BACKGROUND AND AIMS:Current treatment options for alcohol use disorder are limited. Transcranial direct current stimulation has been proposed as a therapeutic approach, but evidence remains scarce. This study aimed to compare active vs. sham transcranial direct current stimulation to evaluate its efficacy and safety in reducing alcohol consumption in a large sample of individuals with alcohol use disorder. DESIGN:REDSTIM is a triple-blind, randomized, sham-controlled trial that was conducted from October 2015 to January 2022. Participants were followed up every 4 weeks for 24 weeks. SETTING:Fourteen sites in France and Monaco. PARTICIPANTS:356 adult outpatients with alcohol use disorder were assessed for eligibility, and 337 were enrolled and randomly assigned (1:1) to receive active or sham stimulation. At baseline, the randomized participants were primarily male (60.5%) with an average age of 51.3 ± 11.3 years. INTERVENTION AND COMPARATOR:Two daily stimulation sessions (anode F4, cathode F3, 2 mA) delivered over five consecutive days vs. sham stimulation. Direct currents were applied via a pair of 0.9% NaCl-soaked surface sponge electrodes (25 cm2). In the sham stimulation group, the initial ramp-up time of 15 s (also up to 2 mA) was immediately followed by a ramp down phase of 30 seconds. MEASUREMENTS:The co-primary outcomes were the change in the number of heavy drinking days (HDD) and total alcohol consumption (TAC) over the follow-up period. Exploratory secondary outcomes included alcohol craving, clinical and biological improvements, quality-of-life, mood, cognitive and safety assessments. FINDINGS:Over 24 weeks of follow-up, vs. sham, the active stimulation group reported statistically significant reductions in the number of HDD [-2.45 HDD/4 weeks, 97.5% confidence interval (CI) = -4.86 to -0.05, P = 0.022]. The reduction in TAC was not statistically significant (-5.96 g/day, 97.5% CI = -15.18 to 3.26, P = 0.147). The interpretation of these findings should take into account the proportion of missing data related to alcohol diary completeness and losses to follow-up. For secondary outcomes at 24 weeks, vs. sham, craving assessments were lower in the stimulation group (-0.36 95% CI = -0.65 to -0.07, P = 0.016), as were carbohydrate deficient transferrin levels (-0.33 95% CI = -0.65 to -0.01, P = 0.045). In the active vs. sham stimulation group, 69 (41.1%) and 62 participants (36.7%) experienced one or more adverse effects, resulting in 6 dropouts. CONCLUSIONS:Among adult outpatients with alcohol use disorder, active transcranial direct current stimulation resulted in a modest but sustained reduction in heavy drinking days over 24 weeks, while no statistically significant effect was observed for total alcohol consumption. The intervention was well tolerated.

This study examines the mediating role of the moral view of addiction in the relationship between neoliberal ideology and public stigma toward pregnant smokers. A total of 935 participants completed questionnaires assessing neoliberal ideology, moral views of addiction, and stigma toward smoking during pregnancy. Moral view of addiction significantly mediates the relationship between neoliberal ideology and the stigmatization of pregnant smokers. Individuals with stronger neoliberal values are more likely to view addiction as a moral failing, which is associated with derogatory cognitions (indirect effect: β = 0.15, p < 0.001), negative emotions and behaviors (β = 0.13, p < 0.001), and personal distress (β = 0.04, p < 0.001) toward pregnant smokers. These findings suggest that moral judgments about addiction might be shaped by neoliberal ideology and contribute to stigma. Addressing these ideological worldviews might be important for understanding stigma and improving healthcare engagement in pregnant smokers.

