In France, alcohol consumption is the second most common cause of so-called preventable cancers after tobacco. Since 2014, in the "Provence-Alpes-Côte d'Azur" (PACA) region, the association Santé! has been developing an innovative intervention to support people suffering from alcohol-related addiction. This intervention, called IACA! must therefore be evaluated on a larger scale before conclusions about its effectiveness can be drawn from a comparative trial. This evaluation requires significant human and material resources. It is therefore recommended to first assess the transferability of IACA! in other care centers in a pilot study.
In France, 11% of cancers in men and 4.5% of cancers in women are attributed to alcohol consumption. It is the second leading cause of so-called preventable cancers, accounting for 28,000 alcohol-related cancers out of 352,000 new cases of cancer affecting annually adults (over 30 years of age). Overall, alcohol is among the top 3 factors contributing to Disability-Adjusted life year (DALYs) in France in 2017. Some cancer risks can be quantified as early as one drink a day (oesophagus, oral cavity, pharynx and breast in women). However, the risks associated with alcohol consumption remain influenced by the quantities consumed. There is therefore an interest, particularly for consumers of the largest quantities, in reducing the quantities consumed. In Europe, while people who drink more than 60 g/d of alcohol for men and 40 g/d for women are estimated to represent only 16.1% of the population for men and 9.3% for women, they represent 87% and 82% of alcohol-related morbidity and mortality respectively. Subjects with addiction (or substance use disorders) have an increased risk of social harm (1.5 to 3 times that of alcohol users without addiction), a higher mortality (1.4 to 6.5 compared to the general population) with a life expectancy of 9 to 20 years shorter than that of the general population. Moreover, even if the quantities consumed are not a valid individual diagnostic criterion, studies show a strong association between the quantity consumed and the diagnosis of addiction. Finally, some studies suggest that the prevalence of secondary harm from alcohol use follows an exponential curve as a function of alcohol consumption. Since 2014, in the PACA region, the association Santé! has been developing an intervention to support people suffering from alcohol-related addiction. This intervention, called IACA! (Integrating and supporting alcohol consumption), differs from the support provided during rehabilitation cures and aims to: fight against discrimination and exclusion of people who drink alcohol, re-engage these individuals in the care process (because they have generally left it) by using the appropriate levers, promote well-being, improve quality of life and recovery and support the recovery in control of consumption. Thus, IACA!, through its philosophy and implementation, is based both on the risk reduction approach historically deployed with drug users and on the recovery approach, developed in the field of mental health. The first one-year results of this program were promising since, of 17 people who received the intervention, all had a social or health benefit, 13 of whom were associated with stabilization (n=4), reduction (n=7) or cessation (n=2) of alcohol use. These promising results must therefore be evaluated on a larger scale before conclusions about its effectiveness can be drawn from a comparative trial. This type of evaluation requires significant human and material resources. It is therefore recommended to first assess in the field: 1) the conditions under which such an intervention is deployed in other centres (adaptations implemented by other centres to deploy IACA! for example, without distorting the intervention), 2) the acceptability and feasibility of the intervention in other centres (are the human and material resources on site sufficient for the successful deployment of the intervention?), 3) the acceptability and feasibility of the large-scale evaluation envisaged.
Study Type
OBSERVATIONAL
Enrollment
32
CH Perrens - Equipe Addiction
Bordeaux, France
MéRISP - Université U1219
Bordeaux, France
Severity of alcohol use
Time frame: 12 months after the start of IACA
Utility dimension of viability - alcohol consumption
Average number of units of alcohol consumption in the past 30 days
Time frame: Baseline (M0)
Utility dimension of viability - alcohol consumption
Average number of units of alcohol consumption in the past 30 days
Time frame: 3 months (M3)
Utility dimension of viability - alcohol consumption
Average number of units of alcohol consumption in the past 30 days
Time frame: 6 months (M6)
Utility dimension of viability - alcohol consumption
Average number of units of alcohol consumption in the past 30 days
Time frame: 9 months (M9)
Utility dimension of viability - alcohol consumption
Average number of units of alcohol consumption in the past 30 days
Time frame: 12 months (M12)
Utility dimension of viability - craving
Craving: average frequency and intensity in the last 30 days
Time frame: Baseline (M0)
Utility dimension of viability - craving
Craving: average frequency and intensity in the last 30 days
Time frame: 3 months (M3)
Utility dimension of viability - craving
Craving: average frequency and intensity in the last 30 days
Time frame: 6 months (M6)
Utility dimension of viability - craving
