Une typologie tridimensionnelle des pratiques de consommation d’alcool au Canada : usages, contextes et motivations de boire

Cette thèse de doctorat a pour objectif de développer une typologie socioculturelle de la consommation d’alcool à partir des mesures d’usages, de contextes et de motivations à boire pour approfondir notre connaissance sur les pratiques collectives de boire au Canada et d’explorer la variabilité des pratiques selon les caractérisations sociodémographiques et socioéconomiques des buveurs . Partant du constat des limites conceptuelles des modèles typologiques développés en alcoologie qui ne permettent pas d’observer toute la complexité des pratiques du boire dans une société puisqu’ils sont construits principalement à partir de l’usage, cette thèse propose de conceptualiser les pratiques de boire comme l’interface de l’usage, des contextes de consommation et des motivations à consommer. Les données utilisées proviennent de l’enquête GENder, Alcohol, and Culture: an international study – Canada. Uniquement les buveurs réguliers (consommant au moins une fois par mois) ont été retenus dans le cadre de cette thèse. Des analyses de correspondances et des analyses de classes latentes ont permis de dériver des typologies tridimensionnelles des pratiques de boire et de les associer à des caractéristiques sociales. Les résultats de recherche sont présentés en trois articles scientifiques qui répondent chacun à un objectif spécifique de la thèse. Le premier article présente une classification des buveurs réguliers canadiens en six grands types et établit le lien entre ces types et le genre ainsi que le groupe d’âge. Le deuxième article teste l’invariance de la typologie selon le genre et propose des classifications distinctes pour les femmes et pour les hommes en lien avec le groupe d’âge et le niveau d’éducation. Le troisième article se concentre sur les buveurs réguliers en emploi et examine l’association entre la position socioprofessionnelle dans la hiérarchie sociale et les pratiques de boire.This doctoral thesis aims to develop a socio-cultural typology of alcohol consumption through measures of use, contexts and motivations to drink in order to explore and deepen our knowledge about collective practice of drinking in Canada, and to explore the variability of practices along demographic and socioeconomic characteristics of drinkers . The general hypothesis of the thesis stipulates that existing typologies in alcohol research do not allow for the exploration of all the complexities of drinking practices within a society because they are based primarily on alcohol consumption. We believe that adding contextual and motivational dimensions to the dimension of use allows for improving the observation and description of collective practices of drinking, which are associated with it. Quantitative data from the GENACIS, GENder, Alcohol, and Culture: an international study – Canada project helped to validate the main research hypothesis. Only regular drinkers (consuming at least once a month) were selected as part of this thesis. Multiple correspondence analysis and latent class analysis permitted to derive three typologies of drinking practices, associated to social features. The results of the research are presented in three scientific articles, each of which responds to a specific objective of the thesis. The first article presents a classification of Canadian drinkers in six major types and establishes the link between these types, age and gender. The second article tests the invariance of the typology according to gender and proposes separate classifications for women and men in relation to age group and level of education. The third section focuses on regular drinkers’ employment and examines the association between professional position in the social hierarchy and practice of drinking

