For the first time since the 2007–2008 reform, the General Inspectorate of Social Affairs has carried out a review of the French system for the treatment of addictions. Covering all types of addiction and all sections of the population – with a particular focus on young people, women and those in vulnerable circumstances – the review finds that the system has solid foundations but is under considerable strain, despite the commitment of professionals. It sets out recommendations to strengthen its management and improve the identification of cases and access to care.

To underpin its findings, the mission focused particularly on the challenges of identification, treatment, continuity of care pathways and coordination between stakeholders. It drew on investigations carried out both at national level and in several regions, a survey of specialist medical and social care facilities, and a statistical study on community-to-hospital pathways relating to alcohol-related disorders.

In their report, the inspectors describe a system whose fundamental principles remain relevant: comprehensive care integrating medical, psychological and social dimensions, and an organisational structure based on complementarity between general practice, hospitals and the specialised medical-social sector. This model aims to address the diversity of situations and needs.

Between poly-substance use and psychiatric comorbidities: increasingly complex care pathways

However, this system is currently under considerable strain. On the one hand, it faces constantly evolving patterns of addictive behaviour and increasingly complex situations, driven by the rise in poly-substance use, psychiatric comorbidities and non-substance-related addictions. On the other hand, the shortage of healthcare staff, particularly doctors, complicates the process of referring stabilised patients to general practice.

Despite the commitment of professionals, care pathways remain hampered by insufficient and inconsistent identification of cases, long waiting times for access to specialist care (an average two-month wait between initial contact and the first appointment with a healthcare professional at a CSAPA¹), as well as difficulties in coordination between stakeholders and a lack of clarity regarding actual needs. The system therefore struggles to provide adequate support, particularly for target groups such as young people or those in precarious circumstances, whilst the needs of women—excluding those who are pregnant—remain insufficiently addressed.

Developing a culture of addiction care

To address these challenges, the report recommends strengthening national and regional governance, based on shared assessments, intervention models and indicators, enabling resources to be tailored to needs. It proposes detailed measures to improve access to primary care, enhance access to and continuity of care, and develop a culture of addiction care, particularly in hospitals.

With regard to professional practice, the report encourages learned societies to draw up recommendations specifically for complex situations. Furthermore, it recommends that the Fund for the Fight against Addiction (FLCA) make interventions targeting women – beyond perinatal situations – a priority.

Strengthening the prevention of alcohol and tobacco addiction

Finally, the report calls for a reduction in the strain placed on the system by tobacco and alcohol addiction, which are responsible for more than 115,000 preventable deaths each year. To this end, it recommends strengthening the policy on alcohol addiction prevention and rolling out the ‘smoke-free healthcare settings’ initiative to all healthcare facilities by 2027–2028.

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