Seeking mental health care from private health practitioners among individuals with alcohol dependence/abuse; results from a study in the French general population

Work context and drinking behavior in the French public service: a qualitative study

Introduction

Alcohol use disorders (AUD) are a major public health problem. Among the working population, alcohol is the most frequently used psychoactive substance, as well as the most inappropriately used. Alcohol consumption reduces the worker's psychophysical integrity, leads to an increase in inappropriate behavior, accidents and injuries, and affects the safety and health of other workers. Thus, the workplace must play an essential role in prevention. Particularly in France, in the civil service, a specific professional sector made up of many professionals exposed to stress, the prevention of AUD must play an essential role. The objective of this study was to describe the framework of alcohol consumption in the French public service in order to understand the sources of alcohol consumption behaviors and to identify the prevention measures to be implemented, in order to reduce the risk of transition to an alcohol use disorder.

Methods

This descriptive qualitative study was based on focus groups. Sampling was purposive and data saturation was verified. Coding was "in vivo," descriptive and pattern-oriented. Analysis was inductive thematic, and the COREQ guidelines were followed.

Results

Firstly, the presence of alcohol in the workplace has been characterized by a before-and-after a prohibition law, and by the revelation of mechanisms for avoiding the ban. Then, the three main determinants for alcohol use disorders were: society, work and personal factors. Lastly, the prevention initiatives identified must be based on both collective and individual approaches. They must be encouraged by the hierarchy, include screening, accompaniment to care, and take into account both work in the workplace and work at home. The fight against work-related alcohol use disorders must be part of the corporate culture.

Discussion

Preventing alcohol-related disorders among civil servants will help fight the burden of non-communicable diseases.

Screening for alcohol use in primary care: assessing French general practitioner practices

Alcohol use is a leading risk factor for premature death and disability. To tackle this issue, more systematic and accurate screening for at-risk consumption is needed in healthcare systems, especially by general practitioners (GPs). We assessed the frequency of at-risk consumption screening by GPs in France. We also identified characteristics associated with more frequent screening and greater use of validated screening tools by these healthcare providers. A cross-sectional survey was conducted among a representative sample of French GPs. Multinomial logistic regressions were used to identify factors associated with more frequent screening and greater use of validated screening tools. Response rate was of 73%. Of the 2412 participants, 42.8% screened all their patients systematically and repeatedly, while 48.0% never used standardized tools to screen potentially at-risk patients. Among other characteristics, being aware of and using the "early identification and brief intervention" screening strategy, and feeling absolutely comfortable talking with patients about reducing or stopping their alcohol use, were both associated with more frequent screening and use of standardized tools. Our results on at-risk alcohol use screening highlight an improvement over data from previous studies. Nevertheless, better training of French GPs in good alcohol screening practices-specifically, increased screening frequency and greater use of standardized tools-may improve identification of at-risk patients.

Silymarin pretreatment protects against ethanol-induced memory impairment: Biochemical and histopathological evidence

BACKGROUND

Ethanol (Eth.) abuse induces memory impairment. Oxidative damage and apoptosis are considered the likely causes of memory impairment. Silymarin (Sil.) is a flavonoid isolated from the plant Silymarin marianum (milk thistle). While studies have reported the neuroprotective effect of Sil. against neurodegenerative processes, the precise mechanism of action of Sil. in Eth.-induced memory impairment remains unclear.

METHODS

Twenty-eight rats were equally divided into four groups: Control (saline 1 ml/rat); Sil. (200 mg/kg for 30 days); Eth. (2 g/kg/day for 30 days); and Sil. + Eth. Behavioral tests including inhibitory avoidance and open field were used to investigate memory and locomotion. Brain antioxidant parameters, including catalase, superoxide dismutase, total antioxidant capacity and total thiol group, plus oxidative parameters, including malondialdehyde and total oxidant status, followed by hippocampal apoptosis (Bax/Bcl2, cleaved caspase) and histopathological changes were evaluated in the groups.

