Three versions of the Short Alcohol Dependence Data Questionnaire (SADD) in Mexican population: a comparative analysis of psychometric properties and diagnostic accuracy / Tres versiones de la Breve Escala de Dependencia al Alcohol (SAAD) en población mexicana: un análisis comparativo de sus propiedades psicométricas y precisión diagnóstica

BACKGROUND: The Short Alcohol Dependence Data Questionnaire (SADD) has shown good reliability and validity in previous studies. In Mexico, although it is widely used in addiction treatment centers, little is known about its psychometric properties and diagnostic accuracy.OBJECTIVE: Hence, this study performed a Confirmatory Factorial Analysis (CFA) on three SADD versions (15, 14 and 12 items) and examined their operating characteristics.METHOD: The sample included 570 individuals from the 30 Addiction Residential Centers localized in the central zone of Mexico.RESULTS: The three versions showed an internal consistency of >.90, fair goodness-of-fit, and significant correlations with the Mini International Neuropsychiatric Interview (MINI) 5.0 Alcohol dependence (AD) diagnostic criteria. The analysis of the operating characteristics revealed that each version accounted for 84-85% of the area under the curve (AUC).DISCUSSION AND CONCLUSION: The three SADD versions possess reliability and validity properties for the assessment of the alcohol dependence syndrome (ADS) and adequate diagnostic accuracy for the improvement of patients with AD in residential settings.

ANTECEDENTES: La Breve Escala de Dependencia al Alcohol (BEDA) ha mostrado confiabilidad y validez en estudios previos. En México, a pesar de que se ha utilizado ampliamente en programas de tratamiento para las adicciones, se conoce muy poco sobre sus propiedades psicométricas y su eficiencia diagnóstica.OBJETIVO: Por lo tanto, el presente estudio realizó un Análisis Factorial Confirmatorio (AFC) en tres diferentes versiones de la BEDA (15, 14 y 12 reactivos) y examinó sus características operativas.MÉTODO: La muestra incluyó 570 personas que recibían atención en centros de tratamiento residencial para las adicciones de la zona central de México.RESULTADOS: Las tres versiones mostraron una consistencia interna >.90, adecuada bondad de ajuste y correlaciones significativas con la Mini Entrevista Neuropsiquiátrica Internacional, v. 5.0, de criterio diagnóstico de Dependencia al Alcohol (DA). El análisis de las características operativas reveló que cada versión representó 84-85% del área bajo la curva.DISCUSIÓN Y CONCLUSIÓN: Las tres versiones de la BEDA poseen propiedades de confiabilidad y validez para la evaluación del síndrome de dependencia al alcohol (SDA) y adecuada eficiencia diagnóstica para el mejoramiento de los pacientes con dependencia al alcohol en escenarios residenciales.

Guía de práctica clínica para la detección temprana, diagnóstico y tratamiento de la fase aguda de intoxicación de pacientes con abuso o dependencia del alcohol Parte I: Tamización, detección temprana y factores de riesgo en pacientes con abuso o dependencia del alcohol / Clinical practice guide for early detection, diagnosis and treatment of the acute intoxication phase in patients with alcohol abuse or dependencepart i: screening, early detection and risk factors in patients with alcohol abuse or dependence

