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Aim: Assessing acceptance of controlled drinking (CD) among French alcohol specialists. Methods: On-line survey of 547 French alcohol specialists. We searched factors associated with acceptance of CD, and factors that affected the specialists' selection of treatment goal. Criteria for success used by specialists in clinical practice were compared with criteria expected to be used in clinical trials. Results: CD was accepted as a treatment goal by 48.6% of alcohol specialists (n = 105, n = 216), and 61.9% practiced CD for their own patients (n = 130, n = 210). Factors in selecting outcome goals were: patient's choice, perceived self-efficacy, relapse history and severity of dependence. Age, profession and basis of specialists' opinion on CD were associated with acceptance of CD. Conclusion: Half of French alcohol specialists accept CD as a goal. Acceptance was associated with specialists' personal and professional characteristics. The criteria for success specialists use in their clinical practice differ from those they expect to be used in clinical trials. [ABSTRACT FROM AUTHOR]

Background: Although the use of cannabis among young people has become a major public health concern, there is no such test in France for general population surveys. Objective: This article aims to present a short screening test for cannabis abuse among adolescents and young adults in general population surveys, the CAST (Cannabis Abuse Screening Test) designed at the French Monitoring Center for Drug and Drug addictions (OFDT). Methods: The survey was conducted in France among 1728 scholars aged 14-22, in secondary schools, high schools, and university. After presenting internal consistency and factorial structure, the authors compared the CAST with the part of the POSIT (Problem-Oriented Screening Instrument for Teenagers) dealing with alcohol and drug abuse among cannabis users in order to validate the optimal thresholds of the CAST for the high risk of abuse defined for the POSIT. Results: The CAST appears to be unidimensional and have high internal consistency (Cronbach's alpha equals 0.81). Among cannabis users whoa are low alcohol consumers, CAST presents very high sensitivity and specificity compared with the POSIT (respectively, 93 and 81%). Conclusions: The CAST seems to be an efficient tool in order to screen for cannabis use disorders among adolescents and young adults. Further research is needed to confirm this result. [ABSTRACT FROM AUTHOR]

— The health costs of alcohol-related problems in France were estimated using two cost evaluation approaches: (1) estimate based on the proportion of cases attributable to alcohol abuse (the alcohol abuse factor); (2) estimate based on prevalence of alcohol abuse for in- and out-patients. For a 10% prevalence of alcohol abuse in the general population, the minimum cost in 1996 was about US$ 2300 million; for a prevalence of 15% it was US$ 2700 million. This cost concerns the health disorders that are linked directly or indirectly to alcohol abuse. It did not allow for injuries from accidents caused by alcohol intoxication and undervalued the cost of out-patient care. Based on the prevalence of alcohol-related disorders seen at hospitals, a percentage of the total in-patient and out-patient costs due to effects of alcohol could be estimated. However, this did not permit an estimate of the cost of care in which alcohol abuse was a risk factor only. Based on the available data showing that between 3% and 10% of inpatients have a directly alcohol-related condition, estimates of in-patient treatment costs varied from US$ 1300 to 2100 million. Among adult out-patients, 20% present with a disorder in which alcohol is a factor or suffer from an alcohol-related illness, which corresponds to a cost of about US$ 1600 million. Thus, these methods yield minimum year's cost estimated between US$ 2500 and 3300 million. These costs are high, compared to the low level of financing for the specialized facilities offering treatment to people in difficulty due to alcohol excess, which was US$ 23 million in that year. As regards social and total costs, estimates from four Western countries have found that about 75% of the total costs of alcohol abuse was attributable to social harm, and 25% to medical costs. Applying this ratio to the French data gives an estimated total cost to French society of about US$ 13 200 million, i.e. 1.04% of the gross national product. [ABSTRACT FROM PUBLISHER]

The prevalence of alcohol use disorders in hospital patients was studied in all the hospitals of one area of France. Alcohol disorders were diagnosed by the head nurse or a physician in the hospital where the patient was being attended, and by means of the CAGE self-questionnaire This descriptive survey, carried out on one particular day, concerned 7626 patients. The prevalence of alcohol disorders was 18%, whereas only 6% of the admissions were for alcohol-related pathologies. Prevalences were 25% in men and 7% in women, 10% in persons aged under 25 years and 43% in men aged between 36 and 55 years. In all, one patient in two was diagnosed directly, though only one in four in the age range under 25 years. These results suggest that too few patients with alcohol use disorders are identified in hospitals, especially in certain age groups and certain types of ward [ABSTRACT FROM PUBLISHER]

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.

