Jacques Besson

Lausanne University Hospital | CHUV · Service de psychiatrie communautaire

This year, the actuality for addictions in this edition addresses four points. The disease model of addiction is criticized by the cognitive neurosciences which need to consider the agentivity of the persons. Regarding the societal actuality, clinical pharmacology review of cannabidiol presents an update on legal cannabis. The suicidality of excess...

Introduction & objectifs La solution orale de methadone a 10 mg/mL est le gold standard dans le traitement agoniste de la dependance aux opioides (TAO). Avec la mise sur le marche suisse de la solution de levomethadone a 5 mg/mL, les risques d’erreurs et de confusion lors de la prescription, la preparation et l’administration semblent significatifs...

Background Methadone oral solution 10 mg/mL is the gold standard in opioid agonist treatment (OAT). With the recent marketing authorisation of the levomethadone solution 5 mg/mL, cardiac toxicity has decreased but the risks of errors and confusion in prescriptions, preparation and administration seems to be significant and the costs will probably b...

It has been demonstrated that people suffering from substance-related addictions are less empathic than their non-addicted counterparts. Our first aim was to verify if this is also true for behavioral addictions. We hypothesized that problem gamblers are less empathic than healthy controls. Our second aim was to identify a cognitive marker of empat...

In 2016, the actuality for addictions in this edition addresses four points. Social neurosciences of addiction are of great importance regarding the vulnerabilities for addiction and for the recovery. Deep brain stimulation is emerging in the therapeutic panel coming from the clinical neurosciences for the addictions. Novelties in opioid agonists f...

The purpose of the present study is to contribute to the understanding of empathy in people with addictive disorders. Previous studies have shown decreased empathy in people suffering from addiction to alcohol, cocaine, and methamphetamine and in people consuming combinations of addictive substances. Here, we compare empathy in a sample of methadon...

The objective of this research is to investigate the possible difference in accumulation of adversity over the life course among decedent gamblers and living control gamblers in the province of Quebec, Canada. A sample of 90 adult men, 41 living participants and 49 suicide decedents, met the criteria for at-risk and problem gambling over the last f...

The objective of this research is to investigate gender difference and the burden of adversity during the life course of people who develop gambling problems. A sample of 86 adult participants met the criteria for at-risk problem gambling over the last 5 years. Data were obtained from informants during semi-structured face-to-face interviews, using...

This year, the actuality about addiction is on psychopharmacology, in the controversy about the prescription of baclofene to reduce the craving for alcohol. More results from controlled studies are expected. The development of smartphones to access toe-Health skills is questionable, especially in matterofevaluation of these programs. Despite of enc...

Addictive disorders can be conceptualized as bonding disorders. People suffering from these conditions partially lose their capacity to be in contact with themselves and others and, generally speaking, to be within the world. The psychoactive drug, along with the compulsive-addictive b ehavior, acts as a substitute for the missing bonding. Conseque...

Switzerland's drug policy model has always been unique and progressive, but there is a need to reassess this system in a rapidly changing world. The IMPROVE study was conducted to gain understanding of the attitudes and beliefs towards opioid maintenance therapy (OMT) in Switzerland with regards to quality and access to treatment. To obtain a "real...

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....

The news in addiction medicine for 2011 include new knowledges coming from the neurosciences, but also new clinical concepts, as the role of hospital addiction units in an integrated network of care. The issue of cocaine vaccination is discussed from an ethical point of view. Finally, the integration of mindfulness techniques is introduced as a use...

β-Arrestin2 (ARRB2) is a component of the G-protein-coupled receptor complex and is involved in μ-opioid and dopamine D(2) receptor signaling, two central processes in methadone signal transduction. We analyzed 238 patients in methadone maintenance treatment (MMT) and identified a haplotype block (rs34230287, rs3786047, rs1045280 and rs2036657) spa...

Cannabis use has a negative impact on psychosis. Studies are needed to explore the efficacy of psychological interventions to reduce cannabis use in psychosis. Our aim is to study the efficacy of a specific motivational intervention on young cannabis users suffering from psychosis. Participants (aged less than 35 years) were randomly assigned to tr...

To determine methadone plasma trough and peak concentrations in patients presenting opiate withdrawal symptoms after introduction of nevirapine or efavirenz. To describe the disappearance of these symptoms after methadone titration based on plasma concentrations rather than on the symptoms. Nine patients undergoing highly active antiretroviral ther...

