Abstracts
Résumé
Cet article porte sur le trouble concomitant état de stress post-traumatique (ÉSPT) et trouble lié à l’utilisation d’une substance (TUS) ; une réalité clinique fréquemment retrouvée chez les adultes où les traitements intégrés sont à privilégier comme modalité d’intervention. Parmi ceux-ci, le programme Seeking Safety (SS) est le plus validé empiriquement. Les preuves de son efficacité sont maintenant solides chez l’adulte et il est le seul traitement à surpasser le traitement contrôle pour l’ÉSPT et le TUS. Les travaux sur la version française sont aussi encourageants. Les jeunes, quant à eux, sont tout aussi à risque pour le type ÉSPT/TUS ; la prévalence étant estimée entre 11 % et 47 % (population générale et clinique). Bien que les impacts psychosociaux soient importants, peu de recherches portent sur les traitements intégrés pour cette clientèle. Deux études récentes mettent toutefois en évidence l’efficacité du programme SS pour les jeunes américains. Des ajustements sont d’ailleurs en cours pour adapter le programme à la réalité des adolescents et de leurs parents et pour en faciliter l’implantation. Des données préliminaires ont été récoltées auprès de jeunes canadiens-français (18 à 25 ans) qui ont bénéficié de séances d’entretien motivationnel combinées au programme SS offertes en groupe (n=6) ou en séances individuelles (n=3). Les résultats suggèrent que la version francophone du programme SS semble efficace en contexte de groupe, puisque des améliorations significatives ont été notées au niveau de la symptomatologie traumatique, de la consommation d’alcool et du fonctionnement selon l’axe 5 du DSM-IV-TR (grandes tailles d’effet). Aucune amélioration significative n’a cependant été notée pour la prestation de soins individuels et pour la consommation de drogues (DAST-20) en contexte de groupe ; bien que ces mesures semblent avoir évolué dans le sens d’un mieux-être. Cette étude suggère que la version française du programme SS est prometteuse dans le traitement de l’ÉSPT-TUS pour une population clinique de jeunes canadien-français. Des études avec groupe contrôle et un plus grand nombre de participants devront toutefois être menées pour confirmer son efficacité.
Mots-clés :
- état de stress post-traumatique,
- troubles liés aux substances,
- comorbidité,
- traitement intégré,
- jeune,
- français
Abstract
This article focuses on post-traumatic stress disorder (PTSD) and substance use disorder (SUD) as a concurrent disorder; a clinical reality frequently found in adults where integrated treatments are recommended as a method of intervention. Among them, the Seeking Safety program (SS) is the most empirically validated. Evidence of its efficacy is now established in an adult population and it is the only treatment that exceeds the control treatment for PTSD and SUD. The work on the French version is also encouraging. Youth, meanwhile, is equally at risk for this type of disorder; the prevalence is estimated between 11% and 47% (community and clinical population). Although psychosocial impacts are important, there is little research on integrated treatment for this population. However, two recent studies demonstrate the efficacy of the SS program for American youth. Adjustments are underway to adapt the program to the reality of adolescents and their parents and facilitate its implementation. Preliminary data were collected from French Canadian youth (18-25 years) who received motivational interviewing sessions combined with SS offered in group (n=6 ) or in individual sessions (n=3). The results show that the French version of the SS program appears to be effective in a group context as significant improvements were noted in the PCL-S, the MAST-22 and also according to the axis 5 of the DSM-IV-TR (large effect sizes). However, no significant improvement was noted for individual care and the DAST-20 in group context; although these measures appear to have evolved in the direction of wellness. This study suggests that the French version of the SS program is promising in the treatment of PTSD-SUD for French-Canadian youth in a clinical context.
