Les Troubles Liés À L'utilisation De Substances

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Les Troubles Liés À L'utilisation De Substances LES RAPPORTS DE RECHERCHE DE L’INSTITUT LES TROUBLES LIÉS À L’UTILISATION DE SUBSTANCES PSYCHOACTIVES Prévalence, utilisation des services et bonnes pratiques Rédaction du document Maria Chauvet, M. Sc. Coordonnatrice, Infrastructure de recherche, Centre de réadaptation en dépendance de Montréal - Institut universitaire (CRDM-IU) Ervane Kamgang, M. Sc. Agente de recherche, Infrastructure de recherche, CRDM-IU André Ngamini Ngui, Ph.D. Chercheur d’établissement, CRDM-IU Marie-Josée Fleury, Ph.D. Directrice scientifique, CRDM-IU Révision scientifique Hélène Simoneau, Ph.D. Chercheuse d’établissement, CRDM-IU Ce document a été produit par le Centre de réadaptation en dépendance de Montréal - Institut universitaire (CRDM-IU) Ce document est disponible intégralement en format électronique (PDF) sur le site Web du CRDM-IU au : www.dependancemontreal.ca Ce document peut être photocopié avec mention de la source. DÉPÔT LÉGAL, 1er trimestre de 2015 Bibliothèque et Archives nationales du Québec Bibliothèque et Archives Canada ISBN : 978-2-9810903-6-2 MOT DE PRÉSENTATION Le Centre de réadaptation en dépendance de Montréal (CRDM) a été désigné Institut universitaire (IU) sur les dépendances par le ministère de la Santé et des Services sociaux le 21 août 2007. En vertu de ce statut, il doit contribuer au développement de services de pointe, à la formation des professionnels du réseau de la santé et des services sociaux, à la recherche et à l’évaluation des modes d’intervention en dépendance. Dans le cadre de sa mission universitaire, le Centre travaille notamment à documenter l’ampleur du phénomène des dépendances au Québec, les facteurs qui y sont associés et les processus pouvant expliquer les trajectoires de consommation ou de rétablissement, de même que l’influence de certains milieux ou réseaux sociaux. Il travaille également à documenter les meilleurs modèles de réadaptation en dépendance. La direction générale du CRDM-IU conjointement avec la direction de la mission universitaire et scientifique sont fières de vous présenter les rapports de recherche de l´IU. Ces rapports visent à rendre accessibles les résultats de recherche à l´ensemble du personnel du CRDM-IU, aux partenaires de l´IU, à la communauté universitaire et à toute autre personne intéressée par leur contenu. Bref, ces rapports de recherche constituent une forme de documentation complémentaire aux articles de revues scientifiques. Nous souhaitons vivement que ce rapport rapproche les milieux de la recherche et de l´intervention et, surtout, qu’il alimente la réflexion et la recherche de solutions afin d’améliorer l´intervention auprès des personnes dépendantes ainsi que les membres de leur entourage. Jacques Couillard Directeur général CRDM-IU III LES TROUBLES LIÉS À L’UTILISATION DE SUBSTANCES PSYCHOACTIVES Prévalence, utilisation des services et bonnes pratiques TABLE DES MATIÈRES LISTE DES ABRÉVIATIONS ET DES SIGLES .............................................................. 1 INTRODUCTION .......................................................................................................... 4 1. CONTINUUM DE CONSOMMATION : DE LA CONSOMMATION À FAIBLE RISQUE AUX TROUBLES LIÉS À L’UTILISATION DE SUBSTANCES PSYCHOACTIVES (TUS) ......................................................... 6 1.1 Consommation d’alcool ...................................................................................7 1.2 Consommation de drogues illicites ................................................................ 8 1.3 Directives de consommation d’alcool à faible risque au Canada ............... 10 1.4 Consommation d’alcool à risque ................................................................... 11 1.5 TUS ................................................................................................................. 14 1.5.1 TUS-Alcool ................................................................................................19 1.5.2 TUS-Drogues illicites ................................................................................20 1.6 Usage non médical des médicaments délivrés sur ordonnance et nouvelles substances .............................................................................. 22 1.7 Phénomène de polyconsommation et des fêtes techno ou raves ............. 23 1.7.1 Polyconsommation ..................................................................................23 1.7.2 Phénomène des fêtes techno ou raves .....................................................25 1.8 Facteurs de risque et de protection pour les TUS ........................................27 2. MÉFAITS ET COÛTS SOCIAUX LIÉS À L’USAGE DES SUBSTANCES PSYCHOACTIVES (SPA) ...................................................................................... 