Education and Training in Addiction Medicine and Psychology across Europe: A EUFAS Survey.

INTRODUCTION: Training in addiction medicine and addiction psychology is essential to ensure the quality of treatment for patients with substance use disorders. Some earlier research has shown varying training between countries, but no comprehensive study of addiction training across Europe has been performed. The present study by the European Federation for Addiction Societies (EUFAS) aimed to fill this gap. METHODS: A Delphi process was used to develop a questionnaire on specialist training in addiction treatment in 24 European countries. The final questionnaire consisted of 14 questions on either addiction medicine or addiction psychology, covering the nature and content of the training and institutional approval, the number of academic professorial positions, and the estimated number of specialists in each country. RESULTS: Information was not received from all countries, but six (Belgium, Denmark, Ireland, Italy, Poland, and Romania) reported no specialized addiction medicine training, while 17 countries did. Seven countries (Belgium, France, Ireland, Italy, Russia, Switzerland, and the Netherlands) reported no specialized addiction psychology training, while 14 countries did. Training content and evaluation methods varied. Approval was given either by governments, universities, or professional societies. Eighteen countries reported having professorships in addiction medicine and 12 in addiction psychology. The number of specialists in addiction medicine or psychology varied considerably across the countries. DISCUSSION: The survey revealed a large heterogeneity in training in addiction medicine and addiction psychology across Europe. Several countries lacked formal training, and where formal training was present, there was a large variation in the length of the training. Harmonization of training, as is currently the case for other medical and psychology specializations, is warranted to ensure optimal treatment for this under-served patient group.

Autobiographical memories cued by self-statements in patients with alcohol use disorder: linking self-conceptions to past events.

The study examined the personal sense of identity in alcohol use disorder (AUD) through the relation between autobiographical memories and individuals' self-conception. The AUD detoxified patients and control participants were asked to create a list of self-statements to which they associated for the three main autobiographical memories illustrating them. The group variable was not associated with the number of positive self-statements, but it was associated with the number of negative self-statements. Furthermore, for the autobiographical memories cued by a positive self-statement, the group was related to the number of positive memories and general memories, while no relation was observed for the memories cued by a negative self-statement. Our results also support that AUD patients' memories cued by self-statements are older and more alcohol-related. Hierarchical regression analyses in the AUD patients demonstrated that the use of adaptive emotional regulation strategies was the only significant predictor of the use of positive or negative self-statements.

Childhood trauma and the severity of past suicide attempts in outpatients with cocaine use disorders.

Introduction: Suicide attempts have been associated with both cocaine use disorder (CocUD) and childhood trauma. We investigated how childhood trauma is an independent risk factor for serious and recurrent suicide attempts in CocUD. Method: 298 outpatients (23% women) with CocUD underwent standardized assessments of substance dependence (Diagnostic and Statistical Manual-mental disorders, fourth edition, text revised), impulsiveness, resilience, and childhood trauma, using validated tools. Suicide attempts history was categorized as single vs. recurrent or non-serious vs. serious depending on the lifetime number of suicide attempts and the potential or actual lethality of the worst attempt reported, respectively. Bivariate and multinomial regression analyses were used to characterize which childhood trauma patterns were associated with the suicide attempts groups. Results: 58% of CocUD patients reported childhood trauma. Recurrent and serious suicide attempts clustered together and were thus combined into "severe SA." Severe suicide attempt risk increased proportionally to the number of childhood traumas (test for trend, p = 9 × 10-7). Non-severe suicide attempt risk increased with impulsiveness and decreased with resilience. In multinomial regression models, a higher number of traumas and emotional abuse were independently and only associated with severe vs. non-severe suicide attempts (effect size = 0.82, AUC = 0.7). The study was limited by its cross-sectional design. Conclusion: These preferential associations between childhood trauma and severe suicide attempts warrant specific monitoring of suicide attempts risk in CocUD, regardless of the severity of addiction profiles.

Four Questions Nurses Can Ask to Predict PTSD 1 Year After a Motor Vehicle Crash.

