Reframing caring for parents who struggle with substance-use disorders.

Nancy Suchman and the colleagues she influenced have produced ground-breaking and attitude-challenging work in understanding how parenting and substance use come together. Dr Suchman and her colleagues make the claim that there is nothing about a substance-use disorder that precludes effective and sensitive caring for children especially with interventions that focus on the parent-child relationship. Suchman's legacy is to highlight how substance use as an illness pulls individuals away from important, caring relationships and limits their giving themselves to those relationships. Restoring the salience of caring relationships and of the individual's ability to care may be as impactful on their substance use as a strict focus on the reduction of drug use and achieving abstinence.

Nancy Suchman y los colegas sobre quienes ella ha ejercido influencia han producido un trabajo innovador y de reto a las actitudes sobre la comprensión de cómo la crianza y el uso de sustancias conviven juntas. La doctora Suchman y sus colegas insisten en el hecho de que no hay nada acerca del trastorno de uso de sustancias que no permita el cuidado eficaz y sensible para niños, especialmente con intervenciones que se enfocan en la relación progenitor-niño. El legado de Suchman es enfatizar cómo el uso de sustancias como enfermedad aleja a los individuos de relaciones importantes y afectuosas y les limita en el proceso de entregarse a tales relaciones. Restaurar la importancia de relaciones afectuosas y de la habilidad del individuo para mantener una relación afectuosa pudiera ser tan impactante en su uso de sustancias como un enfoque estricto para reducir el uso de drogas y lograr el estado de abstinencia.

Nancy Suchman, et les collègues qu'elle a influencés, a fait un travail novateur et généreusement combatif pour la compréhension de la manière dont le parentage et la toxicomanie se rassemblent. Le docteur Suchman et ses collègues soutiennent qu'il n'y a rien dans un trouble lié à l'usage d'une substance qui empêche le soin efficace et sensible aux enfants, surtout avec des interventions qui se focalisent sur la relation parent-enfant. L'héritage légué par Suchman consiste à mettre en lumière la façon dont la toxicomanie en tant que maladie détache les individus de relations importantes et attentionnées et limite le don qu'ils font d'eux-mêmes à ces relations. Le fait de restaurer la prépondérance de relations attentionnées et la capacité de l'individu à prendre soin peut avoir autant d'impact sur leur toxicomanie qu'une attention stricte à la réduction d'utilisation des drogues et l'atteinte de l'abstinence.

Training home visitors in mentalization-based practice: A qualitative case study of clinical supervision in mothering from the inside out.

Attachment-based interventions are important for improving parent-child outcomes. These interventions must be scaled and made available to under-resourced communities. An important part of scaling these interventions is delineating and reproducing high-quality training, including clinical training which often requires the completion of a supervised case. However, descriptions and guidelines for clinical training are frequently broad or not available in the literature. A detailed description of clinical training could lead to further research to improve the effectiveness and dissemination of evidence-based interventions. Mothering from the Inside Out (MIO) is an attachment-based parenting intervention effective at reducing substance use and depression, improving caregiving, and enhancing child attachment. It is now being brought from research to community settings. This paper outlines the didactic and clinical training components of MIO. We then present a qualitative case study of one community-based counselor participating in the clinical training of MIO and employ qualitative methods to describe the main themes that arose during the training. We aim to illustrate how the trainer assisted the counselor in implementing the core components of MIO, which included (a) refining the language used in MIO sessions, (b) making space to explore mental states, and (c) addressing trauma. We conclude by presenting the implications of these findings.

Las intervenciones con base en la afectividad son importantes para mejorar los resultados de relación progenitor-niño. Estas intervenciones deben ser adaptadas y estar disponibles para comunidades sin recursos suficientes. Una parte importante de la adaptación de estas intervenciones es delinear y reproducir el entrenamiento de alta calidad, incluyendo entrenamiento clínico que a menudo requiere completar un caso supervisado. Sin embargo, las descripciones y los parámetros de guía para entrenamiento clínico son frecuentemente generales o no están disponibles en el material escrito. Una detallada descripción del entrenamiento clínico pudiera llevar a una posterior investigación para mejorar la eficacia y diseminación de intervenciones con base en la afectividad. Cuidados Maternales de Adentro Hacia Afuera (MIO) es una intervención de crianza con base en la afectividad que es eficaz para reducir el uso de sustancias y la depresión, mejorar la prestación de cuidado y fortalecer la afectividad del niño. Ahora se le lleva de la investigación a los escenarios comunitarios. Este artículo subraya los componentes de didáctica y entrenamiento clínico de MIO. Presentamos entonces un caso de estudio cualitativo de un consejero con base en la comunidad que participó en el entrenamiento clínico de MIO y empleamos métodos cualitativos para describir los temas principales que surgieron durante el entrenamiento. Nos propusimos ilustrar cómo el entrenador ayudó al consejero a implementar los componentes centrales de MIO, los cuales incluyen (a) refinar el lenguaje usado en la terapia, (b) abrir un espacio para explorar estados mentales, y (c) ocuparse del trauma. Concluimos con la presentación de las implicaciones que conllevan estos resultados.

