ABSTRACT
Antecedentes: En el alcoholismo, el tema del craving es un asunto controvertido. Sin embargo, se sabe que, si un alcohólico puede hablar del suceso en sus propios términos, aumenta la probabilidad de lograr un afrontamiento exitoso y evitar una recaída. No obstante, se conoce muy poco acerca de dicho afrontamiento y aún menos cuando se alude a él con términos propios del bebedor.Objetivo: Conocer el afrontamiento de la "obsesión mental por beber", expresión que suelen utilizar los miembros de Alcohólicos Anónimos (AA) para hablar de las reacciones características del craving.Método: La muestra incluyó a 192 individuos que habían participado en AA durante 10 años en promedio (DE=7.5 años). Se aplicó un instrumento empírico para medir el afrontamiento (Kr=.86). Se utilizó un conglomerado de dos fases para establecer perfiles.Resultados: El análisis encontró cinco estilos de afrontamiento: 1. evadir situaciones inductoras al tiempo que se busca una solución (evasivo-activo); 2. evadir retrayéndose (evasivo-pasivo); 3. mostrar sentimientos de enojo y no hacer nada (emocional-pasivo); 4. recordar y comparar la vida pasada como alcohólicos activos (revalorativo) y 5. negar cualquier afrontamiento (negador).Discusión y conclusion: Los datos son preliminares, pero ofrecen la oportunidad de ampliar y especificar la forma en que ciertos alcohólicos de nuestro país solucionan un problema tan complejo como es el craving. El agrupamiento de respuestas supone esfuerzos o estilos de afrontar que pueden resultar o no efectivos para lograr una recuperación -por ejemplo, prevenir las recaídas en las personas que asisten a los grupos de AA-, por lo que plantea una importante perspectiva de investigación.
Background: Although craving is a controversial concept in alcoholism research, it is known that if an alcoholic can talk about the event using his own words, the probability of successful coping and prevention of relapse is bigger. However, little is known about such coping, and even less when it is articulated from the drinker's perspective.Objective: To identify the coping mechanism to this event that causes physical and emotional responses similar to those of craving, identified with the own language of Alcoholics Anonymous (AA).Method: The sample consisted of 192 individuals who participated in AA meetings for an average of ten years (SD=7.5). An empirical instrument was developed to measure coping (Kr=.86) and a two-phase conglomerate analysis was used to create categories to develop profiles.Results: The analysis showed five coping profiles suggesting that AA members cope with the event as follow: 1. evading but looking for a direct solution (elusive-active conglomerate), 2. evading but retracting (elusive-liabilities conglomerate), 3. getting upset and doing nothing (emotional-passive conglomerate), 4. remembering and comparing their past life (revalorative conglomerate), and 5. denying (denier conglomerate).Discussion and conclusion: Although the data are preliminary, they offer the opportunity to expand and specify how certain alcoholics solve a complex problem, such as craving. The information concurs with literature in the sense that this grouping of responses assumed those efforts that may be effective or not for the recovery process, for example, to prevent relapses in alcoholics who attend AA groups, so it raises an important research perspective.