Historicité des études typologiques en alcoologie

Différentes manières de boire l’alcool sont perceptibles et différentes manières de concevoir la consommation d’alcool le sont également. Afin de « départager » ou « distinguer » les individus et groupes sociaux selon leur pratique de boire, différentes approches conceptuelles ont été utilisées à travers les époques, proposant des classifications des buveurs et buveuses en grands types. Un « type » est une conception abstraite qui regroupe et distingue les sujets ou les objets à partir de traits qu’ils ont en commun. En alcoologie, certaines typologies visent précisément à distinguer les buveurs problématiques ou pathologiques des buveurs non problématiques ou non pathologiques. D’autres typologies visent plutôt à distinguer les sociétés en fonction des pratiques de boire dominantes dans la population. Afin de souligner la contribution de chercheurs d’horizons d’études divers au développement de typologies en alcoologie et d’exposer l’historicité d’un domaine de recherche multidisciplinaire, ce texte fait état des connaissances des recherches typologiques du XXe et XXIe siècle des approches pathologiques et socioculturelles afin d’ouvrir la discussion sur les défis futurs en alcoologie des populations.Just as there are different ways of drinking alcohol, there are also different ways of conceptualizing the consumption of alcohol. In order to “separate” or “distinguish” individuals and social groups according to their drinking practices, different conceptual approaches have been proposed over the years, including classifications of drinking types. A “type” is an abstract concept that groups and distinguishes subjects or objects based on common characteristics. In alcohology, certain typologies aim to precisely distinguish problematic or pathological drinkers from non-problematic or non-pathological drinkers. Other typologies seek rather to distinguish societies based on dominant drinking practices within the population. Highlighting how researchers from a wide variety of backgrounds have contributed to the development of alcohology typologies and presenting the historic nature of a multidisciplinary field of research, this article examines the findings of pathological and sociocultural approaches to typology research in the 20th and 21st centuries and sheds light on future challenges in the alcohology of populations.Diferentes maneras de consumir alcohol son perceptibles, como lo son también diferentes maneras de concebir el consumo de alcohol. Con el objetivo de “separar” o “distinguir” a los individuos y a los grupos sociales según su práctica de consumo de bebida, se han utilizado, a través de las épocas, diferentes enfoques conceptuales que proponen clasificar a los bebedores y bebedoras en grandes tipos. Un “tipo” es una concepción abstracta que agrupa y distingue a los sujetos o los objetos a partir de rasgos que tienen en común. En alcohología, ciertas tipologías apuntan precisamente a distinguir a los bebedores problemáticos o patológicos de los bebedores no problemáticos o no patológicos. Otras tipologías están destinadas más bien a distinguir a las sociedades en función de las prácticas de bebida dominantes en la población. Con el objetivo de destacar la contribución de investigadores de diferentes horizontes en el desarrollo de las tipologías en alcohología y de exponer la historicidad de un campo de investigación multidisciplinario, en este texto se exponen los conocimientos de las investigaciones tipológicas del siglo XX y XXI sobre los enfoques patológicos y socioculturales, buscando abrir el debate sobre los desafíos futuros en materia de alcohología de las poblaciones

Faculty Newsletter

Volume 1, Number 4 February 1997Newsletter sent to faculty in February 1997 with information regarding library services and resource

Faculty Newsletter

Volume 2, Number 3 November/December 1997Newsletter sent to faculty in November 1997 with information regarding library services and resources