RESULTS

While the administration of Eth. impaired memory, Sil. significantly reversed Eth-induced memory deficits. Eth. administration also augmented brain oxidative and hippocampal apoptosis parameters. In contrast, a marked reduction in brain antioxidant and anti-apoptotic parameters was observed in the Eth. group. At the tissue level, hippocampal sections from Eth.-treated animals revealed severe neuronal damage. The administration of Sil. to Eth.-treated rats remarkably alleviated all the said Eth.-induced biochemical and histopathological effects. On the contrary, Sil. alone did not change the behavior and biochemical/molecular parameters.

CONCLUSION

The memory-enhancing effect of Sil. in Eth.-induced demented rats may be partly mediated by the augmented antioxidant effects and amelioration of apoptotic and histopathological changes.

A novel community-based therapeutic education program for reducing alcohol-related harms and stigma in people with alcohol use disorders: A quasi-experimental study (ETHER study)

INTRODUCTION

Alcohol use disorder (AUD) is associated with a significant disease burden in France, where alcohol use is deeply rooted in culture. However, the treatment gap is large because of several barriers, including stigmatisation and drinkers' apprehension about total abstinence. However, standardised and evidence-based interventions based on controlled-drinking for people with AUD are lacking. We aimed to assess the effectiveness of a novel community-based French therapeutic patient education (TPE) program for people with AUD named Choizitaconso.

METHODS

A before-after non-randomised quasi-experimental study, named ETHER, was designed and implemented with people living with AUD, over a period of 6 months. The primary outcome was percentage change in the number of alcohol-related harms experienced. Secondary outcomes were percentage changes in psycho-social patient-reported and community-validated outcomes. Participants in the intervention group (n = 34) benefited from the 10-week TPE program Choizitaconso, while the comparison group (n = 58) received standard care. The Kruskall-Wallis and chi-squared or Fisher's exact tests were used to compare before-after changes in variables in both groups. Linear regression models were used to test for the effect of study group on each outcome and to test for the effect of alcohol consumption as a confounder.

RESULTS

At 6 months, all outcomes but one either remained stable or numerically improved in both groups. Internalised stigma significantly improved in the intervention group (p = 0.026) but not in the comparison group (p = 0.207), with a significant group effect (p = 0.014).

DISCUSSION AND CONCLUSIONS

This study demonstrates the effectiveness of the Choizitaconso TPE program on community-validated outcomes, especially internalised stigma.

Alcohol Consumption in the Specific Socio-Professional Context of the French Public Service: Qualitative Study Protocol

Alcohol, a psychoactive substance with addictive potential, has major consequences on the population and public health. In France, alcohol use disorder affects approximately 3.5 million people, and 41,000 persons died in 2015. Alcohol consumption is significantly correlated to the workplace. Thus, the workplace is an area of opportunity to change risky behaviors and must play a key role in the prevention of alcohol misuse. To do this, it is essential to understand the consumption framework and to identify specific environmental risk factors. This qualitative study aims to describe the framework of alcohol consumption in the French public service. A focus group will be organized in France from November to January 2023. The participants will be: (i) representatives of the Local Health Insurance; (ii) over 18 years old; (iii) active or retired civil servants; (iv) mutualist activists; and (v) representatives of the Union of Health Prevention for the Obligatory System of the Public Service. The exclusion criteria for the study will be: (i) lack of consent form; (ii) inability to participate in the focus group, and (iii) early departure during the focus group. The focus groups will be supervised by two researchers following an interview guide. The data will be analyzed using the methodological framework, which consists in carrying out a thematic analysis. This will allow for an understanding of the sources of usage behaviors, and the identification of the most appropriate intervention functions for suitable prevention actions in order to reduce the risk of a transition to alcohol use disorder.

Title of the study: Practice and attitude of doctors towards patients with substance use: A study from south India

AIM

To evaluate the practice and attitude of doctors towards substance use disorders (SUD) and their management.

METHODS

Following stratified proportionate random sampling, selected doctors in the south zone of Bengaluru, India, were interviewed face-to-face using a structured questionnaire.