ABSTRACT
Antecedentes Cuando algún miembro de la familia presenta un padecimiento mental como la esquizofrenia, y un familiar asume el rol de cuidador, el apoyo social es elemental para afrontar con éxito la funcionalidad familiar y los problemas que ocasionan. Objetivo Determinar los factores de apoyo social y estructural asociados con la percepción de funcionalidad familiar en las personas con trastorno mental y los familiares cuidadores. Material y método Estudio descriptivo, correlacional, transversal, no probabilístico, de participación secuencial, en dos grupos: 72 pacientes ambulatorios diagnosticados con un trastorno de salud mental y 66 familiares cuidadores. Se utilizaron tres instrumentos: el Cuestionario MOS, el Cuestionario APGAR-Familiar y el Cuestionario Duke-UNC-11. Resultados La Funcionalidad familiar (APGAR) es percibida por 58.3% de los pacientes; el 19.4%, disfuncionalidad severa y 22.2%, disfuncionalidad leve. En los familiares, 66.7% percibe funcionalidad familiar; 10.6%, disfuncionalidad severa y 22.7%, disfuncionalidad leve. En el reporte del apoyo estructural (MOS) se observó una diferencia estadísticamente significativa (t=-2.478, gl=136, p=0.014) en la percepción de apoyo instrumental entre los pacientes (̅x=11.68) y los familiares. Estos últimos percibieron menor apoyo instrumental (̅x=9.91). En cuanto al apoyo funcional social (Duke-UNC-11) no se indica diferencia (t=1.170, gl=136, p=.244) entre los familiares (̅x=40.36) y los pacientes (̅x=38.07). El modelo de regresión lineal mostró que los pacientes con mayor tiempo de evolución y con diagnóstico de esquizofrenia predicen disfuncionalidad; en cambio el apoyo social predice funcionalidad (p<.001). En los familiares, a mayor tiempo de evolución se pronostica disfuncionalidad en tanto que el apoyo social predijo funcionalidad (p<.001). Conclusión Es evidente que en la funcionalidad familiar el apoyo social juega un papel importante en pacientes que padecen problemas mentales y en los familiares cuidadores. En los pacientes se observó que a mayor AS perciben mayor funcionalidad familiar. En los familiares el apoyo estructural demostró una mejor percepción de funcionalidad familiar, lo que permite disminuir la probabilidad de recaídas y hospitalización.
Antecedents When a family member suffers from a mental disorder, such as schizophrenia, and a relative takes on the role of caregiver, social support is crucial to successfully addressing family functionality and the problems this may cause. Objective Determine the factors of social and structural support associated with the perception of family functionality in persons with a mental disorder and family caregivers. Material and method This is a descriptive, corelational, cross-sectional, non-probabilistic study, with sequential participation. Subjects were divided into two groups: 72 outpatients diagnosed with a mental health disorder, and 66 kinship caregivers. Three instruments were used: an MOS Questionnaire, an APGAR-Family Questionnaire and a Duke-UNC-11 Questionnaire. Results 58.2% of the patients perceived family functionality (APGAR); 19.4%, severe dysfunctionality, and 22.2%, slight dysfunctionality. Among relatives, 66.7% perceived family functionality; 10.6%, severe dys-functionality, and 22.7%, slight dysfunctionality. In the Structural Support Report (MOS), a statistically significant difference was observed (t=2.478, gl=136, p=0.014) in the perception of instrumental support among patients (̅x=11.68) and relatives; the latter perceiving the least instrumental support (̅x=9.91). In functional social support (Duke-UNC-11) no difference (t=1.170; gl= 136, p=.244) was indicated between relatives (̅x=40.36) and patients (̅x=38.07). The linear regression model showed that patients with the longest period of evolution and diagnosis of schizophrenia predict dysfunctionality, whereas social support predicts functionality (p<.001). Among relatives, longer periods of evolution indicated dysfunctionality, while social support predicted functionality (p<.001). Conclusion It is clear that social support plays an important role in family functionality in patients suffering from mental problems and kinship caregivers. In patients, it was observed that the greater the AS, the higher the degree of family functionality. Among relatives, structural support showed an increased perception of family functionality, which reduces the likelihood of relapses and hospitalization.
