Detección del consumo de alcohol en el primer nivel de atención en México durante la pandemia de COVID-19 / Detection of alcohol consumption at the first level of care in Mexico during the COVID-19 pandemic / Detecção do consumo de álcool no nível da atenção primária no México durante a pandemia de COVID-19

RESUMEN Objetivo. Medir el efecto de la pandemia de COVID-19 en la implementación de un programa de detección oportuna, intervención breve y referencia para tratamiento por consumo de alcohol en centros de salud del primer nivel de atención de la Ciudad de México. Métodos. Se recopilaron los datos en 18 centros de salud de la Ciudad de México entre 2019 y 2021, como parte de un estudio más amplio. Participaron 287 profesionales de la salud, quienes midieron el consumo de alcohol de sus pacientes con la prueba AUDIT-C. Se analizaron aspectos demográficos y patrones de consumo de los pacientes, así como las acciones de atención (detección, intervención breve, entrega de folletos, monitoreo y referencia) en tres momentos: antes de la pandemia de COVID-19, durante el confinamiento y luego del confinamiento. Se realizaron pruebas paramétricas y no paramétricas para identificar la relación y las diferencias entre las variables en los tres períodos. Resultados. Se identificaron 9 090 personas con consumo de alcohol; el porcentaje de detección del consumo tuvo fluctuaciones en los tres períodos estudiados (26%, 53% y 37%, respectivamente). El consumo de riesgo medio y alto fue más frecuente entre hombres jóvenes y con mayor escolaridad durante y después del confinamiento. En el período posconfinamiento aumentaron las acciones de monitoreo y referencia. Conclusiones. La medición del impacto de la pandemia en la implementación de un programa de detección oportuna, asesoramiento breve y referencia para el tratamiento del consumo de alcohol en centros de salud ayuda a elaborar políticas en salud por edad, género, escolaridad y tipo de consumo para el primer nivel de atención.

ABSTRACT Objective. To measure the impact of the COVID-19 pandemic on the implementation of a program for timely detection, brief intervention, and referral for treatment of alcohol consumption in health centers at the first level of care in Mexico City. Methods. The data were collected at 18 health centers in Mexico City between 2019 and 2021, as part of a larger study. A total of 287 participating health professionals measured their patients' alcohol consumption using the AUDIT-C test. The patients' demographic aspects and consumption patterns were analyzed, as well as care actions (detection, brief intervention, provision of leaflets, monitoring, and referral) at three points in time: before the COVID-19 pandemic, during confinement, and after confinement. Parametric and nonparametric tests were performed to identify the relationship and differences between the variables at the three points. Results. A total of 9090 people who consumed alcohol were identified; detection of consumption fluctuated in the three periods studied (26%, 53%, and 37%, respectively). Medium- and high-risk consumption was more frequent among young men with higher schooling during and after confinement. In the post-confinement period, monitoring and referral actions increased. Conclusions. Measuring the impact of the pandemic on the implementation of a program for timely detection of alcohol consumption, brief intervention, and referral for treatment in health centers helps to develop health policies by age, gender, schooling, and type of consumption at the first level of care.

RESUMO Objetivo. Medir o efeito da pandemia de COVID-19 na implementação de um programa de detecção oportuna, intervenção breve e encaminhamento para tratamento pelo consumo de álcool em centros de saúde no nível da atenção primária na Cidade do México. Métodos. Foram coletados dados em 18 centros de saúde na Cidade do México entre 2019 e 2021, como parte de um estudo mais amplo. Participaram 287 profissionais de saúde, que mediram o consumo de álcool de seus pacientes com o teste AUDIT-C. Foram analisados aspectos demográficos e o padrão de consumo dos pacientes, bem como as medidas em termos de atendimento (triagem, intervenção breve, entrega de folhetos, monitoramento e encaminhamento) em três momentos: antes da pandemia de COVID-19, durante o confinamento e após o confinamento. Foram feitos testes paramétricos e não paramétricos para identificar a relação e as diferenças entre as variáveis nos três períodos. Resultados. Foram identificadas 9.090 pessoas com consumo de álcool, sendo que a porcentagem de consumo detectada flutuou nos três períodos estudados (26%, 53% e 37%, respectivamente). O consumo de médio e alto risco foi mais prevalente entre homens jovens e com nível maior de escolaridade durante e após o confinamento. No período posterior ao confinamento, as medidas de monitoramento e encaminhamento aumentaram. Conclusões. Medir o impacto da pandemia na implementação de um programa de detecção oportuna, intervenção breve e encaminhamento para tratamento do consumo de álcool em centros de saúde ajuda na formulação de políticas de saúde por idade, gênero, escolaridade e tipo de consumo para o primeiro nível de atenção.