Les interventions basées sur l'attachement sont importantes quand il s'agit d'améliorer les résultats parent-enfant. Ces interventions doivent être mises à l'échelle et doivent être disponibles pour toutes les communautés ayant peu de moyens. Un côté important de la mise à l'échelle de ces interventions consiste à délinéer et à reproduire une formation de haute qualité, y compris une formation clinique qui souvent exige la réalisation d'un cas supervisé. Cependant les descriptions et les lignes directrices de la formation clinique sont fréquemment larges ou ne sont pas disponibles dans des publications. Une description détaillée de formation Clinique pourrait conduire à des recherches approfondies sur la manière d'améliorer l'efficacité et la dissémination d'interventions fondées sur des données probantes. Le maternage de l'intérieur (abrégé ici MIO pour reprendre l'anglais Mothering from the Inside Out) est une intervention de parentage basée sur l'attachement qui est efficace pour ce qui concerne la réduction de toxicomanie et de dépression, l'amélioration des soins ainsi que de l'attachement de l'enfant. On le fait en ce moment passer des recherches aux contextes communautaires. Cet article décrit les composantes de formation didactique et clinique du MIO. Nous présentons ensuite une étude de cas qualitative d'un thérapeute communautaire participant à une formation clinique du MOI et employons des méthodes qualitatives pour décrire les thèmes principaux qui sont apparus durant la formation. Nous nous donnons pour but d'illustrer la manière dont le formateur a aidé le thérapeute à mettre en place les composantes essentielles du MIO, y compris (a) l'affinage du langage utilisé en thérapie, (b) la nécessité de faire de la place afin d'explorer les états mentaux, et (c) la nécessité d'aborder le trauma. Nous concluons en présentant les implications de ces résultats.

[Drug abuse of pregabalin - state of the situation, risks and means of control]. / Détournement de la prégabaline à des fins toxicomaniaques - état de la situation, risques et moyens de lutte.

Pregabalin is an anticonvulsant widely used for the treatment of epilepsy and neuropathic pain. However, there is a growing concern about its misuse, particularly among drug users and patients with substance use disorders (SUD). It is often used in combination with other psychoactive molecules and at levels well above the recommended doses. Increasing cases of overdose and death associated with the misuse of pregabalin have been reported worldwide. Therefore, raising prescribers' awareness of this scourge is mandatory and the role of the pharmacist is crucial in reducing this phenomenon.

Exploring resting frontal EEG and reflective functioning in maternal substance use.

Maternal substance use is associated with altered neural activity and poor offspring outcomes, which may be facilitated by suboptimal caregiving in the form of impaired parental reflective functioning (PRF). To investigate these associations, the resting-state frontal electroencephalography (EEG) power of 48 substance-using mothers and 37 non-substance-using mothers were examined, specifying seven frequency bands: delta, theta, alpha, alpha1, alpha2, beta, and gamma. Substance-using mothers exhibited enhanced beta and gamma spectral power compared to non-substance-using mothers, potentially reflecting higher arousal states in substance-using mothers. There were no between-group differences in any component of PRF (i.e., levels of pre-mentalizing, certainty, and interest and curiosity). Whole-sample analyses revealed significant positive correlations between pre-mentalizing and delta spectral power. Taken together, these findings suggest potential neural correlates of maternal substance use and PRF, providing an important next step into examining associations between maternal substance use and poor child outcomes.

Se asocia el uso materno de sustancias con la actividad neural alterada y el débil resultado en los hijos, lo cual pudiera ser favorecido por una prestación de cuidado subóptima en forma de un impedido funcionamiento con reflexión (PRF) en el progenitor. Para investigar estas asociaciones, se examinó la fuerza de la electroencefalografía frontal en estado de descanso de 48 madres que usaban sustancia y 37 madres que no usaban sustancias, especificando siete bandas de frecuencia: delta, theta, alpha, alpha 1, alpha 2, beta y gamma. Las madres que usaban sustancias mostraron una fuerza espectral aumentada en beta y gamma, tal como se les comparó con las madres que no usaban sustancias, lo que potencialmente refleja estados más altos de agitación en las madres que usaban sustancias. No se dieron diferencias entre grupos en ninguno de los componentes de PRF (v.g. niveles de pre-mentalización, opacidad e interés y curiosidad). Los análisis de todas las muestras revelaron correlaciones positivas significativas entre pre-mentalización y la fuerza espectral delta. Tomándolos en conjunto, estos resultados indican posibles correlaciones neurales entre del uso materno de sustancias y PRF, lo cual aporta un importante próximo paso para examinar las asociaciones entre el uso materno de sustancias y los débiles resultados en el niño.

La toxicomanie maternelle est liée à une activité neuronale altérée et de mauvais résultats sur les enfants de la personne, ce qui peut être facilité par un mode de soin suboptimal sous la forme d'un fonctionnement de réflexion parentale (PRF en anglais) altéré. Pour enquêter sur ces liens, l'électroencéphalographie frontale au repos (EEG) de 48 mères toxicomanes et de 37 mères non-toxicomanes a été examiné, plus spécifiquement sur quatre bandes de fréquences : delta, thêta, alpha, alpha1, alpha2, béta, et gamma. Les mères toxicomanes ont fait preuve d'une puissance spectrale de béta et gamma importante comparées aux mères non-toxicomanes, ce qui reflète peut-être de plus d' états d'excitation chez les mères toxicomanes. Nous n'avons observé aucune différence entre les groupes pour ce qui concerne les composantes de la PRF (soit, niveaux de pré-mentalisation, d'opacité, d'intérêt et de curiosité). Des analyses sur tout l'échantillon ont révélé des corrélations positives importantes entre la puissance spectrale de pré-mentalisation et la puissance spectrale delta. Considérés dans l'ensemble, ces résultats suggèrent un corrélat neural potentiel de la toxicomanie maternelle et de la PRF, ce qui présente une nouvelle étape importante dans l'examen des liens entre la toxicomanie maternelle et les mauvais résultats sur l'enfant.

Development and validation of a goal attainment scale for families affected by maternal substance use.