31 2.1 Morbidité et mortalité liées à l’usage de SPA dans le monde ..................... 32 2.2 Méfaits, morbidité et mortalité liés à l’usage de SPA au Canada et au Québec ................................................................................................. 33 2.3 Coûts sociaux de l’usage de SPA au Canada et ailleurs ............................ 35 3. DES PERSONNES AUX PRISES AVEC UN TUS ET AYANT DES BESOINS SPÉCIFIQUES .............................................................................. 37 IV 3.1 Troubles concomitants ..................................................................................37 3.2 TUS et santé mentale ....................................................................................37 LES TROUBLES LIÉS À L’UTILISATION DE SUBSTANCES 3.3 TUS et santé physique ..................................................................................47 PSYCHOACTIVES Prévalence, utilisation 3.4 TUS ayant un profil transitoire ou chronique ............................................... 48 des services et bonnes pratiques 4. UTILISATION DES SERVICES POUR LES TUS ET PERSÉVÉRANCE AU TRAITEMENT ................................................................................................. 57 4.1 Historique du programme-services Dépendances au Québec : du modèle moraliste au modèle biopsychosociale ......................................57 4.2 Principaux dispensateurs du programme-services Dépendances ........... 59 4.3 Portrait de l’utilisation des services pour les personnes ayant un TUS.... 62 4.4 Déterminants de l’utilisation des services .................................................. 63 4.1.1 Facteurs prédisposants ...........................................................................65 4.1.2 Facteurs facilitants .................................................................................. 67 4.1.3 Facteurs de besoins ................................................................................. 67 4.5 Persévérance en traitement ........................................................................ 68 5. EFFICACITÉ DES TRAITEMENTS ET BONNES PRATIQUES .............................. 72 5.1 Rétablissement ..............................................................................................72 5.2 Efficacité des traitements .............................................................................75 5.3 Bonnes pratiques ..........................................................................................76 5.3.1 Dépendance : approches, thérapies, stratégies, programmes ou modèles ..........................................................................80 5.3.1.1 Approches cliniques ........................................................................ 80 Approche biopsychosociale ............................................................ 80 Approche systémique .................................................................... 80 Approche du rétablissement (Recovery) ........................................... 81 Approche axée sur les forces .......................................................... 81 Approche de réduction des méfaits ................................................ 82 Approche par étapes (Stepped-Care) ................................................ 85 Modèles de traitement basés sur l’approche des 12 étapes .............. 86 5.3.1.2 Thérapies psychosociales et traitement pharmacologique ..................... 88 Thérapies cognitives-comportementales ......................................... 88 Approche de renforcement par la communauté .............................. 89 Prévention de la rechute .............................................................. 90 Approches motivationnelles ........................................................... 91 V Entretien motivationnel ............................................................... 91 Motivational Enhancement Therapy ................................................. 93 LES TROUBLES Supportive-Expressive Psychotherapy ................................................ 93 LIÉS À L’UTILISATION DE SUBSTANCES ...................................................... PSYCHOACTIVES Traitements pharmacologiques 94 Prévalence, utilisation des services et bonnes pratiques Modèles incluant les membres de l’entourage ................................. 96 Thérapie conjugale comportementale ............................................ 96 Interventions pour amener un membre à changer : « L’intervention » et le « Community Reinforcement Approach and Family Training » ...................................................... 97 5.3.1.3 Stratégies organisationnelles et cliniques ........................................... 99 Stratégies pour mieux joindre, orienter et faciliter l’accès au traitement .....................................................................
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