[Pregnancy and parenthood in the context of addiction]. / Grossesse et accession à la parentalité en contexte d'addiction.

Addictive behaviour in the perinatal period gives rise to significant health risks for the infant and the mother. When the experience of new parenthood coincides with the problem of addiction the parents' psychological problems can be intensified. These specific issues, sometimes difficult for the teams to have to deal with, require the creation of a complex and coordinated care programme.

[Does the use of psychoactive drugs in adolescence create specific problems?]. / Usages de psychotropes à l'adolescence, des problématiques spécifiques?

The use of psychoactive drugs by teenagers presents commonalities and specificities depending on the substances used. The connection noted between the early age of use and the onset of harm, supports the recommendation of early interventions targeting all drugs. However, drug use differs according to the type of substance, highlighting the need to take into accountthese specificities in addiction therapy.

[Current therapeutic strategies for tobacco dependence]. / Stratégies thérapeutiques contre la dépendance tabagique.

Smoking remains the first preventable cause of premature death worldwide. Despite the knowledge of adverse consequences of smoking, many smokers have difficulties to quit for good. This is due to the addictive nature of tobacco, at least as strong as the one of illicit drugs. The mechanisms of nicotine dependence are very similar to those of other addictive behaviors, and are based on disequilibrium of the meso-cortico-limbic reward system. The withdrawal syndrome responds well to nicotine replacement therapy, bupropion, and varenicline. Recent guidelines stress the responsibility of all health care professional to address the smoking problem of every patient through the 5 A model: Ask - Advise - Assess - Assist - Arrange.

[From nicotine dependence to addictology]. / De la tabacologie à l'addictologie.

The concept of addiction has developed in France since the beginning of the 2000s. It has justified by common clinical aspects, high level of co-morbidities between addictions to psychoactive drugs, common cognitive and behavioral mechanisms, the impact of comparable psychological and genetic factors, the same neurobiological mechanisms and the same therapy options in many cases. Although some specificities remain in smoking management: absence of intoxication and abuse diagnosis in DSM-IV, less consensual politics of harm reduction, and own pharmacotherapy solutions. Despite what is commonly thought, tobacco is the most addictive amongst all psycho-active-substances in Western countries.

Characteristics of tobacco withdrawal in pregnant women.

OBJECTIVE: To describe the management of tobacco withdrawal in pregnant women. STUDY DESIGN: The questionnaire-based, descriptive survey included 979 post-partum women. The variables analysed included the characteristics of the mother and neonate at delivery, her smoking habits, her level of exposure to passive smoking, and the barriers to giving up smoking. The chi square test was used to analyse qualitative variables and the Students t-test for quantitative variables. RESULTS: 76% of women who smoked at the start of pregnancy said that they had been asked about their tobacco consumption. However, only 16% had been asked by a clinician or midwife about their attempts to stop smoking. Seven percent were offered a specialised consultation, but only one-third attended. Seventy-six percent of women who failed to stop smoking during pregnancy had a partner who smoked compared with 63% of women who gave up. Dependency and stress during pregnancy also were lower for women who stopped smoking. CONCLUSIONS: Healthcare professionals seems to offer only rudimentary care. Simple strategies to help women give up smoking are required. The partner is an important target, especially if he can be persuaded to give up at the same time.

Description of tobacco addiction in pregnant women.

OBJECTIVE: To compare the characteristics of a group of pregnant women who smoked until delivery with women who gave up smoking during pregnancy. STUDY DESIGN: Questionnaire-based, descriptive study of 979 pregnant women in four regions of France. The variables analysed included the characteristics of the mother and neonate at delivery, the smoking habits of the mother before and during pregnancy, the perception of risk linked to smoking, and the reasons for giving up smoking. RESULTS: Eighteen percent of women smoked until delivery. Fifty-five percent of women gave up smoking during pregnancy, usually in the first trimester. Women who failed to give up smoking were more disadvantaged psychosocially and were more likely to live alone. There was a higher level of dependency among women who failed to give up smoking and a lower perception of risk to the foetus. Among the women who had tried to reduce their tobacco consumption without success, 6% stated that they had been motivated by medical information compared to 28% of women who succeeded in stopping smoking. CONCLUSIONS: Despite the risks associated with smoking the number of pregnant women who smoke until delivery remains high. Knowledge of the psychosocial profile and degree of dependency of these patients is an important step to managing this problem.

[Current therapeutic strategies in smoking cessation]. / Les stratégies thérapeutiques actuelles du sevrage tabagique.

Smoking is a behaviour maintained and enhanced by a dependence mainly induced by nicotine. Despite awareness and knowledge of the associated health risks many smokers find it considerably difficult to quit. The untoward effects of nicotine withdrawal such as apparition of depressive mood, or weight gain, etc. justify the numerous unsuccessful attempts to quit smoking. Treatments with demonstrated efficacy are available and international evidence-based recommendations for cessation interventions have been established. These are: brief advice, assessing the smoking status of each patient and encouraging cessation; nicotine replacement therapies (NRT) [transdermal patch, gum, sublingual tablet or inhalator to be used at sufficiently individualised doses combining, if necessary, two or more NRT products]; bupropion, a more recent treatment: psychotropic drug, a noradrenaline and dopamine re-uptake inhibitor more recently approved for marketing; behavioural and cognitive therapies on their own or combined with pharmacotherapy. Measuring nicotine dependence using the Fagerström Test for Nicotine Dependence may help to define the therapeutic strategy. It is obvious that therapies can only work for smokers who are motivated to stop smoking. Before reaching the decision to quit, the smoker goes through a process in the course of which the role of health professionals' advice is paramount.