研究目的：失眠盛行率高，且容易發展為慢性化的問題，目前多以助眠藥物作為失眠的治療，短期使用雖可幫助緩解失眠症狀，但長期使用的有效性及安全仍有較大爭議，且容易發展出依賴性及耐受性的問題。然而失眠患者中仍有相當高的比例在對藥物療效不滿意的情況下，使用遠超過臨床指引建議的期間，許多失眠患者亦表達出對助眠藥物使用的矛盾心態，顯示助眠藥物的使用仍受其他心理因素影響。過去研究指出計劃行為理論能有效預測及幫助探討物質使用相關行為的認知因素，但助眠藥物的使用除了認知因素的影響外，也會出現較為衝動及難以控制的渴想狀態。因此本研究目的是在於了解長期助眠藥物使用的心理因素，探討助眠藥物使用行為的認知因素，以及在計劃行為理論的架構下，失眠患者對於助眠藥物使用的認知因素是否會受到渴想的影響。 研究方法與結果：本研究以21名失眠患者進行開放式訪談後編制助眠藥物使用之計劃行為理論問卷，招募失眠且有助眠藥物使用經驗的受試者填寫助眠藥物使用計劃行為理論問卷以及助眠藥物渴想量表，並於施測後一個月及三個月的時間點，以電話追蹤其助眠藥物使用狀況，一個月及三個月有效問卷分別為143及139份。結果顯示知覺行為控制為行為意圖的主要預測因子，行為意圖及知覺行為控制能預測一個月及三個月時的藥物使用行為，且行為意圖為使用行為的最佳預測因子；助眠藥物使用行為意圖對一個月及三個月時的助眠藥物使用情況的預測力會受到渴想的負向調節。 結論：本研究結果顯示助眠藥物使用的行為意圖是行為出現與否的主要決定因素，說明失眠患者的確會在認知決策後選擇使用助眠藥物，也會在知覺到較多促進助眠藥物使用之情境或因素時產生助眠藥物使用的行為意圖或直接出現助眠藥物的使用行為，顯示助眠藥物使用行為上外在情境及因素的重要性。此外，本研究結果也顯示助眠藥物使用的行為意圖會受到渴想的干擾，當渴想程度愈高時行為意圖對於實際行為的預測力愈低，而渴想程度愈低時行為意圖對實際行為的預測愈高。此研究結果幫助了解長期助眠藥物使用的心理因素，亦可將其用於幫協助擬定助眠藥物減藥策略。 / Insomnia has high prevalence and is prone to develop into a chronic problem. Hypnotics are the most common choice of treatment for insomnia. Although short-term usage is effective in relieving insomnia, the safety and efficacy of long-term usage are still in controversy. Long-term usage has also been reported to increase risks of tolerance and dependence. Even though the efficacy of hypnotics is not always satisfying, the duration of hypnotics use in insomnia patients is often longer than clinical recommendation. This may be influenced by some psychological factors. The theory of planned behavior has been demonstrated to be able to predict cognitive factors of substance use behaviors. It can therefore possibly be used to model hypnotic use behavior. In addition to cognitive factors, craving that is associated with losing control over drug use may also play a role in the use of hypnotics. The purpose of current study is to 1) explore the cognitive factors of long-term hypnotics use based on the theory of planned behavior, and 2) understand whether the cognitive factors would be influenced by the craving state. Method and result: We first conducted a semi-structured interview with 21 insomnia patients to develop the questionnaire of the theory of planned behavior of hypnotics use and a hypnotic craving scale. The insomnia patients who had used or are currently using hypnotics were recruited to complete the questionnaires. They were contacted by telephone at 1-month and 3-month follow-ups. Total number of valid questionnaires of 1-month and 3-month follow-ups were 143 and 139, respectively. We found that behavior intention could be predicted by perceived behavior control, but not attitude and subjective norms. Frequency of hypnotics use at 1-month and 3-month follow-ups could be predicted by behavior intention and perceived behavior control, and behavior intention was the best predictor. Craving has a negative moderating effect on the relationship between behavior intention and the hypnotics use behavior at both 1-month and 3-month follow-ups. Conclusion: The findings of current study show that behavior intention is the most crucial cognitive factor to predict hypnotics use behavior. It indicates that insomnia patients may have higher behavior intention and are more likely to use hypnotics when they perceive more situational factors that lead to drug use. In addition, our study indicates the association between behavior intention and actual hypnotic use behavior can be moderated by craving. The higher the craving state the lower the predictability of hypnotic use by behavior intention, and vice versa. Our study helps understand the psychological factors of long-term hypnotics use, and assists in developing the tapering interventions.