Alcohol use disorders present a significant public health problem in France and the United States (U.S.), but whether the untoward effect of alcohol on the brain results in similar damage in both countries remains unknown. Accordingly, we conducted a retrospective collaborative investigation between two French sites (Caen and Orsay) and a U.S. laboratory (SRI/Stanford University) with T1-weighted, structural MRI data collected on a common imaging platform (1.5T, General Electric) on 288 normal controls (NC), 165 uncomplicated alcoholics (ALC), and 26 patients with alcoholic Korsakoff's syndrome (KS) diagnosed at all sites with a common interview instrument. Data from the two countries were pooled, then preprocessed and analyzed together at the U.S. site using atlas-based parcellation. National differences indicated that thalamic volumes were smaller in ALC in France than the U.S. despite similar alcohol consumption levels in both countries. By contrast, volumes of the hippocampus, amygdala, and cerebellar vermis were smaller in KS in the U.S. than France. Estimated amount of alcohol consumed over a lifetime, duration of alcoholism, and length of sobriety were significant predictors of selective regional brain volumes in France and in the U.S. The common analysis of MRI data enabled identification of discrepancies in brain volume deficits in France and the U.S. that may reflect fundamental differences in the consequences of alcoholism on brain structure between the two countries, possibly related to genetic or environmental differences., (Copyright © 2014 Wiley Periodicals, Inc.)

Cocaine has become a public health problem. Several studies have shown that cocaine addiction is associated with multiple cognitive damages, such as memory, inhibitory control, attention and executive functions. A French cohort of cocaine addicted patients was divided into two groups: CCU (Current cocaine users) and abstainers. Their cognitive abilities were compared to a control group and associations with clinical determinants were assessed. The CCU group and the abstainers had episodic memory, working memory and inhibitory control disabilities compared to the control group. Both the CCU and the abstainers group had the same cognitive abilities but their clinical determinants for these cognitive abilities differed. In the CCU group, exposure to cocaine seemed to have a negative impact on cognition especially inhibitory control, memory and impulsivity. In the abstainers group, craving and depression impeded cognition.

Aims: To obtain damage/benefit assessments of eight commonly used addictive products and one addictive behaviour from French addiction experts and link these to overall evaluations., Design and Setting: Criteria-based evaluation by experts in addiction. Specific statistical modelling to estimate the relative contribution of various criteria to formulating expert general opinion on products., Participants: Forty-eight French experts in addiction., Measurements: Twelve criteria covering the whole spectrum of damages and benefits to users and to society evaluated using visual analogue scales (VAS). Direct measure of expert overall subjective opinions on products from user and from social perspectives., Findings: Damage scoring identified alcohol (damage score = 48.1), heroin (damage score = 44.9) and cocaine (damage score = 38.5) as the most harmful products to users and to society; gambling was considered the least harmful (score = 22.5), replicating previous results. Damage scoring correlated poorly with legal status or with overall subjective expert opinions of products. Benefit perception scores indicated alcohol as a clear outlier (benefit score = 45.5) followed by tobacco (benefit score = 34.3) and cannabis (benefit score = 31.1). Statistical modelling suggested that experts attributed 10 times more importance to benefit perception than to damages when making their subjective opinion from a user perspective and two times more importance to benefit perception than to damages in formulating their opinion from a social perspective., Conclusions: The perceived benefits of addictive products appear to have a major impact on the opinion of those products expressed by a number of French addiction experts., (© 2012 The Authors, Addiction © 2012 Society for the Study of Addiction.)

