Yann Le Strat

First positive reactions to cannabis constitute a priority risk factor for cannabis dependence

AIMnTo assess the association between first reactions to cannabis and the risk of cannabis dependence.nnnDESIGNnA cross-sectional population-based assessment in 2007.nnnSETTINGnA campus in a French region (Champagne-Ardennes).nnnPARTICIPANTSnA total of 1472 participants aged 18-21 years who reported at least one life-time cannabis consumption, of 3056 students who were screened initially [the Susceptibility Addiction Gene Environment (SAGE) study].nnnMEASUREMENTSnPositive and negative effects of first cannabis consumptions, present cannabis dependence and related risk factors were assessed through questionnaires.nnnFINDINGSnu2003 The effects of first cannabis consumptions were associated dose-dependently with cannabis dependence at age 18-21 years, both according to the transversal approach of the SAGE study and to the prospective cohort of the Christchurch Health and Development Study (CHDS) assessed at the age of 25 years. Participants of the SAGE study who reported five positive effects of their first cannabis consumption had odds of life-time cannabis dependence that were 28.7 (95% confidence interval: 14.6-56.5) higher than those who reported no positive effects. This association remains significant after controlling for potentially confounding factors, including individual and familial variables.nnnCONCLUSIONSnThis study suggests an association between positive reactions to first cannabis uses and risk of life-time cannabis dependence, this variable having a central role among, and through, other risk factors.

Gender differences in firesetting: Results from the national epidemiologic survey on alcohol and related conditions (NESARC)

This study presents gender differences in sociodemographics and in psychiatric correlates of firesetting in the United States. Data were derived from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a representative sample of U.S. adults. Face-to-face interviews of more than 43,000 adults were conducted in the 2001-2002 period. This study focused on the 407 subjects with a lifetime history of firesetting. The prevalence of lifetime firesetting in the U.S. was 1.7% in men and 0.4% in women. Firesetting was significantly associated with a wide range of antisocial behaviors that differed by gender. Multivariate logistic regression analyses indicated associations in both genders with psychiatric and addictive disorders. Men with a lifetime history of firesetting were significantly more likely than men without such history to have lifetime generalized anxiety disorder as well as a diagnosis of conduct disorder, antisocial personality disorder, alcohol or cannabis use disorder, and obsessive-compulsive personality disorder. Women with a lifetime history of firesetting were significantly more likely than women without such history to have lifetime alcohol or cannabis use disorder, conduct disorder, and antisocial or obsessive compulsive personality disorder, as well as psychotic disorder, bipolar disorder or schizoid personality disorder. Women with a lifetime history of firesetting were significantly more likely than men with such history to have a lifetime diagnosis of alcohol abuse and antisocial personality disorder as well as a diagnosis of schizoid personality disorder. Our findings indicate that firesetting in women could represent a behavioral manifestation of a broader spectrum than firesetting in men.

The Role of Brief Motivational Intervention on Self-Efficacy and Abstinence in a Cohort of Patients with Alcohol Dependence:

Objectives: Brief interventions are effective in reducing heavy drinking in the general population but few studies examined whether it is also effective in alcohol dependent patients, and whether brief intervention increases self-efficacy. Method: One hundred and seven patients with alcohol-dependence were randomized in a controlled trial examining the efficacy of a brief motivational intervention on both self-efficacy level and days of abstinence. Results: We found that brief motivational interventions had no effect on days of abstinence, nor on self-efficacy, but that high self-efficacy was consistently correlated with a longer period of abstinence, at all assessment-points. Conclusion: Self-efficacy appears to be a crucial prognosis factor, and is not influenced by brief motivational interventions. Other types of specific psychotherapy, probably more intensive, may be more efficient in alcohol-dependent patients than motivational interventions.

Addiction to self-strangulation: a case-report

Introduction: DSM-5 mentions autoerotic asphyxia in the paraphilic disorders section, as a specifi er for the diagnostic of sexual masochism disorder. Strangulation activities have also been observed in the “choking game”. The term “strangulation activity” is considered as more appropriate than “choking game”. While sharing a same behavior, autoerotic asphyxia and non auto-erotic strangulation activities might represent a very distinct pattern of disorders. We describe here a case report of a 25-year old male internship student who has practiced manual self-strangulation up to 40 times a day since adolescence. In the examination of this case we identify individual clinical aspects of this case in a process-based holistic case conceptualization. Case description: The patient is a 25 years old male with a post-graduate degree who presented with a recent history of poor work performance and work-related stress during an internship. He has a concomitant history of both ketamine and cannabis use disorders, and reports urges to self-strangulate, sometimes specifi cally avoiding contact with friends engage in this behavior and that he has never attempted to discontinue self-strangulation. Neuropsychological assessment found a cognitive functioning below that expected given his educational level. Our intervention consists of a 3-weeks cognitive and motivational therapy program in addiction unit with associated abstinence. Conclusion: Autoerotic asphyxia is a behavior observed not only in the context of sexual masochism disorder, but also as a specifi c addictive behavior, in the absence of sexual arousal, possibly as a result of emotional dysregulation. Case Report Addiction to self-strangulation: a case-report Aurely Ameller1,2*, Yann Le Strat1-3, Marion Cadranel1, Celine Portalier1 and Caroline Dubertret1-3 1AP-HP, Centre Hospitalier Universitaire de Colombes (CHU Colombes), Hôpital Louis Mourier, Colombes, F-92700 France 2INSERM U894, Center of Psychiatry and Neurosciences, Paris, France 3Univ Paris Diderot, Sorbonne Paris Cité, Faculté de médecine Bichat-Lariboisière, France *Address for Correspondence: Aurely Ameller, MD, PhD, AP-HP, Centre Hospitalier Universitaire de Colombes (CHU Colombes), Hôpital Louis Mourier, INSERM U894, Center of Psychiatry and Neurosciences, France, Tel: 0147606409; Fax: 0147606740; Email: aurely.ameller@aphp.fr Submitted: 03 November 2017 Approved: 04 December 2017 Published: 05 December 2017 Copyright: 2017 Ameller A, et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited

AGONIST TREATMENT IN SUBSTANCE USE DISORDERS: Letters to the Editor

Liebrenz et al. [1] suggested that agonist substitution could be an alternative for some benzodiazepinedependent patients. In their thoughtful review, they compared the current usual treatment of benzodiazepine-dependent patients with the approach used in opiate dependence since the early 1960s, for which agonist therapy is considered as the gold standard. The use of nicotine replacement in nicotinedependent smokers also supports the hypothesis that agonist treatment can be useful in the management of substance users other than opiates. The efficacy of smoking cessation medication in supporting abstinence appears to be related directly to its ability to suppress withdrawal symptoms [2]. Furthermore, some evidence suggests that delta-9-tetrahydrocannabinol (THC), the main psychoactive component of cannabis, decreased withdrawal symptoms in cannabis-dependent patients [3–5], whereas various non-agonist treatments showed a lack of efficacy (for a recent review, see [6]). Nicotine replacement treatment and methadone do not usually give users a great deal of positive reinforcement for continued use, but rather prevent the negative reinforcement of withdrawal. Similarly, THC is not highly reinforcing in itself, even in chronic users [7], which might be a factor in successful agonist treatment that leads eventually to abstinence. In any case, the use of an oral form of THC might be expected to avoid the pulmonary complications of smoking cannabis [8]. While these results remain preliminary, they suggest that the effectiveness of agonist treatments is well known in both opiate and nicotine dependences and warrant further research, not only in benzodiazepine dependence, as suggested by Liebrenz et al., but also in cannabis dependence.