Introducción: El alcohol es la segunda sustancia psicotrópica más usada en el mundo y el tercer factor de riesgo para muerte prematura y discapacidad. Su uso nocivo es un problema de salud pública mundial, dado su impacto personal, laboral, familiar, económico y social. Hasta el 70 % de las personas en riesgo de tener problemas con el alcohol no se detectan en la práctica médica, lo que hace pensar que se requieren medidas de tamizaje específicas que permitan la detección temprana y lleven a un tratamiento oportuno. Este artículo presenta la evidencia encontrada en tamización de abuso y dependencia de alcohol y en tamización e identificación de factores de riesgo; también presenta la evidencia relacionada con síndrome de abstinencia, delirium tremens y encefalopatía de Wernicke, con el fin promover una de detección temprana y un tratamiento oportuno. Método: Revisiones sistemáticas de la evidencia disponible y evaluación de las guías pertinentes identificadas en la literatura, para decidir, en cada pregunta, si se adopta o se adapta a una recomendación ya existente, o si se desarrollan recomendaciones de novo. Para las recomendaciones de novo y aquellas adaptadas, se realizó una síntesis de la evidencia, se elaboraron tablas de evidencia y se formularon las recomendaciones basadas en evidencia. Resultados: Se encuentra evidencia y se realizan recomendaciones para tamización pertinente y búsqueda de factores de riesgo, con el fin de realizar un diagnóstico y un manejo oportuno de abuso y dependencia a alcohol y sus complicaciones: síndrome de abstinencia, delirium tremens y encefalopatía de Wernicke...

Introduction: Worldwide, alcohol is the second most-used psychotropic substance and the third risk factor for early death and disability. Its noxious use is a world public health problem given its personal, labor, family, economic and social impact. 70 % of people under risk of having alcohol problems go undetected in medical practice, a fact that underlines the need for specific screening measures allowing early detection leading to timely treatment. This article presents evidence gathered by alcohol abuse and dependence screening as well as by risk factor identification and screening. It also presents evidence concerning withdrawal symptoms, delirium tremens and Wernicke’s encephalopathy in order to promote early detection and timely treatment. Methodology: Systematic revision of the evidence available together with an evaluation of pertinent guidelines found in literature so as to decide whether to adopt or adapt the existing recommendation for each question or to develop de novo recommendations. For de novo recommendations as well as those adapted, it was carried out an evidence synthesis, together with evidence tables and formulation of recommendations based on the evidence. Results: Evidence was found and recommendations were made for the pertinent screening and search of risk factors, in order to perform a diagnosis and carry out a timely management of alcohol abuse, dependence and ensuing complications: withdrawal syndrome, delirium tremens and Wernicke’s encephalopathy...

Estudio preliminar de la expresión del mensaje genético del transportador de serotonina en células mononucleares de sangre periférica en pacientes con dependencia al alcohol con y sin depresión mayor comórbida / Preliminary study of the genetic message expression of serotonin transporter in peripheral blood mononuclear cells in patients with alcohol dependence with and without comorbid major depression

The 2008 National Addiction Survey demonstrated the existence of 39 million alcohol drinkers, of whom 4.2 million are excessive drinkers and 4.8 million are alcohol dependents. No reports of the comorbidity of psychiatric disorders in alcohol consumers in our country exist. Nevertheless, 40% to 50% of alcohol-dependent patients from other countries have some sort of psychiatric disorder, such as major depression. Serotonergic function is a key mediator of mood states, impulsiveness, and addictive behavior, including alcohol consumption. Several studies have noted alterations in the serotonergic system in alcoholics (as demonstrated by an increase in the shooting frequency of raphe nuclei serotonergic neurons, an increase in serotonin levels in the accumbens nuclei, and a loss in serotonergic neurons in the raphe nuclei) and depressed patients (decreases in the density of serotonin reuptake transporter [5-HTT] and serotonin levels [5-HT]). Clinical studies have documented that excessive alcohol intake reduces 5-HT levels and that this condition potentiates psychiatric disorders, such as anxiety, major depression, and alcohol dependence. These data demonstrate an association between alcoholism, psychiatric disorders, and alcohol dependence. By molecular biology techniques, genetic risk factors have been identified and candidate genes, such as 5-HTT, have been selected. This gene is associated with a greater susceptibility to onset of alcohol-dependence and major depression. The 5-HTT gene lies in the SLC6A4 locus of 1 7q1 1.1-q12 and encodes a 600-amino-acid integral membrane protein. This transporter regulates serotonergic neurotransmission through removal of 5-HT from the synaptic space. Pharmacological research has shown that selective reuptake inhibitors (5-HTT blockers) reduce alcohol intake in alcohol-dependent and major depression patients. Serotonergic system receptors, such as 5-HTT, 5-HT1, and 5-HT2, are expressed in nervous system and immune system cells; thus it is likely that both systems have functional similarities. Due to this property, peripheral blood mononuclear cells (PBMCs) can be used to research neurodegenerative, psychiatric, and alcohol dependence disorders. The aim of this study was to assess 5-HTT expression levels in the PBMCs from alcohol-dependent patients and patients with comorbid alcohol-dependence and major depression disorder. Materials and methods The Outpatient Consultative Service from the Centro de Ayuda a Alcohólicos y Familiares (CAAF) and the Centro de Alcohólicos y Drogadictos <