Orientação a práticas parentais: descrição de um programa de intervenção individual breve / Parenting practices orientation: description of a brief individual intervention program / Orientación a prácticas parentales: descripción de un breve programa de intervención individual

A orientação a práticas parentais visa modificar o contexto no qual as crianças estão inseridas como forma de potencializar mudanças em seu comportamento. Esse artigo descreve uma intervenção breve de sete encontros em modalidade individual. O programa teve como finalidades principais auxiliar os cuidadores a identificar e estimular comportamentos adequados em seus filhos; ensinar novos comportamentos; incentivar a autonomia das crianças; encontrar abordagens não-agressivas para lidar com maus comportamentos; e auxiliar na organização da rotina. Como metodologia, realizou-se a descrição de três casos, exemplificando as estratégias adotadas em cada um. A análise dos casos permitiu o delineamento de características comuns entre as práticas parentais dos pais ou cuidadores. Os casos relatados neste estudo evidenciam que as famílias utilizam punição corporal, apresentam dificuldade de empatizar com a criança, possuem um estilo parental autoritário e expectativas incompatíveis com a idade das crianças. Além disso, a infância dos pais ou cuidadores apresentou forte influência no desenvolvimento de suas práticas parentais. A sobrecarga na figura materna também ficou evidente nos casos de famílias intactas. Por fim, a intervenção pode estabelecer um contato inicial da família com um serviço de psicologia, incentivando contato posterior com serviços que possam atender às demais dificuldades. A partir dos resultados examinados, conclui-se que a intervenção breve apresentou resultados positivos na mudança das relações familiares. Porém, o estudo precisa estabelecer uma medição quantitativa antes e depois da intervenção, além de uma sessão de seguimento para verificar se as mudanças são de longo prazo.(AU)

Orientation to parenting practices aims to modify the context in which children are inserted as a means to induce changes in their behavior. This article describes a brief seven-session individual intervention program aimed to help guardians identifying and encouraging appropriate behavior in their children, teaching new behaviors, encouraging autonomy, finding non-aggressive approaches to dealing with bad behavior, and assisting in the routine organization. The study describes three cases, exemplifying the strategies adopted in each of them. The analysis allowed the delineation of common characteristics among parental practices, indicating that families use corporal punishment, struggle in empathizing with the child, and have an authoritarian parental style and expectations that are incompatible with children's age. The results indicate that the childhood of parents and guardians had a strong influence on the development of their parental practices. Moreover, intact families presented an overload in the maternal figure. In this scenario, the intervention can bridge an initial contact between the family and a psychology service, encouraging later contact that can attend to other family difficulties. Despite the positive changes in family relationships enabled by this brief intervention, the study requires a pre- and post-intervention quantitative measurement and a follow-up session to verify whether these changes are long-term.(AU)

La orientación a prácticas parentales tiene por objetivo modificar el contexto en el que viven los niños como forma de potenciar cambios en su comportamiento. Este artículo describe una intervención breve de siete encuentros individuales. El programa tuvo como finalidades principales: auxiliar a los cuidadores en la identificación y estimulación de comportamientos adecuados en sus hijos; enseñar nuevos comportamientos; fomentar la autonomía de los niños; encontrar enfoques no agresivos para manejar malos comportamientos; y ayudar en la organización de la rutina. Para ello, se describió tres casos, ejemplificando las estrategias adoptadas en cada uno. El análisis de los casos permitió el delineamiento de características comunes entre las prácticas parentales de los padres/cuidadores. Los casos reportados en este estudio evidencian que las familias utilizan castigo corporal, presentan dificultad para tener empatía con el niño, poseen un estilo parental autoritario y expectativas incompatibles con la edad de los niños. Además, la infancia de los padres/cuidadores presentó una fuerte influencia en el desarrollo de sus prácticas parentales. La sobrecarga en la figura materna también estuvo evidente en los casos de familias intactas. Por último, la intervención puede establecer un contacto inicial de la familia con un servicio de psicología, incentivando un contacto posterior con servicios que puedan atender las demás dificultades de la familia. La intervención breve presentó resultados positivos en el cambio de las relaciones familiares, pero el estudio necesita establecer una medición cuantitativa pre- y posintervención y una sesión de seguimiento para verificar si los cambios son a largo plazo.(AU)

