Addictology in an Urban Hospital Setting in Cameroon: Lessons from the First Year of Activity of the CSAPA at the Laquintinie Hospital of Douala

Study type and setting

This is a descriptive study analyzing activity data from the first year of operation (January to December 2021) of the CSAPA at the Laquintinie Hospital of Douala.

Data collection and analysis

Data were extracted from the center’s monthly indicator forms. To ensure methodological rigor, a clear distinction was made between unique individual patients (N = 155 new patients registered in 2021) and total clinical consultations (N = 380 total encounters, including 155 initial evaluations and 225 follow-up consultations). All sociodemographic profiles, primary diagnoses, and clinical characteristics were computed using the patient-level denominator (N = 155). Collected quantitative and qualitative variables included:

• Sociodemographic Profile: Age (< 15 years, 15–19, 20–24, 25–29, 30–34, 35–39, 40 years and older) and gender (Male / Female).
• Clinical Status and Active File: New cases, follow-up cases, suspected cases, tested cases, lost to follow-up, and deaths.
• Substances Consumed and ICD-10 Diagnoses: Self-reported consumption of tobacco, alcohol, cannabis, cocaine, amphetamines, opiates (tramadol), or other drugs, coupled with the International Classification of Diseases (codes F10 to F19).
• Psychiatric and Somatic Comorbidities: Depression, schizophrenia, anxiety disorders, acute psychotic disorders, bipolar disorder, as well as serological status (HIV, Hepatitis B/C, Tuberculosis/AFB) and specific medical conditions (Diabetes, Epilepsy, Pregnancy).
• Infectious Disease Screening Protocol: Systematic screening for HIV, Hepatitis B virus (HBV), Hepatitis C virus (HCV), and Tuberculosis (TB) was offered to all admitted patients upon intake. Screening was performed on a voluntary basis following informed consent. Biological screening for HIV (Serology/ELISA), HBV (HBsAg), and HCV (Anti-HCV antibodies) was conducted via venous blood sampling or rapid diagnostic tests (RDTs). Tuberculosis screening was performed through systematic clinical symptom checks (cough, fever, night sweats, weight loss) followed by chest X-ray or tuberculin skin testing/IGRA when clinically indicated.
• Treatment Modalities: Route of administration (smoked, ingested, sniffed, injected), origin of the request for care, and presence of behavioral addictions (gambling, sex/pornography, video games).
• Clinical Diagnostic Process and Criteria: All medical and psychiatric diagnoses were established during the initial evaluation by the CSAPA multidisciplinary team and validated by a senior psychiatrist/addictologist in accordance with the criteria of the International Classification of Diseases, 10th Revision (ICD-10).
• Distinction Between Substance-Induced Psychosis and Schizophrenia: The differential diagnosis between substance-induced psychotic disorders (F1x.5/F23) and primary schizophrenia (F20) was based on ICD-10 temporal criteria. A psychosis was classified as substance-induced when hallucinations or delusional symptoms occurred during or immediately after heavy substance use and resolved within 4 weeks of abstinence. Conversely, a diagnosis of schizophrenia (F20) was assigned when psychotic features persisted beyond 1 month of documented abstinence, or when chronic positive/negative symptoms clearly preceded the onset of substance use.
• Diagnostics multiples: Les patients ont été évalués pour un double diagnostic. Chaque patient a reçu un diagnostic principal d’addiction (codes CIM-10 F10–F19 représentant la substance principale d’abus menant à la consultation) et, le cas échéant, des diagnostics psychiatriques secondaires concomitants (par exemple, troubles dépressifs, anxiété, schizophrénie).
• Clinical Follow-up Indicators and Operational Definitions: Follow-up indicators were derived from the center’s monthly activity register. In routine practice at the CSAPA, “loss to follow-up” was operationally defined as the absence of any clinical contact or attendance at scheduled appointments for a period of 30 consecutive days or more, without formal medical discharge. Because data were collected via monthly aggregate indicator forms rather than a prospective longitudinal cohort tracking system, retention figures represent cumulative monthly care monitoring episodes rather than individual-level longitudinal retention rates.

Sociodemographic Profile and Characteristics of the Active File

During the 12-month study period, a total of 155 unique new patients were admitted to the CSAPA, generating a cumulative total of 380 clinical encounters (155 initial evaluations and 225 follow-up visits).

• Gender Distribution: The managed patient population showed a striking male predominance: 98.1% (n = 152) were male, while females represented only 1.9% (n = 3).
• Age Groups: The 20–24 age group was the most represented, accounting for 36.1% of patients (n = 56), followed by the 25–29 group at 21.9% (n = 34) and the 15–19 group at 17.4% (n = 27). Overall, young individuals aged 15 to 29 years comprised 75.5% (n = 117) of the patient cohort. Patients aged 30–34, 35–39, and ≥ 40 years accounted for 9.7% (n = 15), 6.5% (n = 10), and 8.4% (n = 13), respectively. No patients under 15 years of age were recorded.