Keywords:
- post-traumatic stress disorder,
- substance use disorders,
- comorbidity,
- integrated treatment,
- youth,
- French
Resumen
Este artículo se refiere al transtorno de estrés postraumático (TEPT) y al problema ligado a la utilización de una sustancia como problema concomitante; una realidad clínica que se encuentra frecuentemente en los adultos, con los que se privilegia un tratamiento integrado como modalidad de intervención. Entre estos, el programa Seeking Safety (SS) es el que ha recibido más validación empírica. Las pruebas de su eficacia con los adultos son ahora sólidas y el programa constituye el único tratamiento que supera el tratamiento control del transtorno de estrés posttraumatico/TUS y el TUS. Los trabajos sobre la versión francesa son asimismo alentadores. Lo jóvenes, por su parte, están también sujetos a riesgo de presentar TEPT/TUS, estimándose la prevalencia entre el 11 y el 47% (población general y clínica). Si bien los impactos psicosociales son importantes, pocas son las investigaciones que se realizaron sobre los tratamientos integrados para esta clientela. Dos estudios recientes ponen sin embargo en evidencia la eficacia del programa SS para los jóvenes estadounidenses. Se están realizando ajustes para adaptar el programa a la realidad de los adolescentes y de sus padres y para facilitar su implantación. Se han recabado datos preliminares entre los jóvenes franco-canadienses (18 a 25 años) que han obtenido sesiones de entrevista motivacional combinadas con el programa SS que se ofrece en grupo (n =6) o en sesiones individuales (n=3). Los resultados sugieren que la versión francófona del programa SS parece eficaz en contexto de grupo, ya que se notaron mejoras significativas en lo que se refiere a la sintomatología traumática, el consumo de alcohol y el funcionamiento según el eje 5 del DSM-IV-TR (grandes medidas de efecto). Sin embargo, no se ha notado ninguna medida significativa con respecto a la prestación de atención individual ni al consumo de drogas (DAST 20) en contexto de grupo: aunque estas medidas parecen haber evolucionado hacia una mejora del bienestar. Este estudio sugiere que la versión francesa del programa SS es prometedora para el tratamiento del TEPT-TUS en el caso de una población clínica de jóvenes franco-canadienses. Deben realizarse sin embargo estudios con grupos de control y una mayor cantidad de participantes para confirmar su eficacia.
Palabras clave:
- transtorno de estrés postraumático,
- trastornos ligados al consumo de sustancias,
- comorbilidad,
- tratamiento integrado,
- joven,
- francés
Appendices
Bibliographie
- American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text revision). Washington, DC: Auteur.
- American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Auteur.
- Blanchard, E.B., Jones Alexander, J., Buckley, T.C., & Forneris, C.A. (1996). Psychometric properties of the PTSD Checklist (PCL). Behaviour Research and Therapy, 34, 669-673.
- Boden, M.T., Kimerling, R., Jacobs-Lentz, J., Bowman, D., Weaver, C., Carney, D., Walser, R., & Trafton, J. A. (2011). Seeking Safety treatment for male veterans with a substance use disorder and PTSD symptomatology. Addiction, 107(3), 578-586.
- Brady, K.T., Dansky, B.S., Back, S.E., Foa, E.B., & Carroll, K.M. (2001). Exposure therapy in the treatment of PTSD among cocaine-dependent individuals: Preliminary findings. Journal of Substance Abuse treatment, 21, 47-54.
- Brady, K.T., Killeen, T., Saladin, M.E., Dansky, B., & Becker, S. (1994). Comorbid substance abuse and posttraumatic stress disorder: Characteristics of women in treatment. American Journal on Addictions, 3, 160-164.
- Breslau, N., Davis, G.C., Andreski, P., Peterson, E.L, & Schultz, L.R. (1997). Sex Differences in Posttraumatic Stress Disorder. Archives of General Psychiatry, 54(11), 1044-1048.
- Briere, J. (1995). Trauma Symptom Inventory professional manual. Odessa, FL: Psychological Assessment Resources.
- Briere, J.N. (2000). Cognitive Distortion Scales: Professionnal Manual, Psychological Assessment Resources, Inc., 1-35.
- Briere, J., & Zaidi, L. (1989). Sexual abuse histories and sequelae in female psychiatric emergency room patients. American Journal of Psychiatry, 146, 1602-1606.
- Brislin, R., Lonner, W., & Thordike, R. (1973). Cross-cultural research methods. New-York: John Wiley.
- Brown, P.J., Stout, R.L., & Gannon-Rowley, J. (1998). Substance use disorder – PTSD co-morbidity: Patients’ perception of symptom interplay and treatment issues. Journal of Substance Abuse Treatment, 15, 445-448.
- Cohen, J.A., Mannarino, A.P., Zhitov, A.C., & Capone, M.E. (2003). Treating child abuse-related posttraumatic stress and comorbid substance abuse in adolescents. Child Abuse & Neglect, 27, 1345-1365.
- Cohen, J. (1988). Statistical Power analysis for the behavioral science (2nd ed.). Hillsdale, NJ: Lawrence Earlbaum Associates.
- Cohen, L.R., & Hien, D.A. (2006). Treatment outcomes for women with substance abuse and PTSD who have experienced complex trauma. Psychiatric Services, 57(1), 100-106.
- Cohen, Y., Spirito, A., & Sterling, C. (1996). Physical and sexual abuse and their relation to psychiatric disorder and suicidal behaviour among adolescents who are psychiatrically hospitalized. Journal of Child Psychology and Psychiatry, 37, 989-993.