BACKGROUND: The role of nurses in screening for posttraumatic stress disorder is crucial in trauma units. OBJECTIVES: To create and evaluate an easy and brief tool for nurses to predict chronic posttraumatic stress disorder 1 year after a motor vehicle crash. METHODS: We performed a 1-year follow-up multicenter study from 2007 to 2015, including 274 patients injured in a motor vehicle crash who were hospitalized in an orthopedic trauma unit. Nurses administered the DEPITAC questionnaire. Posttraumatic stress disorder was measured by the Post-Traumatic Stress Disorder Checklist of symptoms during the first year following the crash. A multivariable logistic regression model was implemented to select items significantly associated with posttraumatic stress disorder to improve the DEPITAC questionnaire. Predictive performance to predict posttraumatic stress disorder 1 year after the motor vehicle crash was examined for these different models. RESULTS: Of 274 patients studied, a total of 75.9% completed the questionnaire at 1 year of follow-up. We found that only two questions and two simple elements of the patient's medical record (other injury or a person dying during the crash, perception of vital threat, number of children, and length of stay in trauma) predicted posttraumatic stress disorder 1 year after a motor vehicle crash. CONCLUSIONS: The brevity of this evaluation, simple scoring rules, and screening test performance suggest that this new screening tool can be easily administered in the acute care setting by nurses.

Effect of intrapersonal emotional competences on the relationship between attachment insecurity and severity of eating disorder symptoms in patients with restrictive anorexia.

OBJECTIVE: Attachment insecurity and emotional competences (EC) form a key part of conceptual models of anorexia nervosa (AN). We explored the relationship between attachment dimensions and EC on the severity of eating disorders in patients diagnosed with restrictive AN. METHOD: Sixty-three female patients with restrictive AN and 63 healthy participants completed self-report measures (eating symptoms, EC, attachment, depression, and anxiety). RESULT: Patients with restrictive AN used fewer adaptive and more maladaptive regulation strategies and showed low levels of intrapersonal EC. The partial least squares path modeling analysis showed that high levels of attachment anxiety or avoidance lead to a decrease in intrapersonal EC, which in turn contributes to greater severity of eating symptoms in anorexic patients. CONCLUSIONS: Lower intrapersonal EC played an important mediating role in the effects of attachment insecurity on the severity of eating disorders. The joint use of therapeutic programs that target both EC and attachment processes constitutes a promising approach.

Schadenfreude, malicious and benign envy are associated with low body mass index in restrictive-type anorexia nervosa.

PURPOSE: According to the Cognitive-Interpersonal Maintenance Model of anorexia nervosa, social factors are involved in the maintenance and development of this disorder. Therefore, this study aimed to test whether patients with restrictive-type anorexia nervosa (AN-R) experience malicious envy (negative emotions associated with the wish that others lack their superior quality), benign envy (negative emotions associated with the desire to reach and obtain the others' superior quality) and Schadenfreude (pleasure at the misfortunes of others) with a higher intensity than healthy controls (HC). METHODS: 26 AN-R patients and 32 HC completed scenarios that aimed to induce envy and Schadenfreude and completed questionnaires measuring envy, self-esteem and social comparison. RESULTS: AN-R patients reported more benign envy than HC. Interestingly, higher body mass index (BMI) was associated with less Schadenfreude, malicious and benign envy in AN-R only. CONCLUSIONS: This study shows that AN-R patients present higher motivation to evolve when facing others' superior quality (i.e., benign envy). It also underlines the importance of considering social factors in the maintenance of AN-R and the role of BMI when examining emotions related to others' fortune. LEVEL OF EVIDENCE: Level III, case-control analytic study.

Impaired Specificity of Future Thinking in Alcohol Use Disorders.

BACKGROUND: While there has been a body of work that has investigated past thinking in individuals with alcohol use disorders (AUD), little is known about future thinking in these individuals. METHODS: We invited participants with AUD and control participants to construct past and future events. We have also investigated the relationship between constructing past and future events and depression. RESULTS: By analyzing the specificity (i.e., the ability in constructing specific events situated in time and space) of these events, results demonstrated lower specificity of past and future thinking in AUD participants compared to control participants. No significant differences were observed between the specificity of past and future thinking in AUD or in control participants. Further, significant negative correlations were observed between depression and past/future thinking in AUD participants but not in controls. CONCLUSIONS: Difficulties in constructing specific future scenarios, as observed in AUD participants compared with controls, are presumably related to ruminative thinking and emotional avoidance aspects of depression, which should be investigated in future studies. More specifically, individuals with AUD may tend to construct general future scenarios to dwell on negative past events and/or to avoid coping with hopelessness and processing of upsetting or distressful future scenarios.

