Louise Nadeau - Profile on Academia.edu (original) (raw)
Papers by Louise Nadeau
PLOS ONE, Feb 24, 2016
Road crashes represent a huge burden on global health. Some drivers are prone to repeated episode... more Road crashes represent a huge burden on global health. Some drivers are prone to repeated episodes of risky driving (RD) and are over-represented in crashes and related morbidity. However, their characteristics are heterogeneous, hampering development of targeted intervention strategies. This study hypothesized that distinct personality, cognitive, and neurobiological processes are associated with the type of RD behaviours these drivers predominantly engage in. Four age-matched groups of adult (19-39 years) males were recruited: 1) driving while impaired recidivists (DWI, n = 36); 2) non-alcohol reckless drivers (SPEED, n = 28); 3) drivers with a mixed RD profile (MIXED, n = 27); and 4) low-risk control drivers (CTL, n = 47). Their sociodemographic, criminal history, driving behaviour (by questionnaire and simulation performance), personality (Big Five traits, impulsivity, reward sensitivity), cognitive (disinhibition, decision making, behavioural risk taking), and neurobiological (cortisol stress response) characteristics were gathered and contrasted. Compared to controls, group SPEED showed greater sensation seeking, disinhibition, disadvantageous decision making, and risk taking. Group MIXED exhibited more substance misuse, and antisocial, sensation seeking and reward sensitive personality features. Group DWI showed greater disinhibition and more severe alcohol misuse, and compared to the other RD groups, the lowest level of risk taking when sober. All RD groups exhibited less cortisol increase in response to stress compared to controls.
The dilemma of re-licensing DWI offenders: The offenders’ point of view
Accident Analysis & Prevention, Feb 1, 2016
In many jurisdictions, drivers convicted for the first-time of driving while impaired by alcohol ... more In many jurisdictions, drivers convicted for the first-time of driving while impaired by alcohol undertake a risk assessment that will determine the severity of sanctions and the remedial measures they must follow as requisites for re-licensing. There is uncertainty inherent in the assessment of risk for recidivism, however, many offenders feel unfairly assessed and discommoded by the decision-making process and its consequences. The objective of this qualitative study was to gain insight into the perspectives of offenders regarding re-licensing decision making and sanctioning. Specifically, in focus groups first-time offenders and recidivists were probed as to whether they favoured erring on the side of road safety in decision making, with its consequent greater risk of false positive assessments, or erring on the side of maintaining driving privileges, with its consequent greater risk of false negative assessments. In general, participants preferred a higher probability of false negative vs. false positive assessments. Most cited the consequences of sanctions and remedial measures as too severe to impose them on potentially low-risk drivers, as the assessment and monitoring protocols' limitations could lead to non-equitable treatment. At the same time, recidivists evoked a greater preference for a higher probability of false positive assessments compared to first-time offenders, as they believed that recidivism was more likely to follow a first conviction than did first-time offenders. This information can be useful for a more comprehensive and societally coherent exercise of DWI prevention policies.
Traffic Injury Prevention, May 11, 2018
In a pilot randomised controlled trial of contingency management (CM) and transdermal alcohol mon... more In a pilot randomised controlled trial of contingency management (CM) and transdermal alcohol monitoring (TAM) with driving while impaired by alcohol (DWI) offenders, perceptions regarding the acceptability of a TAM device, recruitment issues, and the impact of CM and TAM on alcohol use over a six-week period were evaluated. The results aimed to inform the design of future trials and programs involving CM and TAM for DWI remediation. TAM devices were affixed to 37 voluntary, community-recruited male DWI offenders with problem alcohol use. They were randomised to one of three groups: i) CM; ii) alcohol use feedback (FB); and iii) TAM device only (CTL). Quantitative and qualitative data were gathered on the acceptability of TAM devices and recruitment, while alcohol use was monitored via TAM and self-report. The TAM device was perceived positively, with benefits for reducing drinking noted. Nevertheless, some of its inconveniences appeared to influence participant recruitment and attrition, including its large size and lack of water-resistance. TAM data revealed a significant main effect of time for reduction in weekly peak transdermal alcohol concentration (p = 0.02), with a decrease between means of weeks 1 and 6 (M = 0.15, SE = 0.02 vs. M = 0.09, SE = 0.02; p = 0.005). No significant group effect was detected. TAM is a viable adjunct to CM with DWI offenders, though the TAM device used here may influence both study recruitment and adherence. These findings can guide the design of future studies into CM and TAM for DWI remediation.