Conhecimento, atitudes e práticas dos profissionais da equipe de saúde da família na atenção aos usuários de substâncias psicoativas / Knowledge, attitudes and practice of family health team professionals in the attention to psychoactive substances users

O abuso do álcool e outras drogas é um problema de saúde pública, e as equipes de saúde da família devem estar capacitadas e qualificadas para cuidar dessa população. Desse modo, o presente estudo teve como objetivo geral: Avaliar o conhecimento, as atitudes e as práticas dos profissionais que integram as Equipes de Saúde da Família na atenção à saúde dos usuários com problemas relacionados ao uso de substâncias psicoativas; e teve como objetivos específicos: Descrever o conhecimento, as atitudes e as práticas frente ao uso de substâncias psicoativas dos profissionais de saúde que integram as Equipes de Saúde da Família; Realizar capacitação em serviço sobre as substâncias psicoativas baseadas na Intervenção Breve par aos profissionais da Equipe de Saúde da Família; Analisar o impacto da capacitação em serviço sobre o conhecimento dos profissionais das Equipes de Saúde da Família nas perspectivas da Intervenção Breve. Metodologia: Trata-se de uma pesquisa seccional do tipo inquérito Conhecimento, Atitudes e Práticas, seguido de um estudo quase- experimental. Para o estudo seccional foram entrevistados 318 profissionais que atuavam nas Equipes de Saúde da Família em uma área de planejamento do município do Rio de Janeiro. O instrumento de coleta de dados foi um questionário autoaplicável com questões referentes a perfil sociodemográfico, conhecimento, atitudes e práticas relacionadas à atenção à saúde dos usuários de substâncias psicoativas. Para o desenho quase-experimental foi realizada uma capacitação em serviço com 17 profissionais das Equipes de Saúde da Família, sendo utilizado um questionário autoaplicável antes e após a intervenção. Todos os dados foram analisados pelo programa Statistical Package for the Social Sciences (IBM SPSS, v. 23,0). Resultados: Evidenciou-se que a maior parte dos entrevistados foram do sexo feminino, adultos (mediana= 38), cristãos, agentes comunitários de saúde e que trabalhavam na Estratégia de Saúde da Família de 1 a 5 anos. Houve predomínio de conhecimento, atitudes e práticas não adequadas relacionadas à atenção à saúde dos usuários de substâncias psicoativas, houve diferença estatística significativa entre atitudes não adequadas e práticas não adequadas. Após a capacitação em serviço observou-se melhora no conhecimento adequado. Conclusão: Observou-se que ainda existe fragilidade no conhecimento, nas atitudes e nas práticas ofertadas pelos profissionais da Estratégia de Saúde da Família para as pessoas com uso/abuso de substâncias psicoativas. Desse modo, recomenda-se maior oferta de cursos de capacitação em serviço sobre álcool e outras drogas para que o mesmo possa influenciar em atitudes e práticas adequadas.