Schizophrenia is associated with disturbances in time-passage experience, yet their fluctuations in daily life and their relationship to clinical symptoms remain unclear. The objectives of this study were to characterize daily disturbances in time-passage experience and to examine their associations with clinical symptoms, measured both in a clinical setting and in daily life, the latter allowing the examination of how moment-to-moment variations in time-passage experience relate to fluctuations in symptom expression. Using Ecological Momentary Assessment (EMA), we investigated time-passage experience in daily life in 33 patients with schizophrenia and 40 healthy controls over one week, with five daily assessments of passage of time judgments (PotJ), referring to the perceived speed of the passage of time at a given moment. Positive and negative symptoms were measured in patients via EMA and using the Positive and Negative Syndrome Scale (PANSS) at baseline. Patients experienced time passage as slower and more variable than controls. These alterations were associated with positive symptoms measured by the PANSS at baseline. Regarding daily intra-individual fluctuations, negative symptoms predicted slower PotJ, which in turn preceded the expression of positive symptoms, followed by a transient acceleration of PotJ. These findings reveal a dynamic interplay between time-passage experience and both positive and negative symptoms, discussed in the context of neurophysiological mechanisms, including spatiotemporal neural activity and dopaminergic function. Overall, EMA proves to be a powerful tool for capturing time-passage experience disturbances in real time and linking them to clinical dimensions through dynamic fluctuation analyses.

Objectif L’addiction est l’un des troubles psychiatriques les plus répandus dans la population générale, et la co-occurrence avec les troubles du sommeil est très fréquente. L’objectif de ce travail était d’explorer, parmi les utilisateurs de l’application KANOPEE, la relation entre les plaintes de somnolence et d’insomnie et l’usage problématique de substances/écrans. Méthodes L’application smartphone KANOPEE propose des interactions avec un compagnon virtuel pour évaluer l’insomnie (Insomnia Severity Index [ISI]), la somnolence diurne excessive (SDE, Epworth Sleepiness Scale [ESS]), et dépister l’usage problématique du tabac, de l’alcool, du cannabis, et des écrans. Les symptômes anxieux et dépressifs sont évalués (PHQ-2, PHQ-9). Un agenda de sommeil de 7jours permet ensuite d’évaluer la durée et la régularité du sommeil. Pour les analyses, les participants ont été répartis en groupes d’addiction principale exclusifs selon l’usage le plus problématique, ou dans un groupe contrôle en cas d’usages non problématiques. Résultats Depuis avril 2020, 14 512 participants ont été inclus (62 % de femmes ; âge moyen : 49 ans ; alcool 18,4 % [n=2676], tabac 12,0 % [n=1739], écrans 10,0 % [n=1458], cannabis 1,7 % [n=247] et contrôle 57,5 % [n=8350]). Les plaintes liées au sommeil étaient fréquentes : 49 % rapportaient une insomnie modérée à sévère, et 42 % une SDE modérée à sévère. Après ajustement sur les données sociodémographiques et le sommeil, l’insomnie était plus fréquente dans les groupes tabac, écrans et alcool. La SDE était plus fréquente dans le groupe écrans, mais moins fréquente dans le groupe cannabis. Après inclusion des variables psychopathologiques, les associations avec l’insomnie perdaient leur significativité, alors que celles avec la SDE restaient inchangées. Conclusion Les plaintes de somnolence sont fréquentes chez les utilisateurs de KANOPEE et associées à l’usage problématique des écrans, indépendamment de l’anxiété/dépression. Les plaintes d’insomnie sont courantes, et associées à l’usage problématique de tabac, alcool et écrans, mais ce lien est largement expliqué par l’anxiété/dépression. L’effet protecteur apparent du cannabis sur la plainte de somnolence contraste avec la littérature : de futures études devront explorer la direction/temporalité de ces liens.

The addiction term is sometimes overused, both in the media and popular discourse, to describe excessive engagement in everyday behaviors such as sugar consumption, screen use, or physical exercise. This overuse may reflect the fact that rewarding behaviors, much like the use of rewarding substances, can lead to repeated use, occasionally beyond what is considered reasonable and with significant negative consequences. This raises fundamental questions: by which criteria can an addiction be identified? Is the phenomenon the same for substances and behaviors? This perspective article proposes to explore these questions by examining the relevance of craving, defined as an intense, persistent, but involuntary desire to use a specific substance/behavior. Although craving is well-established as a core criterion for substance addictions, with strong prognostic value, clinical utility, it has not yet been formally integrated into diagnostic classifications for behavioral addictions. This perspective article reviews recent evidence supporting that craving may represent a transdiagnostic construct across substance and behavioral addictions.