La Encuesta Nacional de Adicciones 2008 reportó que en México existen 39 millones de personas que consumen alcohol y 4.8 millones presentan dependencia. A nivel mundial varios estudios indican que los pacientes con dependencia al alcohol (40 a 50%) presentan comorbilidad con algún tipo de padecimiento psiquiátrico. La función serotoninérgica es un mediador clave en los estados de ánimo, la impulsividad y las conductas adictivas, entre ellas el consumo de alcohol. Se ha reportado que el consumo excesivo de alcohol etílico disminuye los niveles de serotonina, aumenta la frecuencia de disparo de las neuronas serotoninérgicas en el núcleo del rafé y aumenta los niveles de serotonina en el núcleo accumbens. Las técnicas de biología molecular han permitido identificar factores de riesgo genético y se han seleccionado genes candidatos del sistema serotoninérgico, siendo uno de ellos el gen para el transportador de serotonina (5-HTT), el cual se ha demostrado que se encuentra asociado tanto a una mayor susceptibilidad para el establecimiento de la dependencia al alcohol como a la depresión mayor. Los receptores del sistema serotoninérgico como el 5-HTT, el 5-HT1 y el 5-HT2 se expresan tanto en las células del Sistema Nervioso como en las células del sistema inmunológico, lo que sugiere una similitud funcional de ambos sistemas. Es por ello que las células mononucleares de sangre periférica (PBMC) han sido utilizadas como un modelo de estudio en los trastornos de dependencia al alcohol y en los psiquiátricos. El objetivo de este estudio fue evaluar los niveles de expresión del gen 5-HTT en células mononucleares de sangre periférica de pacientes con dependencia al alcohol con y sin depresión mayor comórbida. En el Servicio de Consulta Externa del Centro de Ayuda a Alcohólicos y Familiares (CAAF) y en el Centro de Alcohólicos y Drogadictos <

The complex interplay of genetics, epigenetics, and environment in the predisposition to alcohol dependence / La compleja interacción genética, epigenética y ambiental en la predisposición a la dependencia al alcohol