The abuse of alcohol and other drugs is a public health problem, which family health teams must be trained and qualified for the care of this population. Thus, the present study had the general objective of: Assessing the knowledge, attitudes and practices of the professionals who are part of the Family Health Teams in the health care of users with problems related to the use of psychoactive substances; and had as specific objectives: To describe the knowledge, attitudes and practices regarding the use of psychoactive substances by health professionals who are part of the Family Health Teams; Conduct in-service training on psychoactive substances based on Brief Intervention for professionals in the Family Health Team; To analyse the impact of in-service training on the knowledge of the professionals of the Family Health Teams in the perspective of Brief Intervention. Methodology: This is a Knowledge, Attitudes and Practices sectional survey followed by a quasi-experimental study. For the sectional study, 318 professionals who worked in Family Health Teams in a planning area in the city of Rio de Janeiro were interviewed. The data collection instrument was a self- administered questionnaire with questions related to the socio-demographic profile, knowledge, attitudes and practices related to the health care of psychoactive substances users. For the quasi-experimental design, in-service training was carried out with 17 professionals from the Family Health Teams, using a self-administered questionnaire before and after the intervention. All data was analysed using the Statistical Package for the Social Sciences program (IBM SPSS, v.23.0). Results: It was evident that most of the interviewees were female, adults (median = 38), Christians, community health workers and who worked on the Family Health Strategy for 1 to 5 years. There was a predominance of inappropriate knowledge, attitudes and practices related to the health care of psychoactive substances users, there was a statistically significant difference between inappropriate attitudes and inappropriate practices. After in-service training, there was an improvement in adequate knowledge. Conclusion: It was observed that there is still a weakness in the knowledge, attitudes and practices offered by professionals of the Family Health Strategy for people with use/abuse psychoactive substances. Thus, a greater offer of in-service training courses on alcohol and other drugs is recommended so that it can influence appropriate attitudes and practices.

El abuso de alcohol y otras drogas es un problema de salud pública en el que los equipos de salud familiar deben estar capacitados y calificados para atender a esta población. Por lo tanto, el presente estudio tuvo el objetivo general de: evaluar los conocimientos, las actitudes y las prácticas de los profesionales que forman parte de los Equipos de Salud Familiar en la atención de la salud de los usuarios con problemas relacionados con el uso de sustancias psicoactivas; y tenía como objetivos específicos: describir el conocimiento, las actitudes y las prácticas con respecto al uso de sustancias psicoactivas por parte de los profesionales de la salud que forman parte de los Equipos de Salud Familiar; Realizar capacitación en el servicio sobre sustancias psicoactivas basada en la Intervención Breve para profesionales del Equipo de Salud Familiar; Analizar el impacto de la capacitación en el servicio sobre el conocimiento de los profesionales de los Equipo de Salud Familiar en la perspectiva de la intervención breve. Metodología: Esta es una encuesta seccional Conocimiento, Actitudes y Prácticas seguida de un estudio cuasi-experimental. Para el estudio seccional, se entrevistó a 318 profesionales que trabajaron en Equipos de Salud Familiar en un área de planificación en la ciudad de Río de Janeiro. El instrumento de recopilación de datos fue un cuestionario autoadministrado con preguntas sobre el perfil sociodemográfico, el conocimiento, las actitudes y las prácticas relacionadas con la atención de la salud de los usuarios de sustancias psicoactivas. Para el diseño cuasiexperimental, se llevó a cabo capacitación en el servicio con 17 profesionales de los equipos de salud familiar, utilizando un cuestionario autoadministrado antes y después de la intervención. Todos los datos se analizaron utilizando el Paquete Estadístico para el programa de Ciencias Sociales (IBM SPSS, v.23.0). Resultados: fue evidente que la mayoría de los entrevistados eran mujeres, adultos (mediana = 38), cristianos, trabajadores de salud comunitarios y que trabajaron en la Estrategia de Salud Familiar hace de 1 a 5 años. Predominaran el conocimiento, las actitudes y las prácticas inapropiadas relacionadas con la atención de la salud de los usuarios de sustancias psicoactivas, hubo una diferencia estadísticamente significativa entre las actitudes inapropiadas y las prácticas inapropiadas. Después de la capacitación en servicio, hubo una mejora en el conocimiento adecuado. Conclusión: se observó que todavía existe debilidad en el conocimiento, las actitudes y las prácticas ofrecidas por los profesionales de la Estrategia de Salud Familiar para las personas con uso/abuso de substancias psicoactivas. Por lo tanto, se recomienda mayor oferta de cursos de capacitación en servicio sobre alcohol y otras drogas para que pueda influir en las actitudes y prácticas apropiadas.

