, people committing an infraction linked to associated dementia or dopamine agonist induced mania should be considered as criminally non-responsible.

CONCLUSIONS

Some clinical dimensions such as craving intensity, compulsivity, disorder's severity, volitional control might be forensic targets to assess criminal responsibility.

[How to manage adult attention deficit hyperactivity disorder in patients with substance use disorders?]

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.

[Clinical aspects and therapeutic positioning in addictology]

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.

[Alcoholic disease in women, what specificities?]

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.

[General principles of treatment in addictology]

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.

[Epidemiology of alcohol dependence]

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.

Naltrexone in the Treatment of Broadly Defined Behavioral Addictions: A Review and Meta-Analysis of Randomized Controlled Trials

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.

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.

Tempérament affectif et alcoolo-dépendance : influence de la dépression

Contexte

Une étude préliminaire a évalué la fréquence des tempéraments affectifs décrits par Akiskal et al. [1] dans une population de patients alcoolo-dépendants [2]. Dans cette étude, le score moyen à la sous-échelle du tempérament dépressif était significativement plus élevé dans un groupe de sujets alcoolo-dépendants par rapport à un groupe de témoins [2]. Les objectifs de notre étude étaient :

– déterminer si la dépression pouvait influencer le lien entre tempérament dépressif et alcoolodépendance ;

– comparer les tempéraments entre un groupe de patients alcoolo-dépendants déprimés et un groupe de patients alcoolo-dépendants non déprimés.

Méthode

Cent dix-huit patients, consultant consécutivement, de juillet 2014 à mars 2015, dans le service d’addictologie de l’hôpital Sainte-Anne (Paris) pour alcoolo-dépendance, ont été inclus dans l’étude. Un groupe de sujets alcoolo-dépendants déprimés (n = 38) a été comparé à un groupe de sujets alcoolo-dépendants non déprimés (n = 80). Ils ont été évalués à l’aide de l’auto-questionnaire Temperament Evaluation of Memphis, Pisa, Paris and San Diego (TEMPS-A), à 39 items, explorant les cinq sous-échelles du tempérament affectif :

– cyclothymique ;

– dépressif ;

– irritable ;

– hyperthymique ;

– anxieux [3].

Les troubles psychiatriques associés ont été évalués à l’aide du MINI et de l’échelle de dépression de Beck, à 13 items.

Résultats

Le score total moyen à l’auto-questionnaire TEMPS-A était plus élevé dans le groupe des patients alcoolo-dépendants déprimés que dans le groupe des patients alcoolo-dépendants non déprimés (respectivement scores moyens : 19,24 ± 5,73 vs 14,25 ± 6, 41, p < 0,001). Les scores moyens aux sous-échelles dépressive, cyclothymique et anxieuse étaient significativement plus élevés dans le groupe de patients alcoolo-dépendants déprimés. En revanche, il n’y avait pas de différences significatives pour les sous-échelles irritable et hyperthymique.

Conclusion

La dépression peut constituer un facteur de confusion dans le lien retrouvé antérieurement entre tempérament dépressif et l’alcoolo-dépendance.

Dépendance au cannabis : quelles corrélations entre âge de début de la consommation, troubles cognitifs et psychiatriques ?

Contexte

Certaines études ont retrouvé que la consommation précoce de cannabis était associée à une fréquence plus élevée de troubles cognitifs ou psychiatriques, mais l’âge exact reste indéterminé, entre 13 et 18 ans selon les études [1–4].

Objectif

Comparer certaines caractéristiques cliniques des sujets dépendants au cannabis ayant commencé leur consommation à l’âge de 13 ans ou moins et celles de ceux qui ont commencé après.

Méthodes

Cent soixante-douze patients, consultant consécutivement dans le service d’Addictologie du CH Sainte-Anne pour dépendance au cannabis (critères DSM-IV), entre juin 2007 et juin 2013, ont été inclus dans l’étude. Les patients présentant des troubles psychotiques, bipolaires type 1, des dépendances opiacées ou à la cocaïne étaient exclus de l’étude. Ils ont été évalués à l’aide du Diagnostic Interview for Genetic Studies (DIGS).

Résultats

Les sujets ayant commencé leur consommation de cannabis à l’âge de 13 ans (n = 37) ou moins présentaient plus fréquemment un diagnostic de trouble de personnalité antisociale (respectivement 58,8 % vs 22,1 % ; Chi2 = 16,6 p = 0,0001, OR : 4,9) et rapportaient plus fréquemment des troubles subjectifs de l’attention que les sujets ayant commencé leur consommation plus tard (n = 135) (respectivement 86,5 % vs 66,7 %, Chi2 = 5,53, p = 0,03, OR : 3,02). En revanche, il n’y avait pas de différences significatives entre les deux groupes concernant la fréquence des troubles dépressifs, des phobies sociales, des troubles anxieux, des conduites suicidaires, des traitements anxiolytiques ou antidépresseurs antérieurs, ni de différence au niveau des symptômes de sevrage et des effets subjectifs induits par le cannabis.