L’engagement dans le mouvement des AA : un gage de bonheur

Contexte : Le mouvement des Alcooliques Anonymes (AA) demeure la source d’aide la plus utilisée au monde en alcoolisme. Il propose un modèle de rémission basé sur les principes des 12 étapes et soutenu par une communauté d’entraide qui, au-delà de l’abstinence, vise la reconstruction de sa vie sans alcool et l’atteinte d’un bien-être. Peu d’études ont exploré la qualité de vie des membres abstinents au profit d’une littérature plus abondante concernant l’atteinte et le maintien de l’abstinence.Objectif : Cette étude vise à évaluer un modèle de médiation mettant en relation l’engagement dans le mouvement des AA, tant dans le programme qu’au sein de la fraternité, et le niveau de bien-être psychologique des membres, tout en tenant compte de la qualité de l’expérience positive de l’abstinence.Sélection des études et extraction des données : L’échantillon était composé de 168 membres AA de longue date, appelés « old-timers », avec un taux de réponse de 49 %. Un questionnaire autoadministré a permis d’évaluer l’engagement dans le mouvement, le niveau de bien-être psychologique ainsi que l’évaluation subjective de l’expérience d’abstinence.Résultats : Les membres AA rapportent généralement un niveau élevé de bien-être psychologique, un engagement dans la fraternité et une adhésion aux principes des 12 étapes. La socialisation avec les membres a un effet significatif et important sur le sentiment de bonheur et de satisfaction dans la vie, alors que l’application des étapes de maintien tend à influencer positivement le degré de satisfaction dans la vie et le sens donné à la vie grâce à l’expérience positive de l’abstinence.Conclusion : Les membres « old-timers » abstinents rapportent être heureux, satisfaits dans la vie et donner un sens à leur vie. La relation d’entraide qui se développe dans la fraternité et l’expérience de donner et de recevoir de l’aide contribuent de façon significative à ce bien-être psychologique.Context : Alcoholics Anonymous remains one of the most commonly used sources of support for alcoholics worldwide. It offers rehabilitation process based on the twelve-step program and sustained by an anonymous fellowship for mutual support, and besides remission aims to rebuild the individual’s life without alcohol and help him or her achieve a state of well-being. Few studies have explored the quality of life of abstinent members. Instead most literature has focused on analyzing the success in achieving and maintaining abstinence among the members.Objectives : This study aims to assess a mediation model exploring the relationship between involvement in the AA movement, both in the program and the fellowship, and psychological well-being of old-timers, while taking into account the quality of their experience with abstinence.Study selection and data extraction : The sample consisted of 168 AA members, who have been abstinent and members of AA for an extended period of time, called ‘old-timers’, for a response rate of 49 %. A self-administered questionnaire assessed involvement in the fellowship, involvement in the 12-step program, level of psychological well-being, including happiness, life satisfaction and meaning in life, and the subjective evaluation of the experience of abstinence.Results : AA members reported a high level of psychological well-being, strong involvement in the fellowship, and an adherence to the 12 steps. Socialization with members seems to have a greater effect on happiness and life satisfaction, while the application of the maintenance steps allowed a positive experience of abstinence, and mediated positively the effect on life satisfaction and meaning in life.Conclusion : Old-timers members reported to be happy, satisfied in life and finding meaning in living. The mutual support in the fellowship through experiences of giving and receiving help appear to contribute significantly to the psychological well-being of old-timers.Contexto : el movimiento de Alcohólicos Anónimos(AA) continúa siendo la fuente de ayuda más utilizada enel mundo en materia de alcoholismo. El mismo propone un modelo deremisión basado en los principios de las 12 etapas y sostenidopor una comunidad de ayuda mutua que, más allá de laabstinencia, tiene como objetivo la reconstrucción de una vidasin alcohol y el logro del bienestar. La literatura sobre el logro y elmantenimiento de la abstinencia es muy abundante pero pocos estudioshan explorado la calidad de vida de los miembros abstinentes.Objetivo : Este estudio se dirige a evaluar un modelo de mediación que relacione el compromiso con el movimiento de los AA, tanto en el programa como dentro de la fraternidad, con el nivel de bienestar psicológico de sus miembros, teniendo en cuenta la calidad de la experiencia positiva de la abstinencia.Selección de estudios y extracción de datos : La muestra estuvo compuesta por 168 miembros de larga data de AA, llamados “old-timers” (los antiguos), con un porcentaje de respuesta del 49 %. Un cuestionario autoadministrado permitió evaluar el compromiso con el movimiento, el nivel de bienestar psicológico y la evaluación subjetiva de la experiencia de abstinencia.Resultados : Los miembros de AA declaran generalmente gozar de un nivel elevado de bienestar psicológico, estar comprometidos con la fraternidad y adherir al principio de las 12 etapas. La socialización con los miembros tiene un efecto significativo e importante en el sentimiento de bienestar y satisfacción en la vida, mientras que las etapas de mantenimiento tienden a influir positivamente en el grado de satisfacción en la vida y en el sentido que se le da a la vida gracias a la experiencia positiva de la abstinencia.Conclusión : Los miembros “old-timers” abstinentes declaran ser felices, estar satisfechos con su vida y afirman haberle dado un sentido a la misma. La relación de ayuda mutua que se desarrolla en la fraternidad y la experiencia de brindar ayuda y de recibirla contribuyen de manera importante con el bienestar psicológico

Alcohol use among Inuit pregnant women : validity of alcohol ascertainment measures over time

