NARCOSIS: DEFICIT OR ATTRACTIVE?

For the Doctor Jean-Arthur Micoulaud Franchi

The syndrome called "nitrogen narcosis" has been evidenced by the development of scuba diving in the air. It is more generally part of “inert gas narcosis” since this phenomenon is general and manifests itself with a whole series of inert gases of variable narcotic power (Rostain, Abraini et al. 2006). Narcosis is a syndrome made up of a set of neurological and psychiatric symptoms caused by the inhalation of narcotic gas at more or less significant partial pressures depending in particular on the lipid solubility of the narcotic gas. The neurophysiological mechanism is common regardless of the type of narcotic gas inhaled (Rostain, Abraini et al. 2006).

It is one of the syndromes, with the High Pressure Nervous Syndrome (SNHP) (Rostain 2006), which limits deep-sea access to divers. Narcosis and SNHP are syndromes that research in hyperbaric medicine has tried to limit in the context of deep-sea racing, stimulated by the economic opportunities offered by offshore oil fields. The narcosis is therefore generally analyzed by its deficit and deleterious aspect.

But apart from professional deep dives, the narcosis could not be on the contrary a variable that can explain the enthusiasm of some divers "leisure" for deep-sea diving (more than 40 meters in leisure)? The general aim of this study is therefore to analyze narcosis by its subjective and possibly attractive aspect, and not only medical and deficit. Could not narcosis be attractive instead of just a deficit?

The "special charm" of "the intoxication of the depths"

In any case, this is what is suggested by the 1987 memoir of Valérie Honoré-Castellin (psychiatrist in Marseille), analyzing reports in the form of impressions experienced by 12 professional divers (eight coralers and four divers from COMEX). It is reported that: “narcosis is magic, it's pleasant, it's exhilarating, we feel good”, or “we feel very tall, a bit like a superman, we say to ourselves that ' one is as strong as a cosmonaut who walks on the moon ”(Honoré-Castellin 1987)… Moreover, from 1835, Junod reports, in divers, disorders similar to alcoholic intoxication and describes in the latter“ an imagination lively and thoughts that have a special charm ”(Junod 1835).

This is also what the descriptions of narcosis by the pioneers of scuba diving suggest (Cousteau and Dumas 1953). Indeed, the attraction for deep dives, narcosis and its psychic effects, seem to be intrinsically linked to the history of the divers who allowed the development of recreational scuba diving. In the testimony of Jean-Yves Cousteau and Frédéric Dumas, entitled Le monde du silence, published in 1953, we can see a strong link between the birth of scuba diving and the psychic effect induced by depth (Cousteau and Dumas 1953 ). Thus from the beginning of the book, in the chapter entitled: The drunkenness of the depths, Cousteau and Dumas declare: “Our first summer of deep diving marked our entire existence. (…) We have never gone so low and yet we have never felt so ready ”(Cousteau and Dumas 1953). This was in 1943. Although in 1935, Benhke explained the real cause of "drunkenness of the deep" to the high partial pressure of nitrogen in the inhaled gas mixture (Behnke, Thomson et al. 1935; Rostain, Abraini et al. 2006), this explanation was not yet known to Cousteau's team, which he therefore did not yet call “narcosis”. However, the experimentation of this "intoxication of the depths" seems to have had a unifying role, see founder, in their teams and in the pursuit of their adventures, which will lead to the birth of recreational scuba diving. And Cousteau will continue by comparing the drunkenness of the depths to the consumption of a drug. He will begin by describing his own experience: “Personally, I am quite sensitive to the intoxication of the depths. I admit I love its magic, but at the same time I dread it, because I know that it dangerously weakens the instinct of self-preservation ”. To continue by qualifying: "The drunkenness of the depths has the advantage over drunkenness of alcohol or drugs of not having a continuation. As soon as the intoxicated diver ascends a few meters, his brain clears up; there is no such thing as a cruel “next morning” ”(Cousteau and Dumas 1953). In those years when diving was not yet established as a common hobby (in 1943, and afterwards, the team formed by Cousteau tested the first prototypes and crisscrossed the Mediterranean coast in a van) it remained risky to continue the comparison with the psychotropic drugs at the risk of being criticized for having invented a new drug!

Thus, if scuba diving and "drunkenness of the depths" causes an attractive subjective effect similar to alcohol or other psychotropic drugs, then it is legitimate to ask whether the consumption of psychotropic drugs is more divers, and if there could be an addiction to this attraction of narcosis, as there is an alcohol addiction?

Diving, psychotropic drugs and addiction

The link between scuba diving and the consumption of psychotropic substances is evoked by scattered data from gray literature (congress abstracts, dive reports, forums, and internet debates) which highlight a potentially significant consumption of psychotropic substances in the diving community ( Monteiro, Hernandez et al 1996, Dowse, Shaw et al 2011). However, the exact prevalence of psychoactive substance use is largely unexplored in divers (Hobbs 2008, Dowse, Shaw et al., 2011). Thus, in 2008, Hobbs concluded a comparative analysis article of the subjective and behavioral effect of nitrogen and alcohol by: "The role of diving and drinking history remains an open question" (Hobbs 2008).

