L’usage de cannabis apparaît présent dans tous les segments de la population. Le genre, l'âge, le niveau d’instruction scolaire, l’activité professionnelle et la zone de résidence sont les principaux facteurs discriminants. Ainsi, il s’avère plus fréquent parmi les hommes et les jeunes générations, mais aussi, par exemple, parmi les chômeurs, tandis que les différences entre les actifs occupés se révèlent plus faibles. De même, l’expérimentation et les usages occasionnels se révèlent plus répandus parmi les personnes diplômées du supérieur, au contraire des usages plus réguliers. Ces déterminants sociaux permettent de décrire et de rendre compte des usages dans la population, mais ne peuvent suffire à les expliquer ; ils masquent en effet partiellement les opportunités, les choix et les préférences individuelles de consommation de produits psychoactifs et occultent en particulier que les usages sont très nettement liés à une sociabilité et à un mode de vie. Comme le soulignent les usagers lorsqu’ils énoncent leurs motifs de consommation et d’abandon, le cannabis est partie intégrante de la vie de nombreuses personnes qui ne semblent pas en éprouver de difficultés majeures. Dans l’étude de la surconsommation, il convient d’isoler au sein des usages réguliers, ceux qui seraient problématiques. Si l’épidémiologie de la surconsommation de cannabis reste parcellaire, elle a déjà donné quelques résultats qui rejoignent la pratique des acteurs de terrain, tel que le lien fort entre une telle pratique et une entrée précoce dans les usages. Les véritables avancées sont toutefois à venir, lorsque les instruments de mesure de l’usage problématique de cannabis auront été validés tant au niveau épidémiologique qu’en clinique et utilisés dans les enquêtes en population générale.
La toxicomanie de la mère n'est plus décrite aujourd'hui comme une raison en soi du signalement des enfants. Elle est évaluée comme un facteur parmi d'autres de risque de danger susceptible de conduire à de mauvais traitements et replacée parmi un faisceau d'autres indicateurs. Les professionnels de la maternité évoquent ainsi différents facteurs de risque comme la précarité, la délinquance, la prostitution ou la santé mentale, qui combinés à une prise de produits seraient susceptibles de les conduire à signaler un enfant aux autorités judiciaires.
La place de la médecine dans la société et les rapports entre maladie et santé ont connu de profonds changements dans les dernières décennies. Le droit à la maladie et aux soins a été remplacé par le devoir de santé et il ne s'agit plus de lutter contre la maladie mais de se maintenir en santé. Avec l'émergence de la médecine du risque, un glissement s'effectue de l'évitement à l'anticipation des risques pour aller vers le toujours mieux, et bouleverse les repères entre santé et maladie. Ces transformations ont un impact sur la médecine elle-même et ses modalités de traitement et de suivi des personnes dont le statut entre santé et maladie est de plus en plus brouillé.
RésuméContexte : Les consommateurs de cannabis représentent une population hétérogène en constante augmentation. Même si le cannabis présente un pouvoir addictogène avec des effets néfastes pour la santé, cette substance est également connue pour ses effets thérapeutiques sur de nombreuses conditions et notamment sur la douleur et la dépendance à d’autres substances. Le confinement lié à l’épidémie de Covid-19 a provoqué dès l’annonce des réactions de la part des usagers et des associations de réduction des risques, préoccupés par les situations à risque (stress et sevrage). Dans ce contexte, une enquête a été proposée aux consommateurs quotidiens de cannabis afin d’étudier l’impact du confinement sur leurs usages et leur santé. Les objectifs spécifiques de cet article sont de décrire cette population de consommateurs quotidiens de cannabis, les évolutions d’usage avant et pendant le confinement et le lien avec certaines caractéristiques sociodémographiques, comportementales et sanitaires.Méthodes : L’enquête a consisté en un questionnaire en ligne rempli pendant la période de confinement et diffusé sur différents sites fréquentés par les usagers de cannabis. Ce questionnaire était composé de 3 parties : profil sociodémographique, pratiques de consommation avant le confinement et pendant le confinement. Des données plus précises sur la santé des usagers ont été recueillies telles que les symptômes anxieux, dépressifs, la douleur et les troubles du sommeil.Résultats : Au total, 4 279 questionnaires ont été remplis de manière complète. La population est essentiellement composée d’hommes (75 %), de jeunes (médiane à 27 ans), de personnes diplômées (84 % ont le baccalauréat) et vivant dans des grandes unités urbaines (62 %). L’étude de l’évolution de la consommation de cannabis avant et pendant le confinement permet de distinguer 4 profils : ceux qui ont arrêté (7 %), ceux qui ont diminué (28 %), ceux qui n’ont pas changé (29 %) et ceux qui ont augmenté (36 %). L’augmentation est plus fréquente chez les femmes, pour les personnes habitant dans des grandes villes et celles qui ont stocké du cannabis en prévision du confinement. L’arrêt est associé à un état de santé dégradé (anxiété, dépression, douleur et troubles du sommeil). Ceux qui ont maintenu une consommation stable pendant le confinement semblent avoir eu moins d’effets négatifs sur leur santé.Conclusion : Notre enquête CANNAVID a permis de recruter un échantillon suffisamment important pour pouvoir décrire une partie de la population des consommateurs quotidiens de cannabis et les effets du confinement sur leurs usages et leur santé. Ces données préliminaires montrent que le confinement a provoqué des réactions et des effets qui ont été délétères surtout chez ceux qui ont arrêté ou augmenté leur consommation.
