NICOLAS Sébastien

University of Liberal arts of Poitiers

Department of Psychology

 

 

DISH YOUR GIVES :

" Of the drug addict's psychotherapeutic planning

in a context of hold of it (dé)charge by

the hydrochlorate of methadone and the buprénorphine. "

 

 

Clinical and pathological psychology DESS memory

Academic year 1997-1998

Under the direction of the professor François RICHARD

 

 

PLAN OF THE Invoice

 

Introduction & #9;p4

Of some subjects liminaires	p6

First partie : the héroïnomanie : of the soft lure to the pain

I On the principle of plaisir	p10

To The climbing

Did B Plaisir.vous say plaisir ?

C The " objet-jouisseur "  héroïne.un?

II Toxicomanie : symptom or pathology to part entière ?	p20

To an identity (re)trouvée ?

B Psychopathology and addiction

Second partie : of the reduction of the risques.au risk of a reduction

I The treatments of substitution.pour quoi ? 	p28

To The products

B Toward a reduction of the risques ?

C A substitution to the parole ?

II Of the discharge to the hold in charge	p39

To The institution and the setting

B Of the soins.à the recovery

III The psychologist, the drug addict and the méthadone	p48

To a demande ?

B The analytic approach is she/it foreseeable in the context of the substitution ?

C The psychologist, the drug addict and the methadone

Conclusion	p54

Annexes	p56

Bibliographie	p60

INTRODUCTION

 

 

	À one time where the social problems preoccupy more and more people, the society and the policies wonder on a problematic ancestrale : the hold of drug.

Since the creation of the policies of reduction of the risks following the apparition of the virus of the AIDS, the medias wonder about the measures to prendre ; more and more television broadcasts are dedicated to the drug (cannabis, ecstasy). These two substances are fashionable, one facing the impotence of the coercive measures imposed by the legislator, the other facing the rise of the phenomenon of the rave. Would not we be able there to see a certain nostalgia of the adults of the time also where the LSD was in vogue as well as the cocaine in the " branchés "  surroundings?

	Les mentalities changed well. Five years ago, those that extolled legalization made themselves hoot by the legislators and the public opinion. However, he/it is not at the present time more possible, not to hear to speak of drug to the television, and of a hypothetical debate around the problem of decriminalization or legalization. The suit that has just taken place a few weeks ago in Poitiers, where two individuals were charged after having driven under the ascendancy of cannabis and having been relaxed, is an illustration of it. However, through these passionate proceedings, stay a question : how to take in charge the toxicomanes ? Does one have to take them in charge  besides?

	La question is especially important than the user of drug is considered at a time like a patient for medicine, and like a delinquent for the justice. The policies, them, are not pronounced, and facing what can appear like an illness and an incurable vice, recommend to limit the damages.

	Du stroke, more no one is believable. The legislator who has unapplied laws, the physician to whom one removes the grant of recovery, the policies that don't go until the tip of that that they recommend (one doesn't distribute a heroine, as it is for example the case in Switzerland).

 

	Face to this huddle, the psychologist can feel rerouted well and wonder what he can make in a context filled of paradoxical data.

	Nous will try therefore in this work to see in a first part a few generalities as for the addiction and more especially the héroïnomanie. We will try to see how an individual can be brought to this dependence to the heroine, and if his/her/its conduct justifies a nosologic entity.

	Dans a second part, we will bend on the handling in an institutional context of delivery of méthadone®, trying to surround the effect of this substitution on the drug addict, but also in our daily practice.

 

 

 

 

FIRST PART 

THE SOFT HEROINOMANIE : " DU DELUDES TO THE PAIN "

 

 

 

Plan of the first part

 

I On the principle of plaisir	p10

 

To The escalade	p11

1) the moon of miel	p11

2) the " premiers s" manques	p12

 

Did B Plaisir.vous say plaisir ? 	p14

1) a définition ?	p14

2) Karim has the plaisir	p15

3) on the principle of plaisir	p16

 

C The " objet héroïne.un - jouisseur " ?	p17

 

1) to reach a " normal "  state?	p18

2) Ich - Ideal - Ich	p18

has ) On the concept of Me Idéal	p18

b ) On the concept of ideal of the Moi	p18

3) the héroïne, " objet - jouisseur " to part entière ?	p19

 