The news in addiction medicine for 2010 include somatic, neuroscientific as well as psychotherapeutic aspects. First are considered the risks of cardiac arythmy with methadone as long as the racemate form is prescribed in Switzerland. Then the neurosciences bring their usual novelties in the field of the addictions, this year in relational neurosci...

Is there a neuroethic of addictions? If so, what do the neurosciences contribute to the debate on the individual responsibility of consumers of psychoactive substances? This article reviews the various determinisms, both psychological and neurobiological, whereby addictions call for recognition as diseases. However, clinical data and studies on spo...

The 2009 news in medicine regarding dependence confirm the bio-psycho-social field of addiction medicine and psychiatry. First a statement is made about the risk of cardiac arythmy in opioid substitution treatments. Then a review of the treatment of C hepatitis shows its importance in an addicted population. In the field of cognitive neuroscience,...

Motivational Interviewing (MI) is a therapeutic style well established in the field of treatment of substance disorders. It is defined as “a client-centered, directive method for enhancing intrinsic motivation to change by exploring and resolving client ambivalence” (Miller, W.R., Rollnick, S., 2002. Motivational interviewing: preparing people for...

To assess tobacco, alcohol, cannabis and benzodiazepine use in methadone maintenance treatment (MMT) as potential sources of variability in methadone pharmacokinetics. Trough plasma (R)- and (S)-methadone concentrations were measured on 77 Australian and 74 Swiss MMT patients with no additional medications other than benzodiazepines. Simple and mul...

Cet article présente une réflexion au sujet de la psychothérapie destinée spécifiquement aux personnes toxicodépendantes. La prise en charge de ce type de problématiques a longtemps été considérée comme difficile, voire quasi impossible dans une pratique « classique » de la psychothérapie. Après avoir fourni quelques repères épidémio-logiques et ps...

The highlights 2008 in the addiction field are correlated to the progress of psychiatric neurosciences. Clarifications are also necessary towards the psychiatric comorbidities (schizophrenia) with the addictions. Then, useful considerations are given for the prescription of substitution treatment among HIV patients under tritherapy.

It has been suggested that pathological gamblers develop illusory perceptions of control regarding the outcome of the games and should express higher internal and chance locus of control. A sample of 48 outpatients diagnosed with pathological gambling disorder who participated in this ex post facto study, completed the Internality, Powerful Others,...

In the canton de Vaud (Switzerland) the psychiatric units devoted to mental retardation have been suppressed during the deinstitutionalization process in the 1970/80s. However, the use of psychiatric hospitalizations has increased these last years. This increase is accompanied by an interdiction of seclusion and restraint outside of the specialized...

Background: The use of cannabis among people suffering from psychosis is common and doubles the risk of relapse, aggravates positive symptoms and decreases the level of social functioning. Access to care remains difficult for these patients. Psychotic symptoms themselves could either be a powerful motivation to change behaviour when patients link t...

Methadone inhibits the cardiac potassium channel hERG and can cause a prolonged QT interval. Methadone is chiral but its therapeutic activity is mainly due to (R)-methadone. Whole-cell patch-clamp experiments using cells expressing hERG showed that (S)-methadone blocked the hERG current 3.5-fold more potently than (R)-methadone (IC 50 s (half-maxim...

Genetic variations of the dopamine and opioid receptors could influence the response to methadone maintenance treatment (MMT). We included 238 MMT patients according to their response to treatment and methadone dosing, along with 217 subjects without substance dependence. All were genotyped for polymorphisms of the dopamine D1, D2, micro-opioid and...

This year review emphasizes four aspects coming from addiction psychiatry: 1. Initiation and maintenance of cannabis use. 2. Methadone and heart toxicity. 3. Suicidal behaviour in gambling. 4. Treatment of addictive disorders via internet: present and future perspectives.

Family studies typically use multiple sources of information on each individual including direct interviews and family history information. The aims of the present study were to: (1) assess agreement for diagnoses of specific substance use disorders between direct interviews and the family history method; (2) compare prevalence estimates according...

Background: The use of cannabis among people suffering from psychosis is common and doubles the risk of relapse, aggravates positive symptoms and decreases the level of social functioning. Access to care remains difficult for these patients. Psychotic symptoms themselves could either be a powerful motivation to change behaviour when patients link t...