In a developed society, when a new threat is identifed, the community's answers seek to systematically include a legal component. Drug use is no exception to this rule. We intend to follow from 1845 to 1916, the legal responses that governments have implemented to stop the development of the non-therapeutic use of psychoactive products.
A pediatrician from Nantes (France) “discoverer” of fetal alcohol syndrome: Dr. Paul Lemoine (1917-2006)
Paul Lemoine (1917–2006) is considered to have been the first to have described foetal alcohol syndrome in Ouest-médical in 1968. However, his career and his discovery do not seem to be as popular in France as one might expect. This retrospection aims to situate this discovery in its historical context. The first part presents the author (a biography of Paul Lemoine) and his work (an article by Lemoine and colleagues entitled “Children of alcoholic parents” in Ouest-médical and a Doctor of Medicine thesis by his student, J.-P. Borteyru, on the same subject). The second part provides some explanations to give an understanding of the lack of interest in this discovery and its discoverer in France in the 70s and the 80s (research on the offspring of alcoholics in France at that time, poor communication, conditions allowing a change of perception concerning foetal alcohol syndrome).
The discourse on legal and illegal drugs in medical shows and magazines devoted to public health on TV (1956-the present)
From the 1950s, public health officials who wished to alert the French on the dangers of psychoactive substances have been using a new mass medium: television. First, the ORTF was a state monopoly: it broke into seven structures in the mid-1970s, and then was gradually privatised beginning in 1984, while leveraging its distribution channels. These upheavals of the French media landscape, resulting in an increase in the number of weekly hours of programmes, inevitably changed the listening practices and the design of emissions. How do they affect the magazines devoted to alcohol and drugs?
Heroin use has undergone major upheaval in France since substitution treatments came onto the market in 1996. This result led to the setting up of an exploratory qualitative study among recent heroin users. It is based on an analysis of forty semi-directive interviews conducted with heroin users who started using heroin from 1996 onwards and were aged under thirty the first time they took it. Heroin is principally used as a « day-after solution » following the use of stimulant or hallucinogenic substances in a party context. Occasional even regular use may be recorded, but the majority of the individuals encountered eventually lost control of the frequency of their heroin use. The practices and perceptions that are current in the techno party arena appear to be a vehicle for making heroin use more widespread, but open scenes do not constitute a favourable context for use because heroin practices are rejected in these places. This study puts forward reasoned hypotheses on the changes in heroin use since 1996, and also on the identification of the social and subjective factors which favour its use.
The author analyses the mechanisms by which the trade and use of opium in China during the 19th Century have been labelled by the authorities as a crucial problem on three levels: economy, health and morality. Moreover, he describes the regulations by which the State has tried to solve this problem.
Drugs and addictions: 20 years of developments in France (2000-2020)
This article retraces the main changes reported over 20 years in drug use and addiction practices in France (2000-2020) in the light of the information system set up since the 1990s. It highlights the downward trend of the two most widespread products: alcohol, whose use has been steadily decreasing since the 1950s, and, more recently, tobacco, which is being “denormalized”. In contrast, the proportion of cannabis users has increased among adults, reflecting the ageing of the generations that experimented with this product at the peak of its diffusion, from the 1990s onwards. However, cannabis use is declining among the young people, in line with the European trend. In a context of expanding drug supply, this overview reviews the developments that call for vigilance (the rise of stimulants, increased use of legal opioids) and stresses some emerging problems (the arrival of new synthetic products, drugs diversion for psychoactive purposes, increasing use of non-substance-based addictions).
