ABSTRACT
The 2008 National Addictions Survey reports that dependence on alcohol consumption is higher in Mexico's rural and indigenous communities (10.6%) than in urban areas (9.5%), and that its consequences for the social and health environment are correspondingly greater. This is compounded by the marginalization and poverty of these regions and the scant resources available for dealing with health, particularly alcoholism. The study was carried out in the indigenous zone of El Mezquital in the state of Hidalgo. In this state, the National Addictions Survey (2008) reports that daily consumption is 1.4% and habitual consumption is 6.6% while the index of abuse and dependence is 6.8%, all of which are above the national mean of 0.8%, 5.3% and 5.5%, respectively. One of the consequences is having a mortality rate for hepatic cirrhosis of 40.2 for every 100 000 inhabitants, making this the area with the highest mortality rate from this cause in Mexico, which has an average rate of 26.3 cirrhosis-related deaths for every 100 000 inhabitants. The family is the most immediate group affected by the alcoholism of one of its members, which has severe implications for the psychological and physical health of the other members. Since little is known about the way families in Mexico's indigenous or rural zones deal with this problem, a research project was carried out to find out more about the situation. To this end, an ethnographic study was undertaken to identify the role of alcohol in everyday life and determine families' needs for support and the cultural challenges that must be overcome to undertake an intervention. The results of the ethnographic exploration showed that alcohol consumption is a deeply-ingrained custom in the community that provides group identity and solidarity, particularly for men. Its consumption is closely linked to work, particularly agricultural activities and construction. One important aspect was women's complaints that they did not know what to do about the consequences of excess alcohol consumption on the family's health and economy. In addition to this, a powerful patriarchal influence was identified that prevented women from seeking psychological assistance for the problem of alcohol abuse, which is essentially male. Poverty is one of the characteristics of the desert area of El Mezquital where this study was carried out. It constitutes yet another obstacle to seeking and requesting help, partly because of the adverse geographical conditions that limit transport. In addition to the scant transport services, there are communities in which the nearest health center is just over an hour's walk away. Moreover, families' scant resources are used to cover basic needs, ignoring both physical and mental health aspects. On the basis of an ethnographic study, an intervention program was linguistically and culturally adapted to provide support for families. This resulted in a specialized manual suitable for the region, designed to train health professionals to help relatives cope with a family member's excess consumption. This intervention was carried out between 2008 and 2009 and the results are presented in this study. Intervention model This brief intervention, based on the stress-coping-health model, is designed to help relatives find means of coping with their relatives' consumption in a more beneficial way for their health and to establish or strengthen support networks on the basis of their needs. Three coping styles have been documented: committed, tolerant and independent. The intervention consists of five steps that can be carried out in approximately five sessions. These involve: 1. Exploring family concerns; 2. Providing essential information on the effects of alcohol consumption; 3. Analyzing the coping styles used; 4. Exploring social support networks; and 5. Referring family members to specialized care, where necessary. Through these five stops, the intervention seeks to: a) Reduce the presence of physical and psychological symptomatology; b) Improve coping styles in a way that will benefit the relative's mental health and c) Reduce the presence of depressive symptomatology. Method Objective: The purpose of this study was to evaluate the effects of the brief intervention on relatives of a person who consumes excess amounts of alcohol and to compare these results with relatives who, despite having the same problem, refused to participate in the intervention program. Procedure: the intervention was carried out by two psychologists (facilitators). Health center personnel referred relatives to the facilitators (group that experienced the intervention). The intervention ended when the women felt confident enough to be able to use the new coping styles, which took between 4 and 6 sessions (which lasted from 6 to 8 weeks). The <
El consumo de alcohol en la región indígena del Estado de Hidalgo representa un problema de salud importante. Según la ENA 2008, el consumo diario es de 1.4%, el consuetudinario de 6.6% y el índice de abuso y dependencia de 6.8%, todos por encima de la media nacional de 0.8, 5.3 y 5.5%, respectivamente. Hidalgo presentó en 2007 una tasa de mortalidad por cirrosis hepática de 40.2 por cada 100 000 habitantes, primer lugar del país, que en promedio tiene una tasa de 26.3 habitantes por cada 100 000. La familia es el grupo más inmediato que se ve afectado por el consumo de alcohol, con implicaciones graves para la salud psicológica y física de sus miembros. Para conocer cómo enfrentan esta situación las familias en zonas indígenas del Estado de Hidalgo, se llevó a cabo un estudio etnográfico donde se encontró que el consumo de alcohol es una costumbre arraigada en la comunidad, que proporciona identidad y solidaridad de grupo. Un resultado relevante del estudio fue la queja de las mujeres de no saber qué hacer frente a las consecuencias que tiene el consumo excesivo de alcohol en la familia, así como la fuerte influencia patriarcal que limita a las mujeres para solicitar apoyo psicológico. La pobreza, las difíciles condiciones geográficas, transportes insuficientes y la prioridad de resolver necesidades básicas limitan la búsqueda de apoyo profesional. Como resultado de la exploración etnográfica, se identificó la necesidad de atención a las familias para encontrar mejores formas de enfrentar la problemática; por ello se adaptó un programa para ofrecer acciones de apoyo a familias indígenas. La intervención se llevó a cabo entre 2008 y 2009, los resultados se presentan en este trabajo. Modelo de atención: La intervención breve tiene como meta ayudar a los familiares a encontrar formas de enfrentar las situaciones de consumo de manera más benéfica para su salud y establecer o fortalecer redes de apoyo. Consta de cinco pasos: 1. Escuchar la problemática del familiar, 2. Brindar información relevante, 3. Analizar los estilos de enfrentamiento utilizados, 4. Búsqueda de fuentes de apoyo y 5. Canalización en caso de requerir atención especializada. Éstos se llevan a cabo en aproximadamente cinco sesiones. Material y método Objetivo: Evaluar los efectos de la intervención breve sobre la presencia de sintomatología física y psicológica, los estilos de enfrentamiento utilizados y la presencia de sintomatología depresiva, en personas que conviven con un familiar con consumo excesivo de alcohol. Muestra: 60 mujeres entre 18 y 65 años con problemas por el consumo de alcohol de un familiar (esposo o padre). Se integraron dos grupos, uno con intervención y otro sin ella. Para formar el primero, el personal de los centros de salud canalizó a los familiares con las orientadoras (dos psicólogas) para recibir atención, que concluía una vez que las mujeres manifestaban confianza para utilizar nuevos estilos de enfrentamiento, lo que ocurrió entre las sesiones cuatro y seis. El <