Search

Summary: Today''s juveniles are the first generation to be raised in an environment where gambling is very accessible and socially acceptable. The recent legalization of Internet gambling has increased this accessibility. With 28,8 millions of gamblers in France in 2010, many believe that gambling is an innocent leisure activity. The first results of the national survey on the prevalence of gambling practices conducted in France show that in 2010, 1.3% of the population had a gambling problem. Also, despite the prohibition of gambling to minors, the mean age of onset of gambling behavior in the world is 11.5 years. Gambling (even non-problematic) in adolescence is associated with poor school performance, criminal behavior and family conflict. Recreational gambling shares with pathological gambling high rates of psychiatric comorbidities in adults, and risk behaviors among adolescents. Similarly, international studies show prevalence of problem gambling 2 to 4 times higher among adolescents than among adult, 3.5% to 8% of adolescents between 12 and 17 are pathological gamblers. The validity of the screening instruments and the frequency of spontaneous recovery in adulthood are discussed to explain the high prevalence in adolescence. This article proposes a focus on the practice of gambling in adolescence and its characteristics when the practice becomes pathological. We discuss the epidemiological, diagnostic, etiologic and therapeutic aspects of this problem. Three major types of risk factors implicated in gambling problems are identified: some of them are related to the subject (individual factors), others are related to the object of the addiction, here the gambling activity by itself (structural factors) like Internet with the recent legalization of gambling online, and the last are related to environment (contextual or situational factors). Thus, the development and maintenance of pathological gambling in youth seems to be conditioned by the interaction of a person and a gambling activity, in a particular context. This conceptual model is based on the well-known theory of Olivenstein on toxicomania, which was proposed in the seventies. In France, very few is known about problem gambling in this age and its implications in terms of treatment, prevention and research. There is little in the way of specific treatments for adolescent pathological gamblers so we briefly reviewed possibilities and limits. We discuss the importance to develop prevention, in particular to delay the initiation, and the necessity of research to develop screening instruments and news studies to have a better knowledge of this population. [Copyright &y& Elsevier]

Abstract: The relationship between psychiatry and family depends on the social context in which they enrol. This is particularly because the family represents a social data, in essence, that psychiatry confronts continuously in its various activities and reflections. In this article, these elements will be specified in an approach targeting the context for the emergence of these relations and contemporary implications. It comes to interrogate issues supporting the relationship between family and psychiatry, including taking the definitions relating to them and their distribution field. This implementation issues raised will allow us to register then how a clinical work, specifically with youth, must take account of these elements for will develop and is next to think of contemporary social logics. This dual approach, social and clinical, which should not be confused, but influencing anyway, can give an anthropology of clinical work that measure the place of psychiatry in society and modulate with the current social expectations, approach and clinical work. [Copyright &y& Elsevier]

Abstract: The adolescence corresponds to the period of life where the confrontation in the loss is lively, crucial, particularly at the end of adolescence, when are imperative the changes of identity, ideals, self-image and identity referents, when it is necessary to grant to finish the adolescence without perishing. We present the case of six teenagers having between 17 and 19years, met for different motives for consultation (teenagers demonstrating delirious episodes or behavioural troubles and misconduct, with social difficulties) having satisfied a protocol of TAT. The end of the adolescence signs the elaboration of the depressive position, the problem of which is reactivated during the presentation of the boards of the TAT. According to the significant registration of the events of life (separation, breaks, delirious episodes), the narrative capacity of certain teenagers will be inhibited. The analysis of narratives in the TAT gives evidence of the modalities of psychic treatment of the loss or quite other traumatizing event. Indeed, the processes of discursive elaboration (formal and thematic) underline the efficiency or the failures of the mechanisms of defence and release, self-regulation and relational modality in front of the representation in the board 3 BM. This picture seems to us to support the reading of the psychic resources concerning the singular treatment modality for loss and for breakdown, strongly present at certain teenagers, whose traumatic load of events of life could not be still exceeded. [Copyright &y& Elsevier]

This article consists of a discussion on therapeutic indications for psychoanalytic tools (psychoanalysis, psychoanalytically oriented psychotherapy, or individual psychoanalytic psychodrama) during the crisis of adolescence. These types of tools are among the options for treatment, limited by difficulties in the management of transference when a given adolescent is going through a period of lability of pathological manifestations. Preliminary interviews are thus essential for evaluating such an indication, which will be decisive, but will nevertheless remain temporarily dependent on the adolescent's own transferential engagement. [ABSTRACT FROM AUTHOR]

