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Les Chemins Du Traitement De Raddictionl Jacques Besson Service De Psychiatrie Communautaire Duchuv,Lausanne, Switzerland

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Les Chemins Du Traitement De Raddictionl Jacques Besson Service De Psychiatrie Communautaire Duchuv,Lausanne, Switzerland Date: 27.02.2013 EMH Schweizerischer Ärzteverlag AG Genre de média: Médias imprimés N° de thème: 377.6 4132 Muttenz Type de média: Presse spécialisée N° d'abonnement: 1072864 061/ 467 85 55 Tirage: 3'380 Page: 23 www.sanp.ch Parution: 8x/année Surface: 141'369 mm² Les chemins du traitement de raddictionl Jacques Besson Service de psychiatrie communautaire duCHUV,Lausanne, Switzerland Funding / potential competing interests:Nofinancial support and no other potential conflictofinterest relevant to this article were reported. Summary Approaches to the treatment of addiction Addiction is a challenge for public and mental health systems. What is the role of psychiatry in the interdisciplinary approach of the four pillars policy in Switzerland? For fifteen years the dialogue has evolved from a focus on the substances to a new focus on the persons. One has to pass from the moral judgement to a clinical and scientific one. On the level of public health policy and institutions, the building of a network between the actors in the field of the addictions allows the match- ing of the patients' needs to the environment's resources, with the aim of recovery. The Canton of Vaud has developed an indication process based on validated instruments, für addiction problems requiring public funding. Moreover, the progress in neuroscience increases our knowledge of addiction psychiatry. Indeed, the epidemiology of psychiatric comorbidities, the genetics, the brain imagery or psychophysiology contribute to the scien- tific foundation of addictology and allow a better individualisation of the treatments. A particularly important aspect für the clinicians is the place of psycho- traumatic antecedents in the genesis of addiction. New knowledge about stress, trauma and addiction justifies reconsideration of the treatment process, from the street to the recovery within the community. A "phase- oriented treatment" programme, targeting addicted patients with traumatic antecedents is now starting at the Community Psychiatry Service of the Uni- versity Hospitals in Lausanne, Switzerland. Key words: addiction; treatment; mental health Introduction Les chemins du patient dans les addictions sont aussi les chemins d'une nouvelle science, baddictologie, et les che- mins d'un psychiatre dans les institutions du Canton de Valid et de la Suisse. Pour aborder le sujet,ii taut tout d'abord bien poser les questions. Qu'est-ce que l'addiction? Quels en sont les traitements? Quelle est la place de la psychiatrie, et quelle psychiatrie? Quels patients pour quels traitements ä quel moment? Quels fondements scientifiques et quelles perspec- tives d'avenir sont-ils ä notre disposition [1]? Observation des médias ARGUS der Presse AG Réf. Argus: 49437775 Analyse des médias Rüdigerstrasse 15, case postale, 8027 Zurich Coupure Page: 1/5 Gestion de l'information Tél. 044 388 82 00, Fax 044 388 82 01 Services linguistiques www.argus.ch Date: 27.02.2013 EMH Schweizerischer Ärzteverlag AG Genre de média: Médias imprimés N° de thème: 377.6 4132 Muttenz Type de média: Presse spécialisée N° d'abonnement: 1072864 061/ 467 85 55 Tirage: 3'380 Page: 23 www.sanp.ch Parution: 8x/année Surface: 141'369 mm² droit, (conomie) et d'une importante interdisciplinarite. Correspondance: C'est dans ce nouveau contexte que le Centre hospitalier Prof. Jacques Besson Service de psychiatrie communautaire du CHUV universitaire vaudois (CHUV) inaugure en 1996 un centre CH-1005 Lausanne d'accueil interdisciplinaire pour patients toxicodependants Switzerland jacques.besson[at]chuv.ch Cet article est base sur un discours tenu ä la reunion annuelle II convient egalement de bien saisir les elements histo- de la Societe Suisse de Psychiatrie et Psychotherapie, qui a eu lieu riques et contextuels. Le Canton de Vaud a une large tra- du11au13septembre 2012 ä Interlaken. dition viti-vinicole l'exposant aux problemes d'alcool. Au(le Centre St-Martin) et unc unite hospitaliere specialisee XIX siecle, un Vaudois, le pasteur Louis-Lucien Rochat, aen 1998 (La Calypso, site de Cery). Ces nouvelles unites se fonde la Croix-Bleue. sont largement inspirees des succes de l'alcoologie interdis- En 1975 ä Lausanne, on assiste ä wie experience inter-ciplinaire et ont ete vivemem soutenues par l'Association disciplinaire originale sous l'egide de l'Armee du Salut et deVaudoise de Medecins Concernes par la Toxicodependance son service social, creant une clinique specialisee dans le(AVMCT). Des lors, on assiste ä la mise en reseau des acteurs sevrage des alcooliques en collaboration avec la Polichniquemedicaux cl sociaux, ambulatoires, hospitaliers et residen- medicale