Managing anxiety and depression in alcohol and drug dependence

FRANÇAIS :
De nombreuses recherches ont montré la forte prévalence (30-60%) des troubles comorbides d'anxiété et d'humeur chez des patients usagers de drogues. Cet article propose des réflexions et des pistes pour améliorer l'évaluation des troubles d'anxiété et de dépression : informer les acteurs du soin sur cette prévalence et les divers aspects de cette comorbidité, les rendre disponible, rechercher des traitements efficaces, pour diagnostiquer la comorbidité et les besoins du patient : les difficultés du diagnostic, l'examen des interactions pour choisir le "bon" traitement, et pour gérer cliniquement les cas individuels et planifier le traitement. Enfin il étudie les interventions possibles pour le traitement, la psychothérapie et la pharmacohthérapie, selon les besoins du patient.
ENGLISH :
This article reviews the management of anxiety and depression in alcohol and drug dependence and identifies key issues in the assessment process, as well as potential avenues for treatment : the management of individual cases and issues of service organisation. Although antidepressant or anxiolytic pharmacotherapy may have a role in the treatment of severe disorders, the benefits of using these medications must be balanced against the increased risk of sideeffects or adverse reactions in individuals who continue substance misuse or who have medical complications associated with drug or alcohol dependency. Effective psychosocial approaches largely focus on brief, empirically tested manualised therapies (cognitive therapy). Modifications are required to such approaches to ensure that the interventions are tailored to the needs of clients. The data available demonstrate some evidence for the benefits of structured psychological approaches, but more sophisticated randomized controlled trials are required to evaluate the efficacy of both psychological and pharmacological approaches. (From authors' abstract)