The Effectiveness of a Brief Intervention for Reducing Adolescent Alcohol Consumption / Efectividad de una intervención breve para reducir el consumo de alcohol en adolescentes / Efetividade de uma Intervenção breve para reduzir o consumo de álcool em adolescentes

Abstract Introduction: Although alcohol consumption affects more than half of all adolescents, there are no known studies to assess the effectiveness of interventions to prevent or reduce consumption at a local level. The aim of this randomized clinical trial was to determine the effectiveness and clinical significance of a brief intervention program to reduce the consumption of alcohol and related problems in an educational setting in Argentina. Materials and methods: Systematically selected high school students (N = 167) were randomly assigned to one of three conditions: two control groups (screening, screening and evaluation) and one experimental group (screening, assessment and intervention). With the approval of an Ethics Committee, we implemented a protocol based on international guidelines. The effectiveness measures used were reduction in usual quantity, in high-risk alcohol drinking or in alcohol-related problems. We performed descriptive analyses, linear and logistic regressions, estimates of relative and absolute risk reduction, and the number of patients needed to reduce an event. In the follow-up (N = 150), the quantity of consumption and high-risk consumption were higher in the control groups. Results: The intervention effectively reduced alcohol consumption and related problems in about one out of seven adolescents, with a minimal investment in training and implementation. However, we did not find significant differences in alcohol-related problems among the groups, which decreased under all conditions. Conclusion: Long-term studies could determine whether this change primarily affects the intervention group.

Resumen Introducción: A pesar de que el consumo de alcohol afecta a más de la mitad de los adolescentes, se desconoce la efectividad de intervenciones para evitarlo o reducirlo a nivel local. Este ensayo clínico aleatorizado se propuso determinar la efectividad y significancia clínica de un programa de intervención breve para reducir el consumo de bebidas alcohólicas y problemas relacionados en un contexto educativo de Argentina. Materiales y métodos: Los participantes, estudiantes de educación media seleccionados sistemáticamente (N = 167) fueron asignados aleatoriamente a una de tres condiciones: dos grupos control (tamizaje, tamizaje y evaluación) y uno experimental (tamizaje, evaluación e intervención). Con el aval de un Comité de Ética, se implementó un protocolo basado en lineamientos internacionales. Las medidas de efectividad utilizadas fueron disminución de la cantidad habitual, del consumo de alto riesgo, y de los problemas relacionados con el alcohol. Se realizaron análisis descriptivos, regresiones lineales y logísticas, y estimaciones de reducción relativa y absoluta del riesgo y del número de pacientes a tratar para reducir un evento. En la etapa de seguimiento (N = 150), la cantidad y el consumo de alcohol de alto riesgo fueron mayores en los grupos control. Resultados: la intervención redujo efectivamente el consumo de alcohol y sus problemas en aproximadamente uno de cada siete adolescentes, con una mínima inversión en entrenamiento y aplicación. Sin embargo, no se encontraron diferencias significativas en los problemas relacionados, que disminuyeron en todas las condiciones. Conclusión: Estudios a largo plazo podrían dilucidar si el cambio se sostiene mayormente en el grupo de intervención.

Resumo Introdução: A pesar de que o consumo de álcool afeta a mais da metade dos adolescentes, desconhece-se a efetividade de intervenções para evitá-lo ou reduzi-lo no nível local. Este ensaio clínico aleatorizado se propôs determinar a efetividade e significância clínica de um programa de intervenção breve para reduzir o consumo de bebidas alcoólicas e problemas relacionados em um contexto educativo da Argentina. Materiais e métodos: Os participantes, estudantes de educação média selecionados sistematicamente (N = 167) foram assignados aleatoriamente a três condições: dois grupos controle (peneiração, peneiração e avaliação) e um experimental (peneiração, avaliação e intervenção). Com o aval de um Comitê de Ética, se implementou um protocolo baseado em diretrizes internacionais. As medidas de efetividade utilizadas foram diminuição da quantidade habitual, do consumo de alto risco, e dos problemas relacionados com o álcool. Realizaram-se análises descritivas, regressões lineais e logísticas e estimações de redução relativa e absoluta do risco e do número de pacientes a tratar para reduzir um evento. Na etapa de seguimento (N = 150), a quantidade e o consumo de álcool de alto risco foram maiores nos grupos controle. Resultados: A intervenção reduziu efetivamente o consumo de álcool e seus problemas em aproximadamente um de cada sete adolescentes, com um mínimo investimento em treinamento e aplicação. No entanto, não se encontraram diferenças significativas nos problemas relacionados, que diminuíram em todas as condições. Conclusão: Estudos a longo prazo poderiam dilucidar se a mudança se sustenta maiormente no grupo de intervenção.

