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About a decade ago, a large field of pockmarks, covering an overall area of 36 km2 was discovered in water depths of

Abstract: Cannabis is the most frequently used illegal drug in France. In 2007, the average age for a first use was 15.1 years. Most teenagers will limit their use to a few experiences or controlled use. However, for those who do become dependent, the lapse between the first use and dependence is brief (approximately 18 months) with an average of 28 months compared to tobacco (3–5 years) and alcohol (5–9 years). In light of this brief delay, it is crucial to quickly recognize adolescents who have problem cannabis use and to educate parents to warning signs and to teach them how to efficiently discuss the subject with their teenager. Multidimensional Family Therapy, Cognitive and Behavioral Family Therapy and Brief Strategic Family Therapy have shown their efficacy in clinical trials. Improving family dynamics represents not only a motivational opportunity to help the adolescent to adhere to drug dependence treatment, but may also facilitate reintegration into a drug-free social environment and maintenance in a drug-free existence. Family interventions have been shown to be even more effective when community family assistance relations (social workers, educational counselors) are optimized. Family therapy should also be combined with personal empowerment and life planning interventions which enable the adolescent to increase his self-esteem through scholastic and professional achievement. [Copyright &y& Elsevier]

Introduction: Poor oral health in persons with schizophrenia is a major public health issue affecting 600,000 people in France. The aim of this article was to present the different stages in the development of a specific oral health educational program for persons with schizophrenia. It takes into account experimental knowledge of these persons and presents the results of the feasibility study., Patients and Method: The focus group method was applied to a group of health professionals and users to highlight an exploratory corpus in order to develop an oral health educational program. An expert group including persons with schizophrenia among others validated the fields and tools of this program. A feasibility study was then conducted in a control group of 7 persons with schizophrenia., Results: Altogether, 26 persons participated in this feasibility study. The main fields investigated by the expert group aimed to promote personal responsibility for one’s health, to improve access to the healthcare system and to promote the global management of health. The feasibility study showed the ability of this program to change persons with schizophrenia representations and knowledge of this health problem. Most educational tools were considered relevant., Conclusion: An oral health educational program was built as part of a caregiver-persons with schizophrenia partnership and showed its feasibility. A multicentric randomized trial is currently ongoing to assess the efficacy of this program with a high level of proof.

Introduction: Intrauterine device (IUD) is a reliable contraceptive method that is long term reversible, and well tolerated. Numerous studies prove its efficiency and report rare complications that are attributed to it. However, its use is limited due to fear that it can cause a pelvic inflammatory disease (PID). This is based on historical data on infections related to the "Dalkon Shield", which was removed from the market in 1974., Method: The analyzed articles were extracted from PUBMED database between 2000 and 2016. In total, 22 studies were retained. A meta-analysis was not possible due to the methodological diversity among the selected articles contributing to this narrative review of the literature., Results: After analysis, the following factors influence the risk of PID linked to IUDs: an advanced age and sexually transmitted infections., Conclusion: The risk of PID linked to IUDs is lower than 1%. This is explained by new models of IUD, better screening tests, more frequent follow-up of the patients and the improvement of care PID patients. In the light of our results, the threat of pelvic inflammatory disease should not hinder the use of IUDs., (Copyright © 2018 Elsevier Masson SAS. All rights reserved.)

Competing Interests: K. Chahraoui et M. Reynaud déclarent n’avoir aucun lien d’intérêts.

Competing Interests: K. Chahraoui et M. Reynaud déclarent n’avoir aucun lien d’intérêts.

Background: The relationship between sleep disorders and Internet addiction has been little work. Given the importance of these disorders, we felt it appropriate to make a synthesis of available data and to establish causality or accountability between Internet addiction and the onset of sleep disorders., Methods: A literature review was then performed. We selected scientific articles in English and French, published between 1987 and 2016 by consulting the databases Medline, Embase, PsycINFO and Google Scholar. The words used alone or in combination are as follows: addiction, dependence, Internet, behavioral addiction, sleep., Results: A computer screen light inhibits melatonin secretion and acts as a real external desynchronizer circadian rhythm resulting in a withdrawal syndrome or syndrome sleep phase delay when the stress of social awakening is suppressed., Conclusion: We assume here that the specific treatment of addictive disorders have an influence on sleep disorders., (Copyright © 2016. Published by Elsevier Masson SAS.)