Alcohol dependence is a major global problem, associated with lower quality of physical and mental health, higher mortality and an enormous familial and social cost. Prevention strategies and treatment of this condition are therefore crucial. Success of psychosocial programs and pharmacological treatments has been frequently reported, but a better understanding of the etiology of this chronic disease is needed. For this purpose, the identification of associated factors in different populations is of great significance. It has been clearly demonstrated by twin and adoption studies and supported by animal models that both genetic and environmental components play a substancial role in alcohol dependence. Heritabil ity estimates range from 40 to 60%, depending on the specific analyzed sample. Several coexisting genetic variants in each affected individual, rather than a single gene transmitted in a Mendelian manner, may be the rule in alcohol dependence. Similarly, many environmental factors can increase susceptibility, and because of their diversity, they do not have to be the same in every affected person. Environmental contribution may be linked to epigenetics, which refers to chemical processes that can modify gene activity without changing the sequence of DNA. In humans, the most stable epigenetic process is the union of a methyl group (one carbon atom surrounded by three hydrogen atoms) to cytosines in DNA. Other epigenetic mechanisms are modifications to nuclear proteins called histones, which alter the way DNA is packed. Moreover, non-protein coding RNAs such as microRNAs have been associated with the development of alcohol dependence. MicroRNAs could work as epigenetic intermediaries that allow ethanol to affect complex and divergent developmental mechanisms, which is added to the effect of DNA methylation, histone acetylation, and other epigenetic modifications. Most reasearch points to an association between alcohol dependence and genes related with alcohol metabolism, with neurotransmission of dopamine, GABA, serotonin, glutamate, endogenous opioids, and cannabinoids, signal transduction within the mesolimbic dopamine reward system, and stress response system, among others. During pregnancy, there are several non-genetic factors that may have an important impact on vulnerability to alcohol dependence. Given that the Central Nervous System is developing throughout the entire pregnancy and that alcohol consumed by the mother can reach the fetus through the placental barrier, the brain of a baby is always vulnerable to harm caused by alcohol exposure. Children born to alcoholic mothers may inherit genetic susceptibility variants but at the same time they may be exposed to early effects of ethanol. Heavy alcohol exposure during pregnancy has been associated with mental retardation, epilepsy, attention deficit/ hyperactivity disorder, learning disabilities, and later on with substance abuse, anxiety, personality, affective and psychotic disorders, as well as with engagement in antisocial behaviors and school or work problems. Furthermore, it has been shown that animals exposed to prenatal stress exhibit persisting modifications related to dopamine and glutamate transmission in limbic structures associated with dependence to alcohol and other substances. These alterations may later contribute to increase motivation to drink, to use large amounts of drugs of abuse or to relapse after periods of drug withdrawal. It was shown that after exposure to prenatal stress, male mice consumed more ethanol during alcohol reinforcement in adulthood. In addition, it has been well documented that affective disorders are associated with alcohol dependence. A recent meta-analysis including 54 studies that together involved more than 40749 individuals, confirmed that the 5-HTTLPR polymorphism at the promoter of the serotonin transporter gene moderates the association between stress and depression, where the short allele is related with an increased risk for depression under stress (p = 0.00002). A strong association was detected when the stressful factor was childhood maltreatment (p = 0.00007). Childhood maltreatment, including neglect as well as physical and sexual abuse, is associated with developmental difficulties, low social competence and self-esteem, and it is an important risk factor for binge drinking in adolescence and alcohol dependence in adulthood. Childhood maltreatment may interact with factors such as variants of the monoamine oxidase-A and catechol-o-methyltransferase gene. Adolescence is a critical period for initiation of alcohol intake, experimentation, and establishment of regular drinking patterns. Substance use at this age is considered a risk factor for the development of later alcohol and other drug-related problems, as well as for externalizing disorders such as antisocial personality disorder. Alcohol use initiation is affected by environmental factors such as ethanol availability, parental attitudes, and peer pressure. It has been reported that heavy drinking during adolescence can have a negative impact on brain development. Moreover, dopaminergic and GABAergic systems undergo important changes during adolescence, and they can be affected by alcohol intake. Dopamine is implicated in the rewarding effects of ethanol, and GABA in its sedating effects and development of tolerance. The way an adult copes with environmental challenges is notably influenced by early life experiences and by the familial environment he or she had as an infant, which affects neurodevelopmental behavior. While environmental factors tend to have a crucial role in drinking habits in adolescence, adultood may be characterized by a weaker effect of environment and a higher effect of genetic components. It is probable that a complex set of gene-environment interactions determine the risk to alcohol dependence. Environmental factors that may affect this vulnerability appear at different stages from pregnancy to adulthood. These interactions are mediated by DNA methylation, histone modifications, protein complexes and non-protein-coding RNAs such as microRNAs.

