[Study of defense styles, defenses and coping strategies in alcohol-dependent population]. / Étude des styles défensifs, des défenses et des stratégies de coping au sein d'une population alcoolodépendante.

INTRODUCTION: Defense mechanisms have been seen to greatly change over time and across different definitions made by different theoretical currents. Recently with the definition provided by the DSM IV, defense mechanisms have integrated the concept of coping as a defensive factor. These mechanisms are no longer considered just through a psychodynamic approach but also through a cognitive and behavioral one. In recent years, new theories have therefore integrated these two components of the defensive operation. According to Chabrol and Callahan (2013), defense mechanisms precede coping strategies. In individuals with psychopathological disorders, these authors indicate a relative stability of these mechanisms. Also, we asked about the presence of unique characteristics among people with alcohol dependence. Indeed, studies conducted with people with alcohol dependence highlight the presence of a neurotic defense style and some highly immature defenses (projection, acting out, splitting and somatization). In terms of coping strategies, persons with alcohol dependence preferentially use avoidant strategies and strategies focused on emotion. However, although several studies have been conducted to assess coping strategies and defense styles within a population of individuals with an alcohol problem, at the present time none of them has taken into account all these aspects of defense mechanisms. OBJECTIVE: The aim of this study is therefore to study the defenses and defense styles and coping strategies in an alcohol-dependent population. METHOD: This multicenter study (3 CHU, 1 center of supportive care and prevention in addiction and 1 clinic) received a favorable opinion of an Institutional Review Board (IRB Registration #: 00001072). Eighty alcohol-dependent individuals responded to a questionnaire assessing sociodemographic characteristics and elements related to the course of consumption. Coping strategies were assessed by means of a questionnaire validated in French: the Brief Cope. The Defense Style Questionnaire-40 translated into French, but not validated, assessed defenses and defense style. Descriptive, comparative and correlational analysis was carried out using Statistica software - version 10. RESULTS: The alcohol-dependent people preferentially use emotion focused coping blame and less the problem focused coping humor. The highest immature defense is acting out. Correlational analyses confirm the presence of some significant relationships between defense style and some coping strategies. Thus, the mature style is the only defense style, which is linked with the problem focused strategy humor, and another one coping called distraction. Some singular relationships were found with these two dimensions of coping. Alcohol and drug disengagement show particularly strong relationships with immature defenses such as projection and somatization. Another singular result is indicated by a negative relationship between immature defenses autistic fantasy with the strategy expression of feelings. CONCLUSION: This study found a significant number of relationships between defensive styles, defenses and coping strategies. This research also highlights the value of an integrative approach of defense mechanisms for the analysis of defensive functioning of people with alcohol dependence. Indeed, the relationships between these elements are consistent and allow understanding the defensive operation as a whole to promote a new adapted means of support.

[ADH/D and impulsiveness: Prevalence of impulse control disorders and other comorbidities, in 81 adults with attention deficit/hyperactivity disorder (ADH/D)]. / L'impulsivité dans le TDAH: prévalence des troubles du contrôle des impulsions et autres comorbidités, chez 81 adultes présentant un trouble déficit de l'attention/hyperactivité (TDA/H).

