2009, Number 3
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Salud Mental 2009; 32 (3)
La Terapia Centrada en Soluciones. Una opción de tratamiento para la dependencia al alcohol
Cordero M, Cordero R, Natera G, Caraveo J
Language: Spanish
References: 147
Page: 223-230
PDF size: 132.43 Kb.
ABSTRACT
In Mexico, excess drinking constitutes one of the main public health challenges nationwide. The 2002 National Addictions Survey documented the existence of 11 035 262 heavy drinkers, 3 226 490 habitual drinkers, 2 841 303 persons with alcohol dependence and 2 343 710 persons who started arguing with their spouse or partner when drunk. Illnesses that are directly or indirectly associated with drinking are among the ten leading causes of death in Mexico among the general population: specifically, men die from attacks or homicide, self-inflicted wounds, alcoholic liver disease and other chronic diseases of the liver and alcohol dependence syndrome. Although there are various intervention strategies that attempt to influence this problem, it is not known whether these interventions are a causal factor in the change produced by the consumer and the way in which this change is produced after treatment; one way of determining this is by evaluating their results. Although Solution-Focused Therapy constitutes a differ ent alternative to those that have traditionally been used for treating alcohol consumption, most research conducted in Mexico and other countries is carried out using a social learning model. Although the results of the Solution-Focused Therapy have been documented in various countries in America and the European Community, the findings are insufficient for it to be regarded as an optimal treatment for modifying excess alcohol consumption among the Mexican population. Objective To evaluate the results of the Solution-Focused Therapy in ethanoldependent persons and to determine the differences between those that seek to modify problems associated with alcohol consumption and those that seek to change their drinking styles. Method A comparative O1-X-O2 longitudinal design was used, with a 12- month follow-up. The sample comprised 60 intentionally selected alcohol consumers, ages 18 to 50, who attended the Center of Assistance for Alcoholics and Their Relatives (CAAF) at the Ramón de la Fuente National Institut e of Psychiatry. They had consumed alcohol in the past year, met the Alcohol Dependence Criteria according to the DSM-IV and gave their written consent. The sample was divided into 30 ethanol-dependent persons who attended the CAAF in an attempt to modify their drinking levels and 30 ethanol-dependent persons who sought to modify problems associated with their consumption. In this study, the results of the intervention were defined on the basis of the time elapsed between an ethanol-dependent person’s last therapy session and the time when he or she experiences a relapse and continues with the problems associated with alcohol consumption. The subjects’ history of alcohol consumption was characterized by their pattern of consumption, level of dependence, number of DSM-IV criteria, history of treatment, problems of alcohol consumption in the previous two generations of their families of origin, and alcoholrelated problems. The number of additional sessions, services and treatments were regarded as mediators of the results of the intervention. The information was obtained through various instruments, such as the pre-consultation and initial consultation cards, the Scale of Ethanol- Dependence and a version of the Index of the Severity of Addiction drawn up by the Center of Assistance for Alcoholics and their Relatives. The procedure was carried out in three stages: the baseline, the application of Solution-Focused Therapy and a follow-up beginning twelve months after the last therapy session. The field operation began in April 2002 and ended in August 2004, with the last phase being carried out on both the subjects that had completed their treatment and on those that had interrupted it and requested assistance again at any of the services offered by the CAAF. Results Seventy-eight per cent of the sample were married; 38% had completed elementary school; the average age was 35.5, and most had a low socio-economic level. A total of 39% were heavy drinkers; 43% displayed a substantial level of dependence, and 70% had a record of treatment. The highest need for treatment was recorded in family problems associated with alcohol consumption, totaling 48%. Sixty-three per cent of the sample attended one to three sessions, while the remainder attended over three. A follow-up study of 83% of the sample showed that most sought assistance at two of the Center’s treatment services, while 55% of the dependents received treatment at the CAAF alone. Thirty per cent cut short their treatment because they did not want to stop drinking or did not need help or were annexed; 28% stopped for work or financial reasons, while only 2% reported that the treatment failed to cover their expectations. Fifty-six per cent of the sample did not relapse, and successfully modified the problems associated with alcohol consumption; 32% relapsed and failed to modify their alcohol-related problems, while the remainder relapsed yet managed to modify the problems associated with alcohol consumption (12%) with a value of χ2 = 29.94 and p equivalent to 0.00. The heterogeneity tests did not display statistically significant differences between the subjects that relapsed and continued with their alcohol-related problems (44%) and those that did not relapse and modified their alcohol-related problems (56%) by either alcohol consumption characteristics or the factors mediated by the results of the intervention. The study showed that the first four months after the last therapy session are those during which subjects experience the highest risk of relapsing and continuing with problems associated with alcohol consumption. Just 47% of the patients that cited modifying their drinking levels as the reason for seeking treatment proved not to have relapsed and to have successfully modified the problems associated with their drinking at the 12-month follow-up as opposed to 83% of those that sought to modify the problems associated with their drinking, with a statistical significance of less than 0.01 in the log-rank test. The intervention was observed to achieve better results among alcohol-dependent persons that sought to modify problems associated with alcohol consumption, had a lower socio-economic level, a record of treatment for their alcohol consumption, high levels of dependence, a medium-high need for treatment in psychological, work problems, and did not receive any form of treatment outside the CAAF. The article discusses the role of the demand for treatment as a predictor not only of the search for services, as supported by international literature, but also of the results of the intervention. It confirms the importance of conceiving alcoholism as a symptom resulting from relational systems the drinker maintains with his/her surroundings, rather than as a problem that can be solved by ensuring that the drinker remains sober. The article suggests including a control group with another type of therapeutic intervention in order to compare the results of the Solution-Focused Therapy and have more elements for making evidence-based decisions.
