Les CAARUD, lieux privilégiés d’émergence de signaux pour l’addictovigilance

Do DSM-5 substance use disorder criteria differ by user care settings? An item response theory analysis approach

“…Since substance users in treatment settings showed more severe mental health disability than substance users in HR settings (Compton, Thomas, Stinson, & Grant, 2007;Kidorf et al, 2004;Kidorf et al, 2010;Metzger et al, 1990;Ross et al, 2002), future studies should explore if psychiatric comorbidities in the treatment subgroup could explain the DIF and DTF observed. These populations are different in terms of precariousness (Moracchini et al, 2012;Ross et al, 2005), which has not been fully explored in this study, and which could explain the DIF of criteria related to consequences of use that are contextually and culturally bound. Finally, we cannot exclude that some users attending HR settings may also have been attending treatment settings and conversely, some subjects seeking treatment may also have been attending HR settings.…”

“…Of the pharmacological adaptation criteria (withdrawal and tolerance), cocaine users seeking addiction treatment endorsed "withdrawal" significantly more frequently than cocaine users in harm reduction settings. This could be because subjects entering treatment settings may attempt to reduce use before treatment access, and may experience more withdrawal as a consequence than substance users in HR settings who are not necessarily attempting to reduce use and are in an environment where access to substances is easier (Kervran et al, 2019;Moracchini et al, 2012). Another hypothesis is that users seeking addiction treatment are more prone to experience aversive withdrawal than the others and thus are more likely to look for help and addiction care.…”

“…Of the consequences of use criteria, those related to social impairment and risky use (physical or psychological), which tend to be contextually and culturally bound (Auriacombe et al, 2018;Martin, Langenbucher, Chung, & Sher, 2014) , functioned differently by care settings. The HR subgroup was more likely to endorse "social/interpersonal problems due to use" for cannabis and "neglect roles because of use" and "hazardous use" for tobacco, perhaps due to socioeconomic difficulties, often related to substance use or dealing activities that are more frequent among substance users in HR than for those in treatment (Kervran et al, 2019;Moracchini et al, 2012). For tobacco, "psychological/physiological problems because of use" criterion was more frequently endorsed by substance users in treatment settings, possibly because this group was more aware of such damage caused by tobacco use.…”

Addictovigilance contribution during COVID-19 epidemic and lockdown in France

“…In these conditions, both public and private medical sectors (general and specialized practitioners, nurses, most of other health professionals) decreased their activities, together with addiction specialized structures, in order to insure social distancing and prophylactic barrier measures to reduce the risks of viral contamination. For example, in many areas in France, several first line harm reduction structures [25] and addiction specialized centres modified their way of functioning, with limited access hours, redeployment of nurses and doctors for COVID care, remote consultations, etc., all these changes leading to a degraded operating mode. Some other structures may have also closed their doors, in particular those offering conviviality space with coffee and food for homeless and vulnerable isolated people, because of the impossibility to ensure social distancing.…”

“…Detecting and identifying signals are a cornerstone for addictovigilance actors: they need to be able to label a piece of information received as a signal [5,10,20,25,[31][32][33]. Signals suggesting a public health risk are collected and analysed in continuous manner in a surveillance process implemented by watchdog or public health structures, in a perspective of alert, anticipation and early action.…”