Risk reduction, accommodation… how to cure crack users in Paris?

Risk reduction, accommodation… how to cure crack users in Paris?

Interview with Dr. Mario Blaise, psychiatrist-addictologist for 20 years at Hôpital Marmottan. ((illustration) ©SL / news Paris)

A year from now, crisis crack in paris it seems sunken. “Nurse them! Protect us! ”, shout futilely indignant residents in a double command, safe and sanitary. Basically it’s a question public health who is at the epicenter of the problem: how to cure crack users of their addiction? Reply, News from Paris contacted the doctor Mario Blaise, a psychiatrist-addictologist for 20 years at the Hôpital Marmottan, a care and support center for addictive practices located in the 17th arrondissement. Maintenance.

News: After more than 20 years of practice, have you seen an increase in crack addiction in Paris?

Mario Blaise: The addiction landscape in Paris has evolved. Problems mounted like a mile-feuille. Of course, alcohol or heroin are always in the background. But other products are now highlighted for their media coverage, sociology and store offerings. As such, an open crack scene in Paris crystallized and also attracted former opiate users who switched to the drug.

There is a real questioning of public opinion about the way to break free from crack addiction. What is the most appropriate course of therapy?

MB: It is a set of combined approaches. All addictions have a medical-psychosocial dimension. For example, when someone is on the street, it is difficult to ask them to stop using drugs or alcohol. The whole problem with crack is that the psychosocial dimensions are huge. We cannot treat a Forceval addict and a patient who consumes at home the same.

From a medical point of view, this requires support through various approaches: withdrawal, risk reduction, medication or breaks. [proposer à des usagers de vivre à distance des lieux où ils évoluent habituellement, NDLR]. However, these methods must be put on par with psychosocial issues such as housing, etc.

Is crack treatment special in the addiction landscape?

MB: Crack is a special addiction, but the conditions of use and the sociology of users make it very unique. Dependence does not mainly depend on the product, but on the patient’s relationship to this product. The problems are often the same: the fact of compulsive behavior and taking psychological, somatic and relational risks.

How can consumers find their way back to stable therapy?

MB: It doesn’t happen all at once. You have to be in a relationship of trust with them. One can gradually get the patient settled, followed by medical examinations, etc. You have to understand that some people have gone very far in their addiction and even more so with crack. They promised themselves they would stop and lost control. It takes time to regain control.

Can we be optimistic about the chances of successful therapy for crack addicts?

MB: Patients’ prognosis and their ability to change are closely related to their background and living conditions. We often think about the development of addiction in terms that are too binary: consumes/no longer consumes. If we can get people to reduce risks, consume less and keep their homes, we’ve made good progress.

Crack use involves numerous psychiatric complications, from depression to delusional states. Fortunately, the brain is sufficiently plastic. We see patients who have gone very far in their consumption and who return to “normal” behavior.

What do you think about the use of involuntary care now part of a series of solutions addressing the crack crisis debate?

MB: This only applies to psychiatric emergencies. The problem with addiction is not stopping: it’s not starting over. Forced healing has been tested before and we know it doesn’t work. The moment they come out, they consume again. And when vulnerable people are deprived of their freedom, violent excesses can occur.

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Do you think the health system currently in place to thwart the crack crisis in Paris is effective?

MB: The device is undersized. There is a lack of places in institutional care, consumption rooms… I see inaction and political manipulation of the crack crisis. Instead of being seen as a public health issue, the issue is politicized and ideologised. You have to assume things that are difficult to explain pedagogically. Addiction is paradoxical: it is not enough to say no to make people stop. Consumers need to take back control over behavior that will ultimately belong to them.

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