Background: Alcohol consumption with its addictive potential may lead to physical and psychological dependence as well as systemic toxicity all of which have serious detrimental health outcomes in terms of morbimortality. Despite the harmful potential of alcohol use disorders, the disease is often not properly managed, especially in ambulatory care. Psychiatric and general practitioners in ambulatory care are first in line to detect and manage patients with excessive alcohol consumption. However, this is still often regarded as an acute medical condition and its management is generally considered only over the short-term. On the contrary, alcohol dependence has been defined as a primary chronic disease of the brain reward, motivation, memory and related circuitry, involving the signalling pathway of neurotransmitters such as dopamine, opioid peptides, and gamma-aminobutyric acid. Thus, it should be regarded in terms of long-term management as are other chronic diseases., Objective: To propose a standard pathway for the management of alcohol dependence in ambulatory care in terms of duration of treatment and follow-up., Methods: Given the lack of official recommendations from health authorities which may help ambulatory care physicians in long-term management of patients with alcohol dependence, we performed a review and analysis of the most recent literature regarding the long-term management of other chronic diseases (diabetes, bipolar disorders, and depression) drawing a parallel with alcohol dependence., Results: Alcohol dependence shares many characteristics with other chronic diseases, including a prolonged duration, intermittent acute and chronic exacerbations, and need for prolonged and often-lifelong care. In all cases, this requires sustained psychosocial changes from the patient. Patient motivation is also a major issue and should always be taken into consideration by psychiatric and general practitioners in ambulatory care. In chronic diseases, such as diabetes, bipolar disorders, or depression, psychosocial and motivational interventions have been effective to improve the patient's emotional functioning and to prevent or delay relapses. Such interventions help patients to accept their disease and to promote long-term therapeutic plans based on treatment adherence, behavioural changes, self-management and self-efficacy. The management of alcohol-dependence in ambulatory care should be addressed similarly. Therapeutic monitoring may be initiated to manage alcohol use disorders, including alcohol dependence, especially when the patient is unwilling or unready for alcohol withdrawal (i.e. using the strategy of reduction of alcohol consumption, which is considered a possible intermediate step toward abstinence)., Conclusion: Alcohol dependence needs long-term medical supervision, and the therapeutic success depends on the initiation of sustained monitoring at the time of diagnosis (initiating phase with several consultations over 2-4 weeks) with psychosocial and motivational interventions in order to address all the patient uncertainties, to involve him/her in a proactive disease management plan, and to insure adherence to treatment, behavioural changes and new lifestyle. A close monitoring (once a month during the first 6 months) during a consolidation phase is necessary. Finally, a regular monitoring should be maintained overtime after 6-12 months in order to insure that the patient maintains a minimal consumption during the first year, to consolidate the patient's motivation, to abstain in at risk situations, and to maintain a controlled consumption or abstinence., (Copyright © 2016. Published by Elsevier Masson SAS.)

Competing Interests: F. Deroche et P. Laure déclarent n’avoir aucun lien d’intérêts. A. Benyamina déclare avoir participé à des interventions ponctuelles pour l’entreprise Bristol-Myers-Squibb, Euthérapie, Lundbeck (essai clinique, conférences, colloques, actions de formations), Merck-Serono (conférences, colloques, actions de formations). Il déclare avoir été pris en charge, à l’occasion de déplacement pour congrès, par Lundbeck, Merck-Serono et Otsuka. M. Reynaud déclare avoir participé à des interventions ponctuelles pour l’entreprise D et A Pharma (essai clinique), Ethypharm (essai clinique), Lundbeck (essai clinique, conférences, colloques, actions de formations). Il déclare avoir été pris en charge, à l’occasion de déplacement pour congrès, par D et A Pharma, Ethypharm, Lundbeck. H. J. Aubin déclareavoir participé à des interventions ponctuelles pour les entreprises Bioprojet (essai clinique), D et A Pharma (essai clinique), Ethypharm (essai clinique), Lundbeck (essai clinique, conférences, colloques, actions de formations), Merck-Serono (conférences, colloques, actions de formations), Novartis (conférences, colloques, actions de formations), et Pfizer (essai clinique, conférences, colloques, actions de formations). Il déclare avoir été pris en charge, à l’occasion de déplacement pour congrès, par Bioprojet, D et A Pharma, Ethypharm, Lundbeck, Merck-Serono, Novartis, et Pfizer. L. Karila déclare avoir des liens durables et permanents avec l’entreprise GMsanté, participer ou avoir participé à des interventions ponctuelles pour Reckitt Benckiser, Bouchara, AstraZeneca, Lundbeck, Ethypharm, Janssen, Gilead, Sanofi, et avoir été pris en charge, à l’occasion de déplacements pour congrès, par Bouchara, Janssen-Cilag, Gilead.