Introduction: Cocaine has become a noticeable part of the European drug scene and is the second most commonly used illicit drug among the general population. Craving is a core issue in cocaine dependence and is strongly associated with lapse and/or relapse. However, no craving scale exists in French. The objective of our study was to assess the reliability and validity of a French language version of the 10-item Cocaine Craving Questionnaire-Brief (CCQ-Brief)., Methods: A total of 131 individuals ranging in age from 18 to 65 years were enrolled in a 12-month outpatient treatment program in 2009. The participants were seeking treatment for cocaine dependence. They completed the Mini-International Neuropsychiatric Interview (MINI) and the French version of the CCQ-Brief. At the end of the interview, a Clinical Global Impression Scale (CGIS) was completed by a clinician blind to the subject's treatment group. We evaluated the internal consistency of the French CCQ-Brief using Cronbach's α coefficient and the correlation of each item with the total scale using the Pearson's coefficient. We conducted an exploratory factorial analysis followed by a scree test. Only items with factor loading >0.3 were retained. The convergent validity of the French CCQ-Brief was assessed using Pearson's correlation between the CCQ-Brief and the CGIS., Results: The mean (SD) score of the 10-item CCQ-Brief was 3.4 (1.5). Cronbach's α coefficient 0.88 and remained high even when an item was deleted (ranging from 0.86 to 0.88), indicating that this tool possesses a high internal consistency. Each item exhibited a strong correlation with the total score ranging from 0.62 to 0.83. All items presented factor loadings ranged from 0.47 to 0.83. The correlation between the CCQ-Brief and the CGIS was high (r=0.49, p<0.0001), indicating a sufficient convergent validity., Discussion: The French version of the CCQ-Brief is a reliable and valid instrument that can provide a comprehensive assessment of cocaine craving in treatment-seeking cocaine-dependent patients.

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.)

Background: Normative misperceptions have been widely documented for alcohol use among U.S. college students. There is less research on other substances or European cultural contexts. This study explores which factors are associated with alcohol, tobacco and cannabis use misperceptions among French college students, focusing on substance use., Methods: 12 classes of second-year college students (n = 731) in sociology, medicine, nursing or foreign language estimated the proportion of tobacco, cannabis, alcohol use and heavy episodic drinking among their peers and reported their own use., Results: Peer substance use overestimation frequency was 84% for tobacco, 55% for cannabis, 37% for alcohol and 56% for heavy episodic drinking. Cannabis users (p = 0.006), alcohol (p = 0.003) and heavy episodic drinkers (p = 0.002), are more likely to overestimate the prevalence of use of these consumptions. Tobacco users are less likely to overestimate peer prevalence of smoking (p = 0.044). Women are more likely to overestimate tobacco (p < 0.001) and heavy episodic drinking (p = 0.007) prevalence. Students having already completed another substance use questionnaire were more likely to overestimate alcohol use prevalence (p = 0.012). Students exposed to cannabis prevention campaigns were more likely to overestimate cannabis (p = 0.018) and tobacco use (p = 0.022) prevalence. Other identified factors are class-level use prevalences and academic discipline., Conclusions: Local interventions that focus on creating realistic perceptions of substance use prevalence could be considered for cannabis and alcohol prevention in French campuses.

Background: The effect of normative perceptions (social norms) on heavy episodic drinking (HED) behavior is well known in the U.S. college setting, but little work is available in other cultural contexts. The objective of this study is therefore to assess whether social norms of alcohol use are related to HED in France, taking account of other influential predictors., Methods: A cross-sectional survey was carried out among 731 second-year university students in the Paris region to explore the role of 29 potential alcohol use risk factors. The probability of heavy episodic drinking and the frequency of HED among heavy episodic drinkers were modeled independently. Monthly alcohol consumption was also assessed., Results: Of the students, 56% overestimate peer student prevalence of HED (37% for alcohol drinking prevalence). HED frequency rises with perceived peer student prevalence of HED. Other social norms associated with HED are perceived friends' approval of HED (increasing both HED probability and HED frequency) and perceived friend prevalence of alcohol drinking (increasing HED probability only). Cannabis and tobacco use, academic discipline, gender, and the number of friends are also identified as being associated with HED., Conclusions: Overestimation of peer student prevalence is not uncommon among French university students. Furthermore, perceived peer student prevalence of HED is linked to HED frequency, even after adjusting for other correlates. Interventions correcting misperceived prevalences of HED among peer students have therefore the potential to reduce the frequency of HED in this population.

According to available information, GHB and its precursors--gamma-butyrolactone (GBL) and 1,4-butanediol (1,4BD)--are used especially in a nightlife scene characterized by the search for amplified sensations through the combination of electronic music, marathon dancing, and substance abuse. Evidence indicates that GHB/GHL is used particularly in some subpopulations and in places, such as in gay nightclubs. Commonly known as Gorliquid ecstasy, it was misused in the 1980s for its bodybuilding effects and in the 1990s as a recreational drug at music venues. In the same period, media coverage of the use of GHB in sexual assault (often referred to as date rape) brought the drug into the spotlight. GHB/GHL addiction is a recognized clinical entity evidenced by severe withdrawal symptoms when the drug is abruptly discontinued after regular or chronic use. There is evidence that negative health and social consequences may occur in recreational and chronic users. Nonfatal overdoses and deaths related to GHB have been reported. These undesirable effects and especially the deaths appear to have prompted campaigns to limit the use of GHB. Clinicians must also be aware of GBL, which is being sold and used as a substitute for GHB.

