Joël Tremblay

A loved one's addiction to substance use (alcohol or drugs), gambling, or screen use (e.g. gaming, social media) has significant impact on the quality of life of concerned significant others (CSOs), affecting various aspects of their daily lives. As a result, CSOs implement a range of coping strategies to deal with their loved one's addiction and to try to preserve their personal and family well-being. Several studies have focused on the strategies used by CSOs, but none have provided a comprehensive overview of CSO's experiences of coping across substance use, gambling, or screen-related addiction contexts. A scoping review was conducted to provide a comprehensive overview of the coping strategies used by CSOs of adults whose loved ones experience substance use, gambling, or screen-related addiction. It also sought to extend the previous mapping of coping strategies among CSOs of individuals with gambling problems developed by Côté et al. (2018), by broadening its scope to include substance use and screen-related addictions. To do so, a systematic search was conducted across six databases: PsycINFO, Medline, Psychology and Behavioral Sciences Collection, SocIndex, Cinahl Complete, and Health and Psychosocial Instruments. Among the 64 included studies, most focused on CSOs of individuals with substance use (64%) or gambling (26%), with fewer addressing co-occurring substance use and gambling (6%) and screen-related addiction (3%). Findings indicate that CSOs rely on a broad range of coping strategies aimed at either influencing the loved one's addiction-related behaviours or enhancing personal, couple, or family well-being, alongside emerging strategies not previously captured in existing frameworks. Despite some nuances, the results reveal a trend toward uniformity in coping strategies used by CSOs in substance use and gambling contexts. Evidence on coping strategies used by CSOs in screen-related addiction remains more limited, and comparability with substance use and gambling contexts is less established. CSOs demonstrate active engagement in managing the impacts of addiction through coping strategies that address both the recovery process of their loved ones and the preservation of family and relational well-being, highlighting their central role in the broader addiction context. Not applicable.

Problematic substance/gambling use has major harmful effects on both members of a couple and on their relationship. It is also exacerbated by couple distress. However, for a person with an addiction (PA), the desire to maintain the relationship and the partner’s support are strong sources of motivation and reinforcement for change and recovery. Although research has shown for decades that couple therapy is an effective way to treat addiction, services are focused largely on individual treatments (Ariss and Fairbairn, Consult Clin Psychol 88:526–40, 2020). The first part of this chapter reviews the literature to provide a brief description of the interactions between problematic use and couple relationships and of effective models of couple treatment for addiction, along with their limitations. The second part of the chapter delves more deeply into Integrative Couple Treatment for Addiction, an approach developed by the authors of this chapter. It focuses on assessment and intervention strategies designed for integrating partners of persons with an addiction (PPA) into couple treatment. Specific issues of addiction treatment with couples and observations on the obstacles to disseminating and implementing couple treatments in real-life settings are briefly addressed.

The association between non-pharmaceutical COVID-19 (NP-COVID-19) interventions, which aimed to regulate public behaviour to curb the spread of COVID-19, and road safety has become a significant focus in understanding the unintended consequences of the pandemic. This study concentrates on 17 administrative units to assess the impact of NP-COVID-19 interventions on traffic injuries, and fatalities. Interrupted time-series analyses were conducted from 2015 to 2022, using daily traffic fatality and injury data per 100.000 population. A COVID-19 NP interventions index for Quebec (QCnPI-Index) was created based on 58 interventions implemented from March 2020 to July 2022 in each administrative unit. The association between QCnPI-Index and the two outcomes was mixed. Outaouais, Laval and Laurentides were the only regions where traffic fatalities were significantly reduced. Decreases by 97% (Incidence Rate Ratio [IRR]: 0.03, 95% Confidence Interval [CI]): 0.01,0.62), 99.0% (IRR: 0.01, 95% CI: 0.00,0.27) and 88% (IRR: 0.12, 95% CI:0.02,0.58) were observed respectively. Traffic light injuries significant reductions, except for Côte-Nord and Nord-du-Québec, were observed in 15 regions. The highest reduction of traffic injuries was observed in Laval with a 76% decrease (IRR: 0.24, 95% CI:0.17,0.34). The findings underscore the complex relationship between NP-COVID-19 interventions and road safety, emphasizing the need for comprehensive efforts to understand their diverse effects. Further investigation is warranted to comprehend the discrepancy in the reduction of fatalities compared to injuries. This study highlights the importance of exploring additional factors, such as road safety interventions and analysing specific road users like pedestrians and cyclists, to better understand the impact of NP-COVID-19 interventions on road safety.

Assess the efficacy of integrative couple treatment for pathological gambling (ICT-PG) in comparison to treatment provided in an individual approach. Eighty couples were assigned randomly to ICT-PG (n = 44, M_age = 42.2, SD [13.4], n male gamblers = 29) or individual treatment (n = 36, M_age = 39.9 SD [13.0], n male gamblers = 31) with follow-ups at 4- and 10-months postadmission regarding the severity of gambling, the individual and couple's well-being. Linear mixed and generalized estimating equation models for repeated measures were applied to take into account the dependency of observations. Protocol was preregistered at www. gov (ID: NCT02240485). Participants in both treatments generally improved over time with reductions on gambling expanses from an initial $4,000-$600 in a 90-day period following treatment, without difference across treatment conditions in money spent on gambling or frequency of gambling. However, on different indices of gambling severity, the participants in ICT-PG showed more improvement at follow-ups, with better control capacity (OR = 2.57, p < .0129) and greater reduction in gambling craving (OR = 5.83, p < .0001) and erroneous cognitions (OR = 2.63, p < .0063). The couple treatment was associated with a better individual well-being (e.g., less depression for partners, OR = 5.53; p < .0351, and gamblers, OR = 2.37; p < .0334) and couple well-being (e.g., better dyadic satisfaction for partners, OR = 2.02; p < .0057, and gamblers, OR = 3.07; p < .0212). The results underline the necessity to provide a greater diversity of treatment for gamblers and their partner. Further research should focus on identifying active components of ICT-PG and widen its provision to gamblers with concurrent addiction disorders. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