The Team for Infants Exposed to Substance use (TIES) Program is a longstanding home-based family support program that provides a multidisciplinary, community-facing model to address the complex needs of families with young children affected by maternal substance use. The model required a comprehensive assessment tool to guide creation of individualized family goals with steps to achievement and measurement of progress on those goals. This article describes the development of a goal attainment scale and the analysis conducted to validate the scale for the service population. TIES model developers and community partners developed the goal attainment scale to assess outcomes in key domains: maternal substance use, parenting, child and maternal health, income, and housing. Data were collected from 2012 to 2019 from 220 participants and analyzed in 2020. Exploratory factor analysis (EFA) and confirmatory factor analysis were conducted. Twenty-five of the original 30 items were retained in a six-factor structure. The total percentage of variance explained was 64.44% with six factors, and Cronbach's alpha was .90. For the split-half method, the reliability of scale was .90 for unbiased conditions. Therefore, the scale reached acceptable reliability and validity. The scale provides a comprehensive approach to measure family outcomes across multiple domains addressing key risk and protective factors. This family-centered scale serves both therapeutic and evaluation purposes, acting as an intervention guide and a goal attainment measurement tool.

El Programa del Equipo para los Infantes Expuestos al Uso de Sustancias (TIES) es un programa de apoyo familiar con base en el hogar que ha existido mucho tiempo y que ofrece un multidisciplinario método de cara a la comunidad que se ocupa de las complejas necesidades de familias con niños pequeños afectados por el uso materno de sustancias. Quienes desarrollaron el modelo TIES crearon una herramienta comprensiva de evaluación para guiar la creación de metas familiares individualizadas, pasos para alcanzar y el progreso en cuanto a esas metas. Esta escala de alcance de logros evalúa los resultados en dominios claves: uso materno de sustancias, crianza, salud del niño y de la madre, entradas económicas y vivienda. Este artículo describe el desarrollo y la validez de la escala de alcance de metas. Los datos recogidos del 2012 al 2019 y de 220 participantes se analizaron en 2020. Se llevaron a cabo análisis exploratorios y confirmatorios de factores. Veinticinco de los 30 puntos originales se mantuvieron en una estructura de seis factores. El porcentaje total de variación explicado fue de 64.44% con seis factores y el factor Alpha de Cronbach fue de .90. En cuanto al método dividido en mitades, la confiabilidad de la escala fue de .90 en el caso de condiciones no prejuiciadas. Por tanto, la escala alcanzo una confiabilidad y validez aceptable. La escala ofrece un acercamiento comprensivo para medir los resultados familiares a lo largo de múltiples dominios, ocupándose de factores claves de riesgo y protección. Esta escala centrada en la familia sirve propósitos terapéuticos evaluación y actúa como una guía de intervención y medida de alcance de metas.

Le Programme de l'Equipe pour les Nourrissons Exposés à la Toxicomanie (abrégé TIES, suivant l'anglais The Team for Infants Exposed to Substance use) est un programme de soutien à la famille à domicile mis en place de longue date qui offre un modèle pluridisciplinaire et tourné vers la communauté afin de répondre aux besoins complexes des familles avec de jeunes enfants affectées par la toxicomanie maternelle. Les personnes ayant conçu et développé le modèle TIES ont créé un outil d'évaluation complet afin de guider le développement d'objectifs familiaux individualisés, d'étapes de réussite et de progrès quant à ces objectifs. L'échelle d'étape de réussite évalue les résultats dans des domaines clés: la toxicomanie maternelle, le parentage, la santé de l'enfant et la santé maternelle, les revenus, et le domicile. Cet article décrit le développement et la validation de l'échelle de réussite. Les données ont été recueillies de 2012 à 2019 de 220 participantes et elles ont été analysées en 2020. Des analyses factorielles exploratoires et des analyses factorielles confirmatoires ont été faites. Vingt-cinq des 30 éléments d'origine ont été retenus dans une structure à six facteurs. Le pourcentage total de variance expliquée était de 64,44% avec six facteurs, et l'alpha de Cronbach était de 0,90. Pour la méthode à demi-fraction la fiabilité de l'échelle était de,90 pour des conditions impartiales. L'échelle a donc atteint la fiabilité et la validité. L'échelle offre une approche complète afin de mesurer les résultats de la famille au travers de multiples domaines traitant le risque clé et les facteurs de protection. Cette échelle centrée sur la famille sert un but à la fois thérapeutique et d'évaluation, agissant comme un guide d'intervention et une mesure d'atteinte du but.

[Opioids substitution therapy: A respect for the dignity of the human person]. / Les traitements de substitution aux opiaces : un parcours de respect de la dignité de la personne humaine.

The Opioid substitution treatment (OST) has been highly argumentative in ways that raise important ethical issues. The stigma in treating opioid addiction continues to be a major barrier to effective management plan. It prevents individuals from seeking treatment and is associated with poor mental and physical health. OST are considered to improve outcomes in opioid dependency. They are legitimate therapeutic options because they comply with the four principles of bioethics: autonomy, no maleficence, beneficence and justice. OST plan should conceived in a way that outcomes only giving a medication to the patient. It has many ethical aspects that should be valued: fairness, respect and solidarity. However, OST may be misused or diverted, resulting in negative treatment outcomes, here comes the important role of the multidisciplinary treatment plan to contain and prevent from misuse. We will be discussing in this paper the ethical aspect of the OST and the values that should be promoted, in order to cherish and enhance the dignity of the human being, by replacing a deadly disease with a chronic one giving the patient a chance to lead a normal life.