Psychopharmacology, Sep 11, 2019
Background With driving while impaired by alcohol (DWI) representing a persistent burden on globa... more Background With driving while impaired by alcohol (DWI) representing a persistent burden on global health, better understanding and prevention of recidivism following a first-time DWI conviction are needed. Progress towards these goals is challenged by the marked heterogeneity in offender characteristics and a traffic safety literature that relies on subjective self-report measures and cross-sectional study designs. The present study tested the hypothesis that an objective neurobiological marker of behavioural maladjustment, the cortisol stress response (CSR), predicts future DWI and other traffic convictions over a 9-year follow-up period. Methods One hundred thirty-two male first-time DWI offenders and 31 non-offender comparators were recruited and assessed at intake for their substance use, psychosocial and psychological characteristics and CSR. Traffic conviction data were obtained from provincial driving records. Survival analysis estimated the association between CSR and risk of a traffic conviction over time. Results In support of our hypothesis, blunted CSR predicted traffic convictions during the follow-up duration. This effect generalized to both DWI offenders and non-DWI drivers. While CSR was lower in DWI offenders compared to non-offenders, it did not specifically predict recidivism in DWI offenders. Modelling results indicated that blunted CSR, along with DWI offender group membership, experience seeking and drug use frequency, may demarcate a high-risk driver phenotype. Conclusions CSR is a neurobiological marker of a driver phenotype with elevated generalized driving risk. For drivers with characteristics consistent with this phenotype, expanding the focus of intervention to address multiple forms of risky driving may be necessary to curb their overall threat to traffic safety.
Présenter ou non une utilisation problématique d’Internet : le point de vue de l’usager, du clinicien et de l’Internet Addiction Test
Drogues, santé et société, 2022
Santé mentale au Québec, Nov 5, 2003
Do the Consequences Experienced by the People in the Life of a Problem Gambler Differ Based on the Nature of Their Relationship with the Gambler?
Journal of Gambling Studies, 2021
Consequences experienced by the partners of individuals with a gambling disorder are well documen... more Consequences experienced by the partners of individuals with a gambling disorder are well documented. However, little is known about the deleterious effects experienced by other people than partners of gamblers. A better understanding of these consequences could help improve clinical practices. The goal of this paper is to compare the consequences experienced by partners of gamblers with those experienced by their close family members (parents, adult children, siblings) by using the categorization method proposed by Langham et al. (BMC Public Health, 2016). To achieve this goal, 46 semi-structured interviews were conducted. Results indicate that the extent and intensity of the consequences experienced vary widely based on their level of emotional and financial involvement with the gambler. Considering the specific elements involved for each type of person in a gambler’s life, future research should distinguish participants based on the nature of their relationship with the gambler.
Impacts relationnels et conjugaux vécus par les conjointes de joueurs pathologiques : comparaisons des perceptions des joueurs et de leurs conjointes
Psychotropes, 2022
The Canadian Journal of Psychiatry, 2018
Objectifs: La présente étude dresse le profil clinique des adolescents ayant consulté un centre d... more Objectifs: La présente étude dresse le profil clinique des adolescents ayant consulté un centre de traitement de la dépendance (CTD) au Québec en raison d’une utilisation problématique d’Internet (UPI) afin de développer les connaissances sur cette clientèle spécifique et de cibler avec justesse leurs besoins par rapport au traitement. Méthode: L’étude est réalisée auprès de 80 adolescents âgés entre 14 et 17 ans (M = 15,59) ayant consulté un CTD pour une UPI. Les adolescents ont pris part à une entrevue qui documente les habitudes d’utilisation d’Internet et leurs conséquences, la concomitance de troubles de santé mentale, ainsi que les relations familiales et sociales. Résultats: L’échantillon est composé de 75 garçons (93,8%) et de 5 filles (6,3%), qui passaient en moyenne 55,8 heures (ET = 27,22) par semaine sur Internet pour des activités non-scolaires ou professionnelle. Près de la totalité de ces jeunes (97,5%) présente un trouble de santé mentale en concomitance et plus de 7...