UNLABELLED: Attention deficit hyperactivity disorder (ADH/D) is a neuropsychological developmental disorder characterized by pervasive and impairing symptoms of inattention, hyperactivity, and impulsivity. Whereas it is well known in children, there is still little information about ADH/D in adults, including prevalence. Indeed, there are actually no epidemiological studies in France, despite the considerable impact of this disorder in a patient's professional and affective life. Moreover, ADH/D rarely stays isolated, and many comorbidities often complicate the diagnostic investigation. It is well known that the so-called ADH/D is composed of two main categories of symptoms (Attentional Disorder/Hyperactiviy Disorder), but Impulsiveness also remains a major symptom. OBJECTIVE: The aim of this study was to evaluate not only the prevalence of Impulse Control Disorders (ICD) but also psychological and addictive comorbidities among adult patients with ADH/D. A total of 100 patients from specialized consultations of adult ADH/D were evaluated in this study, but only 81 were included after presenting all the clinical criteria of ADH/D. METHOD: We used the DSM IV-T-R for ADH/D, the Minnesota Impulsive Disorders Interview a semi-structured clinical interview assessing impulse control disorders (ICD) (compulsive buying, trichotillomania, compulsive sexual behaviour, kleptomania, pyromania and intermittent explosive disorder), and the Mini International Neuropsychiatric Interview in order to evaluate psychiatric and addictive comorbidities. RESULTS: More than 90 % of the patients met the early apparition criteria of ADH/D (before 7years). More than half of the patients presented a mixed type of ADH/D (both inattentive and hyperactive-impulsive forms): 55.6 % vs 44.4 % for the inattentive type. The vast majority of patients showed a complete form (with a total of 6 or more symptoms out of 9, of inattentive and/or impulsive-hyperactivity category): 93.8 % and only 6.2 % presented a sub-syndromic form of ADH/D (with 3 symptoms at least of one and/or the other category). Regarding the ICDs, we found a proportion of 66 % of patients manifesting at least one, the most frequent ICD being the Intermittent Explosive Disorder (IED): 29.6 %, followed by Compulsive Buying (CB): 23.4 %, Pathological Gambling (PG): 7.4 %, Kleptomania and Compulsive Sexual Behaviour: 2.4 %, and Trichotillomania: 1.2 %. Among the psychiatric comorbidities evaluated, generalized anxiety disorder: 61.7 %, followed by dysthymia: 44.4 %, major depressive episode: 28.3 %, Agoraphobia: 22.2 %, panic disorder: 17.2 %, hypomanic episode: 16 %, social phobia: 11.1 %, bulimia nervosa: 8.6 %, and antisocial personality disorder and obsessive-compulsive disorder: 3.7 %. Regarding the addictive comorbidities, we found a prevalence of 14.8 % of substance abuse (non-alcohol), followed by 7.4 % of alcohol abuse, 6.1 % of substance dependence (non-alcohol), and 3.7 % of alcohol dependence. CONCLUSION: ADH/D in adults continues to be unrecognized in France. The aim of this study was to evaluate the prevalence of impulse control disorders, psychiatric and addictive comorbidities in adults with ADH/D. The results enable us to appreciate quantitative and qualitative data for 81 French adults with ADH/D. This disorder rarely remains isolated and is often associated with many others, especially anxiety and mood disorders. We also observed that impulsivity stays at the heart of the ADH/D, either through impulsive behaviours or addictive disorders. Considering the lack of studies with ADH/D adults, it is difficult to compare our data. The diagnosis of ADH/D is complex and stays controversial, moreover the strong prevalence of comorbidities points out the importance of differential diagnosis.

[Emotion regulation among psychostimulants drug users at techno parties]. / Régulation émotionnelle chez des consommateurs de psychostimulants en milieu festif techno.

AIM: Deficits in the communication and identifying of feelings are usually observed in substance abuse. Research in several countries has reported sensation seeking and alexithymia implication in addiction. According to a cognitive-developmental model of emotional experience proposed, alexithymia is a deficit in the cognitive processing of emotion that can be seen as an impairment in the ability to consciously experience feeling in the context of autonomic activation indicate of emotional arousal. The primary objective of this study was to identify certain personality dimensions linked with emotions' regulation, i.e. Zuckerman's sensation seeking, alexithymia, and emotional awareness in ecstasy and cocaine users at techno parties. METHODS: Subjects were divided in two groups: 37 male ecstasy or cocaine abusers, and 37 male non-drug users. We hypothesized that ecstasy and cocaine users would exhibit high levels of sensation seeking (high level of sensation seeking,), and emotional dysregulation (high level of alexithymia and depression, low level of emotional awareness). The methodology comprised a questionnaire developed for the study, designed to record sociodemographic data and evaluate psychoactive substance use, the MlINI (mini international psychiatric interview), the Zuckerman 40-item Sensation Seeking Scale (SSS-IV), the Toronto Alexithymia Scale (TAS-20), the Levels of Emotional Awareness Scale (LEAS), and the Beck Depression Inventory (BDI-13). Subjects were recruited during rave-parties. RESULTS: The results showed significantly higher sensation seeking scores for ecstasy and cocaine users for the score total and the disinhibition and experience seeking subdimensions. Ecstasy and cocaine abusers exhibited higher TAS-20 and BDI-13 scores and lower levels of emotional awareness than non-drug users. No correlation between the TAS-20 and depression symptomatology emerged. No significant correlations were found between LEAS and TAS-20. CONCLUSION: These results provide new elements concerning the profile of drug users at techno parties and illustrate the changing practices of ecstasy use. The LEAS and the TAS-20 were not intercorrelated; it seems plausible that they reflect two sides of the emotional states self-report. These results reinforce the suggestion of combining the use of self-reports with non self-report methods.