universitaire et le Centre psychosocial de la Poli-tiels, somatiques et psychiatriques 141. clinique psychiatrique universitaire (la Clinique du Vallon). De plus, comme centre universitaire, le CHUV a deve- Cette experience donnera naissance en 1987 ä la nouvelleloppe plusieurs programmes de formation et des recherches Unite multidisciplinaire d'alcoologie, federant les acteurs duinterdisciplinaires. Les plus recents developpemems concer- Departement de medecine du CHUV, la Fundation vaudoisenem lacreation d'une equipe mobile d'addictologie de contre l'alcoolisme et la Clinique du Vallon. Ces travaux unihaison dans le cadre d'un programme pour les patiems suivis et soutenus par le Service de la sante publique, ilsclits «double diagnostic» (addiction et psychiatrie). En effet, ont abouti ä la creation du Centre de traitement en alcoolo-comme le Canton de Vaud ne dispose pas de local d'injection gie du CHUV en 2000 121. ni de programme de prescription medicale d'heroine, une Sur le plan des drogues illegales, rappelons que la Suissealternative interessante pour acceder aux patients resis- a ete veritablement traumatisee par l'apparition des scenestants au traitement consistecibler leurs nombreuses co- ouvertes ä la fin des annees 1980. L'epidemie du SIDA amorbidites. justifie la multiplication des dispositifs ä senil bas et des trai- tements de substitution facilites. Apres plusieurs votations populaires, la Suisse a inscrit dans la loi sa politique integreePrise en charge interdisciplinaire et en röseau dite des quatre piliers, alliant prevention, therapie, repres- sion et reduction des risques. 11 en a resulte un importantL'existence depuis 1996 d'un centre d'accueil, d'investiga- changement de paradigme 131. tion et d'orientation, qui fonctionne comme centre de refe- En effet, au plan des representations sociales, les addic-rence interdisciplinaire ä disposition du reseau regional a tions relevaient traditionnellement du jugement moral: lesfranchement facilite les collaborations, notamment avec les patients etaient consideres comme relevant du vice, de lamedecins generalistes. Ceux-ci constituent la premiere ligne paresse et de la mauvaise volonte. L'impuissance des mede-pour les traitemems de substitution avec de la methadone, cins releguait les patients au munde social, des patientsmais ont besohl de sonnen de la pari du Centre de reference, pauvres pour une medecine pauvre. II lallait donc changerpour les aspects d'accucil a seuil bas, pour Linvestigation et de paradigme et passer au jugement clinique et scientifique.le traitemem des comorbidites psychiatriques, pour Laccom- L'addiction apparait alors comme un carrefour psycho-pagnement socio-educatit et pour des interventions de crise somatique et psychosocial, pathologie typique de la mo-chez leurs patients substitutes. Sur les 2000 traitements de dernite. Unc nouvelle science est nee: l'addictologie. Celle-cisubstitution dll Camon de Va ud, environ 1500 som pris en dispose de modeles animaux translationnels, d'imagerie ce-charge par les medecins de premier recours de LAVMCT avec rebrale fonctionnelle,une recherche clinique fondee surle soutien des centres de reference. II s'agit d'une reussite de les prenves, de l'apport des sciences humaines (sociologie,Lintegration de la psychiatrie et de la medecine generale Observation des médias ARGUS der Presse AG Réf. Argus: 49437775 Analyse des médias Rüdigerstrasse 15, case postale, 8027 Zurich Coupure Page: 2/5 Gestion de l'information Tél. 044 388 82 00, Fax 044 388 82 01 Services linguistiques www.argus.ch Date: 27.02.2013 EMH Schweizerischer Ärzteverlag AG Genre de média: Médias imprimés N° de thème: 377.6 4132 Muttenz Type de média: Presse spécialisée N° d'abonnement: 1072864 061/ 467 85 55 Tirage: 3'380 Page: 23 www.sanp.ch Parution: 8x/année Surface: 141'369 mm² dans une perspective communallidirC. Developper les ressources humaines Ull SOUtiell pedagogique est offen de plus par de la for- Etablir des liens avec d'autres secteurs mation en ligne (Formatox) et Im programme d'intervision Surveiller ia sante mentale des minorites regionialise (Programme de Perfectionnement des Medecins Soutcnir la recherehe. dans le domaine de la Toxicomanic [PPMTI). Un instrumem Une pyramide des besoins de la population generale a d'evaluation clinique rapide (Rapid Addiction Profile [RAP] montre que les besoins les plus specialises etaient les moins aete developpe pour aider les intervenants ä adopter frequents et les plus coüteux, dans un rapport inverse aux une approche mullidimensionnelle de haddiction, imegrant bcsoins communautaires cl 10 eux sont tres importants et de les dimensions somatique, psychiatrique, de crise et descogts plus eleves. ressources disposition. Des scores de 15 4 pour ehaque C'est la raison pour laquelle depuis une dizaine d'annees, dimension aident ä fixer des priorites. Par exemple, pour la le Camon dc Vaud developpe cm ne chainc de soins «alcool»
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