Craving: average frequency and intensity in the last 30 days
Time frame: 9 months (M9)
Utility dimension of viability - craving
Craving: average frequency and intensity in the last 30 days
Time frame: 12 months (M12)
Utility dimension of viability - severity
Severity score for addictive substances and behaviors
Time frame: Baseline (M0)
Utility dimension of viability - severity
Severity score for addictive substances and behaviors
Time frame: 3 months (M3)
Utility dimension of viability - severity
Severity score for addictive substances and behaviors
Time frame: 6 months (M6)
Utility dimension of viability - severity
Severity score for addictive substances and behaviors
Time frame: 9 months (M9)
Utility dimension of viability - severity
Severity score for addictive substances and behaviors
Time frame: 12 months (M12)
Utility dimension of viability - disorders
Presence of alcohol and other substance use disorders (past 12 months and past)
Time frame: Baseline (M0)
Utility dimension of viability - disorders
Presence of alcohol and other substance use disorders (past 12 months and past)
Time frame: 3 months (M3)
Utility dimension of viability - disorders
Presence of alcohol and other substance use disorders (past 12 months and past)
Time frame: 6 months (M6)
Utility dimension of viability - disorders
Presence of alcohol and other substance use disorders (past 12 months and past)
Time frame: 9 months (M9)
Utility dimension of viability - disorders
Presence of alcohol and other substance use disorders (past 12 months and past)
Time frame: 12 months (M12)
Utility dimension of viability - Other substances
Number of days of use of other substances/behaviours in the past 30 days
Time frame: Baseline (M0)
Utility dimension of viability - Other substances
Number of days of use of other substances/behaviours in the past 30 days
Time frame: 3 months (M3)
Utility dimension of viability - Other substances
Number of days of use of other substances/behaviours in the past 30 days
Time frame: 6 months (M6)
Utility dimension of viability - Other substances
Number of days of use of other substances/behaviours in the past 30 days
Time frame: 9 months (M9)
Utility dimension of viability - Other substances
Number of days of use of other substances/behaviours in the past 30 days
Time frame: 12 months (M12)
Utility dimension of viability - Inventory
Inventory of medical, psychosocial and psycho-educational contacts in the last 30 days
Time frame: Baseline (M0)
Utility dimension of viability - Inventory
Inventory of medical, psychosocial and psycho-educational contacts in the last 30 days
Time frame: 3 months (M3)
Utility dimension of viability - Inventory
Inventory of medical, psychosocial and psycho-educational contacts in the last 30 days
Time frame: 6 months (M6)
Utility dimension of viability - Inventory
Inventory of medical, psychosocial and psycho-educational contacts in the last 30 days
Time frame: 9 months (M9)
Utility dimension of viability - Inventory
Inventory of medical, psychosocial and psycho-educational contacts in the last 30 days
Time frame: 12 months (M12)
Utility dimension of viability - QoL
Quality of life
Time frame: Baseline (M0)
Utility dimension of viability - QoL
Quality of life
Time frame: 3 months (M3)
Utility dimension of viability - QoL
Quality of life
Time frame: 6 months (M6)
Utility dimension of viability - QoL
Quality of life
Time frame: 9 months (M9)
Utility dimension of viability - QoL
Quality of life
Time frame: 12 months (M12)
Conditions of transferability
Conditions of transferability linked to the characteristics of the stakeholders and the context: contextual conditions for success within the centres, the characteristics of professionals and patients influencing outcomes
Time frame: 9 to 12 months (M9 to M12)
Viability and implementation
Implementation of IACA! (process, resources, activities) including the respect of IACA! success principles (skills, postures)
Time frame: 6 to 12 months (M6 to M12)
Viability and utility
"utility" dimension (as a complement to the secondary criteria) of viability through the recovery mechanisms identified as successful mental health recovery
Time frame: 6 to 12 months (M6 to M12)
Viability and affordability
Affordability for professionals and beneficiaries (financial, geographical, social and cultural levers and brakes of the intervention)
Time frame: 6 to 12 months (M6 to M12)
Viability and evaluability
Evaluability of IACA: carrying out this evaluation, the availability of professionals and beneficiaries to answer questionnaires and interviews, missing data in the questionnaires etc.
Time frame: 6 to 12 months (M6 to M12)
Viability and adaptability
Adaptability of IACA! (integration of the action into the context and the current organisation of the centres)
Time frame: 6 to 12 months (M6 to M12)
Viability and acceptability
Acceptability of IACA! by professionals and beneficiaries
Time frame: 6 to 12 months (M6 to M12)
Feasibility study capacity
The centres' capacity for inclusion (eligibility, recruitment rate, refusal rate)
Time frame: 12 months (M12)
Feasibility study complicance
The compliance rates; understanding, acceptability and feasibility of study questionnaires and data collection tools;
Time frame: 12 months (M12)
Feasibility study ressources
The ressources required (time required to complete all study forms, professional/centre capacity, etc.)
Time frame: 12 months (M12)
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