L’addiction est une maladie chronique, avec des facteurs de vulnérabilité intrinsèques (génétique, historique, personnel…) à l’individu et qui s’installe progressivement suite à l’administration répétée de drogues. Une fois installée, il apparait extrèment difficile de s’en défaire, et un perpétuel cycle sevrage/rechute/consommation de drogues, semble se mettre en place, du au manque de traitements existants pour faire face au craving et à la rechute.
Nos études concernant les effets curatifs de l’EE ouvrent de nouvelles perspectives dans le traitement de l’addiction de manière directe mais aussi indirecte.
1) de manière directe car il est très facilement concevable d’appliquer nos résultats des effets curatifs de l’EE en clinique chez l’homme. En effet, nos résultats, extrapolés à l’homme, démontrent que la période d’abstinence constitue une merveilleuse opportunité thérapeutique pour le traitement de l’addiction (Solinas et al. 2010) et que les conditions de vie des personnes dépendantes devraient être considérées comme partie intégrante de leur thérapie. Dans la grande majorité des cas, un addict se retrouve souvent dans un contexte social appauvri, restreint le plus souvent au monde de la drogue (dealers, drogués…) en rupture familiale et avec une diminution des activités de la vie de tous les jours au profit de la recherche et de la prise de drogues. L’EE chez l’animal correspond à un ensemble complexe de stimulations sensorielles, cognitives et motrices en comparaison avec des rats évoluant dans un environnement standard. Ainsi, « enrichir » la vie des personnes en phase de sevrage pourrait passer par des stimulations sociales (recréer un réseau social qui ne soit pas centré sur la drogue), physiques (activités sportives) et intellectuelles (jeu, lecture..) soutenues. Cet enrichissement de la vie quotidienne des patients dépendants pourrait considérablement augmenter le succès des programmes de traitement existants actuellement.
En effet, les traitements actuels de l’addiction n’ont pas montré leur efficacité dans le maintien à long terme de l’abstinence. Deux types de traitement existent, les thérapies médicamenteuses et les thérapies psychologiques. Les thérapies psychologiques sont conçues pour s’appliquer aux mêmes processus cérébraux
motivationnels que ceux qui sont touchés par les substances psychoactives. Elles tentent de remplacer la motivation à utiliser ces substances par la motivation à pratiquer d’autres comportements. Associées à la prévention des rechutes (éviter les situations à risque, mieux apprehender les situations stressantes,…), elles contribuent à aider la personne à élaborer de nouvelles associations stimulus- réponse qui n’impliquent ni l’usage de la substance ni l’appétence. Ces principes sont utilisés pour essayer de "désapprendre" le comportement associé à la substance et d’apprendre d’autres réponses adaptatives. A titre d’exemple la thérapie selon « le management des contingences » a fait ses preuves. Cette technique comportementale est basée sur le conditionnement opérant stipulant que les comportements renforcés positivement ont tendance à être répétés. Cette thérapie permettrait de diminuer l’effet renforçant des drogues via la délivrance de "renforçateurs" naturelles (bons-cadeaux par exemple) si certains objectifs sont atteints et/ou la délivrance de punitions si la consommation se poursuit. Les objectifs à atteindre par le patient sont l’abstinence, la participation à des activités non associées à la recherche de produit, l’augmentation de la compliance et le suivi thérapeutique. Récemment, il a été montré, dans une étude de pharmacologie comportementale, que les sujets renonceraient à consommer de la méthamphétamine s’ils avaient le choix entre cette drogue et de l’argent. La probabilité de consommer ce stimulant diminuerait lorsque la somme d’argent augmenterait. Cependant, ces thérapies ne semblent être efficaces qu’à moyens termes, et lorsque le patient n’est plus encadré, les risques de rechute sont élevés. Dans l’état d’avancement de la recherche en neurosciences sur les traitements de l’addiction, il semble que l’association des thérapies pharmacologiques et psychologiques soit le moyen le plus efficace d’aider les patients à se maintenir dans un état d’abstinence (Roques 2000), mais ne sont malheureusement pas efficaces sur du long terme. En effet, de nombreuses personnes en phase d’abstinence rechutent après une période de sevrage plus ou moins longue. Leur inefficacité à long terme pourrait s’expliquer entre autre par le fait qu’elles ne prennent en considération les conditions de vie des personnes en phase de sevrage.
Ainsi, nos études mettant en évidence que des conditions de vies positives, stimulantes durant le sevrage diminuent les risques de rechute constituent une avancée supplémentaire dans les traitements de l’addiction qui tiennent lieu
en un enrichissement des conditions de vie des patients pourraient représenter une nouvelle arme dans la prise en charge des patients dépendants et si ce n’est de traiter, pourrait contribuer à améliorer l’efficacité des traitements actuels sur la prise en charge de longue durée.
2) de manière indirecte, en considérant l’EE comme un modèle animal de protectiion vis-à-vis de l’installation d’une addiction et des risques de rechute. Ainsi, en utilisant l’EE comme un modèle animal, il est possible de « disséquer » les mécanismes responsables de ces effets préventifs et curatifs et d’envisager ensuite de nouvelles stratégies thérapeutiques de l’addiction, centrées sur un mécanisme particulier. Dans cette optique, le concept de molécules environmentomimétiques s’avère extrêmement prometteur dans la découverte de nouvelles stratégies médicamenteuses en vue d’éliminer le craving et la rechute. Il est possible cependant qu’un mécanisme modulé par l’EE ne puisse pas reproduire de manière indépendante de l’EE les effets curatifs de l’EE. Cependant, cela nous permettra de découvrir des mécanismes adaptatifs de l’organisme en réponse à la drogue et pourra éventuellement permettre la découverte de nouveaux traitements pour lutter contre l’addiction.
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