Keywords: addiction, tobacco, alcohol, drugs, policy, harm reduction
The modalities of initiation into injection in France in the 2000
The Internet survey PrimInject, which aims to highlight the contemporary circumstances of first injection in France, was used during the first two months of its online availability to collect narratives about the outset of injection. A corpus of 16 narratives was formed after excluding narratives about initiations into injection that occurred before 2000. From the analysis of this corpus and based on other works following a typological approach, the article proposes to distinguish four modalities of initiation into injection. These modalities described by users draw on different subjective dimensions in which initiations occur and give ‘good reasons’ – practical and symbolic – to move to injection : managing emotions, social integration, relationship engagement, and hedonism.
Caregivers’ attitudes and beliefs about older people’s misuse of alcohol: A hospital questionnaire survey among 315 health workers
Alcohol misuse is less considered among the elderly, even though it remains prevalent in the ageing population. The apparent neglect of this problem might be due not only to difficulties in screening for it but also due to possible unfavourable carer attitudes. In order to assess the beliefs and attitudes of hospital caregivers towards older people’s’ misusing alcohol and to specify the variables modulating them, a cross-sectional survey, by means of questionnaires, was conducted among 698 nurses and physicians working in eight health facilities around Macon. This questionnaire survey observed their representations, attitudes and knowledge about older people’s’ misuse of alcohol. There were 315 completed questionnaires (response rate: 45%). The feelings declared by the caregivers were categorized as follows: over 75% to listening or availability, 39% to aid or demonstration of skill, 32% to malaise, weakness or avoidance and 7% to aggression, repression or moralizing. The lack of training or lack of time were the only reasons given as possible barriers to the development of appropriate care. Correlations were objectified between positive attitudes and a high level of knowledge, having had a life experience of a familiar person misusing alcohol, or the respondent being an alcohol consumer themself.
Alcohologic liaison interview: a linguistic approach
A problem repeatedly encountered during training for alcoologic interview seems to be independent of the personalities, professions and institutional contexts of the trainees. The assumption is made that it specifically pertains to the linguistic level: it would concern the specific conditions of enunciation of interviews focused on one of the interlocutors, which remain unknown. This leads us to question what is called denial. The difficulties of the professional to talk with alcoholic patients about their dependency are easily attributed to patients’ denial of their illness. But it becomes now thinkable that these difficulties may stem from a gap between the linguistic resources of the two interlocutors.
Drug use in the margins of work: the case of homeless people in Lille
The article focuses on homeless people living in Lille, a medium-sized metropolis in northern France. We address the issue of their intertwined drug consumption and search for solvency through various licit and illicit activities. Heroin in particular was massively used by the persons we interviewed; although heroin prices have dropped since the 1970’s, its purchase still remains an important investment for those whose daily lives are characterized by deprivation (unemployment, lack of housing and healthcare, disaffiliation from family, etc.). As we show, the homeless manage their daily expenses as well as their drug use, mostly through panhandling and hustling. Trafficking drugs can be a solution as well, which is both very risky and profitable. By analysing how drug use and the search for solvency influence each other, this article shows that homeless people at the margins of work engage in various activities and take part in a peculiar economy and that those practices contribute to financing their drug use as well as that of more entrenched users.
Between powerlessness and abstinence among Alcoholics Anonymous : towards the development of the power to act
In North America, and to a lesser extent in Europe and the rest of the world, the 12-step philosophy exercises a considerable impact on the conception of the addiction phenomenon and the intervention process. On what premises does the 12-step philosophy construct its discourse ? What are the final aims of this social movement ? Are there alternative practices to this conception of the addiction phenomenon (once an addict, always an addict) ? To answer these questions from a critical social perspective, the author proposes to analyse some important markers in the social construction of the 12-step discourse and to present alternative markers based on empowering individuals and their social network. Finally he illustrates the foundations that support the development of the power to act from people and from their social network.
Abstinence or controlled gambling? Which objective for which patient? Study of a clinical case of pathological gambling
The various proposed typologies of pathological gamblers do not allow us to establish a consensual conceptual model. Pathological gamblers constitute a heterogeneous group, so the same treatment cannot be offered for all gamblers. However, it appears that subgroups of gamblers with specific traits have been identified, enabling a better understanding of the disorder and thus the proposal of treatment more suited to different pathological gamblers. It seems interesting to have a wide range of intervention options for gamblers related to their particularity. This model would avoid the dichotomy of abstinence or controlled gambling as the only possible objectives and instead highlights the complementarity of these approaches. These concepts are articulated here through the study of a clinical case of pathological gambling.