II y a dix ans, en 1979, la revue Santé mentale au Québec publiait un numéro spécial consacré aux... more II y a dix ans, en 1979, la revue Santé mentale au Québec publiait un numéro spécial consacré aux femmes et à leur santé mentale. Cette question faisait alors l'objet d'un débat de fond dans la société québécoise. En 1980, dans un colloque sur le thème de : Les Femmes et la Folie, plus de mille femmes -professionnelles, enseignantes, chercheures, intervenantes -se réunissaient à Montréal pour réfléchir et discuter de leur situation face à la médecine, à la psychiatrie et au système de soins et de services au Québec. L'essentiel de ce débat a été publié dans la revue Les Femmes et la folie au cours de la même année .
La r�mission sans traitement : �tat de la question pour une consommation probl�matique d�alcool
Ann Medico Psychol, 2008
Cet article poursuit le double objectif d’une recension des écrits et d’une mise à jour de la doc... more Cet article poursuit le double objectif d’une recension des écrits et d’une mise à jour de la documentation sur le thème de la rémission sans traitement des personnes souffrant d’une consommation problématique d’alcool. Il est établi à partir d’une sélection de 26 publications parmi les 95 références recensées. Longtemps considérée comme un phénomène d’intérêt négligeable, la rémission sans traitement acquiert ses lettres de noblesse dans les pays anglo-saxons. De solides études empiriques montrent que la majorité des sujets qui ont une consommation problématique ne consultent jamais mais qu’une importante partie d’entre eux arrive malgré tout à atteindre une rémission. Ce phénomène permet de constater que les trajectoires de changement sont multiples, hétérogènes, et peuvent se situer en dehors de l’utilisation des services de réadaptation. D’importantes lacunes demeurent au niveau de l’opérationnalisation du concept et des méthodes qui permettent de dépister cette population cachée. Néanmoins, les principaux facteurs explicatifs font ressortir le déterminisme de l’environnement et les conséquences négatives de la consommation, notamment sur la santé et les ressources financières.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 alcohol never consult a physician, but that a substantial part does reach a state of remission. How can we understand this data ? The studies show that remission without treatment, observed on a range of serious disorders related to alcohol, happens more often with people whose problems are less serious and who have intrinsic resources. The studies show that rather than a formal model of abstinence, natural recovery may be a pathway out of addiction in which certain forms of consumption remain present (except in cases of severe problematic use where complete abstinence is mandatory). This data thus questions the capacity of reaching these populations and also questions the current objectives of treatments. A compilation of several studies has allowed us to propose an estimate of the rate of prevalence of remission without treatment. Finally, a summary of the principal instigating factors and of the duration of remissions based on quantitative and qualitative studies is proposed as well as a comparison with other substances. In brief, this phenomenon shows alcoholism in a different light. Pathways of change are multiple and heterogeneous and may be found without calling for rehabilitation services. However, important gaps remain on the operational level of the concept and on the methods to reach this hidden population. Nevertheless, the main explanatory factors emphasize the determinism of the environment and more particularly the negative consequences of consumption on health and on financial resources.