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hábito alcohólico representa un riesgo para su salud o ya les ha ocasionado
algún daño. Salud Mental 1992;15(2):14-19.
Beyebach M, Sánchez M, Rodríguez S, De Miguel J, De Vega M et al.
Outcome of solution–focused therapy at a University Family Therapy
Center. J Systemic Therapies 2000;19(1):116-128.
Lafountain RM, Garner NE. Solution-focused counseling groups: The
results are in. J Specialists Group Work 1996;21(2):128-143.
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severity index among outpatients whit severe mental illness. Psychological
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of the ASI in French-speaking alcoholic patients. J Stud Alcohol
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de vida y severidad de la adicción en heroinómanos en mantenimiento
prolongado con metadona. Adicciones 1999;(11)1:43-52.
McLellan AT, Luborsky L, Cacciola J, Griffith J, Evans F et al. New data
from the addiction severity index. Reliability and validity in three centers.
J Nerv Ment Dis 1985;173:412-423.
Sandi LE, Ávila K. Adaptación y validez del índice de gravedad de la
adicción en un grupo de población costarricense. Bol Sanit Panam
Heather N. Effectiveness of brief interventions proved beyond reaseonable
doubt. Addiction 2002;(97):293-299.
Moyer A, Finney J, Swearingen C, Vergun P. Brief interventions for alcohol
problems: a meta-analytic review of controlled investigations in
treatment-seeking and non-treatment-seeking populations. Addiction
Project Match Research Group. Matching alcoholism treatments to client
heterogeneity: Project MATCH post treatment drinking outcomes. J Stud
Mariño MC, Medina-Mora ME, Escotto VJ, De La Fuente JR. Utilización
de servicios en una muestra de alcohólicos mexicanos. Salud Mental
Mariño MC, Medina-Mora ME, De La Fuente JR. Comparación de dos
muestras de pacientes alcohólicos. Salud Mental 1999;22(5):28-33.
Bolvitnik J, Hernández E. Pobreza y distribución del ingreso en México.
México: Ed. Siglo XXI; 1999.
Belló M, Puentes-Rosas E, Medina-Mora ME. El papel del género en la
demanda de atención por problemas relacionados al consumo de alcohol.
Revista Panamericana Salud; 2008(en prensa).
Berenzon GS, Medina-Mora ME, Lara CMA. Servicios de salud mental.
Veinticinco años de investigación. Salud Mental 2003;26(5):61-72.
SSA, INEGI, INPRF, DGE. Encuesta nacional de adicciones, alcohol. México: 1988, 1990, 1994, 1997 y 2002.
INEGI, SSA/DGEI. Estadísticas vitales: mortalidad en Estados Unidos Mexicanos. México: 2003.
Edwards G, Anderson O, Babor TF, Casswell S, Giesbrecht N et al. Alcohol policy and the public good. New York: Oxford University Press; 1994.
OMS, OPS. Guía internacional para vigilar el consumo de alcohol y sus consecuencias sanitarias. 2000.
López J, Rosovsky H. El papel que desempeña el alcohol en los motivos por los que se les da atención en los servicios de urgencias, estimación del riesgo asociado en los traumatismos. Salud Mental 1998;21(3):32-38.
Rosovsky H, Casanova L, Gutiérrez R, González L. Los accidentes y la violencia en México: El consumo de alcohol como factor de riesgo. Anales. México: Instituto Mexicano de Psiquiatría; 1994; pp. 61-64.
Rosovsky H. El peso del consumo excesivo de alcohol en la atención a la salud. Higiene 1997;5(1,2):31-35.
Solís L, Cordero M. El uso de servicios y las recaídas de los pacientes alcohólicos en tratamiento. Resultados de un seguimiento telefónico. Salud Mental 1999;22(2):1-6.
WHO. International guidelines for evaluation of treatment services and systems for psychoactive substance use disorders. 2000.
Bateson G. Pasos hacia una ecología de la mente. Buenos Aires: Carlos Lolhé; 1956.
Berg I, Miller S. Trabajando con el problema del alcohol. Orientación y sugerencias para la terapia breve familiar. España: Ed. Gedisa; 1996.
De Shazer S, Berg I, Lipchik E, Nunnally E, Molnar A et al. Brief therapy: focused solution development. Family Process 1986;25:207-221.
Ayala H, Gutiérrez ML. Una revisión de programas de tratamiento para el consumo excesivo del alcohol. Neurología, Neurocirugía, Psiquiatría 1993;33(1):49-54.