Abstract: Background: Children and adolescents involved with foster care are a population at high risk of developing psychiatric disorders. Here, we aimed to assess in children and adolescents admitted in a University Department of Child and Adolescent Psychiatry whether being involved with foster care would change psychopathology and risk factors they face. Method: We conducted a case-control study in a sample of 103 inpatients aged 6 to 18 years (52 supported by foster care; 51 not supported). Assessment included family and medical histories, psychopathology using the MINI neuropsychiatric interviews (Kid and parents) for axis 1 diagnoses and the diagnostic interview for borderline for axis 2 diagnoses. We also scored the following scales: Global Assessment Functioning, Eysenck Impulsivity and Empathy Scale, Buss and Durkee Hostility Inventory, Harvey Affective Liability Scale. Results: We found more psychosocial life events, both past and recent (occurring less than 2 years) in inpatients involved with foster care (family conflicts, single parent, repeated breaks in places of life, academic failures). We also found more family history of antisocial personality disorder, alcoholism and other drug abuses in first-degree relatives. Regarding axis 1 psychopathologies, we found significantly more conduct disorders, specific developmental disorders and learning difficulties among youths supported by foster care. Finally, we found several prevalent traits of the borderline personality and higher scores of impulsivity, emotional liability and hostility. However, we did not find significant difference for empathy score between the two groups. The results emphasize a condition of cumulative risk factors in the inpatients population involved with foster care. Conclusion: The severity and prevalence of psychiatric disorders among youths involved with foster care and requiring psychiatric inpatient stay show the impact of interactions with the environment on the development of psychopathology in children and, for some of them, the inadequacy of the means of prevention. [Copyright &y& Elsevier]

Abstract: This reports deals with reflections by the medical staff of the Child and Teenager Care Centre about the therapeutic interest of mediator-supervised activities. This Care Centre, which is set within the university department of Child and Adolescent Psychiatry of Brest Hospital, receives mainly difficult teenagers. This study is in line with a redevelopment, at constant means, of our care offer because of the gradual changes observed in the issues and requests we have to cope with. This clinical evolution marked by deep societal motions has imposed us to modify our analysis of psychic suffering expression. The difficult teenager shows us to which extent our therapeutic and institutional tools may sometimes prove to be inadequate: indeed, his/her difficult behaviour means that we have failed. This finding drove us led us to take an interest in mediator-supervised activities that we needed to rediscover prior to appropriating them. As they proved to be better suited to difficult teenagers than “classical” approaches, we will try to highlight the ins and outs while underlining how an efficient therapy can emerge from a thorough organisation of occupations. The experience we have acquired through sailing activities will be used as illustration of our reflection. [Copyright &y& Elsevier]

Abstract: This article presents the principal clinical, methodological and theoretical works carried out these past 30 years concerning the psychoanalytical interpretation of projective tests and their contribution to the psychological evaluation of children and adolescents. Emphasis is given to their function as an interface between the quantitative perspectives which prone objectivity obtained through the use of measurements, and respect for the originality and the singularity of the subject being examined from a clinical perspective. Their specific contributions to the study of psychic functioning are then exposed, making it possible to emphasize their pertinence in the field of diagnostic and prognostic evaluations in child and adolescent psychopathology, but also, their usefulness in the study of interactions between cognition and “affectivity”, perception and “fantization”. The complexities of interpretative modalities, quite different from the simple, haphazard reading of contents, are then recalled. The article ends with an homage to N. Rausch de Traubenberg, the founder of the discipline in France. [ABSTRACT FROM AUTHOR]

Abstract: The study compares a group of adolescents sex offenders (n =36) to a group of adolescents non-sex offenders (n =20). The adolescent sex offenders have more frequently experienced the loss of their father. They presented more submissive, conformism, and sexual inhibition characteristics. However, they did not report more depressive, opposition, conduct disorders nor dependence symptoms. The results are discussed in light of the international literature on adolescent sex offenders. [Copyright &y& Elsevier]