Le comportementalisme et la psychanalyse : les antagonismes et les avenues de solutions
Alcoologie Et Addictologie, 2000
Les therapies cognitivo-comportementales et la psychanalyse s'opposent quant a leur rapport a... more Les therapies cognitivo-comportementales et la psychanalyse s'opposent quant a leur rapport a l'empirisme: les premieres sont issues de la tradition des sciences positives et s'appuient sur la methode experimentale et la seconde est issue d'une multitude d'influences, dont la neurologie clinique, et s'appuie sur les histoires de cas. Les deux modeles proposent des structures antinomiques de la personnalite. Par ailleurs, le skinnerisme et la psychanalyse ont en commun une conception deterministe de la personnalite, contrairement au cognitivisme. L'auteur termine en exprimant le souhait que les forces de ces deux modeles soient prises en compte. Selon la tradition empirique, il serait utile que toutes les interventions en addiction soient fondees sur des donnees probantes. Selon l'apport psychanalytique, on devrait prendre en compte l'inconscient dans l'etiologie des addictions, meme si le traitement psychodynamique ne s'avere pas necessairement l'approche la plus efficace.
Current Gerontology and Geriatrics Research, 2015
This study compares the relationship between drinking profiles and self-rated health with and wit... more This study compares the relationship between drinking profiles and self-rated health with and without adjusting for other determinants of health among a sample of older adults from the general population. Respondents were 1,494 men and 2,176 women aged between 55 and 74 from the GENACIS Canadian survey. The dependent variable was self-rated health, an individual’s perception of his or her own general health, a measure used as a proxy for health status. The independent variables were drinking profiles (types of drinkers and nondrinkers) as well as other demographic, psychosocial, and health-related variables (control variables). After adjustment for other determinants of health, regression analyses showed that (1) frequent/moderate drinkers were more likely to have a better self-rated health compared with nondrinkers (lifetime abstainers and former drinkers) and (2) self-rated health did not differ significantly between frequent/moderate drinkers and other types of drinkers (frequent...
Les femmes et les psychotropes: l'émergence d'un problème social
Psychotropes, 1987
La recherche psychosociale et ses enjeux, 1989
La mesure des événements critiques présente des problèmes méthodologiques significatifs. La premi... more La mesure des événements critiques présente des problèmes méthodologiques significatifs. La première génération d'instruments, en utilisant la perspective du répondant, a mesuré les événements relativement au degré de changement qu'ils sont susceptibles d'induire, sans égard à leur désirabilité. La seconde génération, en introduisant l'idée de "désirabilité", a évalué les événements relativement à l'émoi qu'ils provoquent plutôt qu'au changement qu'ils induisent. La faiblesse fondamentale de ces deux catégories d'instruments est de ne pas permettre une mesure indépendante des agents déclencheurs et des symptômes. Avec l'Inventaire des événements critiques et des difficultés, c'est le chercheur, et non plus le répondant, qui définit ce qui constitue un agent déclencheur. En assurant une datation des variables et une mesure indépendante de la menace à long terme, on a ainsi développé un instrument fidèle et valide pour la recherche...
Santé mentale au Québec, 1990
Non-adherents in mandatory substance abuse evaluation following a DUI offense: their characteristics and reasons for non-compliance
This study investigates the characteristics of individuals who fail to comply with mandated asses... more This study investigates the characteristics of individuals who fail to comply with mandated assessment and remedial measures following a DUI conviction. The characteristics of remedial program non-adherents, including sociodemographic data and driving history, will be described and compared with a matched sample of program adherents. Moreover, an attempt to discern a predictive model for risk of non-adherence will be undertaken. (A) For the covering abstract of the conference, see ITRD Abstract No. E201067.
Journal of Substance Abuse Treatment, 2000
Clinical studies show that heavy and dependant substance users engage with high frequency in high... more Clinical studies show that heavy and dependant substance users engage with high frequency in high -risk sexual behaviors. To better understand the dynamics of unsafe sexual practices among alcoholics or non -intravenous drug users (IDUs), a series of focus group discussions was conducted with 26 single, sexually active men and women in treatment for substance abuse. Results show that unsafe sexual practices in this subgroup may be explained by three factors: (1) intoxication, (2) negative perceptions of condoms, and (3) cognitive distortions. Furthermore, men's negative perceptions of condoms and women's concerns about not opposing men by fear of being rejected seem to be synergetic to bringing about the negative outcome. Implications for clinical practices are discussed.