La dependencia al alcohol es un problema mundial grave, que se asocia con mucho sufrimiento, problemas de salud mental y física, una elevada tasa de mortalidad y un costo social y familiar muy alto. Es por esto que las estrategias de prevención y el tratamiento de la enfermedad resultan cruciales. Se ha reportado que programas psicosociales y tratamientos farmacológicos son hasta cierto punto exitosos actualmente. Sin embargo, se requiere conocer más profundamente la etiología de la enfermedad. Por esta razón, es muy importante identificar los factores que se asocien con el incremento a la susceptibilidad en distintas poblaciones. Se ha demostrado claramente a través de estudios en gemelos y de adopción, así como por investigaciones en animales, que tanto factores genéticos como ambientales son relevantes en la dependencia al alcohol. Se ha estimado que la heredabilidad de esta enfermedad se encuentra entre 40 y 60%, dependiendo de la muestra estudiada, lo cual indica que el ambiente y la genética tienen un peso similar en la susceptibilidad. Muchas variantes genéticas que aumentan la susceptibilidad, en lugar de una sola, podrían coexistir en las personas más vulnerables a la dependencia. De manera similar, muchos factores ambientales parecen estar relacionados, los cuales, debido a su diversidad, intensidad y etapas de la vida en la que se presentan, no son exactamente iguales en diferentes personas con dependencia al etanol. La contribución ambiental podría relacionarse con cambios en la expresión de genes, lo cual involucra a la epigenética. Ésta se encarga del estudio de los procesos químicos, afectados por el ambiente, que pueden modificar la actividad de los genes sin cambiar la secuencia del ADN. En humanos, el proceso epigenético más estable es la unión de un grupo metilo (un átomo de carbón unido a tres átomos de hidrógeno) a las citosinas en el ADN. Otros mecanismos epigenéticos son modificaciones a proteínas nucleares llamadas histonas, proceso que modifica la manera en que se encuentra empaquetado el ADN. Por otra parte, ARNs que no codifican para proteína, como los microARNs, se han asociado al desarrollo de la dependencia al alcohol. Ciertos microARNs podrían funcionar como intermediarios epigenéticos, lo cual propiciaría que el etanol afectara procesos complejos y divergentes del neurodesarrollo, sumándose al efecto de la mutilación en el ADN y de la acetilación de histonas, entre otros procesos epigenéticos. La mayoría de las investigaciones señalan que los genes importantes en la vulnerabilidad a la dependencia al alcohol incluyen algunos que codifican para proteínas del metabolismo del alcohol; de neurotransmisión de dopamina, GABA, serotonina, glutamato, opiodes endógenos y canabinoides; de transducción de señal en el sistema de recompensa mosolímbico; y de respuesta al estrés, entre otros. Durante el embarazo, diversos factores no genéticos tienen un impacto importante en la vulnerabilidad a la dependencia al alcohol. Por ejemplo, debido a que el Sistema Nervioso se desarrolla a lo largo de toda la gestación y que el alcohol consumido por la madre puede llegar al feto a través de la barrera placentaria, el cerebro de un feto siempre es vulnerable al daño provocado por la exposición al etanol. Se ha demostrado que los hijos de mujeres alcohólicas no sólo pueden heredar variantes genéticas de riesgo sino que también pueden estar expuestos tempranamente a los efectos del alcohol consumido por sus madres. El consumo excesivo en el embarazo se ha asociado con retraso mental, epilepsia, déficit de atención/ hiperactividad, problemas de aprendizaje, y más adelante con abuso de sutancias, ansiedad y trastornos afectivos, de personalidad y psicóticos, así como con conductas antisociales y problemas en la escuela o el trabajo. Además, se ha demostrado que animales expuestos a estrés prenatal mostraban modificaciones persistentes relacionadas con la transmisión dopaminérgica y GABAérgica en estructuras límbicas que se relacionan con dependencia al alcohol y a otras drogas. Más adelante, estas alteraciones podrían contribuir a la motivación para beber, a utilizar mayores cantidades de alcohol u otras susancias de abuso o a la recaída después de periodos de abstinencia. Se encontró que ratones macho expuestos a estrés prenatal consumían más alcohol en la edad adulta. La depresión y el estrés se han asociado fuertemente con la dependencia al alcohol. Con un metaanálisis reciente en el que se incluyeron datos de 54 estudios en los que en conjunto se habían reclutado 40 749 personas, se confirmó que el polimorfismo 5-HTTLPR del promotor del gen que codifica para el transportador de serotonina modera la asociación entre el estrés y la depresión y el alelo corto (<

La Terapia Centrada en Soluciones: Una opción de tratamiento para la dependencia al alcohol / Solution-focused therapy: An alcohol dependence treatment option

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 71 0 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 different 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 ethanol-dependent 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 Institute 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 alcohol-related 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 1 2-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.