Abstract Background Fully automated digital interventions delivered via smartphone apps have proven efficacious for a wide variety of mental health outcomes. An important aspect is that they are accessible at a low cost, thereby increasing their potential public impact and reducing disparities. However, a major challenge to their successful implementation is the phenomenon of users dropping out early. Objective The purpose of this study was to pinpoint the factors influencing early dropout in a sample of self-selected users of a virtual agent (VA)–based behavioral intervention for managing insomnia, named KANOPEE, which is freely available in France. Methods From January 2021 to December 2022, of the 9657 individuals, aged 18 years or older, who downloaded and completed the KANOPEE screening interview and had either subclinical or clinical insomnia symptoms, 4295 (44.5%) dropped out (ie, did not return to the app to continue filling in subsequent assessments). The primary outcome was a binary variable: having dropped out after completing the screening assessment (early dropout) or having completed all the treatment phases (n=551). Multivariable logistic regression analysis was used to identify predictors of dropout among a set of sociodemographic, clinical, and sleep diary variables, and users’ perceptions of the treatment program, collected during the screening interview. Results The users’ mean age was 47.95 (SD 15.21) years. Of those who dropped out early and those who completed the treatment, 65.1% (3153/4846) were women and 34.9% (1693/4846) were men. Younger age (adjusted odds ratio [AOR] 0.98, 95% CI 0.97‐0.99), lower education level (compared to middle school; high school: AOR 0.56, 95% CI 0.35‐0.90; bachelor’s degree: AOR 0.35, 95% CI 0.23‐0.52; master’s degree or higher: AOR 0.35, 95% CI 0.22‐0.55), poorer nocturnal sleep (sleep efficiency: AOR 0.64, 95% CI 0.42‐0.96; number of nocturnal awakenings: AOR 1.13, 95% CI 1.04‐1.23), and more severe depression symptoms (AOR 1.12, 95% CI 1.04‐1.21) were significant predictors of dropping out. When measures of perceptions of the app were included in the model, perceived benevolence and credibility of the VA decreased the odds of dropout (AOR 0.91, 95% CI 0.85‐0.97). Conclusions As in traditional face-to-face cognitive behavioral therapy for insomnia, the presence of significant depression symptoms plays an important role in treatment dropout. This variable represents an important target to address to increase early engagement with fully automated insomnia management programs. Furthermore, our results support the contention that a VA can provide relevant user stimulation that will eventually pay out in terms of user engagement.

Objective We identified factors associated with hepatitis C virus (HCV) testing in the previous 6 months in people who inject drugs (PWID) according to gender.Design COSINUS (Cohorte pour l’évaluation des facteurs Structurels et Individuels de l’USage de drogues) is a multisite longitudinal cohort study conducted between June 2016 and May 2019.Setting Harm reduction facilities in two French cities (Marseille and Bordeaux).Participants Eligibility criteria were as follows: 18 years of age or older, French speaking, regular use of illegal drugs or of prescribed medication, having injected at least once in the previous month and being able to provide informed consent to participate. We selected data for 298 participants (624 observations).Primary outcome Self-reporting HCV testing in the previous 6 months. Gender was defined as self-identifying as a woman, man or transgender person.Results Seventy-nine per cent (n=235) of the sample were men, and 63% (n=189) reported HCV testing in the previous 6 months. Our results suggest that men recently incarcerated (OR (95% CI): 3.26 (1.31, 8.12), p=0.011), those regularly attending harm reduction facilities (OR (95% CI): 2.49 (1.47, 4.22), p=0.001), and those with lifetime attempted suicide (OR (95% CI): 2.07 (1.08, 3.95), p=0.028) were more likely to have been tested for HCV in the previous 6 months, whereas older men were less likely (OR (95% CI): 0.46 (0.24, 0.89), p=0.022). Women who had slept in the street (OR (95% CI): 3.95 (1.12, 13.89), p=0.032) were more likely to have been tested for HCV in the previous 6 months, whereas those employed (OR (95% CI): 0.31 (0.12, 0.83), p=0.019) and those with lifetime attempted suicide (OR (95% CI): 0.39 (0.16, 0.97), p=0.044) were less likely.Conclusion Our results highlight the importance of improving current harm reduction facilities for PWID by adapting them to women’s needs and paying special attention to women’s mental health. Furthermore, in the context of primary care, improving provider training and reducing injection-related stigma may improve HCV testing uptake in older men and employed women.