PLOS ONE, Feb 24, 2016
Road crashes represent a huge burden on global health. Some drivers are prone to repeated episode... more Road crashes represent a huge burden on global health. Some drivers are prone to repeated episodes of risky driving (RD) and are over-represented in crashes and related morbidity. However, their characteristics are heterogeneous, hampering development of targeted intervention strategies. This study hypothesized that distinct personality, cognitive, and neurobiological processes are associated with the type of RD behaviours these drivers predominantly engage in. Four age-matched groups of adult (19-39 years) males were recruited: 1) driving while impaired recidivists (DWI, n = 36); 2) non-alcohol reckless drivers (SPEED, n = 28); 3) drivers with a mixed RD profile (MIXED, n = 27); and 4) low-risk control drivers (CTL, n = 47). Their sociodemographic, criminal history, driving behaviour (by questionnaire and simulation performance), personality (Big Five traits, impulsivity, reward sensitivity), cognitive (disinhibition, decision making, behavioural risk taking), and neurobiological (cortisol stress response) characteristics were gathered and contrasted. Compared to controls, group SPEED showed greater sensation seeking, disinhibition, disadvantageous decision making, and risk taking. Group MIXED exhibited more substance misuse, and antisocial, sensation seeking and reward sensitive personality features. Group DWI showed greater disinhibition and more severe alcohol misuse, and compared to the other RD groups, the lowest level of risk taking when sober. All RD groups exhibited less cortisol increase in response to stress compared to controls.
The dilemma of re-licensing DWI offenders: The offenders’ point of view
Accident Analysis & Prevention, Feb 1, 2016
In many jurisdictions, drivers convicted for the first-time of driving while impaired by alcohol ... more In many jurisdictions, drivers convicted for the first-time of driving while impaired by alcohol undertake a risk assessment that will determine the severity of sanctions and the remedial measures they must follow as requisites for re-licensing. There is uncertainty inherent in the assessment of risk for recidivism, however, many offenders feel unfairly assessed and discommoded by the decision-making process and its consequences. The objective of this qualitative study was to gain insight into the perspectives of offenders regarding re-licensing decision making and sanctioning. Specifically, in focus groups first-time offenders and recidivists were probed as to whether they favoured erring on the side of road safety in decision making, with its consequent greater risk of false positive assessments, or erring on the side of maintaining driving privileges, with its consequent greater risk of false negative assessments. In general, participants preferred a higher probability of false negative vs. false positive assessments. Most cited the consequences of sanctions and remedial measures as too severe to impose them on potentially low-risk drivers, as the assessment and monitoring protocols' limitations could lead to non-equitable treatment. At the same time, recidivists evoked a greater preference for a higher probability of false positive assessments compared to first-time offenders, as they believed that recidivism was more likely to follow a first conviction than did first-time offenders. This information can be useful for a more comprehensive and societally coherent exercise of DWI prevention policies.
Traffic Injury Prevention, May 11, 2018
In a pilot randomised controlled trial of contingency management (CM) and transdermal alcohol mon... more In a pilot randomised controlled trial of contingency management (CM) and transdermal alcohol monitoring (TAM) with driving while impaired by alcohol (DWI) offenders, perceptions regarding the acceptability of a TAM device, recruitment issues, and the impact of CM and TAM on alcohol use over a six-week period were evaluated. The results aimed to inform the design of future trials and programs involving CM and TAM for DWI remediation. TAM devices were affixed to 37 voluntary, community-recruited male DWI offenders with problem alcohol use. They were randomised to one of three groups: i) CM; ii) alcohol use feedback (FB); and iii) TAM device only (CTL). Quantitative and qualitative data were gathered on the acceptability of TAM devices and recruitment, while alcohol use was monitored via TAM and self-report. The TAM device was perceived positively, with benefits for reducing drinking noted. Nevertheless, some of its inconveniences appeared to influence participant recruitment and attrition, including its large size and lack of water-resistance. TAM data revealed a significant main effect of time for reduction in weekly peak transdermal alcohol concentration (p = 0.02), with a decrease between means of weeks 1 and 6 (M = 0.15, SE = 0.02 vs. M = 0.09, SE = 0.02; p = 0.005). No significant group effect was detected. TAM is a viable adjunct to CM with DWI offenders, though the TAM device used here may influence both study recruitment and adherence. These findings can guide the design of future studies into CM and TAM for DWI remediation.