A prospective study assessed the outcome in a sample of 122 Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition alcohol-dependent patients in primary care. Standardized questionnaires collected clinical, social, and management data during 875 visits over an 18-month follow-up. A time-event analysis identified outcome predictors. Forty-three percent of patients attempted at least one detoxification during follow-up, one out of three in a hospital. Despite a very high relapse rate (83%), only 14% of the patients attempted a repeated abstinence. Longest and cumulative durations of abstinence appeared to be very close, corresponding to 29% of the follow-up time. The frequency of visits (risk ratio [RR] = 1.08) and visits addressing alcohol consumption (RR = 1.73) significantly lead to detoxification. In this French sample, management by the general practitioners appears to be a positive predictor of outcome in alcohol dependence. Future research could (a) enlighten the relationship between detoxification and frequency or circumstances of the visits and (b) tell whether formal planned follow-up by general practice physicians could improve outcome in alcohol dependence.

Background: Knowledge of the correlates of smoking is a first step to successful prevention interventions. The social norms theory hypothesises that students' smoking behaviour is linked to their perception of norms for use of tobacco. This study was designed to test the theory that smoking is associated with perceived norms, controlling for other correlates of smoking., Methods: In a pencil-and-paper questionnaire, 721 second-year students in sociology, medicine, foreign language or nursing studies estimated the number of cigarettes usually smoked in a month. 31 additional covariates were included as potential predictors of tobacco use. Multiple imputation was used to deal with missing values among covariates. The strength of the association of each variable with tobacco use was quantified by the inclusion frequencies of the variable in 1000 bootstrap sample backward selections. Being a smoker and the number of cigarettes smoked by smokers were modelled separately., Results: We retain 8 variables to predict the risk of smoking and 6 to predict the quantities smoked by smokers. The risk of being a smoker is increased by cannabis use, binge drinking, being unsupportive of smoke-free universities, perceived friends' approval of regular smoking, positive perceptions about tobacco, a high perceived prevalence of smoking among friends, reporting not being disturbed by people smoking in the university, and being female. The quantity of cigarettes smoked by smokers is greater for smokers reporting never being disturbed by smoke in the university, unsupportive of smoke-free universities, perceiving that their friends approve of regular smoking, having more negative beliefs about the tobacco industry, being sociology students and being among the older students., Conclusion: Other substance use, injunctive norms (friends' approval) and descriptive norms (friends' smoking prevalence) are associated with tobacco use.University-based prevention campaigns should take multiple substance use into account and focus on the norms most likely to have an impact on student smoking.

Background: Axis I psychiatric disorders (PD) and substance use disorders (SUD) are common in prison, but only few studies have focused on their association in this setting. Dual diagnosis (DD) (the co-occurrence of a SUD and any axis I disorder) is known to have a poorer prognosis and to require more intense supportive care., Objectives: The objectives of this study were (1) to describe prisoners with DD (prevalence and characteristics); (2) to compare DD prisoners with 3 other groups of prisoners: no diagnosis (ND), SUD alone, or other isolated PD; and (3) to evaluate the impact of DD on suicide risk in prison., Method: A random stratified strategy was used to select 23 various types of prisons and 998 prisoners. Diagnoses were assessed using a unique procedure, each prisoner being evaluated by 2 psychiatrists, 1 junior, using a structured interview (MINI 5 plus), and 1 senior, using an open clinical interview. Following interviews, clinicians met to establish a list of diagnoses. Cloninger's temperament and character inventory was also used., Results: Of the prisoners, 26.3% had a DD. DD prevalence was almost 80% in prisoners with SUD, while only one-third of the prisoners with an axis I PD had co-morbid SUD. No significant differences were observed in drug use patterns between DD and SUD without co-morbid PDs. DD showed the strongest association with suicide risk [OR = 5.7 (1.7-4.6)]., Conclusion: DD is very frequent in prison and is a major risk factor for suicide. Systematic psychiatric/SUD screening of prisoners with either a SUD or an axis I PD should be encouraged.