BACKGROUND : Frequency and quantity of alcohol consumed by women are two important indicators of the risks associated with drinking during pregnancy. Some studies have compared the validity of maternal alcohol report obtained during and after pregnancy. However, to date none have examined alcohol use in a Native Canadian population, such as the Inuit. Effective measurement methods are necessary to better understand why children from some communities seem at increased risk of alcohol-related neurodevelopmental disorders. METHODS : Prospective and retrospective drinking interviews were obtained from a sub-sample of 67 women included in the Nunavik Child Development Study (NCDS), Nunavik, Canada (1995-2010; N=248). Number of days of alcohol consumption and binge drinking (five drinks or more per episode) across pregnancy as well as ounces of absolute alcohol per day and per drinking day among users were collected using timeline follow-back interviews administered both during pregnancy and again 11years after delivery. Consistency of alcohol reports over time, as well as significant differences for alcohol quantities described by users between interviews were examined. Sociodemographic characteristics associated with alcohol use reports were also assessed. RESULTS : The proportion of positive reports of alcohol and binge drinking during pregnancy was higher when women were interviewed prospectively during pregnancy than retrospectively. We observed a fair to moderate agreement of alcohol report between interview periods. By contrast, the number of binge drinking days during pregnancy was slightly higher among alcohol users when documented retrospectively. CONCLUSIONS : Our findings endorse the conclusion that prospective alcohol measures provide more reliable ascertainment and likely generate more valid information about the proportion of children prenatally exposed to alcohol in the Inuit population

Assessing quality indicators related to mental health emergency room utilization

Abstract Background This descriptive study compared 2014–15 to 2005–06 data on the quality of mental health services (MHS) in relation to emergency room (ER) use to assess the impact of the 2005 Quebec MH reform regarding access, continuity and appropriateness of care for patients with mental illnesses (PMI). Methods Data emanated from the Quebec Integrated Chronic Disease Surveillance System (Quebec/Canada). Participants (865,255 for 2014–15; 817,395 for 2005–06) were age 12 or over, with at least one MI, including substance use disorders (SUD), diagnosed during an ER visit, outpatient treatment or hospitalization. Variables included: access (ER use/frequency, hospitalization rates, outpatient consultations preceding an ER visit), care continuity (outpatient consultations following an ER visit/hospitalization, consecutive returns to the ERs), and care appropriateness (high ER use, recurrence of yearly ER visits, length of hospitalization). Frequency distributions were calculated on sex, age and geographic area for ER visits/hospitalizations in 2014–15, and between 2014 and 15 and 2005–06. Results PMI accounted for 12 % of the Quebec population in 2014–15 (n = 865,255), of whom 39% visited an ER for any reason. Amount and frequency of ER use and number/length of hospitalizations were almost twice as high for PMI versus patients without MI; 17% of PMI were also high/very high ER users and were frequently hospitalized. Among PMI, ER users were also frequent users of outpatient services despite a lack of follow-up appointments after ER visits or hospitalizations. Findings revealed some positive changes over time, such as decreased ER and hospitalization rates; yet overall access, continuity and appropriateness of care, as measured in this study, remained low. Conclusions This study demonstrated that the Quebec reform did not produce a substantial impact on ER use or substantially improved care, as hypothesized. Better access and continuity of care should be promoted to reduce the high prevalence of ER use among PMI. Quality improvement in MHS may be realized if ERs are supported by substantial and well-integrated community MH networks

Trajectories of alcohol use and binge drinking among pregnant Inuit women

Background: This study investigated trajectories of alcohol use and binge drinking among Inuit women starting from a year before pregnancy until a year after delivery, examined transition rates between time periods, and established whether specific factors could be identified as predictors of changes in alcohol behaviors. Methods: Drinking trajectories and movement among alcohol users and binge drinkers (i.e., non-binging and binging) were explored by Markov modeling across time periods. Two hundred and forty-eight Inuit women from Arctic Quebec were interviewed at midpregnancy, and at 1 and 11 months postpartum to obtain descriptive data on alcohol use during the year before pregnancy, the conception period, the pregnancy and the year after delivery. Results: The proportions of drinkers and bingers were 73% and 54% during the year prior to pregnancy and 62% and 33% after delivery. Both alcohol use and binge drinking trajectories demonstrated a significant drop in prevalence between the year before conception to the conception period. We also noted high probabilities of becoming an abstainer or not binging at this time. However, up to 60% of women continued to drink alcohol during pregnancy. Women in couples and not consuming marijuana were more likely to decrease their binge drinking at conception. Conclusions: This study emphasizes the importance of including the period around conception in the definition of drinking patterns during pregnancy. The importance of considering alcohol consumption in a multidimensional way (personal, familial and social determinants) is also addressed while trying to minimize problems both for the fetus and the mother