Many studies have shown an increased risk of violent behavior in people who present a severe mental disorder combined with a substance abuse problem. However researchers have yet to place this relationship into a conceptual framework. The following study suggest such a theoritical explanation based on Goldstein's (1985) economic compulsive and psychopharmacological models.
Acceptability and techniques of appropriation employed by users of tools aimed at the reduction of the risks linked to injection – evaluation of the Steribox®
In order to prevent contamination by HIV and hepatitis C, the Ministry of Health makes sterile injection equipment (Steribox kit) available to drug users as part of the harm reduction policy. In order to evaluate the Steribox® and its tools, an “injection kit” module was integrated into the ANRS-Coquelicot study. The main objective of this module was to measure the suitability of the Steribox® for the current needs of drug users, 16 years after its release. This evaluation made it possible to measure the degree of use of the Steribox®, as well as the reasons for the satisfaction or dissatisfaction of its users, with a view to improving risk reduction tools. The open comments gathered from the users made it possible to reveal the stakes of the acceptability of the tools of risk reduction.
Objectivity, regularity, accessibility: what is the role for a public observatory in the field of drugs and addictive behaviour?
Since 1996, the French Observatory of Drugs and Drug Addiction (OFDT) has developed a system of surveys and data collection to document in the most transversal way the field of drugs and addictive behaviours. The OFDT is a specific public operator set up in the form of a public interest group (GIP) involving the State (12 ministerial departments and the Interministerial Mission to Combat Drugs and Addictive Behaviour) and the National Federation of Regional Health Observatories (FNORS). This article allows us to review the history of the OFDT, after 25 years of practice, in order to draw up a review of the implementation of an original observation system in France as in Europe but also to reflect on the missions of a public observatory within the framework of public policies of mobilization against addictive behaviour.
The author outlines a sociological theory of drug dependence. The three factors which contribute to the development of a state of drug dependence are: access to dependence-producing substances; disengagement from proscriptions against their use; role strain and/or role deprivation.
Les usagers de drogues russophones sont présents dans les structures de soin et de réduction de risques franciliennes depuis les années 2000 et leur nombre ne cesse d’augmenter. Cet article présente une tentative d’étude du lien entre les processus psychiques étant à l’origine de la migration précaire et des troubles addictifs à travers les particularités de la construction identitaire dans le cadre des mutations sociétales majeures mais aussi à travers le sens recherché dans la mise à distance. L’approche thérapeutique proposée pour accompagner ce public se construit autour de l’intégration du concept de la transitionnalité à travers la médiation linguistique et culturelle respectant la temporalité des sujets.
Addiction in unaccompanied minors: how to go from drugs to story
The CASITA House of Teenagers based in Seine-Saint-Denis receives young people with diverse origins, migrants or children of migrants. The managed care is pluralist. Receiving and caring for unaccompanied minors is one example. Through the two clinical presentations here we will see here how the consultation of young consumers can be a gateway to an early psychological elaboration of an often very traumatic history. We show how the addictions clinic for unaccompanied minors is unique, combining transcultural and psychoanalytical approaches.
On line gaming addiction: how is it cured elsewhere ?
While MMORPG addiction is growing rapidly, specialists from around the world have had to adapt their treatments. The impact and the influence of socio cultural factors will be emphasised in this study. Methodology: Two clinical cases will be exposed: one case presents Japanese specialists’ approach and the second case focuses on Brazilian specialists. Results: The analysis of how Asians use MMORPG and the Internet has revealed a significant influence of sociological, economical and religious factors in that part of the world. Although the number of teenagers who suffer from this addiction is growing worldwide, the fight against substance abuse remains the priority for some governments, especially in South America.
The repeated administration of morphine to a minimally acculturated group of 14 Africans who were hospitalized for hemoptysia produced very limited psychic effects - including the analgesic effect - and also very limited psychological and physical reactions following termination of the treatment. The author formulates hypotheses to explain these observations.
Based on a research project which evaluated the impact of social, psychological and cultural factors in the adoption of tobacco by preadolescents, the authors acknowledge the existence of three main pathways leading of tobacco use. They also demonstrate the necessity to complement epidemiological data by ethnographic and phenomenological studies if one wants to grasp a comprehensive interpretation of the tobacco problem, and to design a global strategy of prevention.
Exercer une activité de patient-expert dans le champ des conduites addictives, au-delà des seuls programmes d’éducation thérapeutiques du patient, vaut bien une certification de patient-expert addictions (PEA). Il s’agit de légitimer une pratique existante, de développer et sécuriser son pouvoir d’agir de concert avec les acteurs des structures de soins et d’accompagnement, de créer un environnement d’échanges sur les pratiques. Le parcours de certification, individualisé, respectueux et professionnalisant, s’appuie sur un travail réflexif sur son savoir expérientiel au regard d’un référentiel d’activités et de compétences qui prend en compte tous les domaines d’activités du PEA.