En México, el consumo excesivo de alcohol representa uno de los principales retos de salud pública a escala nacional. Aunque existen diversas estrategias de intervención que pretenden incidir en este problema también hay un gran vacío con respecto a si dichas intervenciones son un factor causal en el cambio producido por el consumidor y la manera en que dicho cambio se produce después del tratamiento. Una vía para conocerlo es evaluar sus resultados. La Terapia Centrada en Soluciones (TCS) constituye una alternativa a las que tradicionalmente se utilizan para tratar el consumo de alcohol. Sus resultados se han documentado en diferentes países de América y de la Comunidad Europea, pero no en población hispana. Objetivo Evaluar los resultados de la Terapia Centrada en Soluciones en dependientes al etanol y determinar las diferencias entre quienes buscaban modificar los problemas asociados al consumo de alcohol y los que pretendían cambiar su manera de beber. Método Se trabajó con un diseño longitudinal de tipo O1-X-O2, comparativo, con un seguimiento a doce meses. La muestra se integró con 60 consumidores de alcohol de 18 a 50 años de edad que acudieron al Centro de Ayuda al Alcohólico y sus Familiares (CAAF) del Instituto Nacional de Psiquiatría Ramón de la Fuente. Todos fueron seleccionados de manera intencional, consumieron alcohol en el último año, cubrieron los criterios de dependencia al alcohol según el DSM-IV y brindaron por escrito su consentimiento informado. La muestra se dividió en 30 dependientes al etanol que acudieron al CAAF en busca de modificar su nivel de consumo y 30 dependientes que pretendían modificar los problemas asociados a su consumo. En la presente investigación, los resultados de la intervención se definieron a partir del tiempo transcurrido desde que un dependiente asistía a la última sesión de terapia hasta que presentaba una recaída y continuaba con los problemas asociados al consumo de alcohol. La historia de consumo de alcohol de los sujetos se caracterizó por medio del patrón de consumo, nivel de dependencia, número de criterios del DSM-IV, antecedentes de tratamiento, problemas de consumo de alcohol en la familia de origen en dos generaciones previas y problemas asociados al consumo de alcohol. El número de sesiones, servicios y tratamientos adicionales se consideró como mediador de los resultados de la intervención. Resultados Del total de la muestra, 78% era casado; 38% tenía instrucción básica; la edad promedio fue de 35.5 años; la mayoría pertenecía a un nivel socioeconómico bajo; 39% era consumidor de alto nivel; 43% se ubicó en un nivel de dependencia sustancial y 70% contaba con antecedentes de tratamiento. La necesidad de tratamiento más alta se registró en los problemas familiares asociados al consumo de alcohol con 48%. Del total de la muestra, 63% asistió de una a dos sesiones y los restantes asistieron a más de dos, con un seguimiento de 83% de la muestra. En el análisis de sobrevida, los primeros cuatro meses después de tratamiento se identificaron como los meses de mayor riesgo para recaer. Se observó que la TCS tuvo mejores resultados en dependientes que buscaban modificar los problemas asociados al consumo de alcohol. Éstos se ubicaron en los niveles socioeconómicos más bajos y presentaron un nivel de deterioro importante por el consumo de alcohol.

