Le Travail de Proximité auprès des Usagers de Drogues en Europe : Concepts, pratiques et terminologie

Traduction française, déposée à l'OCDE, de : Outreach Worg Among Drug Users in Europe. Concepts, Practice and Terminology, EMCDDA, June 1999, Insights Series, 2Il s'agit d'un état des lieux du développement du travail de proximité dans chaque pays de l'Union Européenne. Ce travail s'appuie sur l'analyse de la littérature et sur une enquête faite en 1998 pour l'Observatoire Européen des Drogues et de la Toxicomanie. Sont abordés l'histoire du travail de proximité, sa définition, les questions de terminologie, les différentes formes de travail et les modèles d'intervention rencontrés, et enfin les objectifs et les méthodes du travail de proximité. Les points communs entre les pays et les divergences dans les choix et les pratiques ressortent de l'ensemble de ce tableau qui est une première approche de ce suje

Predicting the transition from frequent cannabis use to cannabis dependence: A three-year prospective study

AbstractBackgroundFrequent cannabis users are at high risk of dependence, still most (near) daily users are not dependent. It is unknown why some frequent users develop dependence, whereas others do not. This study aims to identify predictors of first-incidence DSM-IV cannabis dependence in frequent cannabis users.MethodsA prospective cohort of frequent cannabis users (aged 18–30, n=600) with baseline and two follow-up assessments (18 and 36 months) was used. Only participants without lifetime diagnosis of DSM-IV cannabis dependence at baseline (n=269) were selected. Incidence of DSM-IV cannabis dependence was established using the Composite International Diagnostic Interview version 3.0. Variables assessed as potential predictors of the development of cannabis dependence included sociodemographic factors, cannabis use variables (e.g., motives, consumption habits, cannabis exposure), vulnerability factors (e.g., childhood adversity, family history of mental disorders or substance use problems, personality, mental disorders), and stress factors (e.g., life events, social support).ResultsThree-year cumulative incidence of cannabis dependence was 37.2% (95% CI=30.7–43.8%). Independent predictors of the first incidence of cannabis dependence included: living alone, coping motives for cannabis use, number and type of recent negative life events (major financial problems), and number and type of cannabis use disorder symptoms (impaired control over use). Cannabis exposure variables and stable vulnerability factors did not independently predict first incidence of cannabis dependence.ConclusionsIn a high risk population of young adult frequent cannabis users, current problems are more important predictors of first incidence cannabis dependence than the level and type of cannabis exposure and stable vulnerability factors

Integrated Genomics Identifies Five Medulloblastoma Subtypes with Distinct Genetic Profiles, Pathway Signatures and Clinicopathological Features

BACKGROUND: Medulloblastoma is the most common malignant brain tumor in children. Despite recent improvements in cure rates, prediction of disease outcome remains a major challenge and survivors suffer from serious therapy-related side-effects. Recent data showed that patients with WNT-activated tumors have a favorable prognosis, suggesting that these patients could be treated less intensively, thereby reducing the side-effects. This illustrates the potential benefits of a robust classification of medulloblastoma patients and a detailed knowledge of associated biological mechanisms. METHODS AND FINDINGS: To get a better insight into the molecular biology of medulloblastoma we established mRNA expression profiles of 62 medulloblastomas and analyzed 52 of them also by comparative genomic hybridization (CGH) arrays. Five molecular subtypes were identified, characterized by WNT signaling (A; 9 cases), SHH signaling (B; 15 cases), expression of neuronal differentiation genes (C and D; 16 and 11 cases, respectively) or photoreceptor genes (D and E; both 11 cases). Mutations in beta-catenin were identified in all 9 type A tumors, but not in any other tumor. PTCH1 mutations were exclusively identified in type B tumors. CGH analysis identified several fully or partly subtype-specific chromosomal aberrations. Monosomy of chromosome 6 occurred only in type A tumors, loss of 9q mostly occurred in type B tumors, whereas chromosome 17 aberrations, most common in medulloblastoma, were strongly associated with type C or D tumors. Loss of the inactivated X-chromosome was highly specific for female cases of type C, D and E tumors. Gene expression levels faithfully reflected the chromosomal copy number changes. Clinicopathological features significantly different between the 5 subtypes included metastatic disease and age at diagnosis and histology. Metastatic disease at diagnosis was significantly associated with subtypes C and D and most strongly with subtype E. Patients below 3 yrs of age had type B, D, or E tumors. Type B included most desmoplastic cases. We validated and confirmed the molecular subtypes and their associated clinicopathological features with expression data from a second independent series of 46 medulloblastomas. CONCLUSIONS: The new medulloblastoma classification presented in this study will greatly enhance the understanding of this heterogeneous disease. It will enable a better selection and evaluation of patients in clinical trials, and it will support the development of new molecular targeted therapies. Ultimately, our results may lead to more individualized therapies with improved cure rates and a better quality of life

Health and social problems associated with recent Novel Psychoactive Substance (NPS) use amongst marginalised, nightlife and online users in six European countries.