Psychopharmacology, Sep 11, 2019
Background With driving while impaired by alcohol (DWI) representing a persistent burden on globa... more Background With driving while impaired by alcohol (DWI) representing a persistent burden on global health, better understanding and prevention of recidivism following a first-time DWI conviction are needed. Progress towards these goals is challenged by the marked heterogeneity in offender characteristics and a traffic safety literature that relies on subjective self-report measures and cross-sectional study designs. The present study tested the hypothesis that an objective neurobiological marker of behavioural maladjustment, the cortisol stress response (CSR), predicts future DWI and other traffic convictions over a 9-year follow-up period. Methods One hundred thirty-two male first-time DWI offenders and 31 non-offender comparators were recruited and assessed at intake for their substance use, psychosocial and psychological characteristics and CSR. Traffic conviction data were obtained from provincial driving records. Survival analysis estimated the association between CSR and risk of a traffic conviction over time. Results In support of our hypothesis, blunted CSR predicted traffic convictions during the follow-up duration. This effect generalized to both DWI offenders and non-DWI drivers. While CSR was lower in DWI offenders compared to non-offenders, it did not specifically predict recidivism in DWI offenders. Modelling results indicated that blunted CSR, along with DWI offender group membership, experience seeking and drug use frequency, may demarcate a high-risk driver phenotype. Conclusions CSR is a neurobiological marker of a driver phenotype with elevated generalized driving risk. For drivers with characteristics consistent with this phenotype, expanding the focus of intervention to address multiple forms of risky driving may be necessary to curb their overall threat to traffic safety.
Présenter ou non une utilisation problématique d’Internet : le point de vue de l’usager, du clinicien et de l’Internet Addiction Test
Drogues, santé et société, 2022
Santé mentale au Québec, Nov 5, 2003
Do the Consequences Experienced by the People in the Life of a Problem Gambler Differ Based on the Nature of Their Relationship with the Gambler?
Journal of Gambling Studies, 2021
Consequences experienced by the partners of individuals with a gambling disorder are well documen... more Consequences experienced by the partners of individuals with a gambling disorder are well documented. However, little is known about the deleterious effects experienced by other people than partners of gamblers. A better understanding of these consequences could help improve clinical practices. The goal of this paper is to compare the consequences experienced by partners of gamblers with those experienced by their close family members (parents, adult children, siblings) by using the categorization method proposed by Langham et al. (BMC Public Health, 2016). To achieve this goal, 46 semi-structured interviews were conducted. Results indicate that the extent and intensity of the consequences experienced vary widely based on their level of emotional and financial involvement with the gambler. Considering the specific elements involved for each type of person in a gambler’s life, future research should distinguish participants based on the nature of their relationship with the gambler.
Impacts relationnels et conjugaux vécus par les conjointes de joueurs pathologiques : comparaisons des perceptions des joueurs et de leurs conjointes
Psychotropes, 2022
The Canadian Journal of Psychiatry, 2018
Objectifs: La présente étude dresse le profil clinique des adolescents ayant consulté un centre d... more Objectifs: La présente étude dresse le profil clinique des adolescents ayant consulté un centre de traitement de la dépendance (CTD) au Québec en raison d’une utilisation problématique d’Internet (UPI) afin de développer les connaissances sur cette clientèle spécifique et de cibler avec justesse leurs besoins par rapport au traitement. Méthode: L’étude est réalisée auprès de 80 adolescents âgés entre 14 et 17 ans (M = 15,59) ayant consulté un CTD pour une UPI. Les adolescents ont pris part à une entrevue qui documente les habitudes d’utilisation d’Internet et leurs conséquences, la concomitance de troubles de santé mentale, ainsi que les relations familiales et sociales. Résultats: L’échantillon est composé de 75 garçons (93,8%) et de 5 filles (6,3%), qui passaient en moyenne 55,8 heures (ET = 27,22) par semaine sur Internet pour des activités non-scolaires ou professionnelle. Près de la totalité de ces jeunes (97,5%) présente un trouble de santé mentale en concomitance et plus de 7...