Conclusions

Les sujets dépendants au cannabis qui commencent leur consommation avant l’âge de 13 ans ont un risque de présenter un trouble de la personnalité antisociale cinq fois plus élevé et des troubles subjectifs de l’attention trois fois plus élevés, par rapport aux sujets qui commencent le cannabis après l’âge de 13 ans.

Traitements de substitution aux opiacés : particularités de la prise en charge des patients avec schizophrénie

Contexte

Alors que dans l’étude Epidemiologic Catchment Area (ECA, Regier et al., 1900), la prévalence de la schizophrénie était de 11 % chez les toxicomanes aux opiacés, aucune étude à notre connaissance n’a évalué l’efficacité des traitements de substitution aux opiacés (TSO : méthadone ou buprénorphine) chez les sujets présentant une comorbidité dépendance opiacée/schizophrénie (Dervaux et al., 2009). L’objectif de cette étude rétrospective était d’évaluer les différences cliniques et toxicologiques entre deux populations de patients traitées par TSO : un groupe de patients schizophrènes et un groupe de patients sans troubles psychotiques.

Méthode

Nous avons comparé les données sociodémographiques, cliniques et toxicologiques d’un groupe de 31 patients schizophrènes/schizoaffectifs (critères DSM-5) et d’un groupe de 31 patients non psychotiques, appariés sur l’âge, le sexe et le niveau d’étude, suivis dans le service d’addictologie de l’hôpital Sainte-Anne (Paris).

Résultats

Les patients schizophrènes étaient pris en charge plus précocement que les patients non psychotiques (âge moyen du premier recours aux soins addictologiques : respectivement, 27,2 ± 8,3 vs 34,3 ± 8,8 ans, p = 0,002). Ils étaient suivis plus fréquemment dans le service d’addictologie (respectivement, 22,5 ± 12,1 vs 15,7 ± 7,2 consultations/6 mois, p = 0,009). Il n’y avait pas de différences significatives entre les deux groupes concernant les résultats des analyses toxicologiques urinaires recherchant la présence d’opiacés, de cocaïne, d’amphétamines, de cannabis et de benzodiazépines.

Conclusions

Cette étude préliminaire suggère que les patients schizophrènes avec comorbidité dépendance opiacée, traités par TSO, ont recours à des soins spécialisés plus rapidement et de façon plus intensive que les sujets dépendants aux opiacée non psychotiques. Leur consommation de substances était comparable aux sujets non psychotiques. Ces résultats vont dans le même sens que ceux d’une étude sur 129 patients avec une autre pathologie psychiatrique grave (troubles bipolaires, Maremmani et al., 2013). Des études prospectives seraient intéressantes pour confirmer ces résultats.

[Cannabis-induced cognitive and psychiatric disorders]

Several studies have shown that Δ-9-THC the main psychoactive constituent of cannabis, can impair cognitive functions, especially attention, episodic memory, working memory and executive functions. These impairments have been related to the duration, frequency, dose and age at onset of cannabis use. Cognitive deficits may disappear with abstinence, but abnormalities may be long-lasting in subjects who began smoking cannabis before age 15. The lifetime prevalence of cannabis use disorders is about 1% in the general population. The main characteristics of cannabis use disorders are craving, persistent desire or unsuccessful efforts to cut down or control cannabis use, and persistent avoidance of familial, social occupational or recreational activities because of cannabis use. Nine prospective longitudinal studies in the generalpopulation have shown that cannabis use is associated with a two-fold increase in the risk of psychotic disorders, particularly schizophrenia, compared to controls. The risk of psychosis increases in a dose-related fashion. A higher risk of schizophrenia is predicted by earlier onset of cannabis use. The effects of cannabis are exerted primarily through THC interaction with cannabinoid (CB) 1 receptors in the brain. Cannabis exposure may disrupt the last steps of brain maturation, through the endocannabinoid system, thereby increasing the risk of psychosis during adolescence.

Comorbidités psychiatriques chez les patients dépendants au cannabis : spécificités masculines et féminines

Contexte

En dehors de l’étude épidémiologique en population générale NESARC, peu d’études cliniques ont exploré les différences entre hommes et femmes présentant un abus ou une dépendance au cannabis. L’objectif de cette étude était d’évaluer les différences sociodémographiques et cliniques entre les sexes dans une population de 173 patients dépendants au cannabis, demandeurs de soins, sans troubles psychotiques ou bipolaires, ni dépendance à une autre drogue.