Continued diversification and use of new psychoactive substances (NPS) across Europe remains a public health challenge. The study describes health and social consequences of recent NPS use as reported in a survey of marginalised, nightlife and online NPS users in the Netherlands, Hungary, Portugal, Ireland, Germany and Poland (n = 3023). Some respondents were unable to categorise NPS they had used. Use of ‘herbal blends’ and ‘synthetic cannabinoids obtained pure’ was most reported in Germany, Poland and Hungary, and use of ‘branded stimulants’ and ‘stimulants/empathogens/nootropics obtained pure’ was most reported in the Netherlands. Increased heart rate and palpitation, dizziness, anxiety, horror trips and headaches were most commonly reported acute side effects. Marginalised users reported substantially more acute side effects, more mid- and long-term mental and physical problems, and more social problems. Development of country-specific NPS awareness raising initiatives, health and social service needs assessments, and targeted responses are warranted

Sharing, group-buying, social supply, offline and online dealers: how users in a sample from six European countries procure new psychoactive substances (NPS).

Given the multiple ways of regulations and market situations for new psychoactive substances (NPS), it is of interest how NPS users procure their drugs in different countries as well as in different user groups. Data comes from a face-to-face and online survey conducted in six EU countries, covering three groups of current (12-month) adult NPS users: (1) socially marginalized, (2) users in night life, and (3) users in online communities. While the supply situation differed considerably between countries, friends were the most prevalent source for buying, followed by online shops and private dealers. Marginalized users were more likely to buy from dealers, while online respondents showed the highest rates for buying online. While buying NPS from online or offline shops was relatively prevalent, we also found high rates for social supply and buying from dealers. A considerable part of this market may be classified as “social online supply,” with private suppliers procuring their drugs online. The market features among marginalized users resemble more those of illicit drug markets than those for other NPS users

How cannabis users obtain and purchase cannabis: a comparison of cannabis users from European countries with different cannabis policies.

This study examines the role of cannabis policy in how cannabis users obtain and purchase cannabis. A survey was conducted in the Dutch coffeeshops among current cannabis users ( = 1255) aged 18-40 from seven European countries with different cannabis policies. This study investigated whether acquisition methods and supply sources were associated with national cannabis policy, controlling for gender, age, and frequency of use. Cross-national differences notwithstanding, cannabis was easily available to current cannabis users in Europe. Within and across countries, users acquired cannabis in various ways and buyers purchased it from various sources, representing a mixture of open, closed, and semi-open retail markets. Buying cannabis was the most common method of acquisition. Among participants who reported buying their cannabis ( = 929), buying from friends was the most common source of supply, followed by street dealers, home dealers, and delivery services. The vast majority of Dutch participants reported buying cannabis from coffeeshops. Contrariwise, French buyers were more likely to buy cannabis from street dealers and delivery services, and Greek buyers to buy it from home dealers and friends. Overall, the Internet played a marginal role in purchasing cannabis. Our findings confirm the significant role of social supply across Europe. Although cross-national differences were rather common in cannabis acquisition and supply, yet they were not unidirectionally linked with the punitiveness of national cannabis policy. Findings suggest a differentiated normalization of the cannabis retail market, with users often preferring to buy cannabis in a regulated or legal market

Why? Explanations for drug use and drug dealing in social drug research

For thousands of years, humans have been using substances that are called 'drugs' today, for example to relieve pain, to relax, to gain energy, or in the course of cultural and religious rituals. In search for explanations as to why so many people in the 21st century use drugs, and why in such a wide variety, several macro level factors or drivers need to be addressed.Chapters in this volume contribute to the understanding of drug use, drug users, drug markets and drug policy in Europe. All the authors work in this field, and are involved in local, national or international research on drug use, drug users or drug dealers. Their research is not carried out in laboratories nor treatment centres. Some of it is predominantly conducted in libraries and archives, but most takes place elsewhere - on the streets, in nightclubs, in private drug-dealing settings. The authors are social scientists from different disciplines - anthropology, criminology, geography, economics, linguistics, psychology, sociology, social psychiatry - and many of them have an interest in, or are specifically oriented to qualitative research methods, including participant observation, informal conversations and in-depth interviews. In the search for explanations as to why particular groups turn to or continue to use certain substances over others, why some people use drugs, why users prefer particular methods of supply, and why current drug policies exists, each of the chapters underline the utmost importance of this book, which captures many of the complexities of how drug use and drug dealing is explained, experienced and often problematised today