ABSTRACT
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Abstract: Introduction: Currently, there are a number of methodological alternatives to find out the dynamics, the extension and the levels of drug use in the general population. The trends on drug use in our country llave registered important variations in the last 25 years. Among the most outstanding of these trends are: the high and stable use of marijuana, the increase in cocaine use and a decrease in the use of inhalants. Recently an increase in the use of these stimulants has been registered. The different studies show that these trends present some variations, since different group populations with different characteristics have been studied. This is the case of the data obtained by the Drug Information Reporting System -IRSD-which detects users with specific characteristics (regular drug users and advanced cases of addiction). Based on the facts mentioned above, the intention of this article is to present the main trends on drug use in Mexico City within the period between 1986 and 2003, according to the drug Information reporting System -DIRS- and to analyze these trends compared to other studies with different types of population. Background: The Information Reporting System on Drugs IRSD is a mechanism used to obtain data coming from diverse agencies that are related to the problem of the use of drugs; such agencies belong to the health sector or to the agencies of law enforcement. The main advantages of this type of systems are a low cost of operation -since it works with the infrastructure of the institutions that mainly conform the system- its easy application and that it provides current and fast information on the phenomenon. The continuous operation of the IRSD allows the accumulation of data with a sequence which makes possible the analysis of the trends on drug use, the identification of new groups at high risk and new drugs in the market. It also allows to identify the design of the preventive actions derived from the continuous analysis of information coming from its data bases. Mexico City has its own Drug Information Reporting System -IRSD- since 1986 coordinated by the National Institute of Psychiatry Ramon de la Fuente. Its objective is to count on a periodic and homogenous source of information which can be used as a diagnosis tool to design suitable programs of prevention appropriate to the Mexican population from a health perspective. The IRSD carries out semester evaluations of the phenomenon and has done now a total of 34. Method: Sample description: IRSD information between 1986 and June 2003 was used. This data base is conformed by 16,377 studied cases. It is a considered as «case¼ any person who recognizes to have consumed at least once in life some drug with the deliberate purpose of being intoxicated. The cases are also excluded from accidental or occupational exhibition and when only alcohol and tobacco have been consumed. Instrument: The Information is obtained from an individual scale applied twice a year, in health and justice agencies. This schedule collects information on the following aspects: socio-demographic profiles of the users, the reason for entering the institution, problems associated with the drug use and patterns of consumption of 12 drugs. For this article, only the information corresponding to the pattern of consumption was used to identify the trends. The analysis includes the information compiled by the IRSD during the period of 1986 and the first semester of 2003. Procedure: The instrument is applied twice a year, in periods of 30 days, during the months of June and November to any one who uses drugs and has entered the health and justice agencies for such reason. Once the period of information gathering is over, the applied instruments are sent by all the participant institutions to the National Institute of Psychiatry for their processing and analysis. Finally, the results are reintegrated into a report which is distributed among the participant institutions and people interested in this problem. Results: The analysis of the trends on drug use observed by the IRSD during the period 1986-2003 shows the following: Marijuana and inhalants reach the level of higher consumption for all drugs until the second semester of 1997. In the following years there is a decrease for these substances, particularly for inhalants. The trend of cocaine use shows significant changes. The first important increase in the levels of use was observed between the years of 1993 and 1997. At the end of this period the use of cocaine was reported by every 40 of 100 users. The following year this proportion went up to 63, which represents an increase of more than 50 per cent. From this year and up to date the trend shows a stable behavior with similar levels of use. In regard to hallucinogens low levels of consumption have been observed, during the 15 years of evaluation by the IRSD. Approximately five of 100 cases report their use by semester. Sedatives and tranquilizers show the highest increase during the first semester of 1993, with 28 users for every 100 cases; since then a decrease in consumption has been observed. The consumption of stimulants has presented a very irregular trend through the evaluations. For heroin use a very low percentage of consumption is observed with one out of every 100 cases. There was a slight increase only in two evaluations during the first semester of 1992 and 1993. Conclusions: The most outstanding results regarding the tendencies of consumption of addictive substances is the increase of cocaine use at the beginning of the nineties and has always showed a tendency do increase. In the last evaluation certain stability in its consumption, is observed, at least in the last two years. It is important to emphasize that the increase in the consumption of cocaine may probably be associated to its availability in Mexico as well as that for its derivatives. Equally significant within this period of evaluation is the decrease of inhalant consumption, specially during 1999. Some studies show a possible substitution of these substances by cocaine and or its derivatives. The trends of drug use provided by the IRSD must be interpreted taking into account that the drug user population included in the evaluations belongs to a sector that does not represent the whole universe of users in the general population. However the trends of drug use reported by the IRSD are in agreement with those reported by the surveys in general and school population, where marijuana, cocaine and inhalants were reported as the drugs of greater use among the Mexican population. It is important to note that when the lack of financial and or human resources become real obstacles to carry out sophisticated, extensive periodic studies to evaluate drug use, a system of this type is a valuable alternative for the developing countries.