The authors sum up what is known about LSD mechanisms following various experiments (animal, radiolinkage, electrophysiology...). While serotonin seems to be the main neurotransmitter involved in the action of LSD, many questions remain unanswered involving other neurotransmitters.
Neuro inform-actional maps
Attempts to understand addiction must take into account an analysis of higher cognitive function. Recent discoveries in neuroscience make it possible to offer a monistic interpretation of ontogenetic development involving the interaction of organism and environment. This model attempts to offer useful suggestions for understanding drug addiction and guiding counselors in their therapeutic approach.
Substance psychoactive use in prison: a retrospective qualitative study
The prison population is less healthy than the general population and has more frequent co-morbidities, including addictions. The 2003 Drees survey showed that 33% of new prisoners declared a prolonged and regular use of illicit drugs in the 12 months prior to incarceration. We wanted to describe the use of psychoactive substances and the associated risk practices in prison. We conducted nine semi-directed qualitative interviews among drug users who have experienced incarceration in Brest prison. We have highlighted the continued use of licit (tobacco, medical treatments) and illicit (heroin, cocaine, cannabis) drugs in prison with risk-associated practices (sniffing, injection...). The ubiquitous solicitations and drug trafficking with well-known strategies such as barter and exchange were also found in the goal. The respondents also suggested several possible areas for improvement in the care of drug users in prison, based on the diversification of care, including better access to risk reduction, and patient autonomy.
Taking care of an opiod dependant pregnant woman in Alsace: Pregnancy and Addiction Network
Drug abuse during pregnancy raises many questions both for the caring staff and for the patient herself, inducing bilateral suspicion and hindering good medical care. The “Pregnancy and Addiction Network (RMA)” is sponsored by the “ARS” (French State Health Agency) since 2004 to support addictive pregnant women in the medical, social and psychological fields. RMA provides a multidisciplinary well coordinated approach to enable the birth of a healthy infant raised by secured parents both for their addiction and psychosocial behaviours. Starting from the case of an opïod dependant couple requiring AMP (Assisted Medical Procreation), we discuss the benefice of changing commonly spread representations, present major clinical problems and coordination activities of our network.
Cocaine in France: an Expanding Market. Current Trends and Public Responses
Cocaine is the second most abused illicit drug after cannabis in France, which has recently passed into the group of the top five European countries for cocaine consumption. Cocaine is spreading rapidly, resulting in a doubling of the proportion of experimenters in a decade and a strong diversification of user profiles. The number of current users of cocaine is estimated at 450,000, eight times less than for cannabis (3.8 million users per year), but this figure is increasing and relates to an increasingly wide range of age groups, social backgrounds and sectors of activity. This increase in the demand and visibility of cocaine corresponds to a dynamic of significant supply, like the peak of production worldwide in 2017. More available and purer, cocaine is the subject of modalities of multiple traffic and in constant renewal. This article reviews the situation of cocaine and current trends, using all the data produced since the 1990s: government statistical sources (arrests, requests for treatment, etc.), the OFDT’s own information systems (French observatory of drug addiction), etc. The combination of these sources provides an updated synthesis of the cocaine market in France, highlighting the challenges faced by public authorities in the absence of drug treatment for cocaine addiction or substitution.
Over the last 15 years, many studies have explored an emotional trouble in addictive behaviours: alexithymia, a neologism suggested by Sifneos in 1973. Usually, unfortunately, studies consider this dimension as an emotional deficit, prioritising only the quantitative assessment of alexithymia to the detriment of a qualitative study. This paper proposes, firstly, to revisit the definition of the concept and the prevalence of this emotional characteristic in addictive behaviours. In part two, the need to consider, by some subjects, alexithymia like a real adaptation and not a deficit process is reminded; then we ask ourselves how pertinent it is to explore its status in addictive behaviours as a primary or secondary process.
The drug addiction of mothers is no longer considered as a reason in itself for reporting their children to authorities. Their addiction is evaluated as a factor among others, of high risk of further ill-treatment of their children. Maternity professionals mention risk factors such as precarity, delinquency, prostitution or mental health, factors which in combination with illicit drug use could lead them to report children to courts
Based on the practices of the Alternatives Centre at Montreal, the author proposes a plan for the caring of drug addicts, thereby implying varied and complementary forms of intervention outside the institutional sphere.