Aims: Using Cloninger's model of personality, we aimed to specify the relative influence of the more biologically determined variables, temperament and character and more environmentally driven influence, childhood adversity in the development of addiction; and to compare patterns found among alcoholics with those found among drug addicts., Methods: We studied a group of prisoners, at a high risk of substance abuse and past history of childhood adversity. Using a stratified random strategy we selected (i) 23 prisons among the different types of prison in France, (ii) 998 prisoners. Each prisoner was assessed by two psychiatrists--one junior, using a structured interview (MINI 5 plus), and one senior, completing the procedure with an open clinical interview. At the end of the interview the clinicians met and agreed on a list of diagnoses. Cloninger's Temperament and Character Inventory was used to measure personality. Structural equations models, which have been advocated to disentangle the respective influence of complex risk factors, were used., Results: The "novelty seeking" temperament was a crucial vulnerability factor, for both alcoholics and drug addicts, in the same proportion. Character and childhood adversity played a significant part only in the development of drug abuse., Conclusions: In a prison population, a common biological loaded factor, novelty seeking is found both at the core of alcohol- and drug-related disorder whereas environmentally loaded factors play a greater role in drug problems.

Background: Adolescents and young adults seeing a nurse or physician for any reason should be screened for psychoactive substance use. Several English-language questionnaires are available to screen for and assess harmful use of psychoactive substances among adolescents, but to our knowledge, no such instrument exists in French. The aim of the ADOTECNO study was therefore to develop simple and efficient tools for this purpose., Methods: Two questionnaires widely used in French epidemiologic studies (CRAFFT-ADOSPA to screen for harmful use and POSIT to assess the seriousness of consumption from physical, psychological and social viewpoints) were completed by 1728 secondary and post-secondary school students. Statistical analyses assessed correlations between the questionnaires and calibrated optimal cutoff points for the different tools included in ADOTECNO., Results: Correlations between psychoactive substance consumption, responses to the CRAFFT-ADOSPA questionnaire, and POSIT factor A scores showed that CRAFFT-ADOSPA provided early detection of regular alcohol intoxication and of regular and daily cannabis use. At a score of 2, CRAFFT-ADOSPA detects harmful substance use, and at a score higher than or equal to 3 it demonstrates serious substance use., Conclusion: These findings enabled us to recommend useful cutoff values for the CRAFFT-ADOSPA tools for screening subjects at moderate or high risk of substance abuse. This simple broad screening should be complemented for the subjects found to be at risk by a computer-assisted POSIT to guide practitioners in selecting an approach (educational, school, family, psychological, psychiatric, etc.) to care and management according to the specific types of impairment resulting from substance use.

Background: Most studies measuring substance-use disorders in prisons focus on incoming or on remand prisoners and are generally restricted to drugs. However, there is evidence that substance use initiation or continuation occurs in prison, and that alcohol use is common. The aim of this study is 1) to assess prevalence of both drug and alcohol abuse and dependence (DAD/AAD) in a national randomised cohort of French prisoners, short or long-term sentence 2) to assess the risk factors associated with DAD/AAD in prison. a stratified random strategy was used to select 1) 23 prisons among the different types of prison 2) 998 prisoners. Diagnoses were assessed according to a standardized procedure, each prisoner being assessed by two psychiatrists, one junior, using a structured interview (MINI 5 plus), and one senior, completing the procedure with an open clinical interview. At the end of the interview the clinicians met and agreed on a list of diagnoses. Cloninger's Temperament and Character Inventory (TCI) was also used., Results: More than a third of prisoners presented either AAD or DAD in the last 12 months. Cannabis was the most frequent drug and just under a fifth of prisoners had AAD. AAD and DAD were clearly different for the following: socio-demographic variables, childhood history, imprisonment characteristics, psychiatric comorbidity and Cloninger's TCI. Profiles of AAD in prison are similar to type II alcoholism., Conclusion: Regular screening of AAD/DAD in prison, and specific treatment programmes taking into account differences between prisoners with an AAD and prisoners with a DAD should be a public health priority in prison.