Ayala HV, Echeverria L, Sobell M, Sobell L. Autocontrol dirigido: Intervenciones breves para bebedores excesivos de alcohol en México. Rev Mex Psic 1998;2(14):113-127.
Ayala H, Cárdenas G, Echeverría L, Gutiérrez M. Los Resultados iniciales de un programa de autocontrol para bebedores problema en México. Salud Mental 1995;18(4):18-24.
Barragán L, González J, Medina-Mora ME, Ayala H. Adaptación de un modelo de intervención cognoscitivo-conductual para usuarios dependientes de alcohol y otras drogas a población Mexicana: Un estudio piloto. Salud Mental 2005;28(1):61-71.
Campillo C, Díaz-Martínez R, Romero M, Cerrud J, Villatoro J. La intervención eficaz del médico general en el tratamiento de bebedores cuyo hábito alcohólico representa un riesgo para su salud o ya les ha ocasionado algún daño. Salud Mental 1992;15(2):14-19.
Beyebach M, Sánchez M, Rodríguez S, De Miguel J, De Vega M et al. Outcome of solution–focused therapy at a University Family Therapy Center. J Systemic Therapies 2000;19(1):116-128.
Lafountain RM, Garner NE. Solution-focused counseling groups: The results are in. J Specialists Group Work 1996;21(2):128-143.
Lambert MJ, Okiishi JC, Finch AE, Jonson LD. Outcome assessment: From conceptualization to implementation. Professional Psychology Research Practice 1998;(29):63-70.
Zimmerman TS, Prest LA, Wetzel BE. Solution-focused couples therapy groups: an empirical study. J Family Therapy 1997; (19):125-1444.
Skinner H, Horn J, Wanberg K, Foster F. Alcohol dependence scale. Canada: Addiction Research Foundation Press; 1984.
Willenbring M, Bielinski J. A Comparison of the alcohol dependence scale and clinical diagnosis of alcohol dependence in male medical outpatients. Alcohol Clin Exp Res 1994;18(3):715-719.
Solís L, Cordero M, Cordero R, Martínez M. Caracterización del nivel de dependencia al etanol en habitantes de la Ciudad de México. Salud Mental 2007;30(6):62-68.
McLellan AT, Luborsky L, Woody GE, O’Brien CP. An improved diagnostic evaluation instrument for substance abuse patients. The addiction severity index. J Nerv Ment Dis 1980;168(1):26-33.
Torres De Galvis Y. Validación y utilización de instrumentos clínico investigativos en salud mental y farmacodependencia. Colombia: Ed. Fundación Universitaria Luis Amigó; 1993.
Appleby L, Dyson V, Altman E, Luchins D. Assessing substance use in multiproblem patients: Reliability and validity of the Addiction Severity Index in Mental Hospital Population. J Nerv Ment Dis 1997;3(185):159-165.
Carey KB, Cocco KM, Correia CJ. Reliability and validity of the addiction severity index among outpatients whit severe mental illness. Psychological Assessment 1997;(9):422-428.
Daeppen JB, Burnard B, Schnyder C, Bonjour M, Pecoud A et al. Validation of the ASI in French-speaking alcoholic patients. J Stud Alcohol 1996;6(57):585-560.
Fernández MJJ, González PMP, Sáiz MPA, Gutiérrez CE, Bobes GJ. Calidad de vida y severidad de la adicción en heroinómanos en mantenimiento prolongado con metadona. Adicciones 1999;(11)1:43-52.
McLellan AT, Luborsky L, Cacciola J, Griffith J, Evans F et al. New data from the addiction severity index. Reliability and validity in three centers. J Nerv Ment Dis 1985;173:412-423.
Sandi LE, Ávila K. Adaptación y validez del índice de gravedad de la adicción en un grupo de población costarricense. Bol Sanit Panam 1989;107(6):561-567.
Heather N. Effectiveness of brief interventions proved beyond reaseonable doubt. Addiction 2002;(97):293-299.
Moyer A, Finney J, Swearingen C, Vergun P. Brief interventions for alcohol problems: a meta-analytic review of controlled investigations in treatment-seeking and non-treatment-seeking populations. Addiction 2002;97:279-292.
Project Match Research Group. Matching alcoholism treatments to client heterogeneity: Project MATCH post treatment drinking outcomes. J Stud Alcohol 1997;58:7-29.
Mariño MC, Medina-Mora ME, Escotto VJ, De La Fuente JR. Utilización de servicios en una muestra de alcohólicos mexicanos. Salud Mental 1997;22(5):28-33.
Mariño MC, Medina-Mora ME, De La Fuente JR. Comparación de dos muestras de pacientes alcohólicos. Salud Mental 1999;22(5):28-33.
Bolvitnik J, Hernández E. Pobreza y distribución del ingreso en México. México: Ed. Siglo XXI; 1999.
Belló M, Puentes-Rosas E, Medina-Mora ME. El papel del género en la demanda de atención por problemas relacionados al consumo de alcohol. Revista Panamericana Salud; 2008(en prensa).
Berenzon GS, Medina-Mora ME, Lara CMA. Servicios de salud mental. Veinticinco años de investigación. Salud Mental 2003;26(5):61-72.
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