1️⃣ ANALYTICAL SUMMARY

A system with solid fundamentals, faced with uses that are becoming more complex

The French system is based on the triptych city-hospital-medico-social and on a conception of addiction as a multifactorial chronic disease, calling for a global approach (medical, psychological, social) and the participation of the user. This framework is considered coherent and in line with international standards. However, it faces rapid changes: increase in polyconsumption (often with alcohol), rise in cocaine, development of non-substance addictions, and multiplication of complex situations marked by psychiatric comorbidities and a strong social gradient. Addictions are still responsible for over 115,000 avoidable deaths each year, mainly due to tobacco and alcohol (p. 12).

Identified levers for improvement and 20 operational recommendations

The report documents a system under pressure: insufficient and uneven detection, long waiting times, poorly structured management, heterogeneous data, poorly defined coordination roles. It proposes to build on the strengths of the field (commitment of professionals, outreach, microstructures, telemedicine, territorial coordination) and formulates 20 recommendations: strengthen primary care and early detection, reduce waiting times, secure treatments with opioid agonists, better target women, youth, and vulnerable populations, and above all develop a single “pathway” circular jointly led by the DGOS and the DGS, with a common set of indicators and territorial diagnostics (p. 31-51).

2️⃣ KEY POINTS OF THE DOCUMENT

1️⃣ A massive health and social burden

Over 115,000 avoidable deaths per year, with tobacco and alcohol at the top. Tobacco is the leading cause of avoidable mortality, alcohol the leading cause of hospitalisation. Estimated social cost of €156 billion for tobacco and €102 billion for alcohol. (p. 12)

2️⃣ Access delays that penalise entry into care

Nearly two months on average between the first request and effective care in CSAPA; the mission's survey measures an average delay of 38 days between the first contact and the first medical appointment, aggravated by high absenteeism. (p. 21)

3️⃣ A screening too dependent on the user

Referral to CSAPA comes from 46% of patients or their relatives, compared to only 6.42% from city doctors (2022 activity reports). The RPIB is practiced by 68% of doctors for tobacco, but drops to 46% for at-risk alcohol and 22% for cannabis. (p. 19)

4️⃣ A mapping of specialised services

152 CAARUD and 394 outpatient CSAPA identified (64% run by an association or a GCSMS, 36% by a healthcare establishment); 540 reception points for Young Consumer Consultations (CJC) managed by 270 CSAPA. (p. 14)

5️⃣ Alcohol trajectories illuminated by health data

Unprecedented cohort study on the National Health Data System (SNDS): 148,075 patients hospitalised for an alcohol-related disorder in 2023, of which 27% are women; 85% are also followed up in the community and 12% have died after more than two years, revealing breaks in care pathways and fragile city-hospital links. (p. 28 — annex 5)

3️⃣ ACTION TRACKS FOR LOCAL ACTORS

1️⃣ Enhance skills in identification

Mobilise a shared training foundation (RPIB, motivational interviewing, risk and harm reduction) and anchor it in a multi-professional approach supported by CPTS, to no longer rely on the sole initiative of users for identification. (recommendation no. 1, p. 32-33)

2️⃣ Develop and evaluate outreach

Prioritise advanced consultations, mobile teams and telemedicine for young people, vulnerable groups and isolated individuals, by systematising the evaluation of their impact to adjust deployment and funding. (recommendation no. 4, p. 35-36)

3️⃣ Secure reception and reduce waiting times

Draw inspiration from organisations that prioritise based on risk (pregnant women, treatment interruptions, comorbidities), open slots without appointments and limit absenteeism (reminder SMS, tracking apps), while caring for the first reception function. (p. 34-35)

4️⃣ Target explicitly women

Make women's needs visible beyond the perinatal period: include this priority in local priority groups and rely on flexible structures (microstructures, dedicated organisations) that are better accepted. (recommendation no. 5, p. 36-37)

5️⃣ Structure a shared territorial diagnosis

Map out the supply (including prescribers of treatments with opioid agonists) and the needs, with all stakeholders, to objectify the shortcomings and build action plans — the foundation of a future "pathway" circular. (recommendations no. 3 and no. 19, p. 34 & 48)

6️⃣ Strengthen the link with psychiatry

Anticipate psychiatric comorbidities and complex situations by relying on upcoming recommendations from learned societies, to limit the breaks in pathways between addiction and psychiatry. (recommendation no. 11, p. 43)

4️⃣ ADDITIONAL REFERENCES

External references

• OFDT — Drugs and addictions, key figures 2025: ofdt.fr. Updated overview of consumption and its consequences (cocaine, gambling, social costs).

• HAS — Support from the first point of contact to reduce women's alcohol risk (Feb. 2025): has-sante.fr. Guide and tool sheets, directly echoing the "women" priority of the report.

• EUDA — European report on drugs 2026: trends and developments: euda.europa.eu. European framework on supply, use, harm and responses (treatment, RdRD).