Background: Anti-psychotic prescription in schizophrenia is characterised in Europe by frequent associations and high doses. Nevertheless, few longitudinal epidemiological studies have explored anti-psychotic prescriptions., Aim: (1) To describe the evolution of prescription patterns across time; (2) to determine risk factors for prescription of high doses of anti-psychotics and for anti-psychotic combinations., Materials and Methods: Three thousand four hundred seventy three subjects were included in 1993. Data collected in 1993 and subsequently in 1996 and 1999, provided information on demographics, clinical status and prescription. In 1996, the response rate was 68.5% and 56.7% in 1999., Results: The number of anti-psychotics prescribed slightly decreased across time, while doses remained high for one-third of the patients. The factors predicting dose were: dose at previous evaluation, class of anti-psychotic and clinical severity. The factors predicting the number of anti-psychotics were: previous number and class of anti-psychotic and clinical severity., Conclusion: Higher dosage and combinations were related more to physicians' habits than to patient characteristics, as is frequently observed in chronic disease., (Copyright 2006 John Wiley & Sons, Ltd.)

Background: In many European countries, medical education on alcohol remains inadequate in terms of both quantity and quality. The expansion of GP training and care protocols would improve the management and outcome of alcoholic patients. Our purpose was to assess the impact of a multifaceted intervention by trained GPs in the management of alcohol-dependent patients., Results and Discussion: Trained GPs proved better i) in the attempt at abstinence, with 67% patients becoming sober vs. 47% in a comparison sample and ii) in repeat attempt at abstinence in the event of relapse, with an average 2.99 vs. 1.31 attempts per patient. There were no differences in terms of i) relapses, which involved about three in four patients, and ii) prolonged abstinence, which averaged two months. Overall, patients managed by trained GPs remained abstinent 103 days during the 18-month follow-up period vs 68 days for the comparison sample (p = 0.016)., Methods: This 18-month follow-up study had a quasi-experimental design with 24 volunteer trained GPs and a comparison sample of a representative sample of 24 GPs. All GPs included their own already existing DSM-IV alcohol-dependent patients. Patients with depression or anxiety comorbidities were included. Participants were 126 patients in the trained sample and 122 in the comparison sample. The two patient samples were evenly-balanced, averaging 47 years old and 80% males. In the trained sample, consultations were scheduled and management (medication, biological workup) was protocolized, whereas the comparison sample representing standard practice had no obligations., Conclusion: Medical education can sharply improve the management of alcohol-dependent patients and short-term outcome. Trained GPs lead more patients to attempt abstinence and more often than in standard practice. However, a strict medical approach remains limited in the maintenance of medium-term abstinence (over two months), providing a strong argument for multidisciplinary management of alcohol-dependent patients.

Aim: To evaluate the ability to infer alcohol consumption using the %CDT (carbohydrate deficient transferrin) immunoassay (Axis Shield)., Methods: One hundred and eighty-three healthy subjects (143 men, 40 women) undergoing a routine medical check-up at their workplace declared frequency and quantity of alcohol consumption covering the last 4 weeks. Seven sub-groups were made up from this population, according to daily ethanol intake and by increments of 10 g from 0 to 70 g/day. A reference group that consisted of 133 healthy teetotallers (74 men, 59 women) was recruited by occupational medicine in the same conditions as the 183 subjects of the study. Percentage CDT and gamma glutamyl transferase (GGT) were assayed on a fasting blood sample., Results: There was a proportional dose-response effect of daily ethanol intake on %CDT values in the range of 0-70 g per day. A threshold effect on %CDT values for patients having an alcohol intake of over 40 g per day was found, an effect which was not observed for GGT activity., Conclusion: The kit has clinical usefulness, and the value of 2.6% proposed by the manufacturer for the cut-off for hazardous drinking in both sexes has been validated.

Objectives: The CAGE questionnaire is considered a useful tool for detecting alcohol problems, especially in clinical populations. Its sensitivity exceeds 75% and its specificity 90%. Our objective was to assess performance of the French version of the CAGE (DETA) in identifying patients who meet the DSM-IV criteria and to discuss its usefulness in hospitals., Methods: Data come from study of hospital morbidity in the Auvergne district of central France in 1998. Alcohol problems were diagnosed by physicians using the DSM-IV alcohol abuse or dependency criteria. For each diagnostic category, we calculated the performance of the CAGE questionnaire at a cut-off of 2 (CAGE 2+) and of 1 (CAGE 1+)., Results: The study included 5,452 patients--48.5% of them men--in acute- and intermediate-care facilities. CAGE 2+ had a sensitivity of 77% and a specificity of 94% among the diagnosed patients. It was more sensitive for patients diagnosed as alcohol-dependent than for alcohol abusers (61% vs 84%), but specificity was identical for both groups (94%). These results are similar to the properties of the English version. For a cut-off of 1 the CAGE had a sensitivity of 88% and a specificity of 87%., Conclusion: The French version of CAGE is a useful screening tool for alcohol abuse and dependance. Its systematic use in hospitals is desirable: a positive response to any item should attract the physician's attention and lead to further investigation.