Méthodes

Tous les patients de sexe masculin (n = 130) et féminin (n = 43), consultant consécutivement dans le service d’addictologie du centre hospitalier Sainte-Anne (Paris) pour dépendance au cannabis (critères DSM-IV), entre juin 2007 et juin 2013, ont été inclus dans l’étude. Les patients présentant des troubles psychotiques, bipolaires de type 1, des dépendances opiacées ou à la cocaïne étaient exclus de l’étude. Les patients ont été évalués à l’aide du Diagnostic Interview for Genetic Studies (DIGS).

Résultats

La fréquence, présente ou passée, de troubles dépressifs (61,8 % vs 23,1 %, p = 0,0001), de phobies sociales (29,0 % vs 12,4 %, p = 0,02), de troubles anxieux généralisés (43,8 % vs 24,3 %, p = 0,03), de conduites suicidaires (36,6 % vs 11,3 %, p = 0,0001), de traitements anxiolytiques antérieurs (71,4 % vs 44,4 %, p = 0,001), de traitements antidépresseurs antérieurs (63,4 % vs 29,4 %, p = 0,001) et d’antécédents familiaux de dépression (70,3 % vs 39,5 %, p = 0,001), était plus élevée dans le groupe de sujets de sexe féminin que dans le groupe de sujets de sexe masculin. En revanche, la fréquence des effets subjectifs de désinhibition (37,7 % vs 19,0 %, p = 0,03) et d’hypersensorialité (36,9 % vs 19,0 %, p = 0,03), induits par le cannabis, était plus élevée dans le groupe de sujets de sexe masculin.

Conclusions

La fréquence des antécédents de troubles dépressifs et de troubles anxieux, traités ou non, chez les patients dépendants au cannabis, en particulier du sexe féminin, justifie leur dépistage systématique et leur prise en charge intégrée dans la prise en charge addictologique.

Neurological soft signs in non-psychotic patients with cannabis dependence

Psychomotor performance has consistently been found to be altered in chronic cannabis users. Neurological soft signs (NSS) reflect neurological dysfunction involving integrative networks, especially those involving the cerebellum, where cannabinoid receptors are particularly concentrated. Our objective was to study, for the first time, NSS in a group of patients with cannabis dependence compared with a of healthy control subjects, matched for age, gender and level of education. All outpatients seeking treatment for chronic cannabis use in the substance abuse department of Sainte-Anne Hospital in Paris between June 2007 and May 2009 and meeting the cannabis dependence DSM-IV criteria were included in the study (n = 45). Patients with psychotic disorders, bipolar 1 disorder and current alcohol, opioid or cocaine dependence were excluded. All patients and controls were assessed using the Diagnostic Interview for Genetic Studies, which screens for lifetime DSM-IV diagnoses, and the Standardized Neurological Examination of Neurological Soft Signs. NSS scores were significantly higher in patients with cannabis dependence compared with healthy subjects (8.90 ± 4.85 versus 6.71 ± 2.73, respectively, Mann-Whitney: U = 775.0, P = 0.05). Patients had particularly high scores on motor coordination and sensory integration NSS factors. Cannabis dependence is associated with more NSS and especially motor coordination and sensory integration signs. These results suggest that cannabinoids interact with the brain networks underlying NSS, known to be altered in schizophrenia.

[Review of cases of prolonged QTC and wave burst arrhythmia in patients treated with methadone]

INTRODUCTION

For the past 40 years, methadone has been known to be an efficient treatment of substitution. Its use allowed a significant reduction in the mortality related to opioid addiction. Since 2001, many articles have reported some cases of syncope, wave burst arrhythmia, ventricular tachycardia due to prolonged QT interval and sudden death secondary to cardiac arrest, with a risk of prolongation of the QT interval above 440 ms (men) and 460 ms (women). Many explorations have helped in understanding the physiopathology by showing that opioids, including methadone, cause a blockage of the potassium channels of the gene HERG K+P. This event could slow the repolarisation and the atrioventricular cardiac synchronization and could induce ventricular arrhythmia.

LITERATURE FINDINGS

Nearly 20 studies showed a prolonged QT interval secondary to methadone in patients exhibiting the following features: (1) patients with cardiac pathologies, notably bradycardia, congenital long QT interval, myocardial pathologies related to AIDS and electrolyte disturbances; (2) patients receiving concomitant treatment with substances known to prolong QT interval, such as psychoactive stimulants, narcoleptics, tricyclic antidepressants, antiarrhythmic agents, macrolids, quinolones, non diuretic hypokalemiants and certain corticoids; (3) patients receiving treatments that inhibit methadone's metabolism, particularly those that act on the cytochrome P450 3A4 such as SSRI, antifungal agents, some macrolids and some retroviral agents. Many recent studies, while evaluating the dose-dependent effect of methadone on the QT prolongation, showed a tendency to a prolonged QT when using higher doses of methadone.