Associations between parenting representations and behavior among young mothers and mothers with opioid use disorder.

Mothers' representations reflect how they experience their child and their relationship, and can guide parenting behavior. While studies of representations typically focus on infancy, this study examines associations between mothers' representations and behavior with their preschoolers using two samples: young mothers (n = 201; 42% African American, 42% Latina, 8% European-American, 8% multi-ethnic; Mage  = 32 months) and mothers in treatment for opioid use disorder (OUD; n = 150; 100% African American; Mage  = 49 months). This study aims to identify the distribution of representations within these populations, differences in parenting between mothers classified with balanced and non-balanced representations, and distinct parenting behaviors associated with distorted and disengaged representations. The Working Model of the Child Interview was conducted to assess representations, and mother-child interactions were video-recorded. The distribution of balanced, distorted, and disengaged representations was 59%, 25%, and 15% among young mothers, and 21%, 39%, and 40% among mothers with OUD. Balanced representations (coherent, rich, engaged, respectful) were associated with positive parenting, including sensitivity, autonomy support, cognitive support and less negative regard among young mothers, and sensitivity and encouragement in the OUD sample. Mothers with disengaged representations (emotionally distant, lacking detail, indifferent) demonstrated less support for learning compared to mothers with distorted representations (involved but inconsistent, negative, or bizarre descriptions of child).

Las representaciones de las madres reflejan cómo ellas perciben a sus niños y sus relaciones y pueden guiar la conducta de la crianza. Mientras que los estudios sobre representaciones típicamente se enfocan en la infancia, este estudio examina las asociaciones entre las representaciones de las madres y el comportamiento con sus niños prescolares usando dos grupos muestra: madres jóvenes (n=201; 42% afroamericanas, 42% latinas, 8% europeo-americanas, 8% multiétnicas; edad promedio=32 meses) y madres bajo tratamiento por trastornos por uso de opioides (OUD; n=150; 100% afroamericanas; edad promedio=49 meses). El estudio se propuso identificar la distribución de las representaciones dentro de estos grupos de población, diferencias en la crianza entre madres clasificadas con representaciones equilibradas y no equilibradas, y conductas de crianza distintivas asociadas con representaciones distorsionadas y desconectadas. La Entrevista del Modelo de Trabajo del Niño se usó para evaluar las representaciones y se grabaron en video las interacciones madre-niño. La distribución de representaciones equilibradas, distorsionadas y desconectadas fue 59%, 25% y 15% entre madres jóvenes, y 21%, 39% y 40% entre madres con OUD. Las representaciones equilibradas (coherentes, generosas, participativas, respetuosas) se asociaron con una crianza positiva, incluyendo sensibilidad, apoyo de autonomía, apoyo cognitivo y menos consideración negativa entre madres jóvenes, y sensibilidad y estímulo en el grupo OUD. Las madres con representaciones desconectadas (emocionalmente distantes, con falta de detalles, indiferentes) demostraron menos apoyo en el aprendizaje comparadas con madres con representaciones distorsionadas (participativas pero inconsistentes, negativas o extrañas descripciones del niño).

Les représentations des mères reflètent la manière dont elles font l'expérience de leur enfant et de leur relation, et peuvent dguider le comportement de parentage. Alors que les études sur les représentations se focalisent typiquement sur la petite enfance cette étude examine les liens entre les représentations des mères et le comportement de leurs enfants d'âge pré-scolaire en utilisant deux échantillons : des jeunes mères (n=201;42% afro-américaines, 42% de culture latine américaine, 8% européennes-américaines, 8% multi-ethnic; Mâge=32mois) et des mères en traitement pour un trouble de consommation d'opioïde (TCO; n=150; 100% afro-américaines; Mâge=49mois). Cette étude s'est donnée pour but d'identifier la distribution des représentations au sein de ces populations, les différences dans le parentage entre les mères classifiées comme ayant des représentations équilibrées ou non-équilibrées, et les comportements distincts de parentage liés à des représentations déformées et désengagées. Le Modèle Fonctionnel de l'Entretien de l'Enfant a été choisi afin d'évaluer les représentations et les interactions mère-enfant ont été filmées à la vidéo. La distribution de représentations équilibrées, déformées et désengagées était de 59%, 25%, et 15% chez les jeunes mères et de 21%, 39%, et 40% chez les mères avec un TCO. Les représentations équilibrées (cohérentes, riches, engagées, respectueuses) étaient liées au parentage positif, y compris à la sensibilité, au soutien de l'autonomie, au soutien cognitif et à moins d'égard négatif chez les jeunes mères, et à la sensibilité et à l'encouragement dans l'échantillon TCO. Les mères avec des représentations désengagées (émotionnellement distantes, manquant de détail, indifférentes) ont fait preuve de moins de soutien à l'apprentissage comparées aux mères avec des représentations déformées (impliquées mais descriptions incohérentes, négatives ou bizarres de l'enfant).

The age of opportunity: prevalence of key risk factors among adolescents 10-19 years of age in nine communities in sub-Saharan Africa.