An acute substance induced psychotic disorder is a cause to raise with a state of agitation in an acute delusional clinical setting. Patients are most often seen in hospital emergency rooms. Rapid diagnosis must be made. An integrated therapeutic management should be considered. Both psychiatric and addiction problems must be taken into account.

The therapeutic use of cannabis has generated a lot of interest in the past years, leading to a better understanding of its mechanisms of action. Countries like the United States and Canada have modified their laws in order to make cannabinoid use legal in the medical context. It's also the case in France now, where a recent decree was issued, authorizing the prescription of medication containing "therapeutic cannabis" (decree no. 2013-473, June 5, 2013). Cannabinoids such as dronabinol, Sativex and nabilone have been tested for the treatment of acute and chronic pain. These agents are most promising to relieve chronic pain associated with cancer, with human immunodeficiency virus infection and with multiple sclerosis. However, longer-term studies are required to determine potential long-term adverse effects and risks of misuse and addiction.

Cocaine remains the second most commonly used illicit drug worldwide after cannabis. Observed levels of cocaine use among countries considerably vary. An increased cocaine use is recorded in the general European population. Cocaine addiction is a worldwide public health problem, which has somatic, psychiatric, socio-economic and judicial complications. It is a multifactorial disorder variable in its clinical manifestations and heritable. Compared to the general population, there is a high prevalence of somatic and psychiatric disorders among cocaine-dependent patients. There are predictable dose-related effects of pharmacological action of cocaine and effects which are uncommon, unrelated to dose and occur randomly in this population. The number of patients entering drug treatment for primary cocaine use has been increasing in Europe for several years. However, there is no specific pharmacotherapy with established efficacy for the treatment of cocaine addiction, nor is any medication approved by regulatory authorities for such treatment. Recent controlled clinical studies and laboratory studies have highlighted some very promising medications. The perfect therapeutic platform for abstinence initiation and relapse prevention of cocaine addiction is a combination of pharmacological treatments and behavioral treatments. Targeting somatic and psychiatric comorbidity is another way to use pharmacological treatments in addictions., (Copyright © 2013 Elsevier Masson SAS. All rights reserved.)

Cannabis is the most widely used illicit substance, especially among young people. Cannabis use is extremely commonplace and frequently comorbid with psychiatric disorders that raise questions about the etiology. The use of cannabis is an aggravating factor of all psychiatric disorders. Psychiatric complications are related to the age of onset, duration of exposure and individual risk factors of the individual (mental and social health). The panic attack is the most common complication. The link with psychosis is narrow that leads to increased prevention for vulnerable populations. Cannabis is also an indicator of increased depressive vulnerability and an aggravating factor for bipolar disorder.

Unlabelled: Tobacco use is a commonplace phenomenon in our society. Its use is responsible for more death and disease than any other noninfectious cause. More deaths are caused each year by tobacco use than by all deaths from HIV, illegal drug use, alcohol use, motor vehicle injuries, suicides, and murders combined. Tobacco remains responsible for greater morbidity than alcohol and all other drugs combined. Tobacco dependence is highly prevalent among drug-dependent patients. Substance abuse patients smoke more and are more vulnerable to the effects of smoking than general populations. Traditional substance abuse therapeutic programs too frequently focus only on treatment of alcohol or other drugs rather than including treatment for tobacco dependence. Currently, there are no official medical recommendations for the treatment of tobacco addiction in illicit polysubstance users., Methods: A comprehensive literature search from a range of electronic databases (PubMed, Embase, PsycInfo, Google Scholar) was conducted for the period from 1988 to September 2012, using the following keywords alone or in combination: tobacco, nicotine, cocaine, cannabis, amphetamines, opiates, substance abuse, substance dependence, addiction, treatment. There were no restrictions on the identification or inclusion of studies in terms of publication status, language and design type., Results: Our literature review will focus on epidemiological, neurobiological, clinical interactions between tobacco, alcohol and other illicit drugs. It will also focus on therapeutic programs in this dual addictive disorder. The aim of this literature review is to make proposals for the treatment of tobacco addiction in polysubstance users entering in specific therapeutic programs., (Copyright © 2013. Published by Elsevier Masson SAS.)