CONCLUSION

Screening for these risk factors should be carried out before prescribing methadone. EKG should not be systematically performed unless the conditions described above are present or if a higher dose of methadone is needed.

Impulsivity and sensation seeking in alcohol abusing patients with schizophrenia

OBJECTIVE

Some studies have found that high levels of impulsivity and sensation seeking, particularly disinhibition are associated with substance abuse in patients with schizophrenia, as in the general population. However, no study has assessed impulsivity and sensation seeking specifically in schizophrenia patients with alcohol abuse or dependence.

MATERIALS AND METHODS

We compared impulsivity and sensation seeking in a group of schizophrenia patients (DSM-III-R criteria) with lifetime alcohol abuse or dependence (n = 34) and in a group without lifetime substance abuse or dependence (n = 66). The patients were assessed using the composite international diagnostic interview (CIDI) for DSM-III-R disorders, the positive and negative syndrome scale (PANSS), the Barratt impulsivity scale (BIS), the Zuckerman seeking sensation scale (SSS), and the physical anhedonia scale (PAS).

RESULTS

The mean scores for impulsivity and sensation seeking were higher in the group with lifetime alcohol abuse or dependence than in the group without substance abuse or dependence (BIS: 63.4 ± 18.7 vs 51.3 ± 14.2 respectively, ANOVA: F = 11.12, p = 0.001; SSS: 17.6 ± 5.9 vs 13.5 ± 6.7 respectively, ANOVA: F = 7.45, p = 0.008). There was no significant difference between the two groups on PAS score.

CONCLUSION

Increased impulsivity or sensation seeking may be a link between schizophrenia and alcohol abuse or dependence.

Predictive Factors for Successfull Rehabilitation of the Drug Addicts: “Ligne de Vie” Association Experience

The association “Ligne de Vie “, created in 2004 propose to help the professional rehabilitation of the ex-drug addicts. She proposes an access to a professional career and a medico-social support during two years.

The aim of this work is to determine the predictive factors for a successful rehabilitation of ex drug addict's persons.

Are included in this study all the subjects having taken contact with the association between September first, 2005 and on June 30, 2006. The criterion of success is the access to a helped employment and its maintenance beyond the one month trial period. This criterion makes it possible to distinguish group 1 responder from group 2 not responder.

49 subjects were included. 25 were responders (group 1), 24 not responders (group 2). The average of age is 38, 56 years, 36,6 years in group 1, and 40,36 in group 2, with 68% of man in the group 1 and 75,5% in Group 2.

There were a statistically significant factors for financial incomes (p=0,002), the absence of psychiatric comorbidities (p = 0,003), dependences prevailing with heroin (p = 0.02) and with the cannabis (p = 0.04). However there were no differences with the other substances, cocaine, ecstasies, and amphetamine. The substitute treatments do not appear determining, 50% in group 1 versus 76% in group 2.

The absence of an acute psychiatric disorder, a poly drug-addiction with opiates and the financial motivation seems to be more determining than the setting under substitution therapy.

[Tobacco and schizophrenia: therapeutic aspects]

Although patients with have low motivations to quit smoking, smoking cessation treatment can be effective for these patients. Patients schizophrenia who achieve significant smoking reduction during a treatment intervention can at least maintain that level of reduction at 2 years. Cigarette smoking by patients with frequently goes unaddressed, contributing to excess mortality in this population. Behavioural interventions improve smoking cessation in schizophrenia patients. Nicotine replacement can substantially reduce withdrawal symptoms. Bupropion enhances smoking abstinence rates. Bupropion is well-tolerated and safe for use in schizophrenia patients: bupropion does not worsen clinical symptoms of schizophrenia. Atypical antipsychotics may reduce smoking consumption in schizophrenia patients, in particular clozapine. Atypical antipsychotic medication, in combination with the nicotine transdermal patch, significantly enhance the rate of smoking cessation. Interactions between smoking and antipsychotic medication - Smoking increases the metabolism of the antipsychotic medications by inducing the cytochrome P450 1A2 isoform. Smoking lowers the blood levels of typical or atypical antipsychotic medication, in particular haloperidol, chlorpromazine, olanzapine and clozapine. -Abstinence can increase many psychotropics' blood levels. Accordingly, smoking appears to reduce neuroleptic-induced parkinsonism. In contrast, smoking is a risk factor for tardive dyskinesia, independent of neuroleptic exposure.