L’OMS a créé le questionnaire Alcohol, Smoking and Substance Involvement Screening Test (ASSIST), validé en français pour faciliter le dépistage et l’orientation des patients souffrant de conduites addictives. Son usage en psychiatrie est validé, mais il reste peu connu en France. Pourtant, les troubles liés à l’usage de substance sont souvent associés aux troubles psychiatriques. Cette étude évalue son acceptabilité en soins courants psychiatriques.

Des professionnels de santé volontaires du groupement hospitalier de territoire (GHT) Psy Sud Paris ont fait passer les questionnaires à des patients suivis en psychiatrie. Ils ont aussi complété un autoquestionnaire à propos de l’usage de cet outil.

Dix-sept professionnels ont été recrutés et ont proposé à 134 patients de passer le questionnaire. Parmi les patients, 104 ont répondu à toutes les questions (taux de participation de 78 %). Les retours des professionnels montrent que l’outil a été bien accepté par les soignants et par les patients. Sa passation est simple. Quarante-sept pour cent des patients nécessitaient une intervention brève concernant leurs consommations, réalisable par un professionnel de santé non addictologue et 19 % nécessitaient une prise en charge spécialisée en addictologie. Il n’y avait pas de différence selon le sexe, le fait d’être mineur ou majeur, d’être en ambulatoire ou en hospitalisation.

L’outil ASSIST est bien accepté en psychiatrie par les professionnels et les patients, ce qui est en faveur d’une utilisation à grande échelle. Cette étude a débouché sur une formation des professionnels du GHT à l’évaluation des conduites addictives s’appuyant sur cet outil.

According to the literature, between 36 and 56% of people, followed for psychiatric disorder, have had history with substance related disorders. Likewise, approximately 50% of the patients followed for addiction suffer from some psychiatric pathology, with over-representation of schizophrenic disorders, bipolar disorders, severe anxiety or depression. Identifying addictive behaviours is an essential part of the clinical assessment in psychiatry. However, in most cases, the evaluation consists of simply asking patients if they have taken drugs involving under-reporting of their psychoactive substance consumption. World Health Organisation has created the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) questionnaire, validated in French, to facilitate the screening and referral of patients suffering from addictive behaviours. Its use in psychiatry is validated but little known in France. This study assesses its acceptability in common psychiatric care. The secondary purpose is to evaluate the prevalence of certain substances consumption over others amongst patients of the psychiatric department.

Between January and June 2018, voluntary healthcare professionals from the Psy Sud Paris hospital group passed these questionnaires out to psychiatric patients (adults and teenagers, including hospitalisation and medical consultations). Another questionnaire, that is self-administered, was given to the professionnals to collect data on their evaluation of the tool with a Likert scale and free comments. Professionnals who participated in the study have been previously trained on how to pass the ASSIST questionnaire and how to behave depending on the answers given in the questionnaire. These professionals used to work in hospitalisation and ambulatory care units, in psychiatric departments for adults and children.

Seventeen professionals had been recruited and they suggested to 134 patients to fill in the ASSIST questionnaire. Among the patients, 104 answered all the questions (participation rate reached 78 %). The self-administered questionnaires show that the tool was considered by professionals as being very useful (according to 88 % of them), well received by the patients (according to 100 % of professionals), and that its use is simple (according to 88 % of professionals). Different elements were observed by professionnals, notably how quick it is to pass the questionnaire, the discovery of new consumptions amongst patients that are yet known within the service, the importance to keep a systematic and subtle approach to the consumption of substances amongst teenagers. A difficulty in comprehension of some questions was also noticed and the risk to under-evaluate certain consumptions among patients that were hospitalised for a long time. Forty-seven per cent of patients needed a brief intervention regarding their consumption from a healthcare professional other than an addiction doctor and 19 % needed a specialised addictology care. There were no differences according to gender, age or treatment method (ambulatory or hospitalisation).

The ASSIST tool is not only validated by psychiatric services in French but is also well received by the healthcare team and the patients, which is in favour of a larger and more common use, provided that these professionals are trained to use it. This study led to a project of formation of healthcare professionals from the Psy Sud Paris hospital about evaluation of substance-related disorders using the ASSIST tool.