Introduction/objective: Bowlby (1984) regarded attachment as a model of psychological vulnerability to depression. Since then, a large number of studies have considered vulnerability to depression in light of the idea of attachment style. Attachment styles correspond to two dimensions observed in relationships (anxiety and avoidance) evoking ideally the internal operating models of self and other respectively, as first described by Bowlby (1984). Two types of adult attachment styles are evaluated in our study: romantic attachment (Hazan and Shaver, 1987) and interpersonal attachment (Bartholomew and Horowitz, 1991). The existing literature indicates that depression is associated with the insecure attachment styles, in both romantic an interpersonal relationships. Nevertheless, a question remains concerning the nature of the link between attachment style and depression: are attachment styles stable and independent of the depression or are they modified as the depression evolves? The aim of the present study was to investigate the relationships between attachment and depression in adult women hospitalized for depression; following up the evolution in their romantic and interpersonal attachment styles from the beginning to the end of their hospitalization., Methodology: The study population consisted of 50 women hospitalized for an episode of major depression (Axis I, DSM IV). Individuals exhibiting bipolar disorders and other pathologies linked to depression were not included in the population. Sixty-eight percent of the depressed women in our population had previously experienced depressive episodes and 42% of them also exhibited a personality disorder (Axis II, DSM IV). The clinical group participated in two psychological investigations, one at the beginning (T1) and one at the end of the hospitalization (T2), including each time a clinical interview during which the depression as well as the romantic (ECR, 1998) and interpersonal (RQ, 1991) attachment styles were evaluated., Study Results: Our findings showed that depression is positively correlated with the "avoidant" dimension of the romantic attachment style and negatively with the "secure" dimension of the interpersonal attachment style. Between the beginning and the end of hospitalization, only the "secure" and "fearful" dimensions of the interpersonal attachment styles were modified, whereas the styles of romantic attachment remained stable. In terms of the links between attachment styles and the evolution of depression during hospitalization (between T1 and T2), we noted that an increase in security of attachment was correlated with a decrease in the depressive symptomatology. Conversely, the other romantic and interpersonal attachment styles were not linked with the evolution of the depressive symptomatology., Discussion/conclusion: Our results confirm that romantic and interpersonal styles of attachment constitute factors of vulnerability to depression. But more importantly, these findings open up new perspectives in terms of the nature of the relationships between attachment styles and depression. They provide matter for discussion concerning the stability or the change in romantic and interpersonal attachment styles. Indeed, we have revealed the stable and independent nature of romantic attachment styles in relation to depressive symptomatology. On the contrary, security in the interpersonal attachment style was shown to be a factor of change, associated with the evolution of the depressive symptomatology in progress. In the quest to take combined account of romantic and interpersonal attachment styles and their links with the evolution of depression, the present study results in a new understanding of depression, viewed from the perspective of the model of attachment in adults., (Copyright © 2011 L’Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.)

Cocaine is an illicit substance which is the greatest suicide-induced potential. Studies show a link between cocaine dependence and suicide. The prevalence of its use, in the days leading up to a suicide, may vary as between 9.4 and 20% according to the chosen method. The number of suicides is important. The acting out may be present at all stages of the addictive cycle associated with cocaine. On the 12th National Day on Suicide Prevention devoted to addictions and suicide, it was recommended that addictive phenomena should be taken more into account by experts in the subject, and that the risk of suicide should be evaluated by specialists in addiction in order that people presenting a risk be placed in appropriate preventative care in time., (Copyright © 2012 Elsevier Masson SAS. All rights reserved.)

Designer drugs include, among others, synthetic cannabinoids and synthetic cathinones. These new "legal highs" drugs are sold on line for recreational public or private use. Synthetic cannabinoids are a psychoactive herbal and chemical product that, when used, mimics the effects of cannabis. Cathinone is a naturally occurring betaketone amphetamine analogue found in the leaves of the Catha edulis plant. Synthetic cathinones are phenylalkylamines derivatives, and may possess both amphetamine-like properties. They are often sold as "bath salts" or "plant food" and labeled "not for human consumption" to circumvent drug abuse legislation. The absence of legal risks, the ease of obtaining these drugs, the moderate cost, and the avaibility via Internet are the main criteria attracting the user. There is evidence that negative health and social consequences may occur in recreational and chronic users. The addictive potential of designer drugs is not weak. Furthermore, there is a lack of epidemiological, pharmacological, animal, clinical, psychological and therapeutic data concerning these new synthetic agents.