Age Distribution of Patients:

The mean age of the patient population (N = 155) was 24.8 ± 6.2 years (range: 15 to 52 years). Young adults aged 15 to 29 years constituted the vast majority of the cohort, accounting for 76.3% of all admissions (n = 118/155). When stratified into specific age categories:

15–19 years: n = 31 (20.0%)

20–24 years: n = 52 (33.5%)

25–29 years: n = 35 (22.6%)

30–39 years: n = 24 (15.5%)

40 years and older: n = 13 (8.4%)

Patients aged 20 to 24 years represented the single largest subgroup (33.5%). Overall, patients under 30 years of age accounted for more than three-quarters (76.3%) of the active consultations.

Psychoactive Substances Consumed and ICD-10 Diagnoses

Primary clinical ICD-10 diagnoses established at initial patient evaluation (N = 155) revealed:

• ClinClinical Diagnoses (ICD-10):
• Code F19 (Polysubstance use / Disorders due to multiple drug use): Primary diagnosis in 58.7% of patients (n = 91).
• Code F12 (Mental and behavioral disorders due to use of cannabinoids): 29.0% of patients (n = 45).
• Code F10 (Disorders due to use of alcohol): 5.8% of patients (n = 9).
• Code F17 (Disorders due to use of tobacco): 4.5% of patients (n = 7).
• Codes F11, F14, F15 (Opioids, Cocaine, Other stimulants): 1.9% of patients (n = 3).
• Regarding reported substance use (sole or combined): Cannabis was consumed by 86.5% of patients (n = 134), Tobacco by 63.9% (n = 99), Cocaine by 18.1% (n = 28), Alcohol by 13.5% (n = 21), and Opiates/Tramadol by 9.0% (n = 14).

Routes of Administration and Origin of Care Request

• Routes of Administration:
• The smoked route (cannabis, tobacco, freebase cocaine/crack) accounted for 91.2% of recorded uses.
• The oral/ingested route (alcohol, tramadol, psychotropic medications) represented 8.1%.
• The nasal/sniffed route accounted for 0.7%, while the injectable route remained marginal (0.0% to 0.2%).
• Origin of Care-Seeking Initiative:
• In 88.5% of cases, the initial consultation was directly initiated by the immediate family, primarily the patient’s mother (64.2%).
• Spontaneous and voluntary self-referrals by patients accounted for only 7.1% of admissions.
• Medical or judicial referrals made up 4.4%.

Psychiatric and Somatic Comorbidities

• Psychiatric Comorbidities (Dual Diagnosis): Among all users evaluated at the CSAPA:
• Secondary psychiatric comorbidities were identified in 48 patients (overall prevalence of 31.0%).
• Acute and transient psychotic disorders (F23 / F1x.5) were the most frequent psychiatric disorders (n = 26, 16.8%),
• followed by schizophrenia (F20: n = 13, 8.4%)
• depressive disorders (F32–F33: n = 5, 3.2%)
• anxiety disorders (F40–F41: n = 3, 1.9%)
• bipolar affective disorder (F31: n = 1, 0.6%)
• Somatic Comorbidities and Screening: Regarding infectious disease screening within the active file:
• HIV/AIDS serology and tuberculosis screening (AFB) were 100% negative (0.0% positivity).
• Viral hepatitis markers (HBsAg and anti-HCV) tested negative across all controlled cases (0.0% positivity).
• Other non-communicable comorbidities, such as epilepsy (2.1%) and diabetes (0.8%), were recorded.

Clinical Follow-up and Care Continuity

Analysis of the monthly indicator records over the 12 months showed a cumulative total of 339 monthly patient-monitoring episodes maintained in care. A total of 41 episodes of loss to follow-up ($\ge 30$ days of non-attendance) were recorded across the year. No patient deaths were recorded in the hospital register during the operational year.

Behavioral Addictions

Compulsive sexual behavior (compulsive pornography use/masturbation) and gambling disorders were reported by a very small number of users during the year.

A Profile Centered on Youth, Cannabis, and Polysubstance Use

The results recorded during this first year of activity at the CSAPA of the Laquintinie Hospital of Douala (HLD) describe the sociodemographic and clinical characteristics of young adults presenting for psychoactive substance use care. Individuals aged 15 to 29 represent 76.3% of the active patient file. In our series (N = 155), polysubstance use disorders (ICD-10 code F19: 58.7%) and cannabis use disorders (F12: 29.0%) represent the primary reasons for care. These data align with descriptive observations made by Mboua et al. at the Jamot Hospital in Yaoundé [9] as well as those by Kouadio et al. in Abidjan [6], illustrating the high frequency of cannabis and combination substance use among young individuals consulting in urban African healthcare settings. The clear predominance of smoking as the route of administration (91.2%) can be explained by the usual method of cannabis and tobacco consumption, combined with the moderate cost and availability of these products.

Age Distribution and Predominance of Young Adults

The oThe overwhelming representation of young adults aged 15 to 29 years, who account for nearly three-quarters of our cohort (76.3%, n = 118/155), constitutes a key epidemiological characteristic of this cohort. This age distribution aligns with regional data reported by Mboua et al. in Yaoundé [9] and Kouadio et al. in Abidjan [6], confirming that adolescents and young adults represent the majority of patients seeking or brought to addiction consultation in these urban settings.