Intervención Breve con Activación Conductual Sobre los Niveles de Ansiedad y Depresión de Pacientes Hospitalizados con Enfermedad Crónica

Una de las alternativas que ha probado su eficacia para el manejo de ansiedad y depresión es la Activación Conductual (AC), ya que empíricamente ha demostrado tener buenos resultados, además de presentar menos abandonos (Pérez-Álvarez, 2007). Hopko, Lejuez, LePage, Hopko y McNeil (2003), señalan que la AC es igual de eficaz que el tratamiento médico para la depresión mayor. La AC tiene como objetivo que el paciente esté "en acción", más a conductas que a pensamientos o ideas irracionales (Barraca, 2009). El objetivo del presente estudio fue determinar los niveles de ansiedad y depresión de pacientes con enfermedad crónica hospitalizados, del Hospital Juárez de México, y aplicar un programa breve de intervención cognitivo-conductual, con activación conductual, basado en un programa elaborado por Becerra-Gálvez (2013), y analizar el efecto de esta intervención sobre la mejoría de los niveles de ansiedad y depresión en pacientes hospitalizados. Los resultados demostraron que después de esta intervención los pacientes redujeron significativamente sus niveles de ansiedad y depresión. Asimismo, se analizaron las implicaciones de estos resultados y las limitaciones.

One of the alternatives that have proven its efficacy in anxiety and depression management is Behavioral Activation (BA). Empirically, it has been shown that this alternative has a high level of efficacy, having low treatment abandonment (Pérez- Álvarez, 2007). Hopko, Lejuez, LePage, Hopko y McNeil (2003) noted that the BA is as efficient as medical treatment applied to major depression. BA objective is to "sustain activity" in the patient toward behavior rather than thoughts or irrational ideas (Barraca, 2009). The objective of this study was to determine anxiety and depression levels in hospitalized chronic disease patients from Juarez de Mexico Hospital to apply a brief cognitive-behavioral intervention using behavioral activation; this based on Becerra-Gálvez (2013) program. The intervention effect was analyzed in terms of the hospitalized patients' improvement in anxiety and depression levels. Results show that after the intervention, anxiety and depression levels were significatively reduced. The implications of the results are discussed in terms of its implications and limitations.

Adaptação brasileira do manual Brief Intervention for Adolescent Alcohol and Drug Use / Brazilian adaptation of the Brief Intervention for Adolescent Alcohol and Drug Use Manual / Adaptación brasileña del manual Brief Intervention for Adolescent Alcohol and Drug Use

O objetivo deste estudo é apresentar o processo de adaptação para a realidade brasileira do Manual Brief Intervention for Adolescent Alcohol and Drug Use. Na versão original, desenvolvida nos Estados Unidos, o formato das sessões é individual, sendo assim, também se objetivou adaptar o manual para o formato grupal. O protocolo prevê a realização de quatro sessões, sendo que duas delas contam com a participação dos pais/responsáveis. O processo foi realizado em três etapas: 1. tradução e retrotradução do manual e a adaptação das intervenções e recursos; 2. revisão do material por especialistas; 3. adequação das intervenções por meio de dois estudos-piloto, o primeiro em formato individual e o segundo em formato grupal. Os resultados evidenciaram a adequação da versão do manual para a realidade brasileira e para ser utilizado em grupos. (AU)

The purpose of this study is to present the adaptation process of the Brazilian version of the manual Brief Intervention for Adolescent Alcohol and Drug Use. In the original version, developed in the United States, the session format is individual, and so, another objective was to adapt the manual for the group format. The protocol provides for four sessions, two of which involve participation of parents/guardians. The process was carried out in three stages: 1. translation and back-translation of the manual and adaptation of interventions and resources; 2. expert review of the material; 3. verification of intervention adequacy through two pilot studies, the first in an individual format and the second in a group format. The results evidenced the adequacy of the manual revision for the Brazilian context and for use in groups. (AU)