BACKGROUND:In the context of the need to increase treatment options for substance use disorders, recent research has evaluated the therapeutic potential of psychedelics. However, there is an incomplete understanding of psychedelics' effects on craving, a core symptom of addictive disorders and a predictor of substance use and relapse. AIMS:To determine if the use of psychedelics is associated with changes in craving in humans. METHODS:A systematic review of the literature, using PubMed, PsycInfo, and Scopus databases up to May 2023. We included all studies assessing any substance craving levels after psychedelic use (protocol registration number CRD42021242856). RESULTS:Thirty-eight published articles were included, corresponding to 31 studies and 2639 participants, pertaining either to alcohol, opioid, cocaine, or tobacco use disorders. Twelve of the 31 included studies reported a significant decrease in craving scores following psychedelic use. All but two studies had methodological issues, leading to moderate to high risk of bias scores. CONCLUSIONS:Some psychedelics may show promising anti-craving effects, yet the diversity and high risk of bias of extant studies indicate that these results are to be considered with caution. Further well-controlled and larger-scale trials should be encouraged.

Background: Insomnia is strongly associated with stimulant use across various populations and for a wide range of substances. It represents a significant clinical problem among individuals with stimulant use disorders, yet treatment guidelines for this specific population are limited. This gap underscores the need for a systematic review to analyze the pharmacological and non-pharmacological treatments for insomnia in individuals with stimulant use disorders. The aim of this review is to determine the efficacy, safety, and limitations of these approaches and their impact on psychiatric symptoms, stimulant use, and adverse events. Methodology: A systematic review was conducted through January–July 2025 using PubMed, Scopus, and Web of Science. The review focused on the management of chronic insomnia associated with stimulant use, including substances such as amphetamines, methylphenidate, nicotine, caffeine, and cocaine. The systematic review was structured in accordance with the PRISMA guidelines, and identified studies were assessed by title/abstract and full-text evaluation. Results: A total of twenty studies were included in the systematic review. Seven studies examined pharmacological interventions, including modafinil, naltrexone/buprenorphine-naloxone, varenicline, combination NRT, and ramelteon. Thirteen studies investigated non-pharmacological approaches, including Cognitive Behavioral Therapy (CBT), Repetitive Transcranial Magnetic Stimulation (rTMS), Electrical Vestibular Nerve Stimulation (VeNS), maximal strength training, electroacupuncture (EA), and probiotics. The majority of interventions demonstrated positive outcomes in reducing insomnia severity, with some participants achieving non-clinical levels. Commonly reported clinical symptoms related to insomnia included difficulty initiating or maintaining sleep, early morning awakening, and sleep dissatisfaction. Conclusions: Both pharmacological and non-pharmacological interventions showed promise. However, the lack of validated guidelines underscores the need for integrated therapeutic approaches that address the complex comorbidity of insomnia, stimulant use, and co-occurring psychiatric conditions.

BackgroundMedication non-adherence is a leading cause of treatment failure in psychiatric populations. However, current studies highlight the lack of methodological guidance on medication assessments. Ecological Momentary Assessment (EMA), using smartphone-based evaluations, shows promise for real-time monitoring in everyday settings.AimsThis study evaluated EMA's effectiveness in assessing medication adherence in patients with schizophrenia, depression, and substance use disorders (SUD), covering various treatment regimens.Materials & MethodsA total of 133 participants (27 with schizophrenia, 20 with depression, 44 with SUDs, and 42 healthy controls) completed EMA via study-provided smartphones five times daily over 1 week. Treatment regimens, categorized by mono vs. polytherapy and single vs. multiple daily doses, were documented. EMA adherence was calculated from the completion rate of the assessments, while medication adherence was assessed daily for patients. Both mean medication adherence and adherence variation over time were analysed by diagnosis and treatment regimen.ResultsAll groups demonstrated high mean EMA and medication adherence, with minor variations across treatment types. Importantly, patients showed improved adherence over time, independently of diagnosis or regimen.DiscussionThese findings indicate EMA's potential as an effective method for capturing medication adherence in psychiatric populations.ConclusionThe approach's capacity for real-time, context-sensitive data collection could reveal adherence patterns and changes not detectable by conventional methods, offering valuable insights for clinical practice.