Summary: Clinically, adolescent anorexia is defined by means of a rather strict manner: DMS IV criteria. However, other symptoms could be helpful for diagnosis by physicians for: obsessive thoughts about foods; alexithymia; or the existence of troubles in the sense of taste and the sense of smell. Up to today, the main psychopathogical explanation for anorexia leads to a dependence theory linked to a way of life in anorexia as determined by an omnipotent control. However, other hypothesis could be formulated to support the concept of negative hallucination developed by French contemporary psychoanalysis. These could be helpful to create a new way of treating adolescent anorexia. Actually, there are no international guidelines. In France, the way to treat anorexia is often based on a weight contract with separation developed by the “Jeammet team” and varies from one team to another. From our experiences, we propose a new way to treat anorexia based on four important axes: weight contract without separation; individual or grouped psychoanalytic psychotherapy; group therapy based on the clinical difficulty to express emotions and feelings; for families: individual and/or group therapies. [Copyright &y& Elsevier]

Abstract: Anxious school refusal, or school phobia, usually relates to a barrier in the mental process during adolescence, the revealing factor of which is the confrontation with educational institutions. This concept has been the subject of much controversy, although it appears today that the clinical outlines have been refined. Nevertheless, if the paradigm of separation anxiety appears commonly acknowledged in explaining the psychopathology of anxious school refusal in early childhood, this model appears insufficient during adolescence. Indeed, faced with the emergence of puberty, the precariousness of the mental functioning of some adolescents induces a self-sabotage of their capacity to think, hence exhibited under the mask of school phobia. This incapacity to reorganise their internal mode has led us to question the existence of a pre-neurotic organisation, the negative prognosis of which requires specialised and collegial management. [Copyright &y& Elsevier]

Abstract: French penal juvenile justice maintains specific relation with psychiatry and psychopathology. The minority excuse on which it is based leads to a paradigm of relations between justice and psychiatry that is very different from the one established for adult penal system; in the latter, this relation is built on forensic psychiatric approaches opposing treatment to sanction and judicial logic to psychiatric logic. The French juvenile justice system differs from this point of view because it states that juvenile delinquents are always more or less irresponsible; the judicial responses to their delinquent acting have to give priority to education on repression. This leads this system to give a central role to the appraisal of the juvenile delinquents’ personality, that is to say to their psychic functioning; any judicial response has then to give a central space to educational and protective concerns assuming that there are no delinquent conducts that are not the expression of an educational and a psychic difficulty. Then the logic behind this assumption is not as much nosographical as it is psychopathological (with reference to a phenomenological or psychodynamic theory); the most important is not then the disorder diagnostic label but a comprehensive perspective addressing the subject''s psychic functioning pattern. This strong integration of judicial and clinical approaches is then one of the most characteristic specificity of the French juvenile justice system. It deeply influences the way the educational agencies, depending of this system, carry out their task. After an epidemiological approach of the population followed by these agencies, this paper will describe the most frequent psychopathological mechanisms that are found in those who are the most difficult to attend, because of the importance of their acting and their reluctance to tolerate the institutional responses given to them. Two main theoretical axes are proposed to explain these mechanisms: the deprivation theory due to Winnicott and dominant in the English school, and the narcisico-objectal theory due to P. Jeammet, currently central in the French school. We will show that these two theoretical approaches are less opposed than complementary because they both state that external reality has a major influence on the psychic functioning of the concerned subjects. Examining the laws on which is grounded the penal juvenile justice (mainly the 2nd February 1945 order) and the interpretations given to this order since its enactment, the paper describes the practical way used to integrate protection and sanction. It shows that the attempt to abandon this close integration undermine the possibilities to establish network collaborative approaches of difficult adolescents. It then advocates for an increasing attention to this integration around approaches basing clinical approaches on educational activities designed to mediate the relation between the young delinquent and the educational staff, importing in the judicial educational context the well-known principles of milieu therapy in adolescent psychiatry. [Copyright &y& Elsevier]

Abstract: Obsessive and compulsive disorder (OCD) is a common disease in juvenile psychiatry. Its prevalence nears 3 % in youngsters population. OCD is defined by the presence of obsessive thoughts, these thoughts disturb the patient and cause anxiety. The patient engages himself in an active fight against anxiety by realizing a series of codified rituals. This struggle against anxiety causes variable school and social impairment. The choice treatment is behavioural psychotherapy with exposure and response prevention. The medication commonly used is reuptake serotonin inhibitor. In juvenile population, psychotherapy is to be privileged, medication will be used as an adjuvant therapy if necessary. [Copyright &y& Elsevier]

