La définition des mécanismes de défense du DSM-IVTR intègre les stratégies de coping comme modalité défensive. Pour autant, à ce jour, aucune étude ne s’est intéressée à l’analyse de l’ensemble des éléments, c’est-à-dire défenses et coping, au sein d’une population alcoolodépendante.

Le but de cette recherche est d’étudier le fonctionnement défensif chez des personnes alcoolodépendantes à travers l’expression des défenses et stratégies de coping.

Dans le cadre d’une étude multicentrique, 80 personnes consultant pour une problématique alcoolique ont répondu à un questionnaire centré sur les données socio-démographiques et sur le parcours de consommation. Les stratégies d’adaptation (ou coping) ont été évaluées par le Brief Cope et les styles défensifs et défenses ont été relevés par le Defense Style Questionnaire-40.

Les personnes alcoolodépendantes se servent davantage des stratégies de coping blâme, utilisation de substances et acceptation et moins de l’humour. Elles utilisent préférentiellement le style mature et les défenses suppression et anticipation et moins la projection et la dissociation. Des corrélations significatives entre ces procédés ont été mises en évidence.

Cette étude met en avant l’intérêt d’étudier le fonctionnement défensif selon une approche intégrative en vue de favoriser des prises en charge adaptées aux personnes alcoolodépendantes.

Defense mechanisms have been seen to greatly change over time and across different definitions made by different theoretical currents. Recently with the definition provided by the DSM IV, defense mechanisms have integrated the concept of coping as a defensive factor. These mechanisms are no longer considered just through a psychodynamic approach but also through a cognitive and behavioral one. In recent years, new theories have therefore integrated these two components of the defensive operation. According to Chabrol and Callahan (2013), defense mechanisms precede coping strategies. In individuals with psychopathological disorders, these authors indicate a relative stability of these mechanisms. Also, we asked about the presence of unique characteristics among people with alcohol dependence. Indeed, studies conducted with people with alcohol dependence highlight the presence of a neurotic defense style and some highly immature defenses (projection, acting out, splitting and somatization). In terms of coping strategies, persons with alcohol dependence preferentially use avoidant strategies and strategies focused on emotion. However, although several studies have been conducted to assess coping strategies and defense styles within a population of individuals with an alcohol problem, at the present time none of them has taken into account all these aspects of defense mechanisms.

The aim of this study is therefore to study the defenses and defense styles and coping strategies in an alcohol-dependent population.

This multicenter study (3 CHU, 1 center of supportive care and prevention in addiction and 1 clinic) received a favorable opinion of an Institutional Review Board (IRB Registration #: 00001072). Eighty alcohol-dependent individuals responded to a questionnaire assessing sociodemographic characteristics and elements related to the course of consumption. Coping strategies were assessed by means of a questionnaire validated in French: the Brief Cope. The Defense Style Questionnaire-40 translated into French, but not validated, assessed defenses and defense style. Descriptive, comparative and correlational analysis was carried out using Statistica software – version 10.

The alcohol-dependent people preferentially use emotion focused coping blame and less the problem focused coping humor. The highest immature defense is acting out. Correlational analyses confirm the presence of some significant relationships between defense style and some coping strategies. Thus, the mature style is the only defense style, which is linked with the problem focused strategy humor, and another one coping called distraction. Some singular relationships were found with these two dimensions of coping. Alcohol and drug disengagement show particularly strong relationships with immature defenses such as projection and somatization. Another singular result is indicated by a negative relationship between immature defenses autistic fantasy with the strategy expression of feelings.

This study found a significant number of relationships between defensive styles, defenses and coping strategies. This research also highlights the value of an integrative approach of defense mechanisms for the analysis of defensive functioning of people with alcohol dependence. Indeed, the relationships between these elements are consistent and allow understanding the defensive operation as a whole to promote a new adapted means of support.