Michel Landry

The objective of this research is to evaluate the outcomes of a treatment for addicts. 123 subjects were tested before treatment and at 5, 8 and 11 months follow-up periods with a French version of the Addiction Severity Index (ASI). Exposure to treatment was based on the number of clients’ contact-hours with a therapist. The sample was divided into three groups according to the number of hours spent in treatment. The data was analysed using MANOVA on the seven scales of the ASI for the three groups and the four time periods. Results showed that all groups improved significantly but that this improvement was not related to the number of hours spent in treatment

Substance addiction in young adults is particularly problematic. Yet, much remain at stake in understanding the specifics of this population's access to services. The objective of this study is to explore young adults' initiation of substance misuse treatment. Our study sample was composed of 35 individuals aged 18 to 30 with problematic psychoactive substance use who have been identified in criminal courts, hospital emergency departments, and Health and Social Services Centers in Québec (Canada). A thematic analysis was performed on the 62 semi-structured interviews conducted with participants. Three components emerged. First, personal elements-expectations, individual motivations, perceptions of use, and capacity to control it-influence initiation of substance misuse treatment. Second, family and peers have noticeable influences. Finally, system characteristics and prior care experiences also shape the process. Consideration should be given to tailor interventions that can...

Depuis les années 2000, on estime que de 5 % à 8 % des jeunes Québécois éprouvent des difficultés importantes de consommation de substances psychoactives (SPA), ce qui pose la question cruciale des traitements de ces problèmes. Cet article propose d’abord un survol des principaux services offerts aux jeunes et des facteurs, liés ou non au traitement, pouvant expliquer les changements dans le processus de rétablissement des jeunes toxicomanes québécois. La présentation de cinq études dirigées par les auteurs du présent article permet une certaine réflexion sur les services offerts aux jeunes Québécois ayant un problème de consommation de SPA. Il ressort, notamment, qu’une diminution de la consommation de SPA survient dans les six à douze mois suivant l’admission des jeunes dans l’un des traitements. Il ne s’agit généralement pas d’une abstinence complète, ce qui n’est d’ailleurs pas visé par la plupart des jeunes en traitement. Des changements dans d’autres sphères de leur vie, les o...

The objective of this research is to evaluate the outcomes of a treatment for addicts. 248 subjects were tested before and 5 months after treatment with the Addiction Severity Index (ASI). Exposure to treatment was based on the number of clients' contact hours with a therapist. The sample was divided into three groups according to number of hours spent in treatment. The data were analyzed using MANOVA on the seven scales of the ASI for the three groups and the two time periods. Results showed that the severity of addiction problems decreased after treatment, and decreased more for subjects who underwent treatment for a longer period of time.

Treatment dropout is an important concern for professionals working in mental health. While this problem is common, the highest attrition rates have been observed in drug rehabilitation programmes. The present study focuses on the therapeutic alliance, a process variable that has been associated repeatedly with positive treatment outcome in the scientific literature. Respondent behaviour indicative of commitment or resistance to treatment was examined in combination with therapist prognoses. A total of 248 subjects, classified into three subpopulations (justice, n = 50; mental health, n = 53; comparison group, n = 145), participated in the study. Analyses aimed at predicting dropout were conducted using Cox proportional-hazards regressions. The moderating effect of sub-population was tested. Respondents completed a multi-dimensional measure of alliance [California Psychotherapeutic Alliance Scale (CALPAS-P)]. Therapists rated the behaviour of respondents in treatment and made prognoses about perseverance and improvement. An increased risk of dropout was predicted when patients viewed themselves as less committed and perceived the therapist as less understanding and less involved. Therapist prognosis of perseverance was also predictive of dropout. The relationship between patient/therapist evaluations and dropout is affected differently across subpopulations by means of a moderation effect. This paper demonstrates the capacity to predict dropout by measuring therapeutic alliance, therapist prognoses and therapist appraisal of patient behaviour. Moreover, the moderation effect of clinical subpopulation on treatment process variables and dropout is supported in the context of drug rehabilitation programmes.