Abstract: How to understand violence suddenly inflicted by the teenager to himself, when he tempts to suicide? Are parental imagos unconsciously involved in this violent scenario? The authors will be trying to answer to these questions. The thought focuses on the weight of the original objects carried by the teenager committing suicide, maybe without his knowing. Self-attack may protect parental imagos, perceived as fragile, from violence. Extracts of a case history of a young teenager having committed suicide will illustrate the violence of scenarios where parental imagos appear. This violence may be in contrast with the obvious placidity of real familial context. The comparison between unconscious representations of parental imagos and the Sophocles’ tragedy Oedipus the King bring the authors to interrogate themselves about the links between traumatism and sacrifice, the traumatism fixing the violent scenario and the sacrifice repeating it in an attempt to expiation. May suicidal gesture be understood as a breach in a shell of silent and pretences? [Copyright &y& Elsevier]

Abstract: If normal adolescence is characterized by a relationship transformation, pathological adolescence can be understood as a partial or full failure of relationship transformation abilities, well established or not during childhood. The treatment has to take into account the definition of this pathology in regard to this age and, obviously, to avoid reinforcing this failure by interrupting cares. [Copyright &y& Elsevier]

Abstract: Interview with acutely psychotic adolescents confront doctors with a highly complex task. They must reason with the patient and at the same time stay rooted, be both empathic and detached, build up a working alliance and still proceed towards a treatment objective. After a presentation of some lines of theory concerning the nature of psychosis in adolescence, an interview with a young woman suffering of an acute psychosis is presented in detail to show the difficulties and possibilities of an ongoing dialogue in reality. [Copyright &y& Elsevier]

Abstract: Motivational interviews have been proved as efficient for treating adolescent with addictive behaviours. It improves therapists skills by giving them tools to enhance change and create therapeutic alliance, two key concepts to achieve adolescent therapeutic follow-up. Understanding adolescent psychopathology is crucial too, for it is known that adapting technique to context leads to success. [Copyright &y& Elsevier]

Abstract: Understanding the magnitude of the burden of child and adolescent mental disorders is a challenge. Lack of data, lack of understanding, and stigma detract from gaining a true picture of the consequences for the individual and society of child mental illness. New initiatives are attempting to gain more objective data, place the data in a context that appreciates culture and degree of impairment. The World Health Organization along with professional societies has taken up the task of fostering dissemination of new data and newer knowledge about treatment. [Copyright &y& Elsevier]

Objective: To describe symptomatology and specific psychological, social, and academic adaptation in adolescents with depressive disorder and comorbid disruptive behaviour disorder, as well as their family situation. Method: Using binomial logistic regressions, this study compares adolescents with depressive disorder and comorbid disruptive behaviour disorder (n = 25) with adolescents with the same behaviour problems but no comorbid depressive disorder (n = 99). Sex-specific interaction impacts are examined. Results: While both groups have several similar characteristics, youth with a dual diagnosis have more oppositional symptoms and poorer self-esteem. Analyses show no interaction impact from sex variable. Conclusions: Adolescents in both groups would benefit from similar interventions regarding disruptive behaviour disorders and some related problems, such as using psychoactive drugs, socializing with delinquent peers, and difficulty functioning in school. Adolescents with a comorbid depressive disorder need special attention, given the more significant oppositional symptomatology and the poorer self-esteem. [ABSTRACT FROM AUTHOR]

