Jean-Pierre Couteron is a clinical psychologist, co-author of the” Addictology Checklist (Dunod, 2019 for the 3e edition) and working at the support and addiction prevention care center Le Trait d’union Oppelia, in Boulogne-Billancourt (Hauts-de-Seine).
What do you think of collective therapeutic structures and their functioning?
These are places that accompany weaning and where an abstinence clinic is practiced. They have another specificity to privilege the group, with the idea that between users confronted with the same problems one cannot be mistaken, there is a collective mutual aid which is set up. They complement the so-called “collective residential care” system, which also includes residential therapeutic centers and follow-up and addictological rehabilitation care. There are only about fifteen in all in France, which is not huge.
What is the French model of dependency management?
In France, the Minnesota model [qui vise à prendre en charge la personne dépendante aussi bien physiquement que mentalement] and therapeutic communities have long suffered from the experience of the Patriarch [association d’aide aux personnes toxicomanes, fondée en 1974 par Lucien Engelmajer], which had become a sect, and of a dominant frame of reference, mainly psychoanalytic, favoring a very individual approach to the problem and forgetting many of the issues of use. Institutional psychiatry, marked by the experience of the Second World War, remained very concerned with the autonomy of the person.
Then, in the 1980s, came the risk reduction strategy, which was also rejected in its infancy. It was the AIDS epidemic that imposed it, at the beginning less to treat drug addicts differently than to limit contamination. This allowed a huge step forward from a health point of view – the reduction of overdoses and the decline of HIV – but also to reach a whole public that caregivers did not meet on the sole axis of weaning. At the time, harm reduction had to fight against the defenders of the dogma of abstinence. Many players believe that this opposition must be overcome: abstinence is an essential solution for users, risk reduction remains the central axis of diversified support.
The fight against drugs and its trafficking has returned to the forefront of the political agenda. What does that mean ?
You have 42.59% of this article to read. The rest is for subscribers only.