Compared characteristics of current vs. past smokers at the time of diagnosis of a first-time lung or head and neck cancer: a cross-sectional study.

BACKGROUND: Active smoking at the time of diagnosis of a first head & neck (H&N) or lung cancer is associated with a worse cancer outcome and increased mortality. However, the compared characteristics of active vs. former smokers at cancer diagnosis are poorly known. METHODS: In 371 subjects with a first H&N or lung cancer, we assessed: 1) socio-demographic features; 2) lifelong types of smoking; 3) alcohol use disorder identification test (AUDIT); 4) cannabis abuse screening test (CAST); and 5) Mini International Neuropsychiatric Interview (MINI). Using a multivariable regression model, we compared the profile of current smokers and past smokers. RESULTS: Current smokers more frequently exhibited H&N cancer (OR 3.91; 95% CI [2.00-6.51]; p <  0.0001) and ever smoking of hand-rolled cigarettes (OR 2.2; 95% CI [1.25-3.88]; p = 0.007). Among subjects with lung cancer (n = 177), current smoking was primarily associated with ever smoking of hand-rolled cigarettes (OR 2.88; 95% CI [1.32-6.30]; p = 0.008) and negatively associated with age (OR 0.92; 95% CI [0.89-0.96]; p <  0.001). Among subjects with H&N cancer (n = 163), current smokers exhibited a significantly greater AUDIT score (OR = 1.08; 95% CI [1.01-1.16]; p = 0.03). CONCLUSION: At the time of diagnosis of the first lung or H&N cancer, current smoking is highly associated with previous type of smoking and alcohol drinking patterns. TRIAL REGISTRATION: NCT01647425 ; Registration date: July 23, 2012.

Pharmaceutical cognitive doping in students: A chimeric way to get-a-head?

For students, the pressing demands for memorization, top-level performance, and peer competition create an environment favorable for pharmaceutical cognitive doping behavior. We aimed to describe recent practices and the benefit/risk ratio of such behavior and to discuss the issues at stake. The prevalence of pharmaceutical cognitive doping among students has been reported from 1.3% to 33% across studies, with variations depending on country and definition of pharmaceutical cognitive doping. The therapeutic classes most frequently cited as being diverted for doping purposes are psychostimulants and nootropics (methylphenidate, modafinil, piracetam), corticosteroids, sedative drugs and beta-blockers. Some illegal substances such as cannabis, amphetamines and cocaine are also consumed in order to boost mental function. Finally, over-the-counter products, such as caffeine-based tablets or energy drinks, or alcohol, are also widely used by students whose motivations involve enhanced performance, concentration, memory, and staying awake during the revision and exam period. However, the expected (often fantasized) effectiveness of these products does not correspond to the reality of a modest controversial impact on cognitive performance. There appears to be an emerging profile of the student more inclined to doping behavior. Cognitive doping thus raises the question of its regulation, opening a debate opposing, on one hand, individual freedom and supposed collective benefits and, on the other hand, health consequences, educational (in)equality, and the risk of tarnished academic success. Strengthening school and university medicine, through prevention campaigns and the identification of subjects at risk, is essential to limit the extent, risk, and damages associated with such practices.

[Pharmaceutical cognitive doping in students: a chimeric way to get-a-head?] / Dopage cognitif chez les étudiants : un moyen chim(ér)ique de s'en mettre plein la tête ?

For students, the pressing demands for memorization, top-level performance, and peer competition create an environment favorable for pharmaceutical cognitive doping behavior. We aimed to describe recent practices and the benefit / risk ratio of such behavior and to discuss the issues at stake. The prevalence of pharmaceutical cognitive doping among students has been reported from 1.3% to 33% across studies, with variations depending on country and definition of pharmaceutical cognitive doping. The therapeutic classes most frequently cited as being diverted for doping purposes are psychostimulants and nootropics (methylphenidate, modafinil, piracetam), corticosteroids, sedative drugs and beta-blockers. Some illegal substances such as cannabis, amphetamines and cocaine are also consumed in order to boost mental function. Finally, over-the-counter products, such as caffeine-based tablets or energy drinks, or alcohol, are also widely used by students whose motivations involve enhanced performance, concentration, memory, and staying awake during the revision and exam period. However, the expected (often fantasized) effectiveness of these products does not correspond to the reality of a modest controversial impact on cognitive performance. There appears to be an emerging profile of the student more inclined to doping behavior. Cognitive doping thus raises the question of its regulation, opening a debate opposing, on one hand, individual freedom and supposed collective benefits and, on the other hand, health consequences, educational (in)equality, and the risk of tarnished academic success. Strengthening school and university medicine, through prevention campaigns and the identification of subjects at risk, is essential to limit the extent, risk, and damages associated with such practices.