People with mental disorders (MD) have high rates of substance use problems (SUP) that are undertreated and understudied despite their adverse outcomes. The objective of this study is to examine barriers and facilitators that influence help-seeking to addiction treatment from the perspective of people with co-occurring MD and SUP. Forty-three individuals with MD and SUP were selected from the sample (n = 127) of a larger research project. This sub-group participated in semi-structured interviews and completed questionnaires. Interview contents were thematically analyzed using a trajectory approach. Based on participants’ addiction trajectories, two mental health experiences were identified: the “multiple disorders experience” and the “anxiety disorder experience.” The analysis highlighted how participants relate to barriers and facilitators to addiction help-seeking at the individual level (denial/minimization of problematic drug use, fear of being labeled an addict, influence of social networks, and knowledge of addiction services) and health system level (waiting time, costs, relationships with health providers, therapeutic approaches, and availability of psychological support). Interventions should be sensitive to the different experiences of people with MD and SUP. Integrated addiction services and a “no wrong door” approach are suggested.

La prise en charge sociosanitaire de l’usager de substances psychoactives (SPA) n’a cessé d’évoluer au gré des croyances et des découvertes concernant ce nouveau champ d’intervention. Une récente enquête que nous avons conduite sur l’usage de SPA des jeunes Inuits de même qu’une recherche qualitative sur le point de vue des Nunavimmiut quant à la situation de consommation au Nunavik nous permettent de poser un regard sur l’état de situation des pratiques pour aider les personnes à faire face à leur problème de consommation. Qu’en est-il du modèle de l’abstinence et des stratégies de réduction des méfaits dans le contexte inuit? Que pensent les jeunes, les parents, les leaders et les aînés de l’état actuel des services en toxicomanie dans le Nord québécois. Quelles sont les stratégies de résolution de problèmes privilégiées par les Inuits? Les propos recueillis auprès de 109 Nunavimmiut sur la question des services seront analysés afin de nous aider à explorer l’idée selon laquelle l...

Au Québec, à la fin des années 80, l’approche de réduction des méfaits s’est conjuguée à d’autres courants qui avaient déjà commencé à y exercer leur influence pour provoquer une profonde remise en question de la philosophie de traitement et des méthodes d’intervention utilisées alors dans le domaine de la réadaptation en toxicomanie. Cet article décrit plus particulièrement l’impact de l’implantation de cette approche par le Centre Dollard-Cormier en 1997. On y affirme qu’elle a constitué un point de ralliement pour tous les intervenants de ce centre et favorisé, particulièrement à travers l’expression « haute tolérance », l’adoption de valeurs telles que la flexibilité, l’accessibilité, l’acceptation de toutes les personnes qui demandent de l’aide, quels que soient leurs motifs et la précarité de leur situation. À l’aide de l’expérience des cinq dernières années, nous établissons un bilan des forces et des limites de cette approche dans un contexte de réadaptation. Au nombre des f...

Dans le présent article sont exposés les résultats d’une étude sur la consommation de substances psychoactives au Nunavik. Le volet qualitatif de cette étude comporte 108 entretiens semi-dirigés auprès de jeunes, de parents, de leaders et d’Aînés de quatre villages. L’analyse de contenu thématique des résultats a mis en lumière différentes raisons et différents effets de la consommation au Nunavik du point de vue des participants. Parmi les raisons évoquées par les interviewés, on retrouve le plaisir, l’ennui et le manque d’activités, la « colonisation », l’adaptation (coping) à divers problèmes (pauvreté, abus, suicide) et la transmission intergénérationnelle. Sur la question des conséquences de la consommation, les effets sur la famille, dont la violence conjugale et la négligence envers les enfants, mais aussi les comportements déviants, incluant la conduite avec capacités affaiblies, les voies de fait et les délits lucratifs ont été évoqués. Ces résultats sont discutés à la lumi...

