Reynaud Michel, Schwan Raymund
Département de psychiatrie et d'addictologie Hôpital universitaire Paul Brousse 94804 Villejuif.
Rev Prat. 2003 Jun 15;53(12):1304-14.
The recognition of harmful drug use or the dependence on psychoactive substances is aided above all by simple, systematic history taking on the consumption (frequency and quantity) of tobacco, alcohol and illicit products, as an integrated part of the social history. The diagnosis of alcohol addiction takes into account the declared consumption of alcohol, using standard questionnaires (DETA/CAGE and AUDIT) and biological markers to confirm or objectify the diagnosis. The diagnosis of cannabis addiction is made by a clinical evaluation of harmful usage and dependence, the frequency and the quantity of consumption, and the search for complications. It is possible to make use of an auto-questionnaire. Urinary screening can be used to help orientate the history taking. These tests are only of interest in the context of a project of healthcare that has been freely consented to. The diagnosis of tobacco addiction takes into account the significance of the dependence that can be quantified, thanks to Fagerström's test (or more simply by the short Fagerström test). The expired CO level is an objective test of tobacco intoxication and its consequences on respiratory function. It is a good instrument of measurement of motivation. The continine level is still a little known test. The practitioner must also evaluate the factors of severity: certain modalities of consumption, certain personality characteristics or the presence of psychiatric pathology, certain family characteristics or social environments. Finally, he should evaluate the level of motivation for change.
识别有害药物使用或对精神活性物质的依赖，首先要通过简单、系统地了解烟草、酒精和非法产品的消费情况（频率和数量），将其作为社会史的一个组成部分。酒精成瘾的诊断要考虑申报的酒精消费量，使用标准问卷（DETA/CAGE和AUDIT）以及生物标志物来确认或客观化诊断。大麻成瘾的诊断通过对有害使用和依赖情况、消费频率和数量以及并发症的临床评估来进行。可以使用自我问卷。尿液筛查可用于辅助病史采集。这些检测仅在获得自由同意的医疗保健项目背景下才有意义。烟草成瘾的诊断要考虑到通过法格斯特伦测试（或更简单的短法格斯特伦测试）能够量化的依赖程度。呼出一氧化碳水平是烟草中毒及其对呼吸功能影响的客观检测指标。它是衡量动机的良好工具。可替宁水平仍是一项鲜为人知的检测。从业者还必须评估严重程度因素：某些消费方式、某些人格特征或精神病理状况的存在、某些家庭特征或社会环境。最后，他应该评估改变的动机水平。