Thirty- Versus Ten-Day Diazepam Treatment for Alcohol Detoxification and a Comparison of Drinking Patterns, Craving, and Anxiety for up to 12 Weeks: A "Proof-of-Concept" Open-Label Randomized Controlled Trial.

PURPOSE: The aim of this study was to evaluate whether a prolonged detoxification treatment could decrease the relapse rate at 3 months after alcohol cessation in alcohol-dependent individuals through decreasing the levels of postdetoxification craving and anxiety. METHODS: Twenty-six adult patients with alcohol dependence (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision) who began an outpatient alcohol cessation program with an initial drinking goal of abstinence were enrolled in a 3-month, parallel, randomized (1:1 ratio), controlled, open-label, pilot trial. Participants were randomized to receive a detoxification treatment of diazepam with a duration of 30 (n = 12) or 10 days (n = 14). All participants received BRENDA-based psychotherapy during follow-up. RESULTS: No significant between-group difference in relapse to any drinking was found at 3 months (P = 0.20). However, relapse to any heavy drinking at 3 months and regular drinking or heavy drinking during follow-up were significantly lower in the 30-day diazepam group (P = 0.009, P = 0.049, and P = 0.004, respectively). These differences were corroborated by significant differences in the alcohol-specific biological marker carbohydrate deficient transferrin at 3 months. Participants in the 30-day diazepam group also displayed significantly lower scores for alcohol craving (P = 0.007), self-reported anxiety (P = 0.024), and clinician-assessed anxiety (P = 0.002) throughout the follow-up. No serious adverse event was reported during the study. CONCLUSION: This study provides an evidence-based rationale for a double-blind, randomized, placebo-controlled trial to confirm the efficacy of such a procedure on short-term and mid-/long-term drinking outcomes after alcohol cessation in alcohol-dependent individuals.

The dose-effect relationship of baclofen in alcohol dependence: A 1-year cohort study.

OBJECTIVE: Our aim is to study the relationship between dose of baclofen and effectiveness in alcohol dependence. METHODS: Two hundred two patients with alcohol dependence, who received baclofen treatment for drinking reduction, were followed up for 1 year. For each patient-month of treatment, the maximum daily dose of baclofen (DDB) and average weekly alcohol consumption (AWAC) were calculated. We defined a favorable drinking outcome as an AWAC under 200 g/w for at least 2 consecutive months. We divided the DDB of each patient-month into 3 categories (low dose: <90 mg/d, medium dose: 90-150 mg/d, and high dose: >150 mg/d) and investigated the relationship between reaching a favorable outcome and the concurrent DDB category in a time-varying Cox regression analysis. Hazard ratios (HRs) were adjusted based on age, sex, and initial AWAC. RESULTS: One hundred forty subjects were followed during at least 1 month. Of these patients, 58 (41%) had a favorable drinking outcome. In comparison to low dose, medium dose was associated with a decreased rate of favorable drinking outcome (HR = 0.42; 95% CI [0.20, 0.88]), whereas no difference was found with high dose (HR = 1.31; 95% CI [0.65, 2.64]). CONCLUSION: The relationship between dose of baclofen and favorable drinking outcome was U-shaped, that is, was increased at low and high doses compared to medium doses.

Overactivation of the Pupillary Response to Emotional Information in Short- and Long-Term Alcohol Abstinent Patients.

AIMS: The aim of the study was to compare emotional information processing in patients with severe alcohol use disorder in short-term abstinence (<1 month) and long-term abstinence (at least 6 months to 9 years) with control participants. METHODS: We studied the variation in pupil diameter during the presentation of pictures of human interactions associated with positive, negative or neutral valences. RESULTS: Overall, the results of the short-term abstinent group revealed greater pupil dilation regardless of the valence of the pictures while the pupillary response of long-term abstainers did not differ from the control group. More specifically, according to each valence, the pupil response to neutral pictures was greater for both patient groups than for controls. For the long-term abstainers, a negative correlation was found between the length of abstinence and the pupillary response to emotional stimuli. CONCLUSION: In long-term abstainers group, the high activation by neutral stimuli suggests however some difficulties in the processing of nonemotional stimuli, considered emotional ones and may constitute a potential relapse factor or the maintenance of addiction.

