Historique
Article de Périodique
L'abstinence ? Oui… mais avec modération ! Quatre raisons pour de nouvelles recommandations nationales sur l'alcoolodépendance (2013)
(Abstinence? Yes, but with moderation! Four reasons for new national recommendations on alcohol-dependence)
Auteur(s) :
ROLLAND, B. ;
BENCE, C. ;
COTTENCIN, O.
Année
2013
Page(s) :
8-10
Sous-type de document :
Revue de la littérature / Literature review
Langue(s) :
Français
Refs biblio. :
26
Domaine :
Alcool / Alcohol
Thésaurus mots-clés
ALCOOL
;
DEPENDANCE
;
ABSTINENCE
;
RECOMMANDATION
;
REDUCTION DE CONSOMMATION
;
PRISE EN CHARGE
Résumé :
FRANÇAIS :
Les données épidémiologiques dont nous disposons aujourd'hui montrent qu'il existe manifestement des profils très variés de patients alcoolodépendants, avec des trajectoires évolutives et un pronostic parfois radicalement opposés. Pourquoi alors continuer à imposer le modèle historique néphaliste de prise en charge, avec pour objectif unique l'abstinence, qui semble aujourd'hui trop rigide pour répondre au mieux à un panel de situations très différentes ? Il serait indispensable que la communauté addictologique française débate de ces questions aussi actuelles que fondamentales. Et souhaitable qu'elle se positionne clairement sur cette question dans un texte officiel de consensus.
ENGLISH:
Loss of control over alcohol drinking is a fundamental feature of alcohol-dependence. In the 1970's, a boisterous debate had taken place within the specialists to determine whether this loss of control is permanent and irrevocably condemns patients to a lifelong abstinence from alcohol. Controlled-drinking programs emerged as interesting alternatives for helping some of the alcohol-dependent patients to fight against loss of control. In 2001, official French guidelines on alcohol-dependence were published. This document did not say a word about the previous international debate, and clearly opted for defining abstinence as the only credible treatment goal. More than 10 years later, 4 types of arguments should prompt to think that new guidelines are needed.
- Recent epidemiological data show that there are actually many types of alcohol-dependent patients, with very heterogeneous profiles and various outcomes. Among the patients, it seems that a minority, maybe 10 to 25%, may regain a lasting control over alcohol drinking.
- Official national statements require being based on thorough methodological work, including a deep and transparent analysis of the medical literature. The 2001 official recommendations on abstinence care programs did not result from such a systematic approach.
- All around the world, numerous foreign official guidelines now propose using controlled drinking care schemes, which are not supposed to be applied instead of abstinence-based programs, but should complete them and be proposed to patients who are not willing to maintain abstinence at a given stage.
- Fulfilling the patient-drawn care strategy is the new global approach in current health policies, since the World Health Organization promotes the concept of empowerment, which aims at banishing "doctor knows best" approaches.
Consequently, it appears that the classical "only-abstinence" system may be well-fitted for some specific types of patients, but should also be completed by other care offers, which may include controlled drinking programs.
Les données épidémiologiques dont nous disposons aujourd'hui montrent qu'il existe manifestement des profils très variés de patients alcoolodépendants, avec des trajectoires évolutives et un pronostic parfois radicalement opposés. Pourquoi alors continuer à imposer le modèle historique néphaliste de prise en charge, avec pour objectif unique l'abstinence, qui semble aujourd'hui trop rigide pour répondre au mieux à un panel de situations très différentes ? Il serait indispensable que la communauté addictologique française débate de ces questions aussi actuelles que fondamentales. Et souhaitable qu'elle se positionne clairement sur cette question dans un texte officiel de consensus.
ENGLISH:
Loss of control over alcohol drinking is a fundamental feature of alcohol-dependence. In the 1970's, a boisterous debate had taken place within the specialists to determine whether this loss of control is permanent and irrevocably condemns patients to a lifelong abstinence from alcohol. Controlled-drinking programs emerged as interesting alternatives for helping some of the alcohol-dependent patients to fight against loss of control. In 2001, official French guidelines on alcohol-dependence were published. This document did not say a word about the previous international debate, and clearly opted for defining abstinence as the only credible treatment goal. More than 10 years later, 4 types of arguments should prompt to think that new guidelines are needed.
- Recent epidemiological data show that there are actually many types of alcohol-dependent patients, with very heterogeneous profiles and various outcomes. Among the patients, it seems that a minority, maybe 10 to 25%, may regain a lasting control over alcohol drinking.
- Official national statements require being based on thorough methodological work, including a deep and transparent analysis of the medical literature. The 2001 official recommendations on abstinence care programs did not result from such a systematic approach.
- All around the world, numerous foreign official guidelines now propose using controlled drinking care schemes, which are not supposed to be applied instead of abstinence-based programs, but should complete them and be proposed to patients who are not willing to maintain abstinence at a given stage.
- Fulfilling the patient-drawn care strategy is the new global approach in current health policies, since the World Health Organization promotes the concept of empowerment, which aims at banishing "doctor knows best" approaches.
Consequently, it appears that the classical "only-abstinence" system may be well-fitted for some specific types of patients, but should also be completed by other care offers, which may include controlled drinking programs.
Affiliation :
Service d'addictologie, CHRU de Lille, France
Cote :
Abonnement