[Psychopathology in online pathological gamblers: a preliminary study]. / Psychopathologie des joueurs pathologiques en ligne : une étude préliminaire.

INTRODUCTION: The rapidly expanding gambling offline and online have resulted in an increasing number of gamblers and the problem is likely to get worse in the future. However, online pathological gambling is a not well known. This rapidly developing modality of gambling, which requires to be studied, notably in its links with regular pathological gambling and Internet addiction. Depression and personality disorders are known to be often associated with pathological gambling. Personality disorders have an influence on pathological gambling, increasing its severity. Online gamblers seem to have a particular personality profile, compared to offline gamblers, and could present different personality disorders. Depression is a common comorbidity among online gamblers, as well as offline gamblers. Both types of gamblers have personality disorders, but the nature of these disorders differs: prevalency of personality disorders of cluster B (dramatic, emotional or erratic disorders) is more important in offline gamblers, whereas cluster C (anxious or fearful disorders) is more present in online pathological gamblers. In France, few studies have specifically examined this subject. AIMS: The objective of the study is to evaluate scores on depression, personality disorders and internet addiction in online pathological gamblers. METHOD: The South Oaks Gambling Screen (SOGS) is used to assess pathological gambling, Beck's Depression Inventory (BDI) to measure depression, the Personality Disorders Questionnaire (PDQ 4) to assess personality disorders and the Internet Addiction Test (IAT) to assess internet addiction. Participants completed the self-report scales. Questionnaires were strictly confidential. POPULATION: The participants were recruited in gambling places (cafés) and Internet forums. Two groups of pathological gamblers were formed: online gamblers (N=15) and offline gamblers (N=15). Participants gave their informed consent. Participation was voluntary and anonymous and no payment was made. ANALYSIS OF THE DATA: The data collection was carried out with an anonymous file and then placed in a data bank. The statistical analysis was carried out using traditional techniques: averages, frequency, standard deviations. Differences among groups were tested using the t-test. RESULTS: The results showed that the majority of subjects met diagnostic criteria for at least one personality disorder. The majority of pathological online gamblers evidenced personality of cluster C grouping avoidant, dependant and obsessive-compulsive personalities. Personality disorders differ according to the type of gambling: offline gamblers have more disorders of cluster B, while online gamblers have more disorders of cluster C. Some personality disorders, in particular borderline and narcissistic personality disorders, are often associated with pathological gambling and seem to have an increasing effect on depression and pathological gambling's intensity. Pathological gambling is strongly correlated to depression. Online pathological gambling, Internet addiction and offline pathological gambling appear to be strongly correlated. DISCUSSION/CONCLUSION: This study opens new perspectives of questioning and research, in particular for existing links between online and offline pathological gambling and internet addiction, and in existent differences between online and offline pathological gamblers. Online pathological gambling shares common characteristics with pathological gambling and Internet addiction, without being able to be assimilated with one or the other. This type of gambling, therefore, requires to be studied to adapt the actions of prevention and treatment intended for online pathological gamblers.

[Sensation seeking in a French population of horse betting gamblers: comparison between pathological and regular]. / Recherche de sensations dans une population française de joueurs de courses de chevaux: comparaison entre des joueurs pathologiques et réguliers.

