Attachment and Substance Use Disorder: An Interventional Study in an Addictology Day Hospital

In response to the primary outcome criterion, a composite craving score will be assessed during the experimental and follow-up phases. This score is calculated by the investigator at the end of each follow-up visit and is derived from the participant's self-assessment, completed using a patient diary filled out at home. In this diary, participants record each craving episode and rate its intensity using a Visual Analog Scale (VAS) ranging from 0 (no craving) to 10 (intense craving). This VAS has been widely used in craving-related research (Badredine, 2021; Trojak & Demina, 2025).

The Experiences in Close Relationships - Relationship Structures (ECR-RS) (Fraley et al., 2011) is a self-report questionnaire that assesses attachment style across different types of close relationships (parents, friends, and romantic partners). It consists of 9 items rated on a 7-point Likert scale, ranging from 1 (strongly disagree) to 7 (strongly agree). The ECR-RS measures two main dimensions of attachment: anxiety (fear of rejection or abandonment) and avoidance (tendency to avoid intimacy or emotional dependence). High scores on either dimension indicate insecure attachment. The instrument has good psychometric properties, and a French validation was conducted by Lafontaine et al. (2016).

The Childhood Trauma Questionnaire (CTQ) (Bernstein et al., 1994) is a retrospective self-report questionnaire designed to assess the presence and severity of traumatic experiences during childhood. It consists of 28 items rated on a 5-point Likert scale, ranging from 1 (never true) to 5 (very often true). It assesses five forms of maltreatment: physical, sexual, and emotional abuse, as well as emotional and physical neglect. It also includes a minimization/denial scale designed to detect the underreporting of traumatic experiences. Each subscale provides a specific score, and an overall total score can also be calculated. The CTQ has been validated in French by Paquette et al. (2004).

The Medical Outcomes Study Short-Form (MOS-SF-36) (McHorney et al., 1993) is a self-report questionnaire designed to assess quality of life. It consists of 11 questions comprising a total of 36 items. Participants are asked to answer with reference to the previous four weeks across eight subscales: physical functioning, role limitations due to physical health, perceived health, vitality, social functioning and relationships with others, role limitations due to emotional problems, mental health, and health change.

The recommended scoring system for the MOS-SF-36 uses a weighted Likert scoring system for each item. Items within each subscale are summed to obtain a summary score for each subscale or dimension. Each of the eight summary scores is then transformed to a scale ranging from 0 (negative health outcomes) to 100 (favorable health outcomes), yielding a score for each subscale. The French version was validated by Leplège (2001).

The Toronto Alexithymia Scale (TAS-20) (Bagby et al., 1994) is a 20-item self-report questionnaire designed to assess the level of alexithymia, that is, difficulty identifying and expressing emotions. Items are rated on a 5-point Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree). The TAS-20 assesses three dimensions: difficulty identifying feelings, difficulty describing feelings, and externally oriented thinking. A total score above 61 indicates a high level of alexithymia. The scale has been validated in French by Loas et al. (1996).

The Difficulties in Emotion Regulation Scale (DERS; Gratz & Roemer, 2004), in its French version (DERS-F) validated by Dan-Glauser et al. (2015), is a 36-item self-report questionnaire designed to assess difficulties in emotion regulation. Responses are rated on a 5-point Likert scale, ranging from 1 (almost never true) to 5 (almost always true). The scale assesses six dimensions: non-acceptance of emotional responses, difficulties engaging in goal-directed behavior when distressed, impulse control difficulties, lack of emotional awareness, limited access to emotion regulation strategies, and lack of emotional clarity. Higher scores reflect greater difficulties in emotion regulation.

The Rosenberg Self-Esteem Scale (Rosenberg, 1965) is a 10-item self-report questionnaire designed to assess global self-esteem. Items are rated on a 4-point Likert scale ranging from 1 (strongly disagree) to 4 (strongly agree). It includes five positively worded and five negatively worded items, assessing positive or negative self-perceptions. A higher total score reflects more positive self-esteem. The French version, validated by Vallieres and Vallerand (1990), demonstrates excellent psychometric properties.