OBJECTIVE: To measure health-related behaviours and risk factors among sub-Saharan African adolescents. METHODS: Cross-sectional study in nine communities in Burkina Faso, Ethiopia, Eswatini, Ghana, Nigeria, Tanzania and Uganda between 2015 and 2017. Community-representative samples of males and females 10-19 years of age were selected. All communities used a uniform questionnaire that was adapted from the WHO Global School-based Student Health Survey. Weighted prevalence estimates and 95% confidence intervals were calculated for each indicator and stratified by age and sex using SAS version 9.4. All prevalence estimates were pooled across communities through random-effects meta-analyses in Stata version 14. RESULTS: A total of 8075 adolescents participated in the study. We observed a high prevalence of inadequate fruit consumption (57-63%) and low physical activity (82-90%); a moderate prevalence of inadequate vegetable consumption (21-31%), unprotected last sex (38-45%), age at first sex <15 years (21-28%) and bullying and physical fighting (12-35%); and a low prevalence of mental health risk factors (1-11%) and alcohol and substance use risk factors (0-6%). We observed a moderate to high prevalence of daily soft drink consumption (21-31%) for all adolescents. Among sexually active adolescents 15-19 years, 37% of females reported ever being pregnant and 8% of males reported to have ever made someone pregnant. Bullying (23%) and physical fighting (35%) were more common among younger male adolescents . The prevalence of low mood was generally higher among older (15-19 years) than younger adolescents (10-14 years). The proportion of adolescents reporting alcohol, drug or cigarette use was very small, with the exception of khat use in Ethiopia. CONCLUSION: Overall, diet and physical activity, violence, sexual and reproductive health, and depression are important risk factors for these sub-Saharan African communities. These findings suggest that more evidence is needed including novel efforts for the collection of sensitive information, as well as a need to move towards community-tailored interventions to reach adolescent populations with varying needs.

OBJECTIF: Mesurer les comportements liés à la santé et les facteurs de risque chez les adolescents africains subsahariens. MÉTHODES: Etude transversale dans neuf communautés au Burkina Faso, en Ethiopie, à Eswatini, au Ghana, au Nigéria, en Tanzanie et en Ouganda entre 2015 et 2017. Des échantillons représentatifs de la communauté composés d'hommes et de femmes âgés de 10 à 19 ans ont été sélectionnés. Toutes les communautés ont utilisé un questionnaire uniforme adapté de l'Enquête Mondiale sur la Santé des Elèves de l'OMS. Les estimations de prévalence pondérée et les intervalles de confiance à 95% ont été calculés pour chaque indicateur et stratifiées par âge et sexe à l'aide de la version 9.4 de SAS. Toutes les estimations de prévalence ont été poolées dans les communautés via des méta-analyses à effets aléatoires dans Stata, version 14. RÉSULTATS: 8.075 adolescents ont participé à l'étude. Nous avons observé une prévalence élevée de consommation insuffisante de fruits (57-63%) et de faible activité physique (82-90%); une prévalence modérée de consommation insuffisante de légumes (21-31%), du dernier rapport sexuel non protégé (38-45%), du premier rapport sexuel à moins de 15 ans (21-28%) et de l'intimidation et des combats physiques (12-35%), une faible prévalence de facteurs de risque pour la santé mentale (1-11%) et de facteurs de risque pour la consommation d'alcool et de substances (0-6%). Nous avons observé une prévalence modérée à élevée de consommation quotidienne de boissons gazeuses (21-31%) chez tous les adolescents. Parmi les adolescents sexuellement actifs âgées de 15 à 19 ans, 37,0% des femmes ont déclaré avoir déjà été enceintes et 8,0% des hommes ont rapporté avoir déjà enceinté une femme. L'intimidation (23%) et les combats physiques étaient plus fréquents chez les adolescents plus jeunes (35%). La prévalence de la mauvaise humeur était généralement plus élevée chez les adolescents d'âge plus élevé (de 15 à 19 ans) que chez les plus jeunes (de 10 à 14 ans). La proportion d'adolescents déclarant avoir consommé de l'alcool, des drogues ou des cigarettes était très faible, à l'exception de la consommation de khat en Ethiopie. CONCLUSION: Dans l'ensemble, le régime alimentaire et l'activité physique, la violence, la santé sexuelle et reproductive et la dépression sont des facteurs de risque importants pour ces communautés d'Afrique subsaharienne. Ces résultats suggèrent que davantage de données sont nécessaires, notamment de nouveaux efforts pour la collecte d'informations sensibles, ainsi que la nécessité de passer à des interventions adaptées aux communautés pour atteindre les populations adolescentes avec des besoins variés.

[Affective temperaments in drug addicts: A case-control study]. / Tempéraments affectifs des toxicomanes : étude cas-témoins.

INTRODUCTION: The study of affective temperaments is a dimensional approach to personality that would provide a better understanding of the emergence of psychopathological disorders including addictive behaviors. However, in the literature, there is a lack of studies focusing on the links between this type of disorder and affective temperaments. Our objectives were to study the distribution of the five known affective temperaments in a group of drug addicts compared to a control group, and to identify sociodemographic and clinical factors associated with emotional traits. METHODS: This was a case-control study carried out in the drug abuse prevention center "ATUPRET" of Sfax in Tunisia. It included 50 drug addicts, all male, and 50 healthy control subjects matched for age (P=0.22), marital status (P=0.28), socioeconomic level (P=0.36) and educational level (P=0.95). Sociodemographic data were collected through an interview for drug addicts hospitalized in this center while clinical data were collected from medical records. The TEMPS-A questionnaire, 110 questions validated Tunisian version, has been used to evaluate five affective temperaments. RESULTS: The average age of drug addicts was 32.98 years (19-59 years) and the average age at onset of drug use was 20.36 years (12-52 years). Among drug users, the highest mean scores were observed for hyperthymic temperament (13.68±4.20), followed by cyclothymic (13.14±4.89), anxious (11.32±6.00) and depressive (11.02±3.65) ones. The lowest mean score was for irritable temperament (10.14±3.95). All of these scores, except that of cyclothymic temperament, were significantly higher than in the control group (P<0.01). The age of drug addicts was negatively correlated with cyclothymic (P=0.023) and irritable (P=0.035) temperament scores. These two temperaments were more dominant in the group of drug addicts with post-secondary education (P respectively 0.035 and 0.002). The age of onset of psychoactive substance use was negatively correlated with irritable temperament (r=-0.355, P=0.012). Cyclothymic temperament was correlated with alcohol dependence (P=0.03) and psychiatric comorbidity (P=0.01) among drug addicts. CONCLUSION: The present study provides support for the existence of temperamental dysregulation in drug-addicted patients. This result leads us to suggest that affective temperaments are implicated as a potential endophenotype and may represent a marker for the identification of persons vulnerable to drug use. These affective temperaments also appear to influence clinical features of drug addiction.