RESULTS

150 doctors were interviewed. In their practice, a quarter of patients (median of 27.5 (IQR: 11.45-45) use one or other form of Alcohol, Tobacco or Other Drugs of abuse (ATOD). Doctors, in general, enquire about substance use but do not actively intervene. They have mixed attitudes (both positive and negative) towards persons with SUD. A significant positive correlation was noted between the number of years of experience (post-MBBS) with practices related to "brief-intervention" (p = 0.014) and "concerned and sympathetic" attitudes (p < 0.001). However, a significant negative correlation was observed between the number of years of experience and "substance-specific management" practices (p < 0.001). Further, there was a positive correlation between "brief-interventions" practices with the attitude of being "concerned and sympathetic" (p < 0.001). A mediation analysis revealed that nearly a third of the overall effect of the number of years of experience on brief-interventions practices was mediated by a concerned and sympathetic attitude.

CONCLUSIONS

Serious efforts must be made to train doctors in the effective management of SUD. Attitudes of the doctors influence practices such as brief interventions. Programs directed towards changing the attitudes of doctors can bring changes in their practices.

Evaluation of a novel therapeutic education programme for people with alcohol use disorder in France: a mixed-methods intervention study protocol (ETHER)

BACKGROUND

ETHER ("Education THEérapeutique pour la Réduction des dommages en alcoologie" or Therapeutic education for alcohol-related harm reduction) is a multicentre community-based mixed-methods study, which aims to evaluate the effectiveness of the innovative therapeutic patient education (TPE) programme 'Choizitaconso' in a sample of French people with alcohol use disorder (people with AUD). Choizitaconso teaches people with AUD psychosocial skills to help them (re)establish controlled drinking and reduce alcohol-related harms. Recruitment started in October 2019. We present here the protocol of the ETHER study.

METHODS

ETHER's quantitative component involves a 6-month controlled intervention study which evaluates Choizitaconso's effectiveness by comparing 30 people with AUD following the programme with a control group of 60 people with AUD not enrolled in it, using a questionnaire co-constructed by the research team and members of the people with AUD community. Thirty-four alcohol-related harms are assessed and summed to provide an individual measure of the 'harm burden' from consuming alcohol (primary outcome). Secondary outcomes are anticipated and internalized stigma, alcohol consumption measures, craving for alcohol, coping strategies, health-related quality of life, self-confidence to control or abstain from drinking, treatment self-regulation, anxiety and depressive symptoms, alcohol-related neuropsychological impairments, and capabilities (a measure of wellbeing in adults). Data will be collected in face-to-face and phone-based interviews at enrolment and 6 months later. Linear regression models will be used to assess the impact of the TPE programme on changes in the primary and secondary outcomes, while adjusting for other correlates and confounders. The study's qualitative component comprises semi-structured interviews with 16 people with AUD who have already completed the TPE programme at least 6 months before the interview. Qualitative interviews will be analysed using thematic analysis.

RESULTS AND CONCLUSIONS

ETHER is the first evaluation study of an innovative TPE programme specifically designed to reduce alcohol-related harms and reach controlled drinking in France. The involvement of the people with AUD community in selecting which experienced and perceived alcohol-related harms to measure ensures that ETHER will provide healthcare staff and researchers with a relevant set of harm reduction criteria for use in future research. Finally, ETHER will provide scientific justification for implementing novel alcohol-related harm reduction approaches and champion controlled drinking as a therapeutic goal. Trial registration ClinicalTrials.gov, NCT03954054. Registered 17 May 2019-Prospectively registered, https://clinicaltrials.gov/ct2/show/NCT03954054?cond=alcohol&cntry=FR&city=Marseille&draw=1&rank=1 .

Treatment rates for alcohol use disorders: a systematic review and meta-analysis

AIMS

To estimate the treatment rate for alcohol use disorders (AUDs) in the general adult population. Treatment rates were also considered in relation to economic differences.

METHODS

Systematic review and meta-analysis. We searched PubMed, EMBASE, PsycINFO and CINAHL databases to identify studies that reported treatment rates for alcohol use disorders in the general population. Independent reviewers screened the articles based on predefined inclusion criteria. Data were extracted using a standardized data extraction form. We conducted quality assessments of the included studies. The overall treatment rates were estimated from studies that reported any treatment for AUDs from healthcare or informal non-healthcare settings (any treatment). We estimated the separate treatment rates for each diagnostic category as reported in the primary studies: AUD as a single disorder, alcohol abuse and alcohol dependence. Data were pooled using a random-effect model.