Characteristics of Patients with Alcohol Dependence Seeking Baclofen Treatment in France: A Two-Centre Comparative Cohort Study.

AIM: To characterize the profile of patients seeking baclofen treatment for alcohol dependence in France. METHOD: We compared retrospectively baclofen seekers and baclofen non-seekers within a cohort of consecutive outpatients with alcohol dependence who attended a first appointment for alcohol treatment at two French addiction centres between September 2012 and March 2014. We documented socio-demographic characteristics; comorbid psychiatric, addiction, alcohol dependence features; patients' initial drinking goal, and referral status; and treatment retention at 6 and 12 months. RESULTS: Of the 289 patients identified, 107 were baclofen seekers and 182 were baclofen non-seekers. The only parameters significantly associated with baclofen seekers in multivariate analyses were a greater baseline alcohol consumption (ß = 15.4, 95% CI: 0.18-30.65, P = 0.05), a controlled-drinking initial goal (OR = 14.9, 95% CI: 7.7-29, P < 0.0001) and self-referral (OR = 6.6, 95% CI: 3.7-12, P < 0.0001), baclofen seekers being eight times more likely to be self-referred and treatment-naïve (OR = 8.8, 95% CI: 4.1-18.9, P < 0.0001). Baclofen seekers were more likely to be retained in treatment at 6 months (OR = 3.5, 95% CI: 1.8-6.7, P < 0.0001) and 12 months (OR = 1.9, 95% CI: 1.1-3.2, P = 0.019). CONCLUSION: In France, the perspective of controlled drinking offered by baclofen treatment may have attracted more self-referred patients, including those without previous alcohol treatment, to attend treatment, than the usual treatment options. These findings raise the question as to whether future public health strategies on alcohol should more prominently promote some aspects of alcohol treatment, such as patient's preference and treatment options, in order to reduce the treatment gap in alcohol dependence.

[Investigation of the medical and social situation of patients managed by opiate replacement regimens for over 10 years by their GP]. / Enquête sur la situation médico-sociale de patients suivis pour un traitement substitutif aux opiacés depuis plus de 10ans par leur médecin généraliste.

OBJECTIVE: Management with opiate replacement regimens (ORRs) of patients presenting to primary care settings with opiate addiction has become a long-term follow-up. The aim of this survey study was to describe patients who had been prescribed ORRs for at least 10 years by their general practitioner (GP). METHOD: In 2011, two questionnaires were sent to a sample of 38 GPs prescribing ORRs in Northern France. Doctors' questionnaires collected their typology and opinions on their patients receiving opiate substitution treatments for over 10 years. Patients' questionnaires were completed in the presence of the patient. RESULTS: Twenty-three doctors' and 83 patients' questionnaires were suitable for analysis. The average number of listed ORR patients was 14.2 and 3.6 had been managed for 10 years or more. Misuse persisted: 30.5% of GPs considered that it was carried out by at least by 15% of patients. Average dosages were 60.3 mg for methadone and 7.0 mg for buprenorphine. Employment (46.3% of patients had a salary), dwelling and family live (46.3% of patients were in charge of children) were favored. Nevertheless, precariousness persisted: 32% of patients were indebted and help of social workers was not systematically searched. One third of the patients were alcohol and cannabis misusers, 70% were smoking and 34.5% multiple drug misusers. An important number of patients were taking anxiolytics (37.8%) and hypnotics (30.5%). CONCLUSION: After 10 years of follow-up for an ORR by a GP, the social situation of patients seems to have stabilized, but psychoactive drugs consumption remains important.

Impaired processing of self-face recognition in anorexia nervosa.