II y a dix ans, en 1979, la revue Santé mentale au Québec publiait un numéro spécial consacré aux... more II y a dix ans, en 1979, la revue Santé mentale au Québec publiait un numéro spécial consacré aux femmes et à leur santé mentale. Cette question faisait alors l'objet d'un débat de fond dans la société québécoise. En 1980, dans un colloque sur le thème de : Les Femmes et la Folie, plus de mille femmes -professionnelles, enseignantes, chercheures, intervenantes -se réunissaient à Montréal pour réfléchir et discuter de leur situation face à la médecine, à la psychiatrie et au système de soins et de services au Québec. L'essentiel de ce débat a été publié dans la revue Les Femmes et la folie au cours de la même année .
La r�mission sans traitement : �tat de la question pour une consommation probl�matique d�alcool
Ann Medico Psychol, 2008
Cet article poursuit le double objectif d’une recension des écrits et d’une mise à jour de la doc... more Cet article poursuit le double objectif d’une recension des écrits et d’une mise à jour de la documentation sur le thème de la rémission sans traitement des personnes souffrant d’une consommation problématique d’alcool. Il est établi à partir d’une sélection de 26 publications parmi les 95 références recensées. Longtemps considérée comme un phénomène d’intérêt négligeable, la rémission sans traitement acquiert ses lettres de noblesse dans les pays anglo-saxons. De solides études empiriques montrent que la majorité des sujets qui ont une consommation problématique ne consultent jamais mais qu’une importante partie d’entre eux arrive malgré tout à atteindre une rémission. Ce phénomène permet de constater que les trajectoires de changement sont multiples, hétérogènes, et peuvent se situer en dehors de l’utilisation des services de réadaptation. D’importantes lacunes demeurent au niveau de l’opérationnalisation du concept et des méthodes qui permettent de dépister cette population cachée. Néanmoins, les principaux facteurs explicatifs font ressortir le déterminisme de l’environnement et les conséquences négatives de la consommation, notamment sur la santé et les ressources financières.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 alcohol never consult a physician, but that a substantial part does reach a state of remission. How can we understand this data ? The studies show that remission without treatment, observed on a range of serious disorders related to alcohol, happens more often with people whose problems are less serious and who have intrinsic resources. The studies show that rather than a formal model of abstinence, natural recovery may be a pathway out of addiction in which certain forms of consumption remain present (except in cases of severe problematic use where complete abstinence is mandatory). This data thus questions the capacity of reaching these populations and also questions the current objectives of treatments. A compilation of several studies has allowed us to propose an estimate of the rate of prevalence of remission without treatment. Finally, a summary of the principal instigating factors and of the duration of remissions based on quantitative and qualitative studies is proposed as well as a comparison with other substances. In brief, this phenomenon shows alcoholism in a different light. Pathways of change are multiple and heterogeneous and may be found without calling for rehabilitation services. However, important gaps remain on the operational level of the concept and on the methods to reach this hidden population. Nevertheless, the main explanatory factors emphasize the determinism of the environment and more particularly the negative consequences of consumption on health and on financial resources.