AIM: A theoretical position on the role of arousal in gambling comes in the form of Zuckerman's theory of sensation seeking. Zuckerman originally suggested a relationship between sensation seeking and gambling in which individuals entertain the risk of monetary loss for the positive reinforcement produced by states of high arousal during the periods of uncertainty, as well as the positive arousal produced by winning. However, this hypothesis has received inconsistent support. Results of the literature support the view that there is a difference between gambling form selection and use, suggesting that gambling cannot be viewed as an homogeneous activity. The aim of this study was to examine the personality trait sensation seeking in a French population of gamblers who bet on horses at the racetrack. Our results will discuss the disparities of the literature between pathological gambling and sensation seeking. HYPOTHESES: Pathological gamblers who go to the racetrack are higher sensation seekers than regular gamblers. Gamblers betting on many different forms scored higher on sensation seeking. METHOD: Two groups of gamblers were formed and recruited in five different hippodromes. One group of regular gamblers (n=72), from which pathological gamblers were extracted (n=42). The South Oaks Gambling Screen (SOGS) and the DSM-IV criteria for pathological gambling were used to assess the intensity of the gambling behavior, and sensation seeking was measured by Zuckerman's sensation seeking scale. RESULTS: The results showed that pathological gamblers obtained significantly higher scores of sensation seeking than regular gamblers. These results were significant for the global score of sensation seeking as well as for the factors of disinhibition, and boredom susceptibility. No correlation was found between the sensation-seeking scale total score and the number of regular games played. DISCUSSION: The sensation-seeking personality trait permits the discrimination of pathological from regular gamblers who go to the racetrack. In the literature, data came from gamblers who practice off-course betting. Nevertheless, pathological gamblers who go to the racetrack seemed to differ from those who practice off-course betting in terms of sensation seeking. The former are high sensation seekers whereas the latter are low sensation seekers. Racetrack gamblers are likely to be more involved in staking plans than off-course gamblers. One way of conceiving the distribution of sensation seekers within gambling forms might be to combine the relationships depicted with the dichotomy made between skills and luck games, or with the serious-recreational, casino-non-casino distinctions. There is a need to identify clinically distinct subgroups of gamblers who exhibit common, cardinal symptoms but, at the same time, who differ significantly with respect to key variables that are of etiological relevance and can be used in treatment and prognosis. To establish different subtypes, it is important to take into account the venue and the type of games as well as the sensation-seeking scores and the motivation of the gambler. These subtypes of gamblers are discussed.

[Buprenorphine abuse: high dose intravenous administration of buprenorphine]. / Substitution et mésusage: l'injection intraveineuse de buprénorphine haut dosage.

BACKGROUND: In France, actually, around 70 000 drug addicts are treated with buprenorphine available as sublingual tablets. Clinical studies have demonstrated the clinical efficacity of buprenorphine for opiate addiction. But, it has been reported that some of them injected buprenorphine. Some inquiries have suggested measured with 10% to 40% injectors. To use buprenorphine tablets for injections have had heavy sanitary consequences (4). OBJECTIVES: To know the use buprenorphine context in our population and to analyse the circumstances and outcomes of buprenorphine injection for drug addicts. METHOD: In 1998-1999, we conducted a cross-sectional survey using a structured questionnaire. Information wax collected during a 30-minute face-to-face interview through an 69-item structured questionnaire administered by trained investigators. The questionnaire was composed of questions about social demographic data, the drugs taken before the first use of buprenorphine, the circumstances of the first buprenorphine experiment, the reasons for the first buprenorphine injection into drug addicts, the other substances used in the same time, the risks behaviors, the sensations seeking, the medical consequences. The questionnaire was first tested in a pilot study through ten patients. Drug addicts were followed-up in 8 drug abuse treatment centres among which 2 networks of general practitioners in Paris region, in Strasbourg region and in Nice region. The investigators were general practitioners, psychologists, psychiatrists, educators, nurses. All drugs addict which reported use buprenorphine were seen in treatment centre and were 18 years old or older, were eligible. Drugs addict with severe mental disorders, unable to answer the questions were excluded. Respondents received an assurance of confidentiality and informed consent was obtained. Standard descriptive statistics were used to analyse subjects characteristics: frequency, standard deviation. The study was funded by the Observatoire Français des Drogues et des Toxicomanies (OFDT). RESULTS: Of the 779 consecutive drug addicts interviewed, 770 completed the questionnaire. The study has shown that the majority of subjects were male (77.2%), mean age was 31.3 (SD: 5.98). Most of them were unmarried (67.5%). They had no real employment (56.5%). The mean age at the first use opiate was 19.5 (SD: 4.5). The mean age at the first heroin injection was 20.7 (SD: 4.6). At the time of interview, most of drugs addict used more than two types of drugs (42.6%). Many associations with buprenorphine are described particularly associations to alcohol (41.2%), benzodiazepines (40%), cocaine (12.4%), heroin (7.8%), crack (7.2%); most of these subjects getting buprenorphine without any medical prescription. Most drug addicts had asked themselves for using buprenorphine (61.0%). Near fifty per cent (49.5%) injected buprenorphine. Among them, 39.6% injected this substance the first time they used it. Curiosity (72.8%), need for injection (69.0%), sensation seeking (49.0%) were reasons given by drug addicts for buprenorphine injection. Others reasons were given: an inadequate dosage of sublingual buprenorphine, to find buprenorphine in black market. Buprenorphine injection took place in the secure environment (57.5%). Drug addicts were not alone when they injected (53.6%). The introducer was an buprenorphine user (57%). The first buprenorphine injection sensation was not pleasant (61%), although injection of buprenorphine is usually performed by 80% of them. However, 93% had been informed that buprenorphine injection was contra-indicated. CONCLUSION: Since six years, many French patients have received a treatment for opiate addiction. High dosage buprenorphine is actually the principal treatment for substitution medication in France. Some misappropriations and wrong uses have been seen, the most frequent and sever being using tablets for injections. The prevalence of buprenorphine injection is high among drug addicts. The results of the study show that the first buprenorphine Injection takes places place a few time after the first buprenorphine use. The codependance to other substances is one of risk markers for intravenous use of buprenorphine tablets and the dangers of polyintoxication were known. Curiosity, need for injection favour buprenorphine injection. But, the sensation seeking brings on the drug addict too. The rather loose frame of prescription, a lack of training among general practitioners, the fragility of the specialises network, the complexities in the care of drug users which not resumed by a substitution must take into consideration. The drug addict's career, the subject's environment and the circumstances of the buprenorphine injection have not been previously described. However their knowledge are of prime necessity to prevent this abnormal use and to find the best treatment for drug addicts.