This article resumes the psychobiologic mechanisms involved in risk-seeking behaviour. The question is discussed whether some forms of high risk sports meet the diagnostic criteria of dependency. The intensive activation of the adrenocorticotropic pathway may yield to addiction: according to the model of emotion-focussed coping of stress, unpleasan...

Methadone inhibits the cardiac potassium channel hERG and can cause a prolonged QT interval. Methadone is chiral but its therapeutic activity is mainly due to (R)-methadone. Whole-cell patch-clamp experiments using cells expressing hERG showed that (S)-methadone blocked the hERG current 3.5-fold more potently than (R)-methadone (IC50s (half-maximal...

We studied profile of patients (n=1782) treated in specialized centers and general practice (GP) enrolled in methadone maintenance treatment (MMT) programs during 2001 in the Swiss Canton of Vaud. We found that GPs treated the majority of patients (76%). Specialized centers treated a higher proportion of patients with uncontrolled intravenous use o...

This year review emphasizes three aspects coming from addiction psychiatry: 1. Psychosis and cannabis: a motivational approach. 2. Connection between addiction services and psychiatric wards. 3. Use of antiepileptic agents in addiction medicine.

Slow downtitration as a methadone discontinuation method is time-consuming and associated to high dropout rates. Whereas ultra-rapid opiate detoxification methods have recently gained some popularity, they are expensive and may be associated with particular problems in methadone patients. In the present study, a 3-day detoxification procedure accel...

Background and Objective The in vivo implication of various cytochrome P450 (CYP) isoforms and of P-glycoprotein on methadone kinetics is unclear. We aimed to thoroughly examine the genetic factors influencing methadone kinetics and response to treatment.Methods Genotyping for CYP1A2, CYP2B6, CYP2C9, CYP2C19, CYP2D6, CYP3A4, CYP3A5, ABCB1, and UGT2...

Background: Comorbidities such as mental illness and alcohol use disorders (AUD) worsen the prognosis of both conditions. There is a need to identify early alcohol use disorders in psychiatric patients to prevent the development of dual diagnosis diseases, which are more difficult to treat. The Alcohol Use Disorders Identification Test (AUDIT) was...

Co-morbid substance misuse is common in psychiatric disorders, has potentially severe adverse consequences and may be frequently undetected. To measure the prevalence of substance use among patients admitted to a Swiss psychiatric hospital and to examine the potential utility of routine urine drug screening in this setting. 266 inpatients were incl...

While detoxification under anaesthesia accelerates the detoxification procedure, there is a lack of randomised clinical trials evaluating its effectiveness compared to traditional detoxification procedures, and a lack of data on long-term abstinence. Prospective randomised clinical trial. Analysis by intention to treat and per protocol. Setting: Sp...

This year reviews on the addictions emphasizes five aspects, on a bio-psycho-social perspective: (1) The relationship between methadone and cardiotoxicity. (2) The introduction of Eye Movement Desensibilization and Reprocessing (EMDR). (3) The apparition of a possible specific pharmacotherapy for excessive gambling. (4) A better knowledge of the re...

The present study aims to examine the additional effects of hypnosis in the reduction of withdrawal syndrome in an in-patient detoxification treatment program. Thirty-two in-patients aged between 18 and 65 meeting the DSM-IV criteria for multiple substance dependence were randomly assigned to hypnosis condition (two sessions of standardized Erickso...

Background and objective: Recent in vitro studies have suggested an important role of cytochrome P450 (CYP) 2B6 and CYP2C19 in methadone metabolism. We aimed to determine the influence of CYP2B6, CYP2C9, and CYP2C19 genetic polymorphism on methadone pharmacokinetics and on the response to treatment. Methods: We included 209 patients in methadone...

Assertive community treatment (ACT) failed to develop in Europe, and its efficacy is debated. In Lausanne, Switzerland, ACT focuses on difficult-to-engage patients and aims to facilitate linkage with outpatient care through time-limited interventions. This study aimed to evaluate the applicability and efficiency of time-limited ACT. We retrospectiv...

Intravenous methadone is associated with increased risk of morbidity and mortality. A previous report from a methadone center in Fribourg, Switzerland, found a high prevalence (43%) of patients who injected oral methadone. We therefore wished to assess the prevalence of methadone injection among patients in oral methadone programs in 3 other Swiss...