- Cook, J.M., Walser, R.D., Kane, V., Ruzek, J.I., & Woody, G. (2006). Dissemination and feasibility of a cognitive-behavioral treatment for substance use disorders and posttraumatic stress disorder in the Veterans Administration. Journal of Psychoactive Drugs, 38, 89-92.
- Cottler L.B., Compton W.M., 3rd, Mager D., Spitznagel, E.L., Janca, A. (1992) Posttraumatic stress disorder among substance users from the general population. American Journal of Psychiatry, 149, 664–670.
- Dansky, B., Saladin, M., Brady, K., Kilpatrick, D., & Resnick, H. (1995). Prevalence of victimization and posttraumatic stress disorder among women with substance use disorders: A comparison of telephone and in-person assessment samples. The International Journal of the Addictions, 30, 1079-1099.
- Daoust, J.-P. (2011). Séquence d’entretien motivationnel – Protocole d’intervention à double étapes version 2.1. Document inédit.
- Daoust, J.-P., Renaud, M., Bruyère, B., Juery, C., & Najavits, L. (2015). État de stress post-traumatique et usage problématique de substance : Évaluation de programme préliminaire en lien avec l’efficacité d’une clinique spécialisée pour Franco-ontariens en milieu hospitalier universitaire. Revue Psy Cause, 65.
- Deblinger, E., & Heflin, A.H. (1996). Treatment for sexually abused children and their nonoffending parents: A cognitive-behavioral approach. Thousand Oaks, CA: Sage Publications.
- Deblinger, E., Lippman, J., & Steer, R.A. (1996). Treatment for sexually abused children suffering post-traumatic stress symptoms: Initial treatment outcome finding. Child Maltreatment, 1, 310-321.
- Desai, R.A., Harpaz-Rotem, I., Najavits, L.M., & Rosenheck, R.A. (2009). Seeking Safety therapy: Clarification of results. Psychiatric Services, 60(1), 125.
- Desai, R.A., Harpaz-Rotem, I., Najavits, L.M., & Rosenheck, R.A. (2008). Treatment for homeless female veterans with psychiatric and substance abuse disorders: Impact of “Seeking Safety” on one-year clinical outcomes. Psychiatric Services, 59(9), 996-1003.
- Donovan, B., Padin-Rivera, E., & Kowaliw, S. (2001). Transcent : initial outcomes from posttraumatic stress disorder substance abus treatment program. Journal of Traumatic Stress, 14(4), 757-772.
- Faul, F., Erdfelder, E., Lang, A.-G., & Buchner, A. (2007). G*Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behavior Research Methods, 39, 175-191.
- Fortin, M.-F., & Gagnon, J. (2010). Fondements et étapes du processus de recherche – Méthodes quantitatives et qualitatives (2nd ed.). Montréal : Chenelière Éducation.
- Fullilove, M.T., Fullilove, R.E., Smith, M., Winkler, K., Michael, C., Panzer, P.G., & Wallace, R. (1993). Violence, trauma, and post-traumatic stress disorder among women drug users. Journal of Traumatic Stress, 6, 533-543.
- Giaconia, R.M., Reinherz, H.Z., Hauf, A.C., Paradis, A.D., Wasserman, M.S., & Langhammer, D.M., (2000). Comorbidity of Substance Use and Post-Traumatic Stress Disorders in a Community Sample of Adolescents. American Journal of Orthopsychiatry, 70(2), 253-262.
- Giaconia, R.M., Reinherz, H.Z., Paradis, A.D., & et al. (2002). Comorbidity of Substance Use and Post-Traumatic Stress Disorders in Adolescents. Dans P. Ouimette & P. J. Brown (Eds.), Trauma and substance abuse: Causes, consequences and treatment of co-morbid disorders (pp. 209-226). Washington, D.C.: American Psychological Association.
- Hamilton, N. (2006). African-Americam Center for Excellence (AACE) Program ; SAMHSA grant number TI14126 ; final report. Operation PAR, Largo: FL. Rapport non publié,
- Herman, J.L., Russell, D.E.H, & Trocki, K. (1986). Long-term effects of incestuous abuse in childhood. American Journal of Psychiatry, 143, 1293-1296.
- Hien, D. (2009). Trauma Services for Women in Substance Abuse Treatment : an intergrated Approach. Washington, D. C.: American Psychological Association.
- Hien, D., & Scheier, J. (1996). Trauma and short-term outcome for women in detoxification. Journal of Substance Abuse Treatment, 13(3), 227-231. Journal of the Addictions, 30, 1079-1099.