In the field of health care services, resource allocation is increasingly determined based on a population needs model. Although service needs models have been developed for adults with substance use problems, it would seem inappropriate to apply them indiscriminately to young people. The method used proposes six steps: (1) targeting the population, (2) estimating the proportion of the population affected by substance misuse and (3) the proportion of youths who should receive services, (4) identifying categories of services, (5) estimating the proportions of youths who should have access to each category of services, and (6) applying the model to real use of services by youths to recalibrate it. Youths ages 12-17 from the Province of Québec were classified within a tiered model comprising four levels of substance use severity. Youths in need of services varied from 38% (weak response) to 95% (high response) for the highest severity cases. Service categories retained are detoxification/intoxication, outpatient, and residential, with each one being subdivided into four categories. The proportion of youths from each tier who should access categories and subcategories of services varied widely. After a pre-experimentation, the model was adjusted. The model can be applied in different jurisdictions, with the caution of adjusting prevalence to local reality. Further improvement will be based on more accurate information concerning the path of clients through services, better strategies to reach youths in need of services, and increased knowledge of optimal service categories. Models adapted to low- or moderate-income countries, where the health care system has minimal services in the areas of mental health and addiction, should be developed.

A railway accident which occurred in Lac-Megantic in Quebec, Canada, caused disruption for an entire community. This study examines the psychosocial difficulties in a group of exposed adolescents aged between 11 to 17, nine months after the tragedy. The analyses were conducted on a sample of 515 adolescents, attending high school, and living near the impact area. Post-traumatic stress disorder (PTSD), mental health problems (depression, anxiety), and problem use of alcohol or drugs prevalence were estimated. Multiple logistic regression was used to identify risk factors for PTSD clinical threshold. Almost half (43.4%) of adolescents reported being severely exposed to the railway accident and one third (31.3%) have reported a PTSD. Serious injuries, depression and anxiety (p < .05) were associated with greater risks for adolescents with a PTSD. However, sex, victimization, and emerging problems or problem use of alcohol or drugs are not associated with the PTSD. The results of the study highlight the relationship between a traumatic event such as the railway accident and the presence of PTSD nine months after, as well as risk factors for PTSD in adolescents. Paying close attention to mental health problems in adolescents when a traumatic event occurs and provide adequate aid is essential.

Context: Couple treatment for pathological gambling is an innovative strategy. There are some results supporting its potential effectiveness, but little is known about the subjective experiences of the participants. Objective: The aim of this article is to document the experiences of gamblers and their partners participating in one of two treatments, namely individual or couple. Method: In a study aiming to evaluate the efficacy of the Integrative Couple Treatment for Pathological Gambling (ICT-PG), couples who were entering specialized treatment for the addiction of one member who was a pathological gambler were randomly assigned to individual or ICT-PG. Nine months after their admission to treatment, gamblers and partners (n = 21 couples; n = 13 ICT-PG; n = 8 individual treatment) were interviewed in semi-structured interviews. A sequenced thematization method was used to extract the major themes. Results: This study highlighted five major themes in the therapeutic process noted by the gamblers and their partners mainly after the couple treatment but also partly through the individual therapy. These were: (1) the gamblers' anxiety about having to reveal their gambling problems in couple therapy; (2) the wish to develop a mutually beneficial understanding of gambling and its effects on the partners in the two types of treatments; (3) the transformation of negative attributions through a more effective intra-couple communication fostered by the couple therapy; (4) the partners' contribution to changes in gambling behavior and prevention of relapses, which were both better supported in couple therapy; and (5) the interpersonal nature of gambling and its connections with the couples' relationship. However, gamblers who were in individual treatment were more likely to mention that their partners' involvement was not necessary. Participants likewise made a few recommendations about the conditions underlying the choice of one treatment method or the other. Discussion: Participants reported satisfaction with both treatment models, but their experience was more positive in couple treatment. Complementary benefits emerged from each form of treatment, which points to future treatments involving both types. Future research should explore both the couple processes associated with attempts to stop pathological gambling and the various ways of involving partners in the gamblers' treatment.

L’adolescence est souvent le berceau de plusieurs conduites déviantes cooccurrentes. La consommation de substances psychoactives (SPA) et la délinquance figurent parmi ces conduites et entretiennent des liens multiples et parfois complexes. Cette étude vise à explorer le modèle drogue-délinquance économico-compulsif auprès des jeunes. Plus précisément, elle a pour but de : 1) dresser un portrait des habitudes de consommation de SPA et de la délinquance lucrative des jeunes de l’échantillon ; 2) documenter la relation entre la gravité de la consommation de SPA et la commission de délits lucratifs ; ainsi que 3) celle entre le type de SPA consommées et la commission de délits lucratifs ; et de 4) vérifier l’interaction entre le type de SPA consommées et le genre dans la prédiction de la commission de délits lucratifs. Un instrument de mesure sur la gravité des habitudes de consommation de SPA (DEP-ADO) et un autre sur la délinquance (MASPAQ) des adolescents ont été administrés à 1447 jeunes âgés de 15 à 18 ans. Les résultats permettent d’observer en partie le modèle explicatif économico-compulsif chez les jeunes tout en lui apportant certaines nuances.