[Characteristics of chronic wounds in substance abuse: A retrospective study of 58 patients]. / Caractéristiques des plaies chroniques chez les toxicomanes : étude rétrospective de 58 patients.

BACKGROUND: Drug addiction causes chronic wounds (CW) responsible for severe complications. Very few studies are available on this topic. The aim of our study was to describe the demographic, clinical and etiological characteristics as well as the course of CW in drug addicts. PATIENTS AND METHODS: This was a retrospective and prospective multicenter study including all drug addicts with CW. RESULTS: We included 58 patients (17 prospectively), 84.5% of whom were male, of median age 43 years, presenting multiple CW as a result of intravenous (78.2%), inhaled (41.1%) and/or snorted (20%) drug abuse. Addiction to opioids (68.4%), cocaine (47.4%) and/or cannabis (40.4%) was ended and/or treated through substitution in 79.3% of patients. CW were fibrinous and necrotic (42.9 to 53.6%), recurrent (54.2%), and in some cases had been present for more than 1 year (61.5%). Intravenous drug addiction was associated with large, fibrinous, ulcers in a setting of venous and lymphatic insufficiency (74%). Only 23% of these wounds involved the upper limbs. Necrotic ulcers associated with clinical arteriopathy were described mainly with inhaled addiction. Abscesses (50%) and erysipelas (29.3%) were the most common cutaneous complications. After 3 months, 50% of CW were improved and 29.2% of patients were lost to follow-up. DISCUSSION: Drug abuse-related CW occurred preferentially in young men with history of intravenous abuse. For the most part, CW were seen on the legs and were associated with venous and lymphatic insufficiency, and the resulting major risk for cutaneous infection increased morbidity and mortality in this population in whom medical follow-up is inherently complicated.

Prevalence and risk factors for HBV and HCV in prisoners in Iran: a national bio-behavioural surveillance survey in 2015.

OBJECTIVES: To provide more accurate estimates of the prevalence of Hepatitis B (HBV) and Hepatitis C (HCV) and their contributing factors among prisoners in Iran. METHODS: Cross-sectional study of 6200 Iranian prisoners in 2015. Data were collected through questionnaires and interviews. HBV infection and HCV exposure status of the participants was determined by HBsAg and HCV antibodies blood tests using enzyme-linked immunosorbent assay (ELISA). Data were analysed in STATA-12. RESULT: Prevalence of HCV exposure was 9.48% (95% CI: 8.73-10.27), and prevalence of HBV was 2.48% (95% CI: 2.07-2.89) in the general prison population. In multivariate analysis, the most important risk factor for HBV was a history of drug use in lifetime (adjusted odds ratio, AOR: 1.8, 95% CI: 1.17-3.02). The main risk factors for HCV exposure were a history of drug use in lifetime (AOR: 4.08, CI: 2.56-6.27), age over 30 (AOR: 2.68, CI: 2.01-3.56), and having tattoos (AOR = 1.67, CI: 1.35-2.07). CONCLUSION: Although vaccination is used to control HBV among prisoners, prevalence of HCV exposure is alarming in the prison population of Iran, especially among people who inject drugs. Eliminating viral hepatitis in Iran by 2030 requires a national commitment and rapid measures for targeting this high-risk group. Given the increased efficiency of HCV treatment in recent years, prisons provide an opportunity to access patients for treatment.

UNDERSTANDING PARENTING STRESS AND CHILDREN'S BEHAVIOR PROBLEMS AMONG HOMELESS, SUBSTANCE-ABUSING MOTHERS.

This article tested a model of parenting stress as a mediator between maternal depressive symptoms, emotion regulation, and child behavior problems using a sample of homeless, substance-abusing mothers. Participants were 119 homeless mothers (ages 18-24 years) and their young children (ages 0-6 years). Mothers responded to questions about their depressive symptoms, emotion regulation, parenting stress, and child behavior problems. A path analysis showed that maternal depressive symptoms were positively associated with child behavior problems through increased parenting stress whereas maternal cognitive reappraisal was negatively associated with child behavior problems through decreased parenting stress. Moreover, maternal expressive suppression was negatively related to child externalizing problems. Findings support the parenting stress theory and highlight maternal parenting stress as a mechanism associated with homeless children's mental health risk. This study has significant implications for understanding the parenting processes underlying child's resilience in the context of homelessness and maternal substance use.

COGNITIVE AND SOCIOEMOTIONAL FUNCTIONING AT 4½ YEARS IN CHILDREN BORN TO MOTHERS WHO HAVE RECEIVED TREATMENT FOR SUBSTANCE-ABUSE PROBLEMS WHILE PREGNANT.

