Addictions : Cannabis, cocaine, opiate, designer drugs, hypnotics, amphetamines, substance-free addiction

Cannabis addiction

Nightingale Hospitals Paris – Clinique du Château welcomes people finding themselves in difficulty with cannabis for withdrawal and for assessing any related psychological disorders.

Cannabis consumption is a public health concern. At the age of 17, 20% of adolescents use it more than 10 times a year. 15% consume it several times a week.

There are therefore several types of consumers: occasional, regular, dependent.

Broadly, there are two types of user:

  • Those who have a ‘normal’ social life and whose consumption does not have an effect or has little effect on individual function;
  • Those whose consumption has a highly significant effect on their social life and mental health.

Numerous studies show that repeated consumption of cannabis can lead to actual psychiatric disorders in fragile individuals with a predisposition. Chronic use can also lead to the appearance of cognitive disorders, with considerably negative consequences among the young.
(The consequences of drug addiction depend on the drug, the quantity, but also on the consumer: their personality and history.)

Cannabis use can therefore promote an acute psychiatric condition with delirium and hallucinations; regular and long-term use often leads to a state of indifference, disconnection from reality and loss of motivation.

Hospitalisation is indicated in several cases:

  • Where outpatient care is insufficient;
  • Where a break from the environment in which consumption takes place is necessary, or in the event of a psychiatric event.

Withdrawal involves medical treatment, which takes all of the patient’s psychological difficulties into account.

The treatment programme should be defined before admission to the clinic, during a pre-admission consultation.

The objectives of the programme are:

  • To validate the length of stay and the patient’s full cooperation;
  • To present the treatment programme (framework, treatments, therapy groups).

Withdrawal often requires medical treatment to relieve the symptoms brought on by suddenly stopping the toxic substance, while facilitating long-term abstinence.

There are a number of objectives to hospitalisation

  • Indefinite discontinuation of cannabis use.
  • Psychiatric assessment during withdrawal to detect any emerging conditions, likely to require specific treatment.
  • A step back from the environment encouraging consumption of substances in order to put new behaviours in place.

There are daily meetings with the psychiatrist (8 psychiatrists for 44 patients). The therapeutic activities are offered according to the personalised programme.

The patient’s family is informed and can become involved in the care programme if the patient so wishes.
Hospitalisation is decided in agreement with the referring psychiatrist if the patient already has one. Otherwise, an outpatient programme to maintain abstinence is arranged with the patient.

Cocaine addiction

At Nightingale Hospitals Paris – Clinique du Château, treatment for cocaine addiction relies on an agreement-based protocol: we use all available treatments to make the symptoms of craving the least uncomfortable as possible and to reduce craving.

Cocaine use became widespread in the 1990s. The classes affected are fairly heterogeneous. Cocaine is not only used by social groups with high purchasing power or users, it is also used by the middle classes for recreational purposes.

Cocaine is a powerful psychostimulant which can lead to strong physical dependence and to withdrawal symptoms.

Cocaine causes immediate euphoria, a feeling of intellectual and physical omnipotence, and indifference to pain and fatigue. These effects are quickly replaced by a depressive state and anxiety that some relieve by taking opiates such as heroin, or psychoactive drugs such as sedatives or alcohol. Crack is produced from cocaine and causes similar stronger and more acute effects; it is highly addictive and rapidly causes mental, somatic and social complications and requires rapid treatment.

Cocaine can cause severe mental disorders, major mood instability, paranoiac delusions or panic attacks.

It can cause insomnia and memory loss. Also, cocaine can lead to acts of violence, sexual attack or compulsive spending.

Cocaine use is related to severe somatic, cardiac, ENT, neurological (stroke, convulsions), chest (crack-lung) and infectious complications.

Hospitalisation may become necessary where treatment in outpatient care was unsuccessful.

A pre-admission consultation takes place first, during which the following are discussed:

  • The treatment programme;
  • The patient’s commitment to a care agreement.

During hospitalisation, the cocaine user’s medical and psychological characteristics are assessed.

At the Clinique du Château, cocaine withdrawal is part of an agreement-based protocol.

We use all available treatments to make withdrawal symptoms (craving) as least uncomfortable as possible:

  • Tranquillizers, antipsychotics, and/or antidepressants according to any related symptoms from which the patient may be suffering;
  • Psychotherapeutic and motivational support (7 psychiatrists for 44 patients);
  • Corporeal mediation therapeutic activities (relaxation and psychomotricity);
  • Group psychological education approach;
  • Artistic mediation therapy (art therapy).

The patient also commits to observing the treatment agreement:

  • By abstaining from drug consumption;
  • By not bringing drugs or alcohol into the hospital;
  • By agreeing to have drug urine tests and to have their personal belongings checked, where applicable;
  • By not leaving the ground of the clinic, by not receiving visitors, (or have any contact with the outside) for the first week, without medical permission.

Patients are to leave the hospital if they do not observe the rules.

Opiate addiction (heroin, codeine, morphine, tramadol etc.)