- Hien, D.A., Cohen, L.R., Litt, L.C., Miele, G.M., & Capstick, C. (2004). Promising empirically supported treatments for women with comorbid PTSD and substance use disorders. American Journal of Psychiatry, 161(8), 1426-1432.
- Kessler, R.C., Sonnega, A., Bromet, E., Hughes, M. & Nelson, C.B. (1995). Posttraumatic stress disorder in the National Comorbidity Survey. Archives of General Psychiatry. 52, 1048-1060.
- Kilpatrick, D.G., & Saunders, B.E. (1997). Prevelance and Consequences of Child Victimization: Results from the National Survey of Adolescents – Final Report. U.S. Department of justice.
- Kulka, R.A., Schlenger, W.E., Fairbank, J.A., Hough, R.L., Jordan, B.K., Marmar, C.R., et al. (1990). Trauma and the Vietnam War generation: Report of findings from the National Vietnam Veterans Readjustment Study. New York: Brunner/Mazel.
- Liddle, H.A., & Hogue, A. (2001). Multidimensional family therapy for adolescent substance abuse. Dans Wayne, E.F., & Waldron, H.B. (Eds), Innovations in adolescent substance abuse interventions (pp. 229-261). Oxford: Pregamon.
- Lynch, S.M., Heath, N.M., Matthews, K.C., & Cepeda, G.J. (2012). Seeking Safety: An Intervention for Trauma-Exposed Incarcerated Women ? Journal of Trauma & Dissociation, 13(1), 88-101.
- Miller, B.A., Downs, W.R., Gondoli, D.M., & Keil, A. (1987). The role of childhood sexual abuse in the development of alcoholism in women. Violence and Victims, 2, 157-172.
- Miller, B.A., Downs, W.R., & Testa, M. (1993). Interrelationships between victimization experiences and women’s alcohol use. Journal of Studies on Alcohol, supplement no. 11, 109-117.
- Monson, C.M., Gradus, J.L., Young-Xu, Y., Schnurr, P.P., Price, J.L., & Schumm, J.A. (2008). Change in posttraumatic stress disorder symptoms: Do clinicians and patients agree ? Psychological Assessment, 20(2), 131-138.
- Najavits, L. (2003). Seeking Safety : a New Psychotherapy for Posttraumatic Stress Disorder and Substance Use Disorder. Dans P. Ouimette & P. J. Brown (Eds.), Trauma and substance abuse : Causes, consequences and treatment of co-morbid disorders (pp. 147-169). Washington, D.C.: American Psychological Association.
- Najavits, L.M. (2002a). Seeking Safety: A Treatment Manual for PTSD and Substance Abuse. New York, NY: The Guilford Press.
- Najavits, L.M. (2002b). A Woman’s Addiction Workbook. Oakland, CA : New Harbinger.
- Najavits, L.M., Gallop, R.J., & Weiss, R.D. (2006). Seeking Safety Therapy for Adolescent Girls with PTSD and Substance Use Disorder: A Randomized Controlled Trial. Journal of Behavioral Health Services & Research, 33(4), 453-463.
- Najavits, L.M., & Hien, D. (2013). Helping Vulnerable Populations: A Comprehensive Review of the Treatment Outcome Literature on Substance Use Disorder and PTSD. Journal of clinical psychology, 69(5). 433-479.
- Najavits, L.M., Schmitz, M., Gotthardt, S., & Weiss, R.D. (2005). Seeking Safety plus Exposure Therapy for Dual Diagnosis Men. Journal of Psychoactive Drugs, 27, 425-435.
- Najavits, L.M., Schmitz, M., Johnson, K.M., Smith, C., North, T., Hamilton, N., Walser, R., Reeder, K. Norman, S., & Wilkins, K.. (2009). Seeking Safety therapy for men: Clinical and research experiences. Dans : Katlin, L.J., Men and Addictions. Nova Science Publishers, Hauppauge, NY.
- Najavits, L.M., Weiss, R.D., Shaw, S.R., & Muenz, L.R. (1998). « Seeking Safety »: Outcome of a New Cognitive-Behavioral Psychotherapy for Women with Posttraumatic Stress Disorder and Substance Dependence. Journal of Traumatic Stress, 11(3), 437 – 456.
- Norman, S.B., Wilkins, K.C., Tapert, S.F., Lang, A.J., & Najavits, L M. (2010). A pilot study of seeking safety therapy with OEF/OIF veterans. Journal of Psychoactive Drugs, 42, 83-87.
