Abstract : The concomitance of mental health and addiction disorders is a problem in routine medical clinical work. What can we do for patients that are « neither/nor » : those who are neither taken into Addiction Care Unit nor by Mental Health Care structures. We propose that the explanation for this situation seems to be linked to a causal approach in the clinical judgment of medical Doctors. Their model is based on pharmacopsychosis. A medical Doctor has to stop his usual causal judgement so as to put in place an integrated care plan instead of a sequenciel one. He needs to switch from a pharmcopsychosis model to a double pathology model.
From a patient pun « legitime défonce » (mixing self-defence and to be stoned ) expressing his right to take psychoactive substances, as a solution to protect himself from an unfair and absurd world, we examine the ecological function that addiction can have for the subject, and in particular how this notion echoes the notions of reversed debt and destructive entitlement. This is extremely fruitful at the relational level, but also to better understand the barriers that prevent someone from quiting his addiction. In a harm reduction perspective, accepting that someone take drugs can help the person find the time and the way to change without too many complications.