Cognitive and socioemotional functioning at 4½ years of age were examined in children born to mothers with substance-abuse problems (n = 22) recruited from residential treatment institutions while pregnant, and then compared to children born to mothers with mental health problems (n = 18) and children from a low-risk group (n = 26). No significant group differences in cognitive functioning were found, but the children born to mothers with substance-abuse problems showed more caregiver-reported socioemotional problems than did the low-risk children, like the children born to mothers with mental health problems. Birth weight had an effect on internalizing problems at 4½ years and mediated the relation between group and socioemotional problems, although not when controlling for caregiver education, single parenthood, and anxiety and depression. At 4½ years, 7 children born to mothers with substance-abuse problems were placed in foster care. These children had lower birth weight and higher caregiver-rated internalizing problems. In addition to emphasizing the importance of the quality of the prenatal environment, this study suggests that families with previous substance abuse are in need of long-term follow-up to address socioemotional problems and enhance further positive child cognitive development. The foster-placed children may be in particular need of long-term follow-up.

[Care pathway and life course of drug-addicted patients]. / Parcours de soins et de vie des patients toxicomanes.

Placing drug addicts, notably heroin addicts, at the centre of their care project, itself part of a life project, is the objective of the Le Lac d'Argent association in Annecy. Caregivers have been able to reflect on their practices and help to fight against preconceived ideas. This article presents the experience of a global support approach.

A PRELIMINARY EVALUATION OF THE MANAGING YOUTH TRAUMA EFFECTIVELY PROGRAM FOR SUBSTANCE-ABUSING WOMEN AND THEIR CHILDREN.

This article provides a description of the development, implementation, and preliminary evaluation of feasibility and acceptability of the Managing Youth Trauma Effectively (MYTE) program and highlights perceptions of changes in mothers' trauma-informed parenting practices. The program consists of a training and consultation program for staff of the U.S. State of Arkansas' Specialized Women's Programs (SWS), and an 8-week, group psychoeducational program designed to help mothers with substance-abuse problems learn how traumatic experiences may affect their children and how they may help support their children by creating a safe and nurturing environment. A posttraining evaluation with leadership and staff at SWS centers, feedback provided on consultation calls with MYTE facilitators, and a retrospective pre/post survey were used to examine feasibility, acceptability, and perceptions of changes in mothers' trauma-informed parenting practices. Preliminary results suggest that the MYTE program is feasible to implement and is acceptable to training participants, facilitators, and mothers participating in the program. Mothers reported significant growth in their perceptions of use of trauma-informed parenting practices. Future research is necessary to confirm these results and examine the effectiveness of the program using a randomized clinical trial.

SUBSTANCE-ABUSING PREGNANT WOMEN: PRENATAL INTERVENTION USING ULTRASOUND CONSULTATION AND MENTALIZATION TO ENHANCE THE MOTHER-CHILD RELATIONSHIP AND REDUCE SUBSTANCE USE.

Substance-abusing pregnant and parenting women are considered one of the most challenging, but important, target groups for developing early parenting interventions. Some valuable efforts to develop such interventions have been made in the organizational sector in Finland. However, there is a great need for new ways of work that would simultaneously concentrate in substance-abuse treatment and enhance parenting in public healthcare settings. The present article describes the background, content, and protocol of a new prenatal intervention developed for substance-abusing pregnant women in a hospital setting in public healthcare. The intervention includes two new elements and pathways aimed to enhance the mothers' curiosity toward her developing child and provide motivation to stay abstinent from substance use. The pathways are interactive ultrasound consultation and a new pregnancy diary, both using a parental mentalization focus. The intervention elements, experiences from running the intervention, evaluation protocol, and general characteristics of the study sample gained (n = 90) are described and discussed. Two case vignettes from the study sample are presented, and the applicability of this prenatal work with other groups and settings is considered.

A LONGITUDINAL EXAMINATION OF TODDLERS' BEHAVIORAL CUES AS A FUNCTION OF SUBSTANCE-ABUSING MOTHERS' DISENGAGEMENT.

As a group, substance-abusing parents are at risk for maladaptive parenting. The association between substance abuse and parenting may result, in part, from parents' emotional disengagement from the parent-child relationship, which makes perceiving and responding to children's cues more challenging. In this study, we examined whether substance-abusing mothers' levels of disengagement from their relationship with their children (ages 2-44 months), operationalized in two different ways using parenting narratives (representational and linguistic disengagement), prospectively predicted children's engagement and disengagement cues during a structured mother-child interaction. Within a sample of 29 mothers, we tested the hypotheses that greater maternal disengagement at Time 1 would predict a decrease in children's engagement and an increase in children's disengagement at Time 2. Results indicated that representational disengagement predicted a decrease in children's engagement cues whereas linguistic disengagement predicted an increase in children's disengagement cues. Results provide partial support for a reciprocal, iterative process in which mothers and children mutually adjust their emotional and behavioral disengagement with one another.

[Non-drug psycho-active substance use and pregnancy]. / Grossesse et usage de substances psycho-actives non médicamenteuses.