This article pursues the double goal of a review of the literature and of an update of the documentation on remission without treatment for individuals with dual diagnosis disorders. It has been elaborated from a selection of 26 publications among the 95 selected listed references. The difficulties in the responsibility of taking charge of patients, the increase in demand, the low rate of success of the treatment are all elements that made natural recovery seem an impossible phenomenon. This article explores the items related to natural recovery and provides the groundwork for a better definition of this phenomenon : must one regard natural recovery as a reduction in the volume of alcohol consumed, as a reduction in the clinical signs of alcohol disorders ? What is the time required before one can assume the stability of the phenomenon and the avoidance of relapses ? These questions must be considered as empirical studies show that the majority of people with a problematic use of al...

This paper is a retrospective study with a five year follow-up which examines the variations in substance use and the determinants of these variations. This exploratory research studied a sub-sample of 22 participants, selected from an initial sample of 197 patients with concurrent substance use and other mental health disorders. At the quantitative level, the statistical analysis shows an improvement in the problematic use of alcohol and drugs but no change in psychological state, health, family and interpersonals relations, as well as employment. At the qualitative level, the analysis of the participant's subjective view indicates that the two main elements of progression in substance use are the effects and the availability of substances. The main elements of reduction in substance use are the use of services, the personal techniques developed by participants, the family network, physical health, lack of financial resources, "occupational" activities, and a process ...

Publicly funded community-based physical therapy (PT) services in Canada's most populous province of Ontario were partially delisted, or deinsured, in April 2005. Two previous studies examined the short-term effects from the client and provider perspectives; and in this study, we follow up with participants from these preceding studies to assess long-term consequences of this policy. Sixteen of 18 providers (89%) and 64 of 98 clients (65%) agreed to participate in a follow-up telephone interview. Our results indicate that 12 months following delisting, and despite government assurances that access would be preserved, clients rendered ineligible for publicly funded services report ongoing access barriers across Ontario. Clients in this study also express concern about their overall health and report an increased use of other insured health professionals (e.g., physicians) and services (e.g., hospitals). On the other hand, providers within the network of publicly funded clinics report an important decrease in demand for PT services, whereas those from other settings report little change. We conclude that delisting policies may have long-term consequences on uninsured or underinsured clients and that evidence-based policy planning is warranted to ensure that the goals of reform are aligned with the desired outcomes at the client, provider, and system levels.

This research used a qualitative methodology and was conducted on a sample of 22 participants with concomitant substance-related and mental health disorders. Today, dual diagnosis patients represent the standard rather than the exception. Our objectives were to consider the elements and processes of the social network to explain variations in consumption of alcohol and drugs. The social network refers to all bonds established by patients, mainly family, couple, friends and therapist relationships. The 22 patients have used a specialized addiction treatment in Montreal (Canada). A focused qualitative interview was conducted with each participant using an audionumeric recording. The analysis follows the method of the mixed approach of Miles and Huberman, which combines the objectives of the grounded theory and the ethnography. All the interviews were transcribed then coded and analyzed with QSR N' Vivo 2.0. The method uses an iterative process making a constant return between verbatim and codes. The qualitative analyses present patients' perceptions on the increases and reductions in alcohol and drug consumption. Family network refers to participants where the family is named as supporting a decrease in drug consumption: couple network refers to intimate relations supporting a decrease in consumption. Mutual help network refers to alcoholics anonymous (AA) or other self-help groups. Several verbatim have been included. We propose strategies for the substance abuse treatment centers based on: (1) the paradox influence of the social network and the importance of clinical evaluation of patients of social networks; (2) emotions management, especially negative feelings, which include training of feeling, recognizing and naming, ability to the express and communicate to others; (3) importance of groups of mutual aid providing periods of sharing, validating individual experiences and pushing away loneliness; (4) function of social support of the clinical professionals as substitute of an overdrawn network.