Síndrome de dependencia al alcohol: comparación entre hombres y mujeres

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Summary The main objective of this paper is to describe the way in which the Alcohol Dependence Syndrome is manifested, according to the criteria and indicators proposed by the DSM-IV, in a female sample that sought help at a treatment center due to alcohol consumption-related problems. A comparison was made with the results obtained in a previous 211-male-sample at the same treatment center. Method: This project is a case study in which a sample of 100 females was interviewed at the Clínica para Atención de Problemas Relacionados con el Alcohol (CAPRA) (Clinic for the Attention of Alcohol Related Problems) at the Hospital General de México (the main general hospital for patients who do not have social security benefits and come from different regions of the country including rural areas). The criteria for inclusion were: being aged 18 or over, female, having sought help for the first time (at these centers) due to alcohol problems and being physically and mentally able to answer the questionnaire correctly. Females that had previously been treated were included. However, one of the requisites was that they had to have drunk alcohol during the year before the interview to warrant recent and current consumption, regardless of being exposed to prior treatments, since the questionnaire includes the previous 12 months as a parameter. The instrument used to conduct this study was the Composite International Diagnostic Interview, Substance Abuse Module (CIDI-SAM). This instrument has been widely used with excellent results on various population samples in the U.S., as well as on the male population receiving treatment in Mexico. The instrument included the following sections: sociodemographic characteristics, amount and frequency of consumption; physical, psychological and social problems; symptoms of alcohol dependence, and pathways to health services. A few new sections were incorporated with specific characteristics for women, such as the effects of alcohol on women, alcohol consumption during pregnancy and nursing, partner's alcohol consumption and violent behavior in the couple and their associated risks. Results: The average age of the women interviewed was 47 years old, ranging from 22 to 91. Thirty-two percent were either married or living with a partner, 20% were divorced, 26% were widows and 22% were single. Seventy-four percent of them had children and they had 4.5 children in average. The average educational level was 4.7 years. Fifty-two percent of the respondents reported drinking alcohol every day and 19% almost every day (five or six days a week), with an average of 4.2 drinks per occasion (52% of the women reported having three to four drinks per occasion). The preferred reported beverage was «pulque¼ (28%), followed by beer (25%) and distilled beverages (21%). Other traditional drinks and «96° proof" alcohol also showed a significant percentage (20%). As for the Alcohol Dependence Syndrome, 50% of the women met the dependency criteria proposed by the DSM-IV, compared with 82% of the 211 men interviewed in the same center with a statistically significant difference (X2= 34.22; p = 0.000). Women with alcohol dependence syndrome presented an average of five symptoms. A more detailed analysis was carried out based on the severity of the dependence syndrome, measured by the number of reported symptoms (1-2, 3-4, 5-7). The most frequently reported symptom across all levels of severity was the presence of physical and/or psychological problems. In the group of non-dependent women (those who reported less than 3 symptoms), an important difference between men and women was observed. The most frequent symptoms reported by men, after the presence of physical and psychological problems, were withdrawal symptoms (34.2%) and loss of control (15.8%). In the case of the women, unsuccessful efforts to reduce alcohol intake (16%) and withdrawal symptoms (16%) appeared in the second place. The group of women with low dependence (three to four criteria reported) presented similar characteristics to those observed in the group of non-dependent women. In men with low levels of dependence, the most frequent symptom presented were: giving up or reducing activities (social, occupational or recreational) in order to drink and withdrawal symptoms. In the groups with the highest severity level (5-7 symptoms), differences between men and women were less evident. Conclusions: The most important differences in dependence symptoms between men and women are probably related to gender-specific cultural expectations and social norms regarding alcohol use. This situation is reflected in the type of symptoms presented more frequently in women and men. Women reported more symptoms related to unsuccessful efforts to reduce alcohol intake; whereas men presented symptoms related to the time spent drinking or recovering from the effects of alcohol and giving up or reducing activities (social, occupational or recreational) in order to drink. The information presented evidences the need to conduct more specific studies that take in consideration biological and psychological, as well as social conditions underlying female alcohol use in order to provide appropriate and effective treatment to meet their gender needs and expectations.