Background: Long-term drug rehabilitation programmes are now recognised as being more effective than the ambulatory treatments, if one refers to the long-term abstinence. However, the majority of these programmes are open only to the patients abstinent from all substances. Consequently, detoxification units must be adapted to treat a broad variety...

In Switzerland, general practitioners (GPs) manage most of the patients receiving methadone maintenance treatment (MMT). Using a cross-sectional postal survey of GPs who treat MMT patients and GPs who do not, we studied the difficulties encountered in the out-patient management of drug-addicted patients. We sent a questionnaire to every GP with MMT...

Using data from the Public Health Service, we studied the demographic and clinical characteristics of 1,782 patients enrolled in methadone maintenance treatment (MMT) during 2001 in the Swiss Canton of Vaud, comparing our findings with the results of a previous study from 1976 to 1986. In 2001, most patients (76.9%) were treated in general practice...

Social phobia is among the most frequent psychiatric disorders and can be classified into two subtypes, nongeneralized and generalized. Whereas it significantly worsens the morbidity of comorbid substance abuse disorders, and it often is associated with reduced treatment responses, there is still lacking data on its prevalence in clinical populatio...

Although detoxification cannot, in itself, be considered a treatment for addiction, it is one of the most pivotal phases. In order to facilitate entry into recovery and/or rehabilitation programs, a detoxification treatment has to be experienced as easy and safe by the patient. In consideration of the many inconveniences related to standard withdra...

A recent comparative randomized double-blind study has suggested the utility of a carbamazepine/mianserin combination as a treatment for opiate withdrawal. The aim of the present study was to explore the feasibility and efficiency of this combination under naturalistic conditions. Five hundred and fifty mostly polysubstance abusing patients treated...

Nicotine cessation programmes in Switzerland, which are commonly based on the stage of change model of Prochaska and DiClemente (1983), are rarely offered to patients with illicit drug dependence. This stands in contrast to the high smoking rates and the heavy burden of tobacco-related problems in these patients. The stage of change was therefore a...

The aim of the study was to validate a French adaptation of the 5th version of the Addiction Severity Index (ASI) instrument in a Swiss sample of illicit drug users. The participants in the study were 54 French-speaking dependent patients, most of them with opiates as the drug of first choice. Procedure: Analyses of internal consistency (convergent...

The objective of the current study was to determine the predictive value of high normal gamma-glutamyltransferase (GGT) level as an indication of heavy drinking in young men. In a sample of 577 men attending a one-day army recruitment process mandatory for all Swiss men at age 19 years, GGT level was evaluated as the dependent variable for each of...

Alcohol treatment professionals are often reluctant to address tobacco dependence in their patients or to implement smoke-free policies in inpatient treatment programs, fearing, among others, non-adherence to alcohol treatment. The aim of the present study was to evaluate the acceptance of an intended smoking ban in a specialized hospital for alcoh...

In recent years, psychopharmacology has developed many new molecules. Some of these are particularly promising as treatment of patients with a drugs dependence disorder, as therapy of comorbidities and as direct treatment of dependence itself. Among antidepressants many clinical and pre-clinical studies confirm the advantages of venlafaxine and mir...

The therapeutic role of the family therapy for the drug addict proved to be effective. This applies to the adolescent who misuses substances as well. Studies have shown that the reconstruction of every family's specific history during therapy can constitute a powerful factor of change. A family history creates awareness on difficulties within the f...

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New methods of ultra-rapid opiate detoxification (URD) under intravenous sedation have been criticized because of limited data on safety and long-term follow-up. Premedication with buprenorphine has been advocated to improve safety by decreasing vomiting. Prior research has not explored URD in socially impaired patients. Sixteen patients were detox...

Rapid antagonist induction under anesthesia is a method that has been increasingly used to detoxify opiate addicts. These procedures are useful to reduce the duration and the discomfort of withdrawal. However, the high risk and the cost of these methods require randomized clinical trial to evaluate safety and clinical effectiveness. The University...

With some 30 000 dependent persons, opiate addiction constitutes a major public health problem in Switzerland. The Swiss Federal Office of Public Health (FOPH) has long played a leading role in the prevention and treatment of opiate addiction and in research on effective means of containing the epidemic of opiate addiction and its consequences. Maj...