Introdução: A dependência de cocaína é doença crônica e afeta uma população bastante heterogênea. Fatores psicológicos, biológicos e sociais estão envolvidos com o quadro e sua evolução. A fissura, sintoma importante, pode ser influenciada por aspectos biológicos e psicológicos e altera o curso do quadro. Além disso, faltam sistemas classificatórios desta doença tão complexa. Os objetivos deste estudo são: investigar como a fissura pode ser influenciada por traços de personalidade e tentar agrupar pacientes com diferentes características pessoais em relação à resposta ao tratamento cognitivo comportamental. Métodos: Foram avaliados 100 pacientes que iniciaram o tratamento manualizado proposto. Classes de participantes que apresentavam características psicológicas relacionadas ao uso da droga e impulsividade semelhantes foram identificados em análise de classes latentes. A associação destas variáveis na adesão ao tratamento foi investigada. Dentre o grupo que terminou as quatro avaliações ao longo do acompanhamento, analisou-se como os traços de personalidade influenciam a intensidade, frequência e duração da fissura, usando o modelo de Equações de Estimativas Generalizadas com estrutura de correlação autorregressiva. Resultados: Dois grupos foram delineados. Participantes do Cluster 1 (n=60) foram caracterizados com maior nível de impulsividade, uso de maior quantidade de cocaína, maior nível educacional, mais história de tratamentos prévios e mais história familiar positiva de TUC que o Cluster 2 (n=40). Indivíduos do Cluster 1 aderiram mais ao tratamento. Em relação à fissura, observou-se que varia ao longo do tratamento. Traços de personalidade como busca por novidades, dependência de gratificação e esquiva ao dano interagem com a intensidade da fissura e persistência interage com a duração. Existe interação entre intensidade da fissura, uso de droga e via de administração. Conclusões: informações sobre características pessoais associadas à não adesão e ao abandono de tratamento, assim como à variação da fissura e sua correlação com fatores de personalidade devem ser investigados e avaliados para que tratamentos mais atrativos e eficazes possam ser propostos / Introduction: Cocaine dependence is a chronic condition affecting a very heterogeneous population. Biological, psychological and social factors are involved in addiction and how it evolves. Craving is an important symptom, it is influenced by both psychological and biological factors, and affects how the patient addiction evolves. Furthermore, there are no classifying systems for this very complex disease. The aims of this study are to investigate how craving is influenced by personality traits, and atempt to cluster patients with different personality traits in terms of their response to cognitive behavioral therapy. Methods: This study evaluate 100 patients who started the proposed manualized treatment. Latent class analysis was used to cluster subjects with similar psychological characteristics, cocaine use related aspects and impulsivity. This study looked at the association between these variables and adherence to treatment. We analyzed how personality traits influence craving intensity, frequency and duration in the group of subjects completing the four follow-up period evaluations, using the Generalized Estimating Equations model and an autoregression correlation structure. Results: Two clusters emerged: Cluster 1 (n=60) subjects were characterized as being more impulsive, using larger amounts of cocaine, having more years of schooling, a history of more prior treatments, and increased positive Family history of cocaine abuse than Cluster 2 (n=40) subjects. Individuals in Cluster 1 adhered more to treatment. Regarding craving, we found that it varied over the course of treatment. Personality traits such as novelty seeking, reward dependence and harm avoidance interact with intensity of craving, and persistence interacts with duration. There is an interaction between intensity of craving, drug use and route of administration. Conclusion: information about the personal characteristics associated with treatment non-adherence and abandonment, as well as the variation in craving and its correlation with personality traits must be investigated and analyzed so that more effective and attractive treatments may be developed