Le comportementalisme et la psychanalyse : les antagonismes et les avenues de solutions
Alcoologie Et Addictologie, 2000
Les therapies cognitivo-comportementales et la psychanalyse s'opposent quant a leur rapport a... more Les therapies cognitivo-comportementales et la psychanalyse s'opposent quant a leur rapport a l'empirisme: les premieres sont issues de la tradition des sciences positives et s'appuient sur la methode experimentale et la seconde est issue d'une multitude d'influences, dont la neurologie clinique, et s'appuie sur les histoires de cas. Les deux modeles proposent des structures antinomiques de la personnalite. Par ailleurs, le skinnerisme et la psychanalyse ont en commun une conception deterministe de la personnalite, contrairement au cognitivisme. L'auteur termine en exprimant le souhait que les forces de ces deux modeles soient prises en compte. Selon la tradition empirique, il serait utile que toutes les interventions en addiction soient fondees sur des donnees probantes. Selon l'apport psychanalytique, on devrait prendre en compte l'inconscient dans l'etiologie des addictions, meme si le traitement psychodynamique ne s'avere pas necessairement l'approche la plus efficace.
Current Gerontology and Geriatrics Research, 2015
This study compares the relationship between drinking profiles and self-rated health with and wit... more This study compares the relationship between drinking profiles and self-rated health with and without adjusting for other determinants of health among a sample of older adults from the general population. Respondents were 1,494 men and 2,176 women aged between 55 and 74 from the GENACIS Canadian survey. The dependent variable was self-rated health, an individual’s perception of his or her own general health, a measure used as a proxy for health status. The independent variables were drinking profiles (types of drinkers and nondrinkers) as well as other demographic, psychosocial, and health-related variables (control variables). After adjustment for other determinants of health, regression analyses showed that (1) frequent/moderate drinkers were more likely to have a better self-rated health compared with nondrinkers (lifetime abstainers and former drinkers) and (2) self-rated health did not differ significantly between frequent/moderate drinkers and other types of drinkers (frequent...
Les femmes et les psychotropes: l'émergence d'un problème social
Psychotropes, 1987
La recherche psychosociale et ses enjeux, 1989
La mesure des événements critiques présente des problèmes méthodologiques significatifs. La premi... more La mesure des événements critiques présente des problèmes méthodologiques significatifs. La première génération d'instruments, en utilisant la perspective du répondant, a mesuré les événements relativement au degré de changement qu'ils sont susceptibles d'induire, sans égard à leur désirabilité. La seconde génération, en introduisant l'idée de "désirabilité", a évalué les événements relativement à l'émoi qu'ils provoquent plutôt qu'au changement qu'ils induisent. La faiblesse fondamentale de ces deux catégories d'instruments est de ne pas permettre une mesure indépendante des agents déclencheurs et des symptômes. Avec l'Inventaire des événements critiques et des difficultés, c'est le chercheur, et non plus le répondant, qui définit ce qui constitue un agent déclencheur. En assurant une datation des variables et une mesure indépendante de la menace à long terme, on a ainsi développé un instrument fidèle et valide pour la recherche...
Santé mentale au Québec, 1990
Non-adherents in mandatory substance abuse evaluation following a DUI offense: their characteristics and reasons for non-compliance
This study investigates the characteristics of individuals who fail to comply with mandated asses... more This study investigates the characteristics of individuals who fail to comply with mandated assessment and remedial measures following a DUI conviction. The characteristics of remedial program non-adherents, including sociodemographic data and driving history, will be described and compared with a matched sample of program adherents. Moreover, an attempt to discern a predictive model for risk of non-adherence will be undertaken. (A) For the covering abstract of the conference, see ITRD Abstract No. E201067.
Journal of Substance Abuse Treatment, 2000
Clinical studies show that heavy and dependant substance users engage with high frequency in high... more Clinical studies show that heavy and dependant substance users engage with high frequency in high -risk sexual behaviors. To better understand the dynamics of unsafe sexual practices among alcoholics or non -intravenous drug users (IDUs), a series of focus group discussions was conducted with 26 single, sexually active men and women in treatment for substance abuse. Results show that unsafe sexual practices in this subgroup may be explained by three factors: (1) intoxication, (2) negative perceptions of condoms, and (3) cognitive distortions. Furthermore, men's negative perceptions of condoms and women's concerns about not opposing men by fear of being rejected seem to be synergetic to bringing about the negative outcome. Implications for clinical practices are discussed.