Contenu du sommaire : La réduction des risques : une approche unique pour des dommages différents ?

The description of two centres for drug use in the Maastricht area (visited in January 2005), brings an opportunity to evaluate two characteristics of the highly integrated harm-reduction policy of the Netherlands. The Maastrict injection Centre is a low-threshold “out-patient” institution, where social workers try to make room for ordinary life, based on a principle of empowerment. The Centre for controlled distribution of heroin, in Heerlen, works on the basis of a higher threshold, in particular regarding conformity controls. Although they are complementary as to how they work, these centres nevertheless exemplify two alternative ways for drug users to become part of the Polity.

This paper provides a synthesis of the methodology and of the main results of a survey aiming to better understand the impact of harm reduction stands on the perceptions and relationship young people within the techno scene have on psychoactive substances use and their related risks. Within this festive scene, we can distinguish, in France, the “rave” type, which is legal and abides by security norms, and the “free” type, which is illegal and underground, but where harm reduction stands are more active and present since a longer time. The concept of “usage logic” used for this study emphasises that the meanings conferred to psychoactive substances use are linked to the way festive people do define the context in which this usage is done. In this analytic perspective, we can better understand the effect of the festive scene definition, as being safe or not, on the perception of the risks and on the integration of harm reduction information into usage practices. A comparative analysis was done on the state of the collective knowledge on drug use and on the relationships to risk taking within the two types of scenes. The results of this survey are more of exploratory type than exhaustive and systematically verified, but they give, nevertheless, indicatives and interpretatives data about the impact of harm reduction interventions and of the legal setting of the festive scene.

Alcoholic mothers' babies and their families make up population that is difficult to manage during perinatal periods. The “Centre d'action médico-sociale précoce” (Camsp) deals with infants up to 6 years old children with learning difficulties due to different handicaps. This Centre aims to reduce handicaps or, at least, prevent over-handicaps. The effects of Camsp's work in the city of Havre are studied through the paths of eleven children with foetal alcohol syndrome (Fas) or foetal alcohol spectrum disorders (Fasds) through semi-directive interviews with the head of Camsp.

Developed by Michael J. Apter, reversal theory is a psychological theory addressing the inconsistency and changeability of individuals. The theory specifically focuses on motivational styles, proposing that people regularly reverse between different psychological states, depending upon the meaning and motives felt by an individual in different situations at different times. According to Apter, reversal between psychological states would be pathological in addictions. In these cases, reversal would be stuck in the paratelic state and the addict would find a way (e.g. through drugs) to maintain a high level of arousal. In France, many studies focused on the telic/paratelic states showed a stuck reversal in the paratelic state in drug addicts but none of these studies have evaluated the other motivational states. As the same way, there was no research on reversal theory and motivational states in anorexics. The main purpose of this study is evaluating the eight motivational states in drugs addicts and anorexics and comparing in this way a drug addiction with a non-drug addiction. The population (n=150) is composed of three groups: 60 drugs addicts, 30 restrictive anorexics, 60 controls. We used the recent french version of the Apter motivational styles profile (Amsp). Statistical tests showed a very different motivational profile in the three groups: telic, conformist, sympathy, alloic in controls; paratelic, negativistic, sympathy, autic in drug addicts; telic, conformist, mastery, autic in anorexics. The important differences between drug addicts and anorexics underline the existence of two types of addictions: those focused on sensations seeking, impulsivity, attraction for dangerous situations and those focused on sensations avoiding, pathological self-control and repulsion for risk-taking.

Decision-making deficits are at the centre of the definitions of addiction disorder. These deficits would be only the expression of a motivational bias because of which the patient is feeling the sensation of ‘craving' and chooses to consume the substance of dependence in an automatic and compulsive way. The action of this substance on the mesolimbic dopaminergic reward system implies long-lasting modifications of the neural networks implied in the decision-making process, mainly the orbito-frontal cortex, the dorsolateral prefrontal cortex, the anterior cingular gyrus and the limbic system. Indeed, the addict's decisional balance could be biased in favour of the consumption of the substance because of dysfunctional emotional (impaired salience attribution) and cognitive systems (impaired response inhibition).

This paper follows those published in several issues of “Psychotropes” journal in 2005, which covered the websites of Western European countries (except France, which will becovered in the last article in the series). This paper covers the websites of Central European countries (Hungary, Poland, Czech Republic, Slovak Republic and Slovenia), and also some Russian sites whose Internet landscape is not well known. Of course, this virtual tour cannot be exhaustive. It has been facilitated mainly by consulting the excellent Elisad Gateway now covering these countries. Moreover, because it was done at a specific moment in space and time, some of the sites mentioned here may disappear, or change contents, while new sites may appear, and especially in these countries where the Internet landscape, as well as the institutions, are subject to frequent changes.