Nightingale Hospitals Paris – Clinique du Château welcomes patients having fallen victim to opiate abuse or dependence, for withdrawal, or for replacement treatment, and for withdrawal, replacement treatment, and evaluating any related psychological disorders.

Heroin is a strong opiate produced by synthesis from morphine, an opium poppy extract. Morphine is the most effective drug against pain. This drug, like any opiate analgesics such as codeine or tramadol, can be misused and carry the same risks as heroin.

Heroin produces an immediate calming effect, and leads to euphoria and an ecstatic reaction. The immediate feeling of intense pleasure is followed by drowsiness, and sometimes nausea, dizziness and slowed respiratory and heart rate. With repeated use, tolerance to the product sets in and the pleasure related to consumption decreases.

In just a few weeks, users feel the need to increase the quantity and frequency of the doses and tolerance sets in. Withdrawal symptoms appear a few hours after the last dose and include severe pain, digestive disorders, insomnia and intense craving which encourages repeated use. Daily life is centred on consumption and dependence sets in.

Hospitalisation is indicated where outpatient care is insufficient, and where it is necessary for the patient to be removed from the environment in which they consume the drug. The objective of hospitalisation is cessation of consumption and compulsive use of opiates and to start replacement treatment where appropriate. The treatment covers the medical and psychological aspects of each patient, withdrawal being just one of the steps.

The treatment programme should be determined before admission to the clinic, either in agreement with the psychiatrist treating the patient wishing to cease consumption, or at a pre-admission consultation with a doctor from the clinic. The programme covers the hospitalisation objectives, and the care agreement between the patient and the care team (supervised outings and visits, regular urine tests, no drug or alcohol consumption, personal belongings checked where necessary).

Medical treatment may involve:

  • Either a withdrawal programme directly, with medication to treat the physical and psychological effects of withdrawal experienced;
  • Or a prescription for replacement treatment. It consists of treating opiate dependence by ceasing consumption of the analgesic drug or heroin and replacing them with oral extended release opiates.

Daily meetings with the psychiatrist (8 psychiatrists for 44 patients) and therapeutic activities (psychomotricity, relaxation, art-therapy, patient meetings on psychiatric conditions) target the same objectives that are decided at daily staff meetings. The patient’s family is informed and can become involved in the care programme if the patient so wishes.

Hospitalisation is decided by the patient’s psychiatrist if they have one, otherwise the doctor at the clinic can offer outpatient treatment in order to maintain abstinence when they leave the clinic.

Addiction to designer drugs and other psychostimulants (amphetamines and derivatives)

The use of ‘Legal or Herbal highs‘ designer drugs has been on the rise for some years now. There are many, readily available and affordable products; they represent a highly assorted range of substances which mimic the effects of various narcotics (ecstasy, amphetamines, cocaine, cannabis etc.).

Among the numerous products, cathinone derivatives (‘Mephedrone‘) and other ‘amphetamine-like‘ derivatives are the most common. The effects sought are similar to those of amphetamines: stimulation, euphoria, disinhibition, sociability, increased sexual desire and performance, less fatigue etc.

The use of these Designer Drugs can cause serious psychiatric disorders such as acute delirium and/or hallucinations and serious behavioural disorders, and can lead to severe dependence. Some practices related to consumption by intravenous injection such as slamming, carry the risk of local or systemic infections.

Specialist outpatient care is necessary and hospitalisation is often indicated in order to firstly evaluate and treat any related psychiatric or medical complications, and secondly to start withdrawal and set up a psychotherapeutic programme for maintaining abstinence following discharge from the clinic.

Substance-free addiction

Nightingale Hospitals Paris – Clinique du Château welcomes patients with substance-free addiction for withdrawal, evaluation and even treatment of the related psychological conditions, and for setting up a care programme after leaving the clinic.

Substance-free addictions involve behaviour and disorders similar to those observed with substance dependence. For example, compulsive craving, amount of time spent on an activity, neglect of other activities, development of tolerance to the activity, persistent behaviour despite the negative effects, withdrawal syndrome and difficulties controlling the behaviour or stopping it. They may relate to gambling, internet (on-line video games), sex (pornography on internet) etc.

Pathological gambling or gambling addiction is the main and most common substance-free addiction. However, for some years now, screen addiction, especially with on-line video games, on-line gambling (sports betting, casinos etc.) and pornography on the internet, has been rising significantly.

Such behaviour can become problematic and lead to psychological and social difficulties: anxiety, depression, isolation, difficulties at work or school etc.

Hospitalisation is therefore indicated in order to start withdrawal and to make a psychiatric assessment for detecting any related conditions which may require specific treatment.

Therapeutic activities are offered depending on the personalised programme. There are daily meetings with the psychiatrist (8 psychiatrists for 44 patients) which include methods to help patients change their habits, relapse prevention strategies and a care programme for when they leave the clinic. The patient’s family is informed and can become involved in the care programme if the patient so wishes.

Alcohol addiction