Contexte La psychiatrie clinique engage des enjeux conceptuels, méthodologiques et normatifs qui exigent une posture réflexive et critique. Une approche philosophique semble essentielle pour mieux saisir ces enjeux, ce que propose la philosophie de la psychiatrie. Objectifs Pour faciliter l’initiation à la philosophie de la psychiatrie, cet article propose une cartographie pédagogique articulée autour de quatre « mouvements » pour penser la psychiatrie : expliquer, décrire, interpréter et transformer. Une telle proposition a pour objectif d’offrir aux cliniciens des outils philosophiques pour situer, analyser et enrichir leur réflexion clinique ou de recherche. Méthodes Les apports respectifs et complémentaires de quatre traditions philosophiques associées à ces mouvements sont présentés : l’épistémologie psychiatrique (« expliquer »), la phénoménologie psychiatrique (« décrire »), l’herméneutique psychiatrique (« interpréter ») et la psychiatrie critique (« transformer »). Résultats Une présentation de l’origine historique, des objectifs et des principaux thèmes est proposée pour chacun de ces quatre courants, accompagnée de références bibliographiques clés. Non exclusifs, ces mouvements doivent être considérés comme une boussole pédagogique pour orienter l’exploration du champ de la philosophie de la psychiatrie, sans prétendre en réduire la complexité ou la richesse. Discussion et conclusion Une telle cartographie pédagogique peut permettre aux étudiants et praticiens en psychiatrie d’apprendre à nuancer leurs croyances et représentations, en développant une culture de l’incertitude et de l’humilité, encourageant le dialogue interdisciplinaire, guidant les questionnements conceptuels et, par extension, soutenant les questions éthiques inhérentes à la discipline.

BACKGROUND:Cognitive disorders associated with addictive disorders are well established in the literature for numerous substances and behaviours. Very few studies have examined the effect of polydrug use on cognitive functioning. These studies have focused on the cognitive effect of one substance among others in very small samples. They did not take into account HCV/HIV infections, which are highly prevalent among polydrug users due to frequent injections and sharing of materials and whose impact on cognition is well documented. In our study, we aim to investigate two critical cognitive functions in the addiction process, memory and inhibitory control, in a population of people who inject substances (PWIS). METHOD:Thanks to the COSINUS Cohort, we evaluated polydrug use of PWIS, inhibitory control, and memory in 383 PWIS by administering the Go/No-go test and the 5-word test. PWIS were recruited in drug consumption rooms (DCRs) and harm reduction facilities. RESULTS:93% of PWIS are polydrug users. Our findings demonstrate typical effects of substance use on memory, revealing a deficit associated with age, along with risky alcohol and cannabis use, while showing a potential benefit from the use of psychostimulants. We found a positive impact of educational level on impulsivity. PWIS who request job assistance and education training exhibit lower free recall compared to the others. HCV/HIV infections are associated with a negative effect on cognition, but the results are mixed. DCR attendance is associated with a positive effect on both memory and inhibitory control. CONCLUSION:Our study confirms the importance of screening for cognitive deficits in polydrug users, improving specific treatment for cognitive deficits in PWIS through appropriate mental health care, and encouraging multidisciplinary harm reduction and psychiatry care.