RESULTS

Thirty-two articles were included to estimate the treatment rates (percentage treated among the total number of people with AUDs). The pooled estimate of people with AUDs who received any treatment were 14.3% (95% CI: 9.3-20.3%) for alcohol abuse, 16.5% (95% CI: 12-21.5%) for alcohol dependence and 17.3% (95% CI: 12.8-22.3%) for AUD. A subgroup analysis by World Bank economic classification of countries found that the treatment rate for AUD was 9.3% (95% CI: 4.0-15.7%) in low and lower-middle-income countries.

CONCLUSION

Globally, approximately one in six people with AUDs receives treatment. Treatment rates for AUDs are generally low, with even lower rates in low and lower-middle-income countries.

Socio-Cognitive Factors Associated With Lifestyle Changes in Response to the COVID-19 Epidemic in the General Population: Results From a Cross-Sectional Study in France

BACKGROUND

The aims of the present study were to assess changes in lifestyles in the general population in response to coronavirus disease 2019 (COVID-19) lockdown and the influence of COVID-19 perceptions, as assessed by the Extended Parallel Process Model (EPPM), on these changes.

METHODS

Data were collected from 4005 individuals through an online survey conducted 3-4 weeks after the nationwide lockdown implementation in France. Participants were asked whether they practiced five behaviors (i.e., screen watching, snacking, eating fruits and vegetables, exercising, and walking) less often, as often as, or more often than prior to the lockdown. Beliefs and expectations toward the COVID-19 epidemic were also assessed using an adapted version of Witte's EPPM, together with sociodemographic and environmental variables. Among the respondents consuming regularly alcohol and tobacco, logistic regressions were performed to estimate the Odds ratios (ORs) of increase (yes/no) and decrease (yes/no) in drinking and smoking since the lockdown.

RESULTS

More than 8 in 10 respondents reported unhealthy changes in lifestyle since the lockdown, mostly in relation to physical activity. The unhealthy changes were positively associated with male sex (RR = 1.17; confidence interval [95% CI] = 1.10-1.24), living urban density, having a garden (RR = 1.16 [1.07-1.26]), financial difficulties because of COVID-19 (RR = 1.09 [1.02-1.18]), and lack of fear control (RR = 1.04 [1.01-1.09]) and negatively with cognitive avoidance (RR = 0.92 [0.89-0.95]). Less than 4 in 10 respondents reported healthy changes over the same period, mostly in relation to better eating habits. They were positively associated with living with more than two persons (RR = 1.22 [1.02-1.45]), having a terrace (RR = 1.14 [1.02-1.29], and perceived efficacy (RR = 1.11 [1.04-1.08]) and negatively with being aged 40 or higher. Alcohol consumption overall declined in regular drinkers, while a slight increase in tobacco use was observed in regular smokers.

DISCUSSION

The COVID-19 pandemic and lockdown resulted in frequent and mostly unhealthy changes in lifestyle among the general population. These changes were related to individual and environmental characteristics but also to EPPM appraisals in the wake of fear appeal from COVID-19 campaigns. Communication and preventive measures should include messages and initiatives toward the maintenance of healthy lifestyles during pandemics such as the adaptation of physical activity and eating guidelines to the particular contexts of mobility restriction and infection control.

Screening and care for alcohol use disorder in France: expectations, barriers and levers using a mixed-methods approach

Background

The widespread under-screening and under-treatment of alcohol use disorder (AUD) contributes to its health and socioeconomic burden. We conducted a mixed-methods (qualitative and qualitative) study in people with alcohol use disorder (PWAUD) to explore their expectations, as well as barriers and levers to AUD care.

Methods

Individuals with AUDIT > 15 (N = 179) were interviewed using computer-assisted interviews in several medical and non-medical sites (e.g., bars) (quantitative substudy). We also conducted semi-structured face-to-face interviews with 36 PWAUD (qualitative substudy). Using logistic regression, we explored factors associated with having previously received/sought care for AUD. Three major themes were identified in the qualitative textual analysis using a descending hierarchical classification.