[Risks incurred by the first intravenous drug injection]. / Prises de risques lors de la première injection intraveineuse de drogue.

AIMS: The objectives of the study were to describe the circumstances surrounding the initiation of intravenous drug use, the role of the introducer and to evaluate intravenous drug users risk behaviors at the first injection of drug. DESIGN: In 1997, we conducted a cross-sectional survey using a structured questionnaire concerning the initiation process into intravenous drug abuse. IDUs were interviewed in four treatment drug abuse and psychosocial centers in Paris and in one prison. PARTICIPANTS: Of the 152 consecutive IDUs interviewed, 143 completed the questionnaire, 83 were male. FINDINGS: The mean age at first opiate use and at first injection were 19 years (SD: 4.3) and 20 years (SD: 4.3). At first injection, heroin was the main used drug (91%), the subject was with others persons (91%), asked himself for injection (70%) albeit had not planned this injection (40%). The subject injected at a friend's home (31%). The introducer was an IDU (93%), mean age 23.4 (SD: 5.2). He or she was a friend (61%) or a sexual partner (14%). The preparation of the first injection and the injection were made by the introducer in 72 % and 74 % of cases. The injecting equipment had been borrowed (22%) from an IDU whose HIV status and HCV status were unknown in 83 % and 85 % of cases. CONCLUSION: Our study shows novel results about the first injection, they are of prime importance for harm reduction. The introducer plays a major role in preventing risk-behavior at the first injection and for education about safe injecting practices.

Prises de risques lors de la premiere injection intraveineuse de drogue.

Aims. - The objectives of the study were to describe the circumstances surrounding the intiation of intravenous drug use, the role of the introducer and to evaluate intravenous drug users risk behaviors at the first injection of drug. Design.- In 1997, we conducted a cross-sectional survey using a structured questionnaire concerning the initiation process into intravenous drug abuse. IDUs were interviewed in four treatment drug abuse and psychosocial centers in Paris and in one prison. Participants.- Of the 152 consecutive IDUs interviewed, 143 completed the questionnaire, 83 were male. Findings. - The mean age at first opiate use and at first injection were 19 years (SD: 4.3) and 20 years (SD: 4.3). At first injection, heroin was the main used drug (91%), the subject was with others persons (91%), asked himself for injection (70%) albeit had not planned this injection (40%). The subject injected at a friend's home (31%). The introducer was an IDU (93%), mean age 23.4 (SD: 5.2). He or she was a friend (61%) or a sexual partner (14%). The preparation of the first injection and the injection were made by the introducer in 72% and 74% of cases. The injecting equipment had been borrowed (22%) from an IDU whose HIV status and HCV status were unknown in 83% and 85% of cases. Conclusion. - Our study shows novel results about the first injection, they are of prime importance for harm reduction. The introducer plays a major role in preventing risk-behavior at the first injection and for education about safe injecting practices.