Annuellement, plus de 19 millions d’individus consomment de la cocaïne dans le monde et sur ce nombre, 16 % développeront un trouble de l’usage de cocaïne (TUC). Ce trouble est associé à de hauts niveaux de problèmes de santé physique, mentale ainsi que sociale et aucun traitement pharmacologique efficace n’est actuellement disponible. Le cannabidiol (CBD) a suscité un important intérêt en tant que traitement prometteur pour les troubles d’usage de substance (TUS). Par exemple, certaines données probantes suggèrent que le CBD pourrait diminuer la consommation de cocaïne et possèderait des propriétés anxiolytiques. De plus, le CBD augmenterait les taux plasmatiques d'anandamide (AEA), influençant possiblement certaines de ses propriétés thérapeutiques. L’objectif général de cette thèse était d’évaluer l’efficacité du CBD par rapport au placebo pour le traitement du TUC. Plus précisément, dans le premier article présenté dans cet ouvrage, nous nous sommes principalement intéressés à l’effet du CBD sur l’envie impérieuse de consommer (craving), sur la consommation de cocaïne et sur le délai avant une rechute, et ce chez des participants avec un TUC. Par la suite, dans le second article, nous avons étudié les possibles propriétés anxiolytiques du CBD chez nos participants. Finalement, dans le troisième article de cette thèse, il a été question de l’effet du CBD sur les taux plasmatiques d’AEA. Un essai randomisé contrôlé de supériorité en double insu a été conduit au Centre hospitalier de l’Université de Montréal pour répondre à ces objectifs. L’étude était divisée en deux phases, soit une première où les participants étaient hospitalisés pendant une période de dix jours et une seconde d’une durée de 12 semaines pour effectuer un suivi ambulatoire. Au total, 78 individus (14 femmes) présentant un TUC ont été assignés au hasard, par blocs stratifiés, à 800 mg par jour de CBD (n=40) ou à un placebo (n=38). Les variables primaires de cette étude étaient le craving induit par un scénario de consommation de cocaïne (phase I) et le délai avant une rechute (phase II). Concernant les variables secondaires, nous avions le craving induit par un scénario de stress (phase I) et l’utilisation de cocaïne (phase II). Finalement, plusieurs variables exploratoires ont été étudiées telles que l’anxiété, les niveaux d’AEA et de cortisol ainsi que les symptômes de sevrage. Dans un premier lieu, nous avons démontré que le CBD était similaire au placebo pour induire un craving suite à un scénario de consommation de cocaïne ainsi qu’à un scénario de stress. De même, le délai avant une rechute ainsi que la consommation de cocaïne durant la phase II de l’étude étaient similaires entre les deux groupes de traitement. Au niveau des variables exploratoires, les participants des groupes CBD et placebo présentaient des scores d’anxiété ainsi que des niveaux de cortisol et d’AEA similaires. Finalement, le CBD était bien toléré et le principal effet secondaire était la diarrhée. Globalement, nous n’avons trouvé aucune preuve concernant l’efficacité de l’administration quotidienne de 800 mg CBD sur nos différentes variables chez nos participants. Notre étude a mis en évidence l’important besoin de poursuivre la recherche pour identifier un traitement pharmacologique efficace pour aider les individus avec un TUC. / Annually, more than 19 million people use cocaine worldwide. Of that number, 16% will develop cocaine use disorder (CUD). CUD is associated with high levels of physical, mental, as well as social health problems, and no effective pharmacological treatment is currently available. Cannabidiol (CBD) has generated significant interest as a promising treatment for substance use disorders (SUD). For example, some evidence suggests that CBD may decrease cocaine use, and that it may also have anxiolytic properties. In addition, CBD could increase plasma levels of anandamide (AEA), possibly influencing some of its therapeutic properties. The main objective of this thesis was to evaluate the effectiveness of CBD compared to placebo for the treatment of CUD. Specifically, in the first article presented in this thesis, we focused on the effect of CBD on craving, cocaine use, and time to relapse in participants with CUD. Subsequently, in the second article, we investigated the possible anxiolytic properties of CBD in our participants. Finally, in the third article, the effect of CBD on plasma AEA levels was discussed. A randomized, controlled, double-blind superiority trial was conducted at the University of Montreal Hospital Center to explore these objectives. The study was divided into two phases: a first where