Cannabis is by far the illegal substance the most widely used by youth aged 12-25 years. One out of five persons living in France has already tried it once in his lifetime. Although the psychiatric symptoms as well as the cognitive and acute or chronic behavioral effects linked to repeated use of cannabis are well documented in the literature, search for persistent cognitive effects amongst chronic users has not provided convincing evidence because of methodological biases. The issue is nevertheless most crucial, especially amongst teenagers, due to the potential risks of deteriorated academic, social and occupational performance. The longer the exposure to the effects of the substance, the greater the risk of complications. Based on data reported in the literature, we report the cognitive effects associated with chronic use of cannabis as well as its social and educational consequences.

Background: The aim of this study was to better evaluate the role of alcohol drinking in fatalities linked to road traffic accidents., Methods: The data of accidents were collected by a French official agency from police records, including many variables, among which was a blood alcohol test. They were analyzed in a descriptive way and toward a logistic regression. This exhaustive database comprised all of the 500,961 accidents with casualties that involved less than three vehicles (28,506 fatal accidents) recorded in France during a 52 month period (September 1995 to December 1999). The results of the alcohol tests were known in 78.7 of the drivers., Results: The blood alcohol concentration was over the legal limit (0.50 g/L in France) in 9.8% of the accidents with casualties overall. Considering only fatal accidents, the rate of positive alcohol test in drivers was approximately 31.5%. This rate varied depending on the period and the type of accident, raising up to 71.2% in single-vehicle accidents (loss of control) at night during the weekend. The percentage of positive alcohol tests also dramatically increased following the number of fatalities per accident (87.5% in single-vehicle accidents during weekend nights involving three or more killed). The logistic regression in single-vehicle accident shows that the higher odds ratios concern the positive blood alcohol test (OR = 4.19), clearly overwhelming the other precipitating factors of accidents (age of driver, meteorological conditions, time of day, and other factors)., Conclusions: Drinking alcohol before driving is a well known factor of accidents. We clearly demonstrate here that it is the main factor leading to deaths linked to road traffic accidents in France. The results are strengthened, and some analyses are allowed, by the exceptional features of our database. The authors emphasize the need for prevention measures.

Background: The Auvergne region of central France has the third highest mortality rate in the country for alcohol-related disorders and the highest level of alcohol consumption among young people., Methods: An exhaustive cross-sectional study of regional hospital morbidity related to alcohol was undertaken on a single day in May 1998, including 9,552 hospital beds. All inpatients age 16 and older in the Departments of Medicine, Surgery, Obstetrics and Gynecology, Psychiatry, and Medium-Stay Services were studied. The aim was to define alcohol-related behavior patterns (by using the Diagnostic and Statistical Manual of Mental Disorders [DSM-IV] criteria of abuse and dependence and the CAGE questionnaire) and to measure the proportion of nonsomatic alcohol-related care dispensed in hospital., Results and Conclusions: The prevalence of alcohol use disorders in all wards was 20%. Half of these patients were alcohol dependent, a quarter were diagnosed as alcohol abusers, and a quarter had an alcohol-related problem that was not identified during the stay. Alcohol use disorders were more common in male inpatients (34% vs. 8% in female inpatients) and in certain age groups. One male subject in two and one female subject in five between 34 and 45 years had an alcohol-related problem. Almost 25% of male inpatients studied between the ages of 16 and 20 years had an alcohol-related problem, but only half had been diagnosed previously. Hospital care for alcohol-related health problems was seriously inadequate. On average, 38% of patients diagnosed with an alcohol use disorder received relevant nonsomatic alcohol care, of which 13% were alcohol abusers and 50% were alcohol-dependent patients., Significance: This exhaustive study demonstrates the degree of alcohol-related morbidity among hospitalized patients, which is particularly high in men, in the Auvergne region of France. The study emphasizes the lack of diagnosis, particularly for the young, and the apparent deficiencies in the hospital management of these patients.

