Résumés
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
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