Internal resources Health Practices 

See articles on Addictions: https://pratiquesensante.odoo.com/blog/tag/addictions-115 

5️⃣ FREQUENTLY ASKED QUESTIONS (FAQ)

1️⃣ Is the French model of addiction treatment considered poor?

No. The IGAS considers it to be generally well designed and consistent with international standards, but weakened by the increase in needs and the complexity of situations. (Summary, p. 3-4)

2️⃣ What is the main barrier to accessing care?

The too late identification and the guidance that relies mainly on the users themselves, combined with high access delays and significant absenteeism at appointments. (p. 19-21)

3️⃣ What are the Equip'Addict microstructures?

A device resulting from the « article 51 » experiment that secures the practice of a general practitioner supported by a multidisciplinary addiction team; the report recommends its inclusion in common law. (recommendation n°2, p. 33-34)

4️⃣ Why is there particular attention to women?

Because their needs are increasing and remain poorly identified outside of pregnancy. The report recommends making it a priority in its own right, beyond just the perinatal period. (recommendation n°5, p. 36-37)

5️⃣ What is the proposed « pathway » circular?

A unique circular jointly issued by the DGOS and the DGS, designed to bring coherence to the entire system around the concept of pathways, with an identified project team. (recommendation n°13, p. 44-47)

6️⃣ Does the report address screens and addiction care stops?

No. These two topics are explicitly outside the scope as they are addressed in separate recent works. The report, however, covers addictions with and without substances (gambling, video games). (p. 11)

7️⃣ On what data is the report based?

About forty national interviews, three regional trips (non-representative, for illustrative purposes), a flash survey of CSAPA and CAARUD (50% of respondents) and the use of SNDS for alcohol. (Methodology, p. 277-282)

6️⃣ REWRITING IN EASY TO READ AND UNDERSTAND (FALC)

What is this report about?

• This report is about addictions in France.

• An addiction is the need to consume a product or engage in an activity, even when it is harmful.

• There are product addictions: tobacco, alcohol, drugs.

• There are also non-product addictions: gambling, video games.

• The report is written by IGAS. It is a state service that verifies and provides advice.

What the report says

• The French healthcare system is good overall.

• But it is too fatigued. There are too many patients and not enough resources.

• Tobacco and alcohol cause more than 115,000 deaths per year. These deaths could be avoided.

• Problems are identified too late.

• Often, the person must ask for help themselves. Doctors identify too few.

• You have to wait almost 2 months to be treated in a specialised centre (the CSAPA).

What the report proposes

• Train more professionals to identify problems early.

• Reach out to people who do not come: young people, women, poor people.

• Reduce the waiting time for care.

• Better help women, not just when they are pregnant.

• Write a clear and unique rule to organise care.

• Better work together between the city, the hospital and the centres.

7️⃣ CROSS-SECTIONAL ANALYSIS — VALUES OF HEALTH PRACTICES

• Literacy : The report remains an expert document poorly suited to varying levels of understanding; it does not provide literacy tools, but highlights the importance of spotting and first-line information.

• Empowerment : The active participation of the user in constructing their pathway is established as a principle, and peer support is the subject of a dedicated annex (annex 4).

• Participation : The co-construction of the pathway with the user is valued; the method has integrated the collection of users' perceptions of their pathway (Methodology).

• Community health: The collective dimension appears through outreach, territorial coordinations and the local anchoring of systems, more than through a formalised community approach.

• Ethics : Gender bias (under-reporting of women) and the social gradient are identified as aggravating factors to be corrected; the contradiction with the evaluated actors is a methodological principle.

• Human rights: Access without judgement, free and anonymous (CAARUD, CSAPA), risk reduction and attention to vulnerable populations reflect an approach of equity and inclusion.

• Intersectorality : Partnerships are recommended with the National Education, local missions, the social sector, justice and psychiatry.

• Partnership : Collaboration models are described: CPTS, territorial coordinations, microstructures, tele-expertise between town doctors and referring addiction specialists.

• Fight against discrimination: Stigmatisation (especially of women and vulnerable individuals) is identified as an obstacle to overcome; non-judgment and the diversity of audiences are taken into account.

8️⃣ EVALUATION OF THE RELIABILITY OF THE RESOURCE

Scientific relevance: high.

Independent institutional source (IGAS), explicit and contradictory method, recent and cross-referenced data (SNDS, PMSI, OFDT, EUDA, OECD), production of original data (flash survey CSAPA/CAARUD, SNDS cohort). Assumed limitations: non- representative movements, flash survey with 50% respondents — to be read as qualitative insights, not as exhaustive measures.

Operational relevance: indirect but real.

This is not an intervention guide: the levers (outreach, microstructures, RPIB, territorial diagnostics) are useful for orienting a local strategy, arguing a need with an ARS or supporting advocacy, rather than for equipping a facilitation session.

9️⃣ STRATEGIC HASHTAGS

#Addictology #HealthPrevention #RiskReduction #CarePathways #FirstContact #PublicHealth #RPIB #healthpractices

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