Abstract: The Attention-Deficit and Hyperactivity Disorder is frequent and well known in childhood and in child psychiatry. However, this disorder is widely under-diagnosed in adults. There has been a greater interest in this disorder for several decades: Several studies have indicated a persistence of symptoms beyond childhood and adolescence in up to 66% of cases, which leads to a prevalence of 5% in the general population of adults. This disorder is diagnosed on clinical presentation. The diagnostic criteria in adults are facilitated if the first symptoms of this disorder are detected before the age of seven. The symptoms are similar to those observed in children, even thought attention deficits are more frequent than impulsiveness or psychomotor hyperactivity in this population. Very often, patients diagnose their disorder on their own via journals or Internet, and then they try to find a specialist. The DSM-IV and ICD-10 criteria for adults include several items typically found in children suffering from this disorder, and differentiate several subtypes. This paper tries to clarify the functioning of this disorder, with the objective of a better knowledge and treatment for patients who are seriously handicapped by their trouble. Whereas there is a gender ratio of 4:1 (males: females) in children, women are as much concerned as men in the adult forms. The daily life of patients suffering from hyperactivity is disturbed in nearly all fields, including work, relationships and leisure. The disorder can lead to severe consequences for patients and their environment, including loss of work, separations, accidents and chaotic lifestyles. Hyperactivity can be difficult to distinguish from some of the other psychiatric disorders - mostly borderline or dissocial behaviour -, such as bipolar or conduct disorders. However, it can also occur in co-morbidity of any one of these disorders, and this in up to 60% of the cases. Nevertheless, it is important to mention that this disorder is usually present before the onset of the other co-morbid disorders. Multiple etiological factors seem to be implicated in this disorder. Several studies have highlighted the possible contribution of perinatal, neurobiological, neuroanatomical, neuropsychological and genetic factors. The abnormality most explored is the imbalance between noradrenergic and dopaminergic systems. Similarly, genetic studies underline the aberrations found in the dopamine transporter gene and in the D2 and D4 receptor genes. For general practitioners, social workers, forensic institutions or courts, it is important to realise that these patients can beneficiate from an adequate and effective treatment. Pharmacological treatments are the same as the ones for children, they include méthylphénidate and atomoxetine but also antidepressants and antihypertonics. Beside pharmacotherapy, psycho-education can significantly improve symptoms and results in improving self-management of daily life difficulties. [Copyright &y& Elsevier]

Abstract: This work is intended to study the influence of gender on psychopathology disorders in child and teenager. Material and methods: This retrospective and comparative study concerns 264 girls and 264 boys with the same age and socioeconomic level, and having consulted in a child psychiatry service through two years. We compared the psychopathology disorders in both groups according to the axis I of the CFTMEA. Results: The following results were observed: a) 8.7% of both sexes suffered from psychotic disorders; b) neurotic disorders with hysteric dominant were significantly more frequent in girls at all ages; c) depression was significantly more frequent in girls during adolescence, and in boys under the age of 12; d) reactional disorders were significantly more frequent in girls at all ages; e) Borderline disorders, and especially psychopathy, were more frequent in boys at all ages. Conclusion: Our results are closely akin to those of the literature concerning the frequency of internalized disorders (nevrotic and reactional disorders) in girls, and expressed disorders (borderline disorders as psychopathy) in boys. [Copyright &y& Elsevier]

Abstract: Conduct disorder (CD) is the most common psychiatric disorder in youth from the community and encompasses one-third to one-half of all referrals to child and adolescent clinics. The treatment of this condition is often complex and requires a multimodal approach. In order to help clinicians, we propose a review of therapeutics tools for which randomized controlled studies are available. First, three psychosocial treatments are briefly described as they have been shown to be effective in treating CD: (i) parents training programs, well evaluated and more effective among younger patients (ii), cognitive psychotherapy, more effective among adolescents and (iii) multisystemic therapy that should be given to most severe cases because of its cost. Second, a complete review of placebo-controlled studies evaluating psychotropic drugs in CD is provided. These drugs belong to three pharmacological groups of compounds: (i) neuroleptics when aggressivity is high or to obtain rapid sedation, (ii) mood stabilizers especially useful in case of mood liability, (iii) stimulants especially when there is a comorbid attention-deficit/hyperactivity disorder. However, the evidence for an effective role of pharmacotherapy in CD is still limited. Treatment should be multimodal and individualised to each patient''s specific condition after a careful evaluation of the child''s psychopathology and context. [Copyright &y& Elsevier]

Abstract: The purpose of this paper is to present the psychoanalytic individual psychodrama, as practiced in France within a psychiatric institution. After an overview of historical and theoretical issues, authors present a case report concerning the outcome of an adolescent suffering from schizophrenia, after ten years of treatment. The case analysis highlights the re-investment of mental functioning and the recover of the free association ability. Specially, authors describe the last year of the treatment and the pathways by which main psychical conflicts have been elaborated. [Copyright &y& Elsevier]

Abstract: Hypersexuality is a frequent symptom in bipolar episode in teenagers. It can (1) favour at risk behaviours and put the adolescent in a dangerous situation, a rape being the first clinical manifestation of a manic episode; (2) induce sexual delusional ideas and/or false allegations of sexual abuse as psychotic features are frequent in this age range. In the present paper, we briefly report four recent cases seen a tour institution, and discuss the clinical, therapeutic and forensic implications of such situations. [Copyright &y& Elsevier]

