FRANÇAIS :
Si les trajectoires de sortie des addictions, en particulier de l'alcool, sont bien documentées, le passage des drogues à l'alcool l'est moins. Une approche biographique a permis d'analyser comment les personnes passent d'un produit à l'autre au long cours et comment elles analysent leurs trajectoires de sortie des addictions.
Méthodes : Trois cent quarante et une personnes (dont 34 % de femmes) ont été interrogées à l'aide d'un questionnaire biographique en région parisienne. Des questions ouvertes visaient à comprendre les liens qu'elles établissaient entre différents événements de leur vie, si elles avaient le sentiment d'être sorties de leur addiction et quels avaient été les éléments qui leur paraissaient des forces ou des faiblesses dans leur parcours.
Résultats : Tous sont polyconsommateurs. Quatre-vingt-deux personnes avaient déclaré une polyconsommation avec dominante alcool, sans consommation de drogues. Cent vingt et une ont été polyconsommateurs avec une dominante drogues (surtout héroïne), sans abus d'alcool, et avaient cessé leur consommation de drogues en moyenne dix ans avant l'enquête. Le dernier groupe comprend 138 personnes qui avaient été dépendantes à l'héroïne ou à la cocaïne et à l'alcool au cours de leur vie. Un tiers (35 %) a été dépendant successivement à l'alcool puis aux drogues, et plus de la moitié (55 %) dépendants successivement aux drogues puis à l'alcool. Un dixième a été codépendant, c'est-à-dire dépendant simultanément à l'alcool et aux drogues (10 %). Le groupe ayant été principalement dépendant à l'alcool était le plus âgé, en moyenne 49,7 ans, et 55 % d'entre eux étaient abstinents au moment de l'enquête. Au contraire, le groupe sans dépendance à l'alcool, était plus souvent sous traitement de substitution aux opiacés.
Conclusion : Certaines personnes sont prises en charge pendant des décennies par les centres de soins des addictions, passant d'une dépendance à une autre. Leur consommation d'alcool devrait être évaluée et objet d'attention afin de leur éviter de sortir des addictions à un autre produit par un usage abusif d'alcool.

ENGLISH:
Pathways from alcoholism to recovery are documented; less often are those from drug addiction to alcoholism. Biographical approaches allow analyzing how people change their uses and talk about their trajectories of recovery.
Methods: Three hundred and forty-one people (34% women) in the Paris area were questioned on their trajectories with a biographical questionnaire. Some open questions were aimed to understand the connection they made between events in their lives, how recovered they felt and what they considered strengths or obstacles. All the participants had stopped at least one product. Their mean age was 43, and 26% were over 50.
Study objectives: How can the differences between one substance addicts and dual abusers be explained? Can we hypothesize a better result for the patients with a single dependence to alcohol in their lives for the following two reasons? (1) They could really be taken in charge for their alcoholism whereas the dual abusers mostly receive cared for their illicit drug problems with an under estimation of their problem with alcohol. In this case, they turn to alcohol after weaning themselves from their drug dependence so as to return to a social consumption, especially when they are given an opiate treatment. (2) Conversely could we suggest that the dual substance abusers had different trajectories from their childhood (more adverse events, more social difficulties, mental health problems), and that this accumulation explains their skipping from one substance or behaviour to another without any real recovery for decades?
Results: All respondents were polydrug users. Eighty-two had been dependent mainly on alcohol. One hundred and twenty-one people had been drug addicts (mostly heroin), which they had stopped on average ten years before the survey. The last group included 138 persons who had been heroin or cocaine addicts and alcoholics in their lives, a third of whom had been dependent on alcohol before their drug addiction (35%), a tenth on both at the same time (10%) and more than half of the users (55%) had turned from drug addiction to alcoholism. The group concerning alcohol dependence includes the oldest participants, on average 49.7, and 55% of them were abstinent at the survey. Conversely, the group "with no alcohol dependence" had mainly turned to opiate treatments. Their histories in dependence and in various social statuses also showed a longer duration out of employment, in sickness or invalidity, or in prison, for the drug dependents as opposed to the "mainly" alcoholics. The population with dual substance abuse experienced twice as many adverse childhood events as the others (P Conclusion: Some people stay for decades in drug addiction centers switching from one dependence to another. Their alcohol drinking should be addressed earlier to prevent them from turning to drinking excessively in order to wean themselves from their drug addiction.