Addiction: prevention and support to promote recovery

How can we prevent addiction and improve monitoring of addicts undergoing treatment? Since September 2024, the Monaco Centre for Addiction Treatment, Support and Prevention has been open to anyone aged 15 or over who is resident, working or in education in the Principality. MonacoSanté explains how it works.

Support without stigma, prevention without blame. Covering all forms of addiction – alcohol, tobacco, hard or soft drugs, gambling or screens – the Monaco Centre for Addiction Treatment, Support and Prevention (CSAPAM) aims to be the first port of call in the Principality for anyone seeking to break free. With an active list numbering 130 patients since September 2024, when it first opened in Fontvieille, Dr Jean-François Goldbroch, a psychiatrist, addiction specialist and the deputy director of CSAPAM, and his team have been dispensing advice and strategies to offer the best possible treatment of this challenging disease. “We often sum up addiction by talking about the 5Cs: Consequences, loss of Control, Compulsion, Craving (the uncontrollable need to consume) and repeated Consumption. Indeed, the definition of addiction is loss of the freedom to abstain from consumption or from a behaviour regardless of the impact”, explains Dr Goldbroch. 

A neurological disease with serious consequences

Individuals who are suffering from addiction often feel shame and guilt. CSAPAM’s goal is to help them understand that they are first and foremost the victims of a disease. “It’s a neurological disease, but one whose causes and effects can be psychological, psychiatric, somatic, social, familial, professional and academic. Once it takes root, it has to be treated”, stresses Dr Goldbroch. “Addiction acts at the neuronal level.. For example, all it takes is for stress to occur and a substance to come along and ease that feeling. The neurones register that effect, and it becomes impossible to retake control without external help”, adds Evelyne Walter, administrator and healthcare executive at CSAPAM. “Reason does not exist: it is the neurones that are in charge,” notes Dr Goldbroch. Dialling down the drama, removing the guilt and re-evaluating: these are the three pillars that guide Dr Goldbroch and Héloïse Le Besq, the nurse who assists him. “Our job is to reduce the risks with regard to the substance, but also to find a new equilibrium that will offer protection.” The team looks beyond identifying a substitute product and putting treatment in place, working to develop other sources of pleasure, satisfaction or relief. “This helps to prevent addiction from showing its face, or at least reducing its intensity”, explains Dr Goldbroch. New behavioural therapies, like EMDR or hypnosis (particularly for tobacco addiction), are effective tools. He also recommends meditation, mindfulness and yoga. 

Special focus on young people aged 15 and over

With adolescence considered a period when people are at risk, a “young user” consultation has been set up. During this pivotal stage of life, “the brain is highly reactive to dopamine. The reward system is triggered very quickly. The frontal lobe is less able to control, and so there is less moderation. At the cerebellar level, there is going to be a little more impulsivity. All of these characteristics are neuronal as well as psychological. The more we take preventive action at an early stage, the lower the risk of descending into a deep addiction », explains Dr Goldbroch. Designed especially for teenagers aged 15 or older who are in education in Monaco, this consultation relies on information, prevention and assessment. The idea is to quickly reduce risk-taking and prevent its reoccurrence. “Young people can even come along without their parents to get information and be assessed”, notes Evelyne Walter. If treatment is required, the team always informs parents and works with them. “Parents can also come along by themselves to get some information and find out what to do if they suspect addiction. We will seek to reassure them or to arrange treatment if needed”, adds Dr Goldbroch. An alliance and a caring relationship is established with families. In Monaco, this approach forms part of collaborative work undertaken with schools. 

Awareness for older generations too

While young people are at the heart of the Centre’s work, the older generations are also well represented among patients. “There’s no age limit when it comes to treating addiction”, stresses Evelyne Walter. Medication, alcohol... Above the age of 60, certain vulnerabilities can lead to late-onset addiction. “A break-up, the death of a spouse, a move or other source of stress can lead to a loss of equilibrium. Equally, loneliness can lead to substance use”, notes Dr Goldbroch. The doctor notes that, in Monaco, older people are particularly concerned about their independence. “The consequences of this can be serious – things like falls or isolation. A fall at 70 is very different to a fall at 30. Never think that it is too late to ask for help.” The Monaco Centre for Addiction Treatment, Support and Prevention also relies on healthcare professionals who work with this group – geriatricians, general practitioners, nurses – to help them identify those at risk. 

Establishing a network of professionals around addiction

Conquering addiction is a long struggle at any age, not least since one addiction can hide another. “It’s not really ever possible to say that you are free of addiction. But it is possible to find a new equilibrium that offers protection. A more comfortable life without tobacco, without alcohol, without drugs, because you’ve found something else. A new life”, says Evelyne Walter. CSAPAM fulfils a public service function, particularly with regard to new drugs that are gaining ground: “Nitrous oxide, amphetamines, methamphetamines and LSD, which is coming back. We’re also seeing an increase in the use of cocaine, not just for partying, but also for work, ‘to keep going’. These substances are highly toxic, however”, warns Dr Goldbroch. The struggle goes on, with the same determination, and a desire to bring professionals together. “We want to bring together all those who are worried about addiction for some joint reflection on this issue,” he concludes.

Practical information: Opening hours: Monday to Friday, 9 am to 4.30 pm. By appointment only. Free and confidential. Young user consultations on Wednesdays, with or without an appointment.

Contact: Monaco Centre for Addiction Treatment, Support and Prevention 7, bis avenue des Ligures - 1st floor. Espace Fontvieille, Monaco. Tel.: 00 377 98 98 27 97