Very recently the Gary Smerdon team from the Plymouth Diving Diseases Research Center (DDRC) in the United Kingdom, has just published two studies of psychoactive substance use at 479 English recreational divers aged from 16 to 59 (Dowse, Cridge). et al 2011, Dowse, Shaw et al 2011). The first studies the consumption of illicit psychotropic drugs, compared to BCS (British Crime Survey) data, which are considered as reference data for the general population (Dowse, Shaw et al., 2011). The second studies drug use (Dowse, Cridge et al., 2011).

Consumption of illicit psychoactive substances is no greater than in the general population, or even lower (Dowse, Shaw et al., 2011). However, three limits not discussed in the article are however to be noted.

- The consumption of legal psychoactive products (tobacco and alcohol) associated with illicit products has not been studied (Dowse, Shaw et al. 2011). Only secondary results on tobacco and alcohol consumption are present in the drug use study (Dowse, Cridge et al. 2011). Yet the possible link between scuba diving and alcohol consumption has been pointed out (Hobbs 2008). However, a questionnaire on alcohol consumption was available on the DDRC website, but is now withdrawn, which suggests ongoing data processing and therefore future publications by this DDRC research group.

- Only the consumption of psychotropic drugs is analyzed. Dependence on these substances with the possible consequences and pathologies induced has not been studied (Reynaud 2006).

- The fact of being a diver is not weighted by the type of diving practice favored by the subject: with or without risk-taking, an important factor for analyzing the pleasure-seeking behavior of divers (Bonnet, Pedinielli et al. 2001; Bonnet, Pedinielli et al. 2003; Bonnet, Fernandez et al. 2008).

This last point is important, since Bonnet et al. have shown that the emotional profile of at-risk divers (whose dive depth and narcosis search are important criteria) showed a higher predisposition to negative emotions compared to non-risk divers (Bonnet, Pedinielli et al., 2001; Bonnet, Pedinielli et al., 2003). This type of temperament is also found as a risk factor for dependence (Reynaud 2006), and allows to consider a psychological link between dependence and deep risk diving.

The general aim of this study is to consider narcosis by its attractive subjective aspect (Junod 1835, Cousteau and Dumas 1953, Honoré-Castellin 1987). The medical objective is to analyze the issue of dependence among scuba divers to try to fill the limits of the studies of (Dowse, Shaw et al., 2011) and to extend the studies of Bonnet et al. . (Bonnet, Pedinielli et al., 2001, Bonnet, Pedinielli et al., 2003, Bonnet, Fernandez et al., 2008). The hypothesis involves redefining scuba diving as: a high-pressure nitrogen inhalation device to achieve a psychotropic effect, and to investigate whether diving could be included in "likely consumption practices". induce an addiction "(Reynaud 2006). The possible dependence on narcosis and the consumption of licit psychotropic substances in divers (alcohol and tobacco) will therefore be analyzed. Since co-dependence is a frequent phenomenon in addiction therapy (Reynaud 2006), there may be a link between the risk of alcohol and tobacco addiction and the risk of addiction to narcosis.

Secure and not prohibit your diving!

The definition of scuba diving may seem reductive and objectionable. Scuba diving is of course more than just a device for high pressure inhalation of a psychotropic gas. However, this definition is only heuristic in order to analyze a possible psychiatric / addictological consequence of scuba diving with air not yet explored.

Our results must remain neutral in view of the social legitimacy of this practice. We also recall that the social acceptance of certain drugs (alcohol, tobacco, caffeine) and the stigmatization of others (illicit psychotropic drugs) is not determined solely by objective medical and scientific facts and also involves conflicts of value ( Jayle 2006). Our results, whatever they are, will not be able and will not be able to prohibit at the end the practice of the deep diving under the source of pleasure on the pretext that it would be potentially addictogenic by the narcotic effect.

On the other hand, to explore the problematic of addiction in scuba diving could allow to highlight possible side effects of this practice related to the inhalation of psychotropic gases under certain pressure conditions. It would then be a matter of informing and explaining to divers who are anxious to develop a responsible and autonomous practice in the spirit of progressive training at the levels of diving practice, coaching by pairs, and the book on safety rules of Jean-Jacques Grenaud and Mathieu Coulange (2008).

"Dive Experience of Enticing Profoundness"

In the absence of a tool to analyze the possible dependence on narcosis, this study consisted in constructing and validating a self-questionnaire to measure the potential dependence on high-pressure nitrogen and on submarine diving. deep air. We named this questionnaire by the acronym DEEP for Dive Experience of Enticing Profoundness.

This acronym was taken in reference to the attraction for the depth and the possible pleasure of narcosis, mentioned above (Cousteau and Dumas 1953, Honoré-Castellin 1987). The use of the term "Profoundness" in English does not refer not only to depth but also to a certain mystical aspect (which could be translated as "inner depth") and that is why it has was chosen as suggested by the subjective descriptions of the divers (Cousteau and Dumas 1953, Honoré-Castellin 1987). It must be remembered that although Cousteau discovered the term of nitrogen narcosis after the war, he asserted that "for us, this narcosis was, and will remain, the drunkenness of the great depths" (Cousteau and Dumas 1953).

In reference to the possible link between consumption of psychotropic drugs and practices of deep-sea diving (Bonnet, Pedinielli and 2003, Hobbs 2008, Dowse, Shaw et al 2011), we will also analyze the consumption of psychotropic drugs by self-questionnaire. Associated laws: tobacco and alcohol.