Abstract: Skin cutting types of self-mutilation behaviours are more and more frequent among adolescents. Like eating disorders for the last decades, they could in future significantly contribute to the demand for psychiatric care. These behaviours reveal a relationship pathology and show border line features in the functioning of personalities from various psychological organisations. Within the hospital ward — the privileged observation field, where these behaviours can turn epidemic — they are part of a transference on the ward, and as such require an adequate answer from the medical staff. [Copyright &y& Elsevier]

Abstract: Whether Attention Deficit Hyperactivity Disorder (ADHD) and bipolar disorder are related syndrome in young people is currently debated. The present report critically reviews the available literature on the topic. The prevalence rate of ADHD is 5 to 9% among school children of the general population, while the rate is 0.3% for bipolar disorder in the child and adolescent population. The relationship between both disorders is difficult to assess as several symptoms do overlap. The clinical course is continuous in ADHD child whereas it is rather episodic and discontinuous in bipolar adolescent. In psychiatric setting, comorbidity between the two disorders has only been reported by one group –11% in outpatients and 22% in hospitalized patients presenting ADHD– but these results were methodologically discussed. Similarly, in longitudinal studies of ADHD, cases of comorbidity with bipolar disorder have only been reported by the same group. The hypothesis of common vulnerability factors shared by these disorders, including common genetic factors, is not validated. However, cases of patients presenting ADHD and bipolar disorder may be encountered in paediatric and psychiatric settings. We will report one of such cases that will introduce the discussion. [Copyright &y& Elsevier]

The etiological factors associated with the syndrome of anorexia nervosa are heterogenous. This pathology which is connected with adolescence and the effect of the onset of puberty has in particular been associated with narcissistic disorders (notably the concept of negative narcissism), leading to behavioral disorders. Although some studies have examined the role of the parents’ personality in the etiology of this disorder, only few studies have focused on certain specificities of family dynamics. The functioning of the family group can thus lead to an intergenerational lack of differentiation, and an intense interactivity that is fostered by an incestual bond. On the basis of a case study in which a multifocal treatment approach was adopted, we have analyzed how traumatisms, the suppression of mourning and loss at the parental level can be responsible for the development of an intergenerational lack of differentiation. This results in an impossibility to integrate the sexual element during adolescence: sexuality is viewed as a threat by the anorexic subject. The trauma associated with puberty is intensified by a particularly stimulating and exciting reality, i.e. that of a continuing state of narcissistic seduction. It is therefore necessary to determine what prevented the initial expression of mourning and loss which could have instigated a first separation with the primary object. From this viewpoint, a multifocal approach is advocated so that the symptoms of the young adolescent and their relation to family history can be more widely investigated and understood. [Copyright &y& Elsevier]

Child and adolescent psychopathology are often manifested by acute crisis. Itˈs now allowed that these spectacular expressions of decompensations are understood by linkage with the biography and structure of children and adolescents. Care settings must be thought of in this way. If not, the risk is to organize the treatment only with crisis reference. In these cases, individual crises develop quickly into institutional crises, and impeach efficacy. Starting from two clinical observations, the author tries to demonstrate how complementary links between different partners are able to help the therapy. [ABSTRACT FROM AUTHOR]

Abstract: Nowadays, even when it is still classified as a narcotic, of which the detention implies judicial pursuits, marijuana is underestimated in all its consequences and all its effects. Approximately 50 % of 17-year-olds declared experimenting with marijuana starting at the average age of 15 (OFDT 2007). “Cohesion” and “Power”, two fundamental elements of the family structure that were not yet explored in this domain, were able to inform us on the link between them and adolescent''s marijuana consumption. For this, knowing the difficulty of adolescents’ recruitment, we chose an adapted and attractive tool to evaluate, at this age, a reality as complex as the family universe, the Family System Test (FAST). The research was conducted at the Monceau Center for Family Therapy with adolescents (n =18) aged between 15 and 19. The results showed weak hierarchic relations with big “intergenerational coalitions” within the families. Furthermore, an absence or a bad relationship with the father would have a link with the highest levels of marijuana consumption. At last, the study showed that the non-equilibrated family structure (extreme levels of cohesion and power) could be more significantly correlated with marijuana consumption behaviour, on a larger sample. [Copyright &y& Elsevier]