Several observational factors may explain this demographic distribution:

• Neurobiological and Developmental Context: The age range of 15–29 corresponds to a critical period of neurodevelopment during which the prefrontal cortex responsible for executive control, decision-making, and impulse regulation is not yet fully mature. This maturational delay heightens novelty-seeking behaviors, risk-taking, and susceptibility to substance experimentation [10].
• Socioeconomic and Environmental Stressors: Young people in Douala face substantial socioeconomic pressures, including high youth unemployment, school dropout, and rapid urban transformations. In this context, affordable psychoactive substances, particularly cannabis and tobacco, are frequently used as coping mechanisms against stress, boredom, and social precariousness [11].
• Family-Driven Healthcare Seeking: The high proportion of young users in our active file is also directly linked to healthcare access dynamics. As 88.5% of consultations are requested by family members (predominantly mothers), young adults living under the family roof are more likely to be coerced or encouraged into treatment by concerned relatives compared to older, socially isolated chronic users [9, 11].

Consequently, these descriptive findings highlight the importance of developing targeted early intervention programs, school-based prevention strategies, and youth-friendly addiction services tailored specifically to the psychological and social needs of adolescent and young adult populations.

o-occurring Psychiatric Symptoms and « Dual Diagnosis »

The interconnection between psychoactive substance use and psychiatric comorbidities emerges as a central element of our study. Nearly one-third of evaluated patients (31.0%, n = 48/155) presented a co-occurring psychiatric condition, primarily represented by acute and transient psychotic disorders (16.8%, n = 26/155) and schizophrenia (8.4%, n = 13/155). While these cross-sectional data demonstrate a high co-occurrence of substance use disorders and psychotic symptoms, the descriptive nature of this study does not allow for establishing direct causal relationships between cannabis use and the onset of primary psychotic disorders. These findings are consistent with observational research conducted in psychiatric and addiction settings in Central and West Africa [12,13], supporting the clinical relevance of an integrated multidisciplinary team combining psychiatric and addiction medicine expertise within the CSAPA at HLD [1].

Furthermore, no positive cases of HIV, viral hepatitis (B and C), or active tuberculosis were detected among screened patients. This low biological rate aligns with the non-parenteral administration profiles observed in our sample (predominantly smoked and oral routes) and the absence of intravenous drug use, an epidemiological pattern also described in other West African series [6,7]. However, these screening results must be interpreted cautiously, as screening was offered voluntarily and reflects only the subset of admitted patients who actively consented to testing, preventing generalization to all community substance users.

Family Involvement, Patient Referral Dynamics, and Under-Representation of Women

An analysis of healthcare access patterns highlights two major sociocultural characteristics:

• Predominant Family Initiative: In 88.5% of cases, the initial consultation is requested by the immediate family, primarily the patient’s mother (64.2%). Conversely, self-referred requests by users themselves account for only 7.1% of cases. While this illustrates the pivotal role of African family solidarity as the main vector for entering care, the very low proportion of self-referrals may also suggest limited personal awareness of addictive disorders or treatment hesitation among users [3,14].
• Marked Under-Representation of Women: Women represent only 1.9% of users recorded during the year. This low rate, also noted in similar studies in Abidjan and Lomé [6,7], is unlikely to reflect a true absence of substance use among women, but rather points to significant social and cultural stigma. This negative stereotype surrounding female substance abuse likely encourages concealment of use and acts as a major barrier to accessing public hospital facilities [3,15].

Study Limitations

This study has several methodological limitations inherent to its descriptive design based on routine indicator forms:

• Absence of Causal and Efficacy Inferences: Due to the cross-sectional and descriptive design, no causal inferences can be drawn regarding substance use and the etiology of psychiatric disorders, nor can conclusions be made regarding the formal therapeutic efficacy of the center’s interventions.
• Lack of Longitudinal Patient Tracking: The absence of an individual prospective cohort tracking system prevents the exact calculation of long-term individual retention rates, as patient status was captured through aggregated monthly reporting episodes rather than longitudinal individual follow-up.
• Definition and Potential Misclassification of Loss to Follow-up: « Loss to follow-up » was defined administratively (absence of contact for ≥ 30 days), which may misclassify patients who relocated, spontaneously remitted, or sought care in other facilities.
• Survival and Mortality Under-Reporting: Zero recorded deaths in routine hospital registers may reflect passive under-reporting once patients drop out of clinical care rather than true long-term survival.
• Selection Bias: The study population consists exclusively of patients reaching a tertiary referral hospital, predominantly brought by family members, and therefore cannot be generalized to non-treatment-seeking substance users in the general population.

The firThe first year of activity of the CSAPA at the Laquintinie Hospital of Douala demonstrates the clinical utility and healthcare need for such a facility in an urban Cameroonian setting. To optimize its operation, several key action areas are recommended:

• Targeted Prevention: Intensify awareness campaigns among youth (in school and university environments) regarding the dangers of cannabis and polysubstance use.
• Family Support: Establish listening spaces and psychological support services for parents (particularly mothers) who carry the demand for care.
• Reaching Female Users: Design specific reception and outreach strategies to reduce the social stigma surrounding female addiction.