TWO CALCULATION SCHEMES: We estimated the cost of health care related to alcoholism using two different medicoeconomic approaches. PREVALENCE OF ALCOHOLISM: Corresponding costs of alcohol-related conditions can be calculated from the prevalence of alcoholism in hospitalized and ambulatory patients. It is however impossible to calculate the alcohol-related cost, even for heavy drinkers, when alcohol is involved as a risk factor. METHOD ONE: For a 10% prevalence of excessive alcohol intake in the general population, the minimal cost in 1996 would be approximately 14 billion francs ($2.2 billion). For a 15% prevalence, it would reach 16 billion ($2.6 billion). This cost only concerns diseases directly or indirectly related to alcoholism. The estimated hospital cost of diseases directly related to alcoholism, that is alcoholic dependence and psychosis, cirrhosis, and upper airway-digestive cancers, reaches 6 to 6.5 billion francs ($1-$1.03 billion) respectively for a 10 or 15% prevalence. Total costs (hospital and ambulatory costs) are between 6.4 and 6.9 billion francs ($1.02-$1.04 billion). For diseases where alcohol is only a risk factor, the minimal cost varies between 7.5 and 9.5 billion francs ($1.20-$1.51 billion). METHOD TWO: With this method, the minimal total cost is to the order of 20 billion francs ($3.75 billion) with half being hospital costs and half ambulatory costs. This cost only concerns alcohol in overt disease states. Costs related to alcohol as a risk factor are not included in this estimation as there is no known coefficient for attribution. HIGH COST OF ALCOHOLISM: Both of our methods used a minimizing estimation scheme and found total costs to lie in the range of 15 ñ 20 billion francs ($2.38-$3.75 billion). Extrapolating from studies conducted in other countries where social costs amounted to 75% of total costs, it can be considered that alcoholism in France costs more than 80 billion francs ($12.7 billion) a figure exceeding 1% of the GNP.

Aims: Buprenorphine at high dosage became available in 1996 for substitution treatment in France. This drug is considered particularly safe and has become widely available in general medical practice. We investigated the possible implication of a buprenorphine-benzodiazepine association in six deaths of known abusers., Design: Full investigation of cause of death was conducted for six drug abusers., Setting: The deaths occurred in two regions of France (Auvergne and Lorraine). Assays were carried out by the Institut de Medecine Legale at Strasbourg, France, one of the few French laboratories equipped to assay buprenorphine., Measurement: First, the blood and urine underwent triple exhaustive screening. Secondly, buprenorphine and norbuprenorphine were analysed in all the autopsy samples by HPLC/MS., Findings: Benzodiazepine-buprenorphine associations were found in every case; no other substances that could account for the death were found. The tissue concentrations were markedly higher than the blood levels., Conclusion: If the number of deaths linked to such drug misuse proves high, it may be necessary to review how buprenorphine is dispensed.

The present study evaluates the accuracy of submammary thoracic perimeter for lung size matching between donor and recipient and analyzes the influence of donor lung size discrepancies on functional outcome after double lung transplantation. The population is composed of 18 double lung graft recipients, 16 of whom had cystic fibrosis. The lung size match was assessed by comparison of predicted total lung capacity of donor and recipient: five patients were matched in a 10% confidence interval; four received smaller lungs, and nine received larger ones. The functional outcome was assessed with the spirometric values measured at 3 and 6 months after transplantation. The final functional result was not influenced by the lung size (r = 0.142 for total lung capacity; r = 0.372 for vital capacity; r = 0.378 for forced expiratory volume in 1 second). For larger lungs the final result tended to the recipient's predicted, whereas for smaller lungs, spirometry tended to the donor's predicted (r = 0.906 for total lung capacity; r = 0.875 for vital capacity; r = 0.874 for forced expiratory volume in 1 second). The thoracotomy effect, that is, restrictive syndrome at 3 months that resolves at 6 months, was not correlated with the lung size (r = 0.07 for total lung capacity; r = 0.436 for vital capacity). It is concluded that respiratory functional result is not affected by larger lungs; despite the wide range of error, the submammary thoracic perimeter appeared to be a satisfactory selection parameter in this group of patients.

The authors isolated 2 Isospora species from ducks: Isospora mandari and Isospora sp. This was the first report of the genus Isospora from the duck in France. One of the 2 isolated species (Isospora sp) has not been described in the duck before.