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Introduction: Cocaine use is associated with multiple complications, some of which can mimic systemic diseases, especially Antineutrophil Cytoplasmic Antibody (ANCA) associated vasculitis. We report a case of Cocaine Induced Midline Destructive Lesions (CIMDL) for which a diagnosis of granulomatosis with polyangiitis (GPA) was discussed., Case Report: A 42-year-old male, cocaine consumer, was admitted in our department for a centrofacial destructive process. He had no extra ear, nose and throat (ENT) involvement. ANCA were positive with a perinuclear fluorescence pattern and an anti-Proteinase 3 specificity. Regarding this unusual immunologic pattern and in the absence of histological argument for a GPA, a diagnosis of CIMDL was made., Conclusion: CIMDL is a centrofacial destructive process due to intranasal cocaine use. It is frequently associated with the presence of p-ANCA with both anti-HNE and anti-PR3 specificity., (Copyright © 2020. Published by Elsevier Masson SAS.)

Aim: Deficits in the communication and identifying of feelings are usually observed in substance abuse. Research in several countries has reported sensation seeking and alexithymia implication in addiction. According to a cognitive-developmental model of emotional experience proposed, alexithymia is a deficit in the cognitive processing of emotion that can be seen as an impairment in the ability to consciously experience feeling in the context of autonomic activation indicate of emotional arousal. The primary objective of this study was to identify certain personality dimensions linked with emotions' regulation, i.e. Zuckerman's sensation seeking, alexithymia, and emotional awareness in ecstasy and cocaine users at techno parties., Methods: Subjects were divided in two groups: 37 male ecstasy or cocaine abusers, and 37 male non-drug users. We hypothesized that ecstasy and cocaine users would exhibit high levels of sensation seeking (high level of sensation seeking,), and emotional dysregulation (high level of alexithymia and depression, low level of emotional awareness). The methodology comprised a questionnaire developed for the study, designed to record sociodemographic data and evaluate psychoactive substance use, the MlINI (mini international psychiatric interview), the Zuckerman 40-item Sensation Seeking Scale (SSS-IV), the Toronto Alexithymia Scale (TAS-20), the Levels of Emotional Awareness Scale (LEAS), and the Beck Depression Inventory (BDI-13). Subjects were recruited during rave-parties., Results: The results showed significantly higher sensation seeking scores for ecstasy and cocaine users for the score total and the disinhibition and experience seeking subdimensions. Ecstasy and cocaine abusers exhibited higher TAS-20 and BDI-13 scores and lower levels of emotional awareness than non-drug users. No correlation between the TAS-20 and depression symptomatology emerged. No significant correlations were found between LEAS and TAS-20., Conclusion: These results provide new elements concerning the profile of drug users at techno parties and illustrate the changing practices of ecstasy use. The LEAS and the TAS-20 were not intercorrelated; it seems plausible that they reflect two sides of the emotional states self-report. These results reinforce the suggestion of combining the use of self-reports with non self-report methods., (Copyright © 2011 L’Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.)

In France, workplace testing of drugs of abuse and psychotropic drugs is rarely performed; meanwhile it is a major public health problem. Furthermore, France is the European country that has been associated with the highest increase of the use of drugs of abuse, particularly cannabis. So workplace biological screening of drugs of abuse and of psychotropic drugs exposure is of major concern. New analytical techniques have been developed during the last years. The authors will consider analytical screening of drugs of abuse and particularly the comparison of analytical techniques applied to urine and saliva. The advantages and the disadvantages of these two matrices will be considered. Urinary and blood quantification will be reviewed, but also the interest of hair testing to explore chronic exposure. The research of psychotropic drugs in biological fluids is also a part of this paper. New analytical trends are promising and complete analysis of these substances will be soon routinely possible in blood using a single spot test., (Copyright © 2012 Elsevier Masson SAS. All rights reserved.)

Introduction: Lots of similar vulnerabilities to substance use disorders are described in the literature: clinical, genetics, family, environment, etc. Although, when we follow up patients, we know perfectly well that there are also differences due to the substance mainly causing addiction. But we found very little research on the differences between various substance use disorders according to the substance mainly causing dependence., Hypothesis: Our main hypothesis was that significant differences do not exist in medical and social data between patients with substance use disorders according to the substance mainly used. We expected to find significant differences between illegal substance use disorders (opiates, cocaine, cannabis) and legal substance use disorders (BZD, alcohol)., Objective: Our study aimed to identify differences between patients with substance related disorders in medical and social data according to the main addictive substance., Material and Method: A specific software has been created by the CEIP and the Department of Addictology of Nantes University Hospital. Anonymous data were gathered and all patients gave their written consent. This database has been declared to CNIL (number 1350706). All data have been directly collected by the physician during medical consultation. The following data were recorded during the first medical examination: age, sex, illicit substance use, prior criminal record or psychiatric disorders, prior addictive behaviours among relatives and/or friends, family history (divorce, separation, abandonment). Other data were gathered prospectively: socioprofessional insertion, marital status, drug prescriptions (time and duration)., Results: We found significant differences in social (age, sex) and medical data (prior psychiatric disorders) between patients according to the substance causing dependence. We identified five profiles depending on the substance: cannabis, cocaine, heroin, alcohol and benzodiazepine., Discussion: We clearly identified different types of patient's profiles according to substances mainly causing addiction. These differences can modify our strategies of prevention and treatment, so as to meet patients' needs better., (Copyright © 2010 L’Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.)

Frequently the addicted patients consults their family doctor or internist for infectious problems related to the use of such substances. Complaining about a physical pain without acknowledging their dependence is an easier and less stigmatizing way to proceed. This article summarized the various signs and symptoms that can be identified by the physician in order to confirm the suspicion of abuse or dependence and consequently propose a global care program that includes referral to addiction specialists.

Key points. Cocaine, the second most frequently consumed illicit substance after cannabis in both United States and Europe, remains the psychostimulant of choice for many, often mixed with other psychoactive substances. It is most frequently associated with alcohol, and a diagnosis of alcohol dependence may be made in 50%-90% of cocaine-dependent subjects. When treating cocaine addicts, it is important to characterize not only the modalities of cocaine use but also the modes of consumption of other substances, notably alcohol. Alcohol is often consumed to reduce the anxiety and discomfort resulting from cocaine withdrawal. Alcohol may also trigger an irresistible craving for cocaine, which can result in frequent relapses even after several months of cocaine abstinence. Brief intervention and motivational interview techniques can help to reduce alcohol use and prevent cocaine relapses in this context. In the absence of severe cocaine withdrawal symptoms, the guidelines for treating alcohol withdrawal syndrome may be applied for cocaine and alcohol codependence. Lower doses of benzodiazepine are needed for treating this alcohol-cocaine withdrawal syndrome. Cognitive behavioral therapies, alone or in combination with psychotropic medication, are accepted therapeutic approaches for alcohol-cocaine dependence. It is also accepted that over the long term the combination of psychotherapeutic treatments is usually more effective than any single approach. In the absence of a therapeutic consensus, four drugs (disulfiram, baclofen, topiramate and naltrexone) are most often recommended to promote and maintain abstinence; nevertheless, their efficacy has not been proven and their use remains experimental and off-label: they have not been approved by health authorities as treatment for addictions., (Copyright (c) 2009 Elsevier Masson SAS. All rights reserved.)