BACKGROUND: The consumption of psycho-active substances (PAS) by pregnant women is in a growing increase around the world. It is a major problem of public health in some countries due to serious and negative consequences for children and society as well as for pregnant women. This problem has also increased among women in Morocco. However, it is still neglected and underrated in the absence of any official statistical data. This is the first study leading to a better profiling of pregnant women who may consume psycho-active substances during their pregnancy; it would permit better medical and psychosocial care of both women and children. OBJECTIVES: To determine the prevalence and the factors associated with the psycho-active substances used by pregnant women and describe their socio-demographic characteristics. METHODS AND PATIENTS: A trans-sectional study was carried out from September to October 2010, including pregnant women consulting at the obstetrical service of the provincial hospital Moulay Abdellah in the city of Salé. The study included women who were pregnant or had recently given birth, and not having any serious mental disorders that could have upset their cognitive abilities. The data was collected through a straight questionnaire of 25 items specifying the socio-demographic characteristics, data about pregnancy and habits of using psycho-active substances. RESULTS: One hundred and fifty pregnant women were included in the study. The majority of them (83.2%) were aged 20 to 40 years old, 94.6% were married, 96% were unemployed and depended on their spouses for their financial resources and 80% had normal domestic relationships (from average to good quality). Among the women, 31.3% of them reported traumatic events in the past. The prevalence of psycho-active substance consumption by the pregnant women of our sample was 11.3%. The used substances were tobacco (9.3%) and cannabis (4%). These women were more likely to have a low level of education (47.1 vs 16.5). They were victims of abuse or neglect in their past (82.3 vs 24.9), and their relationships with their spouses were bad (70.6 vs 13.5) with a lack of desired pregnancy (47.1 vs 27.8) and poor follow-up (47.1 vs 3.8). The results show statistically significant differences. CONCLUSION: Not only should decision-makers draw attention to the seriousness of the problem because of the relatively high rate of psycho-active substance consumption, but also they should increase obstetric team's awareness to look systematically for psycho-active substance use.

The Varieties of Psychedelic Expertise in 1960s Canada: The Psychiatrists behind the Addiction Research Foundation's Study of LSD Therapy.

In 1962, Ontario's Addiction Research Foundation launched the first double-blind randomized controlled trial of LSD therapy as a treatment for alcoholism. The study, which found that LSD was not effective, was heavily criticized by other therapists working with the drug. These critics argued that the Toronto researchers who carried out the study were biased against LSD and used an anti-therapeutic method that was destined to produce negative results. Instead of creating a comfortable and supportive environment, they stressed, the Toronto group restrained patients to a bed in a hospital ward, used an unusually large dose of LSD, and hardly provided any careful therapeutic support. Some even compared this method to a "form of torture." Historians have paid little attention to the study, mentioning it only as an example of flawed or naïve LSD therapy that contrasted with the more advanced "psychedelic" approach developed in Saskatchewan. In this paper, I take a closer look at the Toronto psychiatrists who carried out the study and created the unique method that was employed. I show that they were actually quite excited about LSD and were more sophisticated in their approach to its use than has been appreciated by historians and critics. In many ways, they had their own brand of LSD expertise that differed from that of the Saskatchewan group. Some of the problems with the ARF study, then, did not stem from negative bias or a lack of competency, but instead resulted from the awkward relationship between LSD therapy and controlled trials.

Résumé. En 1962, la Fondation pour la recherche sur la toxicomanie de l'Ontario lançait son premier test aléatoire et contrôlé en double aveugle de thérapie par le LSD pour traiter l'alcoolisme. L'étude, qui concluait que le LSD n'était pas efficace, a fait l'objet de critiques sévères de la part d'autres thérapeutes qui utilisaient cette drogue. Ces thérapeutes soutenaient que le groupe de recherche torontois avait un parti pris défavorable au LSD et avait employé des méthodes antithérapeutiques dans le but de produire des résultats négatifs. Ainsi, selon eux, au lieu de créer un environnement offrant un réel soutien, le groupe de Toronto attachait les patients à leur lit d'hôpital, employait des doses inhabituellement élevées de LSD et ne fournissait à peu près aucun soutien thérapeutique. La méthode a même été comparée à « une forme de torture ¼. Les historiennes et les historiens ont accordé peu d'attention à l'étude, sauf pour la citer comme exemple déficient ou naïf de thérapie par le LSD, en l'opposant à l'approche « psychédélique ¼ plus avancée mise au point en Saskatchewan. Dans cet article, je m'intéresse aux psychiatres qui ont mené l'étude de Toronto et conçu la méthode originale employée à la Fondation. Je montre que l'usage du LSD suscitait beaucoup d'enthousiasme dans le groupe et que son utilisation de cette drogue était plus complexe que l'ont reconnu jusqu'ici l'histoire et la critique. À plusieurs égards, le groupe de Toronto disposait de sa propre expertise en matière de LSD, différente de celle de ses collègues de la Saskatchewan. J'en conclus qu'une partie des problèmes attribués à l'étude conduite par la Fondation ne provient pas d'un préjugé défavorable ou d'un manque de compétence, mais plutôt des liens complexes entre la thérapie par le LSD et les essais cliniques.

[Puffy hand syndrome: A little-known diagnosis]. / Le syndrome des grosses mains : un diagnostic méconnu.

INTRODUCTION: Puffy hand syndrome is a rare complication of intravenous drug addiction. Diagnosis is based on the patient's history and clinical examination. OBSERVATIONS: A woman and two men, aged 42, 39 and 36 years old, are described. All had a history of intravenous drug use of heroin and oral buprenorphine misuse. Puffy hand syndrome appeared during drug addiction (n = 2) or after its withdrawal (n = 1). It was associated with acrocyanosis (n = 1) or injection scars (n = 1). Upper limb ultrasonography showed sequelae of venous (n = 3) or arterial (n = 1) thrombosis. An upper limb lymphoscintigraphy in one patient showed decreased radionuclide uptake of axillary lymph node and subdermal reflux tracer in the forearm. Treatment was based on low-stretch bandages to reduce the volume and then elastic compression sleeve for long-term stabilization. CONCLUSION: Puffy hand syndrome seen in intravenous drug addicts is poorly understood. It is a chronic complication despite the cessation of drug use. This syndrome has to become more widely known because its management is mandatory, although symptomatic.