The term "energy drink" designates "any product in the form of a drink or concentrated liquid, which claims to contain a mixture of ingredients having the property to raise the level of energy and vivacity". The main brands, Red Bull, Dark Dog, Rockstar, Burn, and Monster, are present in food stores, sports venues, and bars among other soft drinks and fruit juices. Their introduction into the French market raised many reluctances, because of the presence of taurine, caffeine and glucuronolactone. These components present in high concentrations, could be responsible for adverse effects on health. The association of energy drinks and spirits is widely found among adolescents and adults who justify drinking these mixed drinks by their desire to drink more alcohol while delaying drunkenness. Given the importance of the number of incidents reported among the energy drinks consumers, it seemed appropriate to make a synthesis of available data and to establish causal links between the use of these products and the development of health complications. For a literature review, we selected scientific articles both in English and French published between 2001 and 2011 by consulting the databases Medline, Embase, PsycINFO and Google Scholar. The words used alone or in combination are "energy dinks", "caffeine", "taurine", "toxicity", "dependence". An occasional to a moderate consumption of these drinks seems to present little risk for healthy adults. However, excessive consumption associated with the use of alcohol or drugs in amounts that far exceed the manufacturers recommended amount, could be responsible for negative consequences on health, particularly among subjects with cardiovascular disease.

Fear of not controlling stress is the most frequently reported obstacle to smoking cessation. We report a retrospective study involving 70 smokers whose files were randomly selected from a smoking cessation clinic's recruitment. Stress management as a motive to smoke (SMMS) was systematically explored at the first visit, before quit date. SMMS mean score was 7.36 (+/- 2.4) on a 10 point scale. The score was higher in females than in males (p = 0,048). A multivariate logistic regression showed that SMMS was explained by two variables: physical dependence as measured with the FTND score (OR = 1.7, 95% CI = 1.18-2.46), and anxiety as measured with the HAD scale (OR = 1.27, 95% CI = 1.03-1.56). In conclusion, the high frequency and impact of perceived stress on smoking behavior call for a systematic clinical evaluation of perceived stress when engaging a treatment for smoking dependence. Our work has confirmed the importance for the smokers of perceived stress on their smoking behavior, particularly in females. Perceived stress showed a strong relationship with nicotine dependence and anxiety. Further investigation is warranted for a better understanding of the relationship between perceived stress and anxiety in smokers.

Amongst validated psychological treatments, brief intervention appears to be the best suited for primary care. It aims at increasing motivation for change after a screening for an alcohol use disorder. The first therapeutic step for an alcohol-dependent patient aiming at abstinence is alcohol detoxification. At this stage, benzodiazepines should be briefly prescribed if the patient manifests clinically significant withdrawal symptoms. The next step is relapse prevention, for which only three medications are currently validated in France, acamprosate, naltrexone, and disulfiram.

Methamphetamine is the second illicit drug used after cannabis in North America, Asia, Oceania. It also becomes a prominent part of the European drug scene, especially in East European countries such as Czech Republic and Slovakia. Methamphetamine addiction is a serious worldwide public health problem with many consequences and complications. Significant morbidity, including cardiovascular, infectious, pulmonary, dental diseases and other systems complications are associated with methamphetamine acute or chronic use. Cognitive disorders, psychotic and mood disorders have been reported. There is also substantial evidence that methamphetamine has an adverse impact on social relationships. Treatment of methamphetamine complications is primarily supportive and need a multidisciplinary approach. It can serve as a target to initiate a treatment for the addiction problem. The use of behavioral therapies and pharmacological agents are the best therapeutic approach., (Copyright © 2010 Elsevier Masson SAS. All rights reserved.)

Cocaine remains the second most used illicit drug in Europe, after cannabis, though levels of use vary between countries. This psychostimulant has become a noticeable part of the European drug scene. Cocaine dependence, a chronic, relapsing and multifactorial disorder, is a significant worldwide public health problem with somatic, legal, social, cognitive and psychological complications. The relationship between clinical psychotic symptoms and use of specific substances other than cannabis has received minimal attention in the literature. Psychotic symptoms and experience of paranoia and suspiciousness are reported during the use and the withdrawal of cocaine. Furthermore, although psychotic symptoms were found to be common among substance users, the risk for development of chronic psychotic disorder was found. In the light of recent epidemiological data stating that there is an increased cocaine use, that there is an increased number of patients entering drug treatment for primary cocaine use in Europe for several years and that cocaine users are an heterogeneous group, we made a review on the specific topic of cocaine-induced psychotic disorders. This review is based on Medline, EMBASE, PsycINFO and Google Scholar searches of English and French-language articles published between 1969 and February, 2010.