II Toxicomanie : symptom or pathology to part entière ?	p20

 

To An identity (re)trouvée ?	p21

1) the medicine classique	p21

2) the " moderne "	p22 medicine

3) it is necessary " toxico " to be for " ex-sister " ?	p22

 

B Psychopathology and toxicomanie	p23

1) Névrose	p23

2) Psychose	p23

3) Perversion	p24

 

 

	Nous are going to be interested in this first left to a reflection on the addiction. Although we limited ourselves here to a discussion on the héroïnomanie, a lot of these concepts could be widened to a lot of conducts addictives. Are we going to ask us a simple question (requiring an answer more complexe) : why does one come to take the héroïne ?

	Nous will try to see then if one can consider the addiction like a fully-fledged pathology, or if it is necessary to understand it like a symptom.

Second part 

  Of the reduction of the risks.

to the risk of a reduction 

 

 

 

Plan of the second part

I The treatments of substitution.pour quoi ?

To The produits	p28

1) historique	p28

2) indications	p29

a)la méthadone®

b)le subutex®

B Toward a reduction of the risks? 	p30

C A substitution to the parole ?	p32

1) when the speech is dangereuse	p32

2) the drug addict, " être parlant "	p33,

3) a group of parole.pour qui ?	p34

a) a group

b) how would operate this groupe ?

has ) some technical characteristics

b ) who speaks and who intervient ?

c) the effect of group

d) of the group to the individual

II Of the discharge to the hold in charge	p39

To the institution and the cadre	p40

1) the institution	p41

2) the cadre	p43

B Of the soins.à the guérison ?	p44
    1. Soigner ?	p44

2) desire, demand and besoin	p46
    1. das wunsch : the desire
    2. the demand
    3. the need

III The psychologist, the drug addict and the méthadone	p48

To a demande	p48

B The analytic approach is it foreseeable in the context of the

substitution ?	p49

C The psychologist, the drug addict and the methadone & #9;p50

  1. 1) a construction identitaire impossible ?	p50

    2. 2) of the manque.au manque	p51

  2. 3) of the care to the psychothérapie.sous what forme ?	p52

CONCLUSION

 

	Il would have been possible to debate on the utility or no to use some substitute products. However, these are currently to the agenda and the essential condition to open a center of specialized care in addiction, and to receive some subsidies.

	De this fact, he/it seemed more interesting to me to see how the psychologist can exercise in such an institution, and there to find his/her/its place. If the present substitution of the inconveniences, she/it presents at least an interest, the one to give back the tie and to allow a first approach of a center to people who are very often marginalized. The psychologist has all his/her/its place and his/her/its utility therefore well in such a center, so much for the patients that for the team who often asks to understand what passes himself of it. Without wanting to fill the role of this " sujet inferred savoir " (SSS), we can bring a new lighting and can bring thus to the nursing a vision a little different from theirs, that permits a real handling, where each, conscious of his/her/its expertises and his/her/its limits, appears in a therapeutic project.

	Ainsi, the multidisciplinarity becomes it an activator as for a possible improvement of the drug addict's conditions of life (on a psychic plan, but also sanitary and social).

	Dans of such conditions, then maybe, the drug addict will succeed him to evolve, to change and to regain his/her/its free autonomy.

	Si the méthadone® and the subutex® don't appear as " outils " idéals to hire a therapeutic work, since capable to reinforce the demand based on the need, demand that is to the contrary of a handling of orientation analytique ,; Is one able however to believe in a " idéale " handling, without running the risk to answer the drug addict's transfer that searches for The ideal product and idéalisé  desperately?

	En effect, doesn't this last search for t he/it doesn't produce It who would be able to come to plug this béance, this emptiness fondamental ?

	Mais through the heterogeneity of the courses and the nosologic structures that appear us, does have t there him not a plot commune ?

To the risk to go has against current of what happens currently, could we consider the addiction like a fully-fledged nosologic entity, these structures that we think " cerner " would not they of the symptoms of neurotic, psychotic type or pervers  be? Could we consider the addiction like a shape of pathology of the agir ?

Bibliography

 

- ANZIEU D., The group and the thoughtless person, Dunod, 1984,

1988

- BERGERET J., The drug addicts among the other, Odile Jacob, 1990,

- OLIEVENSTEIN C., There are not happy addicts, the paperback, 1991,

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