Results

Not socializing with heavy drinkers (AOR [95%CI]:3.84[1.66–8.85]), regular smoking (9.72[3.91–24.15]) and feeling discriminated against (2.35[1.10–5.05]) were independent levers to having sought/received care for AUD, while being aged < 50 and employment were independent barriers. The five predominant themes in PWAUD discourses emerging from the textual analysis were: drinking context, medical care, alcohol treatment, tobacco/addiction and family. When triangulating results from the logistic regression and the textual analysis, two barriers (social drinking and difficulties with the medical care system), and two levers (family influence and tobacco addiction), emerged.

Conclusion

These results underline the need for interventions targeting families and the social network to increase awareness about AUD and related care. Simplified and novel comprehensive care trajectories are urgently needed to reduce the clinical and public health burden of AUD.

Depressive symptoms are related to boredom proneness in patients receiving hospital care, regardless of alcohol status, lifestyle, or social support

We examined the relationship between boredom proneness and psychological distress in patients receiving hospital care due either to excessive alcohol consumption or to gastrointestinal diseases. Sociodemographic data were collected together with boredom proneness subscales (internal/external lack of stimulation), psychological distress, physical activity, and social support. Boredom proneness due to a lack of external stimulation seemed to constitute a prominent personality trait in patients with alcohol consumption. But depressive symptoms were related only to boredom proneness due to a lack of internal stimulation in all patients, regardless of alcohol status, lifestyle, or social support. Potential implications for practice and future research are discussed.

Cohort Alcohol Use in France and the Transition from Use to Alcohol Use Disorder and Remission

The study aimed to examine the age of onset of stages of alcohol use in the general population, and to estimate the association of cohort use with the probability of transitioning from alcohol use to alcohol use disorder (AUD) and remission. French data (N = 2,894) from the European Study of the Epidemiology of Mental Disorders Survey and collected in 2000 were used. Data on lifetime history of alcohol use and DSM-IV alcohol use disorders, and remission were collected. Nearly every adult has consumed alcohol at least once in their lifetime (92.8%), and among users, 88.3% developed regular use, 6.0% met criteria for abuse and 1.7% for dependence. One-third of the population (32.8%) had used alcohol by the age of 15. Over 85% of cases of regular use were established prior to age 25, as were 61.1% of abuse and 39.4% of dependence cases. The proportion of people in an individual's age and sex cohort who had already used alcohol by a given age was positively and significantly associated with increased odds of transitioning to each stage examined. The findings highlight sensitive periods of life where persons are at greater risk for transitioning to a higher level of alcohol use, and underscore the importance of cohort use in transition risk.

Caring for patients with mental disorders in primary care: a qualitative study on French GPs' views, atittudes and needs

BACKGROUND

Patients suffering from mental health disorders have complex care needs, associating poorer physical health status and depreved social condition. Given their central role in primary health care, GPs should be highly involved in providing global and cooperative care to these patients in partnership with mental health specialists.

OBJECTIVE

To understand the GP's views, attitudes and needs in the care of patients with mental disorders.

METHODS

We led a qualitative study from June to July 2017, with semi-structured interviews led on GPs' activity in Marseille (France). We performed an inductive thematic content analysis, using Excel software.

RESULTS

We interviewed 22 GPs. The GPs felt comfortable providing total care for their patients with anxiety and depression (most of the time perceived as 'minor cases'), whereas they felt uncomfortable and poorly integrated in the care of patients with psychotic symptoms (often perceived as 'severe'). They wanted to improve communication with psychiatrists.

CONCLUSION

The GPs seemed to assess the complexity of the cases and therefore their ability to deal with them, based on the type of their patients' psychiatric symptoms. For the 'severe patients', they felt they didn't have a significant role to play as a family doctor, while it has been shown that these patients have poorer physical health and need more coordinated care than other patient groups. An improved communication between GPs and mental health providers could reduce the difficulties for GPs in the care of people with mental health disorders and make possible a whole patient-centred approach.