Body image disturbances and massive weight loss are major clinical symptoms of anorexia nervosa (AN). The aim of the present study was to examine the influence of body changes and eating attitudes on self-face recognition ability in AN. Twenty-seven subjects suffering from AN and 27 control participants performed a self-face recognition task (SFRT). During the task, digital morphs between their own face and a gender-matched unfamiliar face were presented in a random sequence. Participants' self-face recognition failures, cognitive flexibility, body concern and eating habits were assessed with the Self-Face Recognition Questionnaire (SFRQ), Trail Making Test (TMT), Body Shape Questionnaire (BSQ) and Eating Disorder Inventory-2 (EDI-2), respectively. Subjects suffering from AN exhibited significantly greater difficulties than control participants in identifying their own face (p = 0.028). No significant difference was observed between the two groups for TMT (all p > 0.1, non-significant). Regarding predictors of self-face recognition skills, there was a negative correlation between SFRT and body mass index (p = 0.01) and a positive correlation between SFRQ and EDI-2 (p < 0.001) or BSQ (p < 0.001). Among factors involved, nutritional status and intensity of eating disorders could play a part in impaired self-face recognition.

Resurgence of anorexic symptoms during smoking cessation in patients with a history of anorexia nervosa: An unseen problem?--Report of two cases.

This report describes a resurgence of anorexic symptoms during a smoking cessation program in two patients with a history of anorexia nervosa. These two events were identified among patients lost to follow-up by using a strategy implemented to limit early drop out. In both cases, the resurgence of anorexic symptoms occurred rapidly after having reached abstinence from tobacco and was described as a response to the weight gain they had experienced just after the start of smoking cessation. The smoking cessation process itself was considered as the most plausible explanation for these two events. Given the potential serious consequences, further research is needed to determine whether such events are frequent during smoking cessation but being unseen because of being hidden in the loss to follow-up. This report also suggests that systematic screening for both binge eating and anorexic behaviors during smoking cessation is warranted.

The impact of discontinuing methylphenidate on weight and eating behavior.

Chronic administration of the amphetamine-derivative methylphenidate (MPH) may induce appetite reduction and weight loss. By contrast, the effects that stopping chronic MPH may exert on eating behavior and body weight are poorly known. We report the case of a male patient with childhood attention deficit/hyperactivity disorder (ADHD), who discontinued MPH treatment at the age of 11 years and was lost to follow-up until the age of 16. The patient's body mass index increased by five points within 1 year of MPH cessation while the symptoms of ADHD were re-emerging. The patient secondarily developed DSM-5 criteria for eating disorders. Discontinuing chronic MPH can significantly affect weight and eating behavior. Such risks should warrant further studies, as they could be particularly increased in patients with ADHD, who share common vulnerability factors with both obesity and eating disorders.

Synthetic cathinones: a new public health problem.

New psychoactive substances (NPS) have completely modified the drug scene and the current landscape of addiction. Synthetic substances, such as substituted or synthetic cathinones, also known as « legal highs ¼, are often produced and used to mimic the effects of controlled drugs such as cocaine, methylenedioxymethamphetamine (MDMA, ecstasy), and methamphetamine. The overwhelming majority of synthetic cathinones are produced in China and South East Asian countries. The Internet has emerged as the new marketplace for NPS, playing a major role in providing information on acquisition, synthesis, extraction, identification, and substance use. All these compounds are intentionally mislabeled and sold on-line under slang terms such as bath salts, plant food, plant feeders and research chemicals. They are sometimes labeled « not for human use ¼ or « not tested for hazards or toxicity ¼. The rapid spread of NPS forces member countries of the European Union to adapt their response to the potential new dangers that may cause. To date, not only health actors but also the general public need to be clearly informed and aware of dangers resulting from NPS spread and use. Here, we review the major clinical effects of synthetic cathinones to highlight their impact on public health. A literature search was conducted from 2009 to 2014 based on PubMed, Google Scholar, Erowid, and governmental websites, using the following keywords alone or in combination: "new psychoactive substances", "synthetic cathinones", "substituted cathinones", "mephedrone", "methylone", "MDPV", "4-MEC", "addiction", and "substance use disorder".

[Temporary recommendation for use on off-label baclofen: viewpoint of Prescribers of the CAMTEA system]. / La « recommandation temporaire d'utilisation ¼ sur le baclofène : point de vue des prescripteurs du dispositif CAMTEA.

The use of high dose baclofen for alcohol-dependence emerged in France from 2008 based on empirical findings, and is still off-label. However, due to the rapid increase in this prescribing practice, the French health authorities have decided to frame it using an extraordinary regulatory measure named "temporary recommendation for use" (TRU). Baclofen prescribers from CAMTEA, a regional team-based off-label system for supervising baclofen prescribing, which was developed much prior to the TRU, discuss herein the pros and cons of this measure and the applicability of its different aspects in the daily clinical practice.