Screening and care for alcohol use disorder in France: expectations, barriers and levers using a mixed-methods approach.

BACKGROUND: The widespread under-screening and under-treatment of alcohol use disorder (AUD) contributes to its health and socioeconomic burden. We conducted a mixed-methods (qualitative and qualitative) study in people with alcohol use disorder (PWAUD) to explore their expectations, as well as barriers and levers to AUD care. METHODS: Individuals with AUDIT > 15 (N = 179) were interviewed using computer-assisted interviews in several medical and non-medical sites (e.g., bars) (quantitative substudy). We also conducted semi-structured face-to-face interviews with 36 PWAUD (qualitative substudy). Using logistic regression, we explored factors associated with having previously received/sought care for AUD. Three major themes were identified in the qualitative textual analysis using a descending hierarchical classification. RESULTS: Not socializing with heavy drinkers (AOR [95%CI]:3.84[1.66-8.85]), regular smoking (9.72[3.91-24.15]) and feeling discriminated against (2.35[1.10-5.05]) were independent levers to having sought/received care for AUD, while being aged < 50 and employment were independent barriers. The five predominant themes in PWAUD discourses emerging from the textual analysis were: drinking context, medical care, alcohol treatment, tobacco/addiction and family. When triangulating results from the logistic regression and the textual analysis, two barriers (social drinking and difficulties with the medical care system), and two levers (family influence and tobacco addiction), emerged. CONCLUSION: These results underline the need for interventions targeting families and the social network to increase awareness about AUD and related care. Simplified and novel comprehensive care trajectories are urgently needed to reduce the clinical and public health burden of AUD.

[Creative variations of a "Photographs" workshop in helping people to quit smoking]. / Déclinaisons créatives d'un atelier "Photographies" dans l'aide au sevrage tabagique.

In the field of addictology, care integrates activities that reactivate forgotten senses, emotions and postures. A "Photographs" workshop, led by a nurse in the addictology department, was modulated into a "Brief group photo-motivational intervention" to help people quit smoking. From this experience emerged an educational sequence of "Photo-Expression" integrated into the patient's therapeutic education programme "Help to stop smoking".

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.

The management of opiate use disorders in France: results of an observational survey of general practitioners.

BACKGROUND: When opioid-agonist treatments were approved in France in 1995, opiate use disorders began to be managed and treated by general practitioners (GPs), who have since then been encouraged to treat substance use disorders (SUDs) for heroin and other illegal substances. The objective of this study was to describe rates of: 1) SUDs in general practices in France; 2) characteristics of GPs treating SUDs; and 3) clinical practices surrounding SUDs. To place these data in the context of SUD treatment, we also gathered information from practicing SUD specialists. METHODS: Between December 2011 and January 2012, a nationally representative sample of GPs and SUD specialists were interviewed by phone, using a 12-item questionnaire that covered number of SUD patients, types of SUDs, and treatments. Data collected were confidential, and analysis was blinded with regard to physician identity. RESULTS: Forty-four percent of GPs and 68 % of specialists were included in the analysis. The mean number of patients estimated to have been seen at least once in the previous year was 3036 for GPs and 920 for specialists. Ninety-six percent of GPs reported having patients with SUDs. Tobacco, alcohol, and psychoactive drugs were the SUDs most frequently encountered by GPs, whereas tobacco, alcohol, heroin, and cannabis were most frequently encountered by specialists. Forty-three percent of GPs saw at least one patient with a heroin use disorder (HUD), and 82 % of GPs treating patients with HUDs had prescribed an opioid-agonist treatment during the previous 12 months. CONCLUSIONS: The results of this study suggest that a large number of GPs now treat patients with opiate use disorders and that doctors appear to be convinced of the benefits of opioid-agonist therapy and have overcome their initial concerns. This represents a significant change in practice patterns since the introduction of opioid-agonist treatments in France.