Traitements médicamenteux et psychothérapiques de l’alcoolodépendance

Abstract

Despite what hospital nomenclature might seem to imply, treatment for alcohol dependence is not weaning; it is more comprehensive and mainly aimed at the overall phenomenon of addiction. Up until now, the objective of treatment has been to obtain total abstinence by any means. However, current treatments and research are aimed at enabling the dependent subject to learn to regain control over a disease defined precisely by the repeated impossibility of controlling behavior that persists notwithstanding his awareness of its deleterious consequences, be they physical, psychological, familial, professional and/or socio-environmental. Reestablishing control is by no means easy and the journey is fraught with pitfalls related to the person, the product and the environmental context. Insofar as none of these three factors prevail over the others, the therapeutic objective is necessarily triple. It is the patient himself who decides either to maintain alcohol abstinence or to attempt controlled consumption below thresholds for hazardous drinking. His choice may vary according to time and circumstances and it will in all likelihood entail a concrete psychotherapeutic approach associated with pharmacological treatment. Addiction to alcohol, a chronic and recurrent disease, requires first and foremost the setting of desired and achievable objectives that will orient psychotherapeutic actions accompanied by pharmacological treatments. To help the patient achieve his objectives, the addictologist will address abstinence (or control) as well as relapse, combat compensation phenomena and intervene with regard to co-addictions, psychiatric comorbidities and somatic comorbidities. Patients and therapists alike will be called upon to co-construct relapse prevention strategies and to develop psychotherapy taking into account the patient's initial pain and capacities for introspection. In France, four pharmacological treatments have received marketing authorization for abstinence maintenance, and two for controlled management.