- Ouimette, P., Brown, P.J. (2002). Trauma and Substance Abuse: Causes, Consequences, and Treatment fo Comorbid Disorders. Washington, D.C.: American Psychological Association.
- Ouimette, P., Moos, R.H., & Brown, P.J. (2003). Substance use disorder-posttraumatic stress disorder co-morbidity : A survey of treatments and proposed practice guidelines. Dans P. Ouimette & P. J. Brown (Eds.), Trauma and substance abuse: Causes, consequences and treatment of co-morbid disorders (1st ed., pp. 91-111). Washington, D.C.: American Psychological Association.
- Paglia-Boak, A., Adlaf, E.M., & Mann, R.E. (2011). Drug use among Ontario students, 1977-2011: Detailed OSDUHS findings (CAMH Research Document Series No. 32). Toronto, ON: Centre for Addiction and Mental Health.
- Paglia-Boak, A., Adlaf, E.M., Hamilton, H.A., Beitchman, J.H., Wolfe, D., & Mann, R.E. (2012). The mental health and well-being of Ontario students, 1991-2011 : Detailed OSDUHS findings (CAMH Research Document Series No. 34). Toronto, ON: Centre for Addiction and Mental Health.
- Reiger, D.A., Farmer, M.E. & Rae, D.S. (1990). « Co-morbidity of mental disorders with alcohol and other drug abuse, Results from the Epidemiological Catchment Area (ECA) study », Journal of the American Medical Association, 264, 2511–2518.
- Riggs, P.D., & Davies, R.D. (2002). A clinical approach to integrating treatment for adolescents depression and substance abuse. Journal of the American Academy of Child and Adolescent Psychiatry, 41, 1253-1255.
- Riggs, D.S., & Foa, E.B. (2008). Treatment for Co-morbid Posttraumatic Stress Disorder and Substance Use Disorder. Dans S. H. Stewart & P. J. Conrod (Eds.), Anxiety and Substance Use Disorder: The Vicious Cylce of Comorbidity (pp. 119-137). Boston, MA: Springer.
- Selzer, M.L. (1971) ‘The Michigan Alcoholism Screening Test (MAST): The quest for a new diagnostic instrument’, American Journal of Psychiatry, 127, 1653-1658.
- Skinner, H. A. (1982). The Drug Abuse Screening Test. Addictive Behaviors, 7, 363-371.
- Skinner, W.J., O’Grady, C.P., Bartha, C., & Parker, C. (2004). Les troubles concomitants de toxicomanie et de santé mentale : guide d’information. Canada : Centre de toxicomanie et de santé mentale.
- Simoneau, H., & Guay, S. (2008). Conséquences de la concomitance des troubles liés à l’utilisation de substances et à l’état de stress post-traumatique sur le traitement. Drogues, santé et société, 7(2), 125-160.
- Stewart, S.H., & Conrod, P.J. (2008). Anxiety disorders and substance use disorders co-morbidity: common themes and future directions. Dans Stewart, S.H., & Conrod, P.J. Anxiety and Substance Use Disorders: The Vicious Cycle of Comorbidity (pp. 239-257). New York: Springer.
- Triffleman, E., Carroll, K., & Kellogg, S. (1999). Substance dependence posttraumatic stress disorder therapy: An integrated cognitive-behavioral approach. Journal of Substance Abuse Treatment. 17, 3-14.
- Weathers, F. W., Litz, B. T., Herman, D. S., Huska, J. A., & Keane, T. M. (1993). The PTSD Checklist (PCL): Reliability, validity, and diagnostic utility. Paper presented at the 9th Annual Conference of the ISTSS, San Antonio, TX.
- Weaver, C M., Trafton, J.A., Walser, R.D., & Kimerling, R.E. (2007). Pilot test of Seeking Safety with male veterans. Psychiatric Services, 58, 1012. Also, see reply: Najavits, L. M. (2007). Letter to the editor: Reply to Weaver et al. (2007). Psychiatric Services, 58, 1376.
- Weller, L.A. (2005). Group therapy to treat substance use and traumatic symptoms in female veterans. Federal Practitioner, 22(4), 27-38.
- Zlotnick, C., Johnson, J., & Najavits, L.M. (2009). Randomized controlled pilot study of cognitive behavioral therapy in a sample of incarcerated women with substance use disorder and PTSD. Behavior Therapy, 40(4), 325-36.
- Zlotnick, C., Najavits, L.M., Rohsenow, D.J., & Johnson, D.M. (2003). A cognitive-behavioral treatment for incarcerated women with substance use disorder and posttraumatic stress disorder: Findings from a pilot study. Journal of Substance Abuse Treatment, 25. 99-105
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