La notion de compensation s’applique à la compréhension des polyconsommations. Les contours mal définis de cette notion compromettant toutefois son utilité clinique, l’objectif de cet article a été de revisiter ses premières assises pour justifier sa place dans le champ de l’addictologie. Une généalogie historique a été ainsi faite sur une sélection de la littérature, cherchant à retracer les origines du concept dans la neurologie et la psychopathologie du xix^e siècle et ses remaniements ultérieurs par la psychanalyse. Les résultats visent le raffinement conceptuel des compensations en addictologie, redéfinissant cette notion en tant que comportement ou processus qui, soutenu par des mécanismes psychiques conscients et inconscients, sert à moduler le manque de jouissance consécutif à la rupture d’avec une pratique addictive. Ce concept permet ainsi l’évaluation de la trajectoire d’un sujet qui s’adonne à plusieurs pratiques addictives, à approcher les complications liées à des sevrages et à estimer finement la question des liens entre addictions et troubles psychiques.

In clinical practice, it is common to encounter several addictive behaviors that occur concomitantly or sequentially in subjects, this phenomenon has been identified with classical tags such as “mixed substance abuse” or “polysubstance dependence”. In despite of the elimination of a specific category for viewing the phenomenon as a whole since the DSM-5, its clinical significance is still relevant and practitioners often use descriptive terms such as “polydrug/polysubstance use”, “polydrug/polysubstance abuse” or “polysubstance involvement”. In France, the situation is almost identical. There are multiple points of view regarding the simultaneous addictive practices of a subject: “associations of addictions”, “co-addictions”, “overlaps”, “polysubstance use”, “dual addictive problems” or “poly-addictions”, for example. Recently, quite a few of the country's clinician-researchers have been using the term compensation to identify these phenomena. This notion remains, albeit, limited by theoretical considerations in French addictology studies, and clearly needs to be further addressed since it is imprecise. Thus, the objective of this article will be to revisit the original and theoretical groundwork of the concept of compensation to reinforce its clinical utility and its rationale basis in the field of addictions.

Via a review of the classic scientific literature, this approach is in line with the historical genealogy. It is a question of going back to the foundations of the concept of compensation, which finds its origin in neurology and psychoanalysis, then to compare them with the contemporary findings, modest and generally more descriptive. Research guidelines could thus be established to restore the clinical utility of the concept of compensation in contemporary addictology.

A current opinion attributed to Adler the origin of the psychoanalytic concept, however this origin is rather multifaceted and complex. When he stated it in 1907 in The Psychological Compensation of the Inferior State of the Organs, the notion of compensation had already been in circulation half a century earlier in the Franco-German work in neurology and psychopathology. At the beginning, the compensations describe an organic or psychological substitution with a neurological base (Charcot, Adler) as an unconscious regulation of a normal conscious state (Jung) or a search for balance when faced with an increase of excitement (Breuer). A later, richer and better defined concept of compensation appeared in Freud's work and continued in the French psychoanalytic tradition thanks to Lacan's work. Indeed, in Freud the notion of compensation goes from a neurological operation to remedy the imbalance of a dysfunctional neuronal function to anthropological and psychopathological analysis. According to him, the constraints of civilization would install in the individual a system of psychological compensation through diversions and sublimation but also harmful consumption. In other words, for the Freudian conception, the very act of harmful consumption would be in itself a compensation activity. Psychoanalytic tradition has developed this thought by Lacan's works on enjoyment. These foundations authorize to conceive the compensation in addictology as a behavior or process, supported by conscious and unconscious psychological mechanisms, which serves to modulate the lack of enjoyment following the break with an addictive practice.

In its clinical use, this concept of compensation takes into account the primordial discordance between the social component, the moral constraints and the subjective need for an additional supply of enjoyment. By considering compensations as a solution of recovery of enjoyment for a given subject, the clinician gets a better understanding of the person's addictive trajectory and polysubstance use. This concept also permits the accompaniment of addict patients to improve: compensations are to be understood as the reconstruction of a lost mythical harmony, they can render clarity to the new inventions of the subject to mitigate the dismantling of this reconstruction during withdrawal and they also promote therapeutic creativity to temper the abrupt loss of enjoyment that ensues. In addition, the addictive trajectory of a subject is often marked by breaks in equilibrium with the product (withdrawal, reduced consumption) or polyconsumption that would lead to compensation. This raises specific concerns for researchers and practitioners as new consumption patterns involve implementing adapted strategies of support.