participants were hospitalized for a period of 10 days, and a second phase consisting of a 12 week outpatient follow-up. A total of 78 individuals (14 women) with CUD were randomly assigned to stratified blocks at 800 mg per day of CBD (n = 40) or placebo (n = 38). The primary outcomes in this study were craving induced by a cocaine use scenario (phase I) and time to relapse (phase II). The secondary outcomes were craving induced by a stress scenario (phase I) and the use of cocaine (phase II). Finally, several exploratory variables were studied such as anxiety, AEA and cortisol levels, as well as withdrawal symptoms. First, we demonstrated that CBD was similar to placebo in inducing craving following a cocaine use scenario as well as a stress scenario. Likewise, the time to relapse, as well as cocaine use during phase II of the study were similar between the two treatment groups. In terms of exploratory outcomes, participants in the CBD and placebo groups had similar anxiety scores, as well as cortisol and AEA levels. Ultimately, CBD was well tolerated and the main adverse event was diarrhea. Overall, we found no evidence regarding the effectiveness of administering daily 800 mg CBD on the various measured outcomes in our participants. Our study highlighted the significant need for further research to identify an effective pharmacological treatment to help individuals with a CUD.

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This diploma thesis explores the phenomenon of formation and development of alcohol dependence. In the first series focuses on the historical description, which demonstrates considerable anchored in the life of our ancestors already. It also defines the concept of addiction, its causes and consequences, whether psychological, medical or social. Its objective is to describe the possibilities of social work in this phenomenon. defines therefore primarily targets and understanding of social work and consequently specifics of client alcoholism. An important element is the role of the social worker in the client's motivation to change, which uses Nešpor's model of spontaneous changes in motivation. Then, on the basis of available social services selects several most suitable, which can help to improve the client's situation. Has an essential role in this issue also primary prevention, ie it discusses the methodology, target groups, focusing on adolescents and the focus is on the firm role of the family. Finally contains some official documents on primary prevention, which are discussed current issues of primary prevention practice and subsequent survey, mapping aspect of social workers on the incidence risk of alcohol dependence among adolescents attending social facilities.

No / Observational studies have shown that attentional bias for smoking-related cues is associated with increased craving and relapse. Laboratory experiments have shown that manipulating attentional bias may change craving. Interventions to reduce attentional bias could reduce relapse in smokers seeking to quit. We report a clinical trial of attentional retraining in treatment-seeking smokers. This was a double-blind randomised controlled trial that took place in UK smoking cessation clinics. Smokers interested in quitting were randomised to five weekly sessions of attentional retraining (N=60) or placebo training (N = 58) using a modified visual probe task from one week prior to quit day. Both groups received 21 mg nicotine patches (from quit day onwards) and behavioural support. Primary outcomes included change in attentional bias reaction times four weeks after quit day on the visual probe task and craving measured weekly using the Mood and Physical Symptoms Scale. Secondary outcomes were changes in withdrawal symptoms, time to first lapse and prolonged abstinence. No attentional bias towards smoking cues was found in the sample at baseline (mean difference = 3 ms, 95% CI = -2, 9). Post-training bias was not significantly lower in the retraining group compared with the placebo group (mean difference = -9 ms, 95% CI = -20, 2). There was no difference between groups in change in craving (p = 0.89) and prolonged abstinence at four weeks (risk ratio = 1.00, 95% CI = 0.70, 1.43). Taken with one other trial, there appears to be no effect from clinic-based attentional retraining using the visual probe task. Attentional retraining conducted out of clinic may prove more effective. CLINICAL TRIAL REGISTRATION: UK Clinical Trials ISRCTN 54375405.