OBJECTIVES:The complexity of psychiatry requires an integrated approach that combines empirical practice, experiential insight, and theoretical reflection. This study, integrated within a broader international project, aimed to assess self-reported conceptual competences among French psychiatry students and practitioners, underlining the pedagogical necessity of integrating philosophy into psychiatry education to address both clinical and research challenges. METHODS:A cross-sectional survey was conducted among French psychiatric residents, practicing psychiatrists, and retired psychiatrists recruited through professional networks and associations. Participants completed an online questionnaire on self-reported conceptual competences in psychiatry consisting of 18 items rated on a 5-point Likert scale, plus a complementary item. The questionnaire was structured into three dimensions: perceived integration of conceptual competences (7 items), perceived execution of conceptual competences (3 items), and declared knowledge of conceptual competences (8 items). A complementary item assessed the declared nature of six psychiatric conditions. RESULTS:A total of 353 participants, primarily women (65.2%) and psychiatry practitioners (53.4%) with an average age of 33.3years, completed the questionnaire showing varied familiarity with conceptual issues in psychiatry. The mean scores across the three dimensions of conceptual competences were as follows: 3.19 for the perceived integration of conceptual competences dimension, 3.14 for the perceived execution of conceptual competences dimension, and 3.81 for the declared knowledge of conceptual competences dimension. Among participants, 90.1% endorsed the need for including philosophical training in psychiatric curricula, with 80.2% supporting skill development in this area. High agreement was observed on the need for multiple perspectives (94.3%). Confidence in conceptual understanding was moderate (41.9%), while critical evaluation confidence was lower (24.4%). DISCUSSION:The findings support the need for incorporating conceptual competences into psychiatry education and practice. Frequent encounters with philosophical challenges in clinical settings, coupled with noted gaps in current training, highlight the critical importance of structured pedagogical approaches in psychiatry to examine these conceptual issues. Longitudinal studies will be needed to evaluate the potential impact of such educational programs on the evolution of participants' conceptual competences across the three dimensions of the questionnaire.

Substance Use Disorders (SUD) can be conceptualized as a prospective link from cues to craving and use. To explore the nonlinear relationships between craving and cues, this study applied dynamical systems theory (DST) to ecological momentary assessment (EMA) data. Optimized linear Seasonal Auto-Regressive Integrated Moving Average with eXogenous variable (SARIMAX) models were used to phenotype patients with SUD (alcohol, tobacco, cannabis, opiates, and cocaine), considering the potential for complex interactions between cue exposure and craving intensity in daily life. These phenotypic profiles were replicated in computational DST models to analyze the nonlinear interactions between cues, craving, and use. The study involved 211 individuals and 8260 observations, with 154 patients fitting the SARIMAX model for the influence of cues on craving, and 57 patients fitting the SARIMAX model for a possible influence of craving on cues. Two DST models were adjusted to replicate the complex temporal dynamics of SUD based on these two directions of influence. The first DST model (adjusted to the influence of cues on craving) showed that an increase in cues leads to a rise in craving, which then diminishes both cues and craving itself, with use patterns following craving’s trajectory. This patient profile is driven by a phenomenon of “maximum cue saturation”. The second DST model (adjusted to the influence of craving on cues) demonstrated that an increase in craving was followed by an increase in cue reporting, leading to use, with use peaking and then craving droping. This patient profile is characterized by a phenomenon of “maximum use saturation”. Both models highlight craving as an essential modulator between cues and use, opening new therapeutic avenues.

Introduction Addiction is considered a chronic disease associated with a high rate of relapse as a consequence of the addictive condition. Most of the current therapeutic work focuses on the notion of relapse prevention or avoidance and the control of its determinants. Since only a small portion of patients can access alcohol addiction treatment, it is crucial to find a way to offer new support towards safe consumptions, reductions or cessations. The harm reduction (HR) approach and mental health recovery perspective offers another way to support the patient with alcohol addiction. Vitae is a realist evaluation of the impact, viability and transferability of the IACA! programme, an HR programme based on the principle of psychosocial recovery for people with alcohol use disorders.Methods and analysis The Vitae study adheres to the theory-driven evaluation framework where the realist evaluation method and contribution analysis are used to explore the effects, mechanisms and influence of context on the outcomes and to develop and adjust an intervention theory. This study is a 12-month, multi-case, longitudinal descriptive pilot study using mixed methods. It is multi-centred, and carried out in 10 addiction treatment or prevention centres. In this study, outcomes are related to the evolution of alcohol use and the beneficiaries trajectory in terms of psychosocial recovery during these 12 months after the start of IACA!. The target number of participants are 100 beneficiaries and 23 professionals.Ethics and dissemination This research was approved by the Committee for the Protection of Persons Ouest V n°: 21/008-3HPS and was reported to the French National Agency for the Safety of Health Products. All participants will provide consent prior to participation. The results will be reported in international peer-reviewed journals and presented at scientific and public conferences.Trial registration numbers NCT04927455; ID-RCB2020-A03371-38.