El objetivo de este estudio es presentar el proceso de adaptación en el contexto brasileño del Manual Brief Intervention for Adolescent Alcohol and Drug Use. En la versión original desarrollada en Estados Unidos, el formato de las sesiones es individual, siendo así, el objetivo del trabajo también fue adaptar el manual para el formato grupal. El protocolo incluye cuatro sesiones, dos de ellas con la participación de los padres/tutores. El procedimiento se llevó a cabo en tres etapas: 1. traducción y retro-traducción del manual y adaptación de intervenciones y recursos; 2. revisión del material por especialistas; 3. adecuación de las intervenciones por medio de dos estudios piloto, el primero en formato individual y el segundo en formato grupal. Los resultados señalaron adecuación de la versión del manual para la realidad brasileña y para ser utilizado en grupos. (AU)

Barreras en la transferencia de la tecnología: Un estudio cualitativo de las intervenciones breves y los centros de atención a las adicciones / Barriers to technology transfer: Qualitative study of brief interventions and treatment centers for addiction

RESUMEN: Introducción: La transferencia y la traducción de los programas con evidencia científica a los escenarios clínicos, con frecuencia se encuentra limitada por una serie de barreras en su aplicación que complica la obtención de beneficios para la sociedad que requiere servicios eficaces. Objetivo: Identificar las barreras en la adopción de los programas de intervención breve para el tratamiento por el consumo abusivo de alcohol y otras drogas. Métodos: Es un estudio cualitativo con una muestra intencional conformada por 16 expertos en procesos de transferencia. Se realizaron entrevistas a profundidad, se transcribieron y los datos se sometieron a un análisis de contenido. Resultados: Las principales barreras encontradas en el proceso de transferencia de la tecnología para la adopción del modelo de intervención breve para la atención de trastornos por abuso de sustancias fueron: los procedimientos de índole burocrático y políticas institucionales, el desconocimiento de las bases teóricas de las intervenciones breves y la diversidad de usuarios que demandan el servicio. Discusión y conclusión: El proceso de transferencia de la tecnología para la adopción de programas en los escenarios clínicos, requiere de un esfuerzo deliberado y conjunto, planeado desde su inicio para lograr la transferencia. Las barreras señaladas por los propios actores que participan en el proceso deben considerarse en el desarrollo de estrategias dirigidas a transferir los programas de intervención breve.

ABSTRACT: Introduction: The transfer and translation of programs with scientific evidence to clinical scenarios is often limited by a number of barriers for their implementation, making it difficult to provide benefits for a society that requires effective services. Objective: The aim of this study was to identify the barriers for the adoption of brief intervention programs for the treatment of alcohol and other drugs abuse at addiction treatment centers in Mexico. Methods: This is a qualitative study with a purposive sample consisting of 16 experts on transfer processes. Focused interviews were conducted and transcribed, and the data were subjected to content analysis. Results: The results reported several barriers for the adoption of programs in clinical scenarios. These include the following: bureaucratic procedures and institutional policies, lack of knowledge of the theoretical bases of the program and the diversity of users demanding the service. Discussion and conclusion: The study discusses the fact that the technology transfer process requires a deliberate, combined effort to ensure the implementation of programs in clinical scenarios. The barriers identified by the actors involved in the process should be considered in the development of strategies to disseminate brief intervention programs.

Barreras para implementar el despistaje, intervenciones breves y referencia al tratamiento por problemas de consumo de alcohol y otras drogas en hospitales que atienden personas que viven con el VIH/SIDA en el Perú / Barriers to implementing screening, brief intervention and referral to treatment for substance use in HIV/AIDS health services in Peru

RESUMEN Objetivos. Evaluar la factibilidad de implementar la detección, intervención breve y referencia a tratamiento (SBIRT, por sus siglas en inglés) en los servicios de atención para personas viviendo con el virus de inmunodeficiencia humana/ síndrome de inmunodeficiencia adquirido (PVVS). Materiales y métodos. Se realizó un estudio de tipo cualitativo, luego de capacitar profesionales de salud (incluyendo, enfermeras y médicos) que proveen atención de salud a PVVS en la aplicación del SBIRT, se realizaron grupos focales para explorar las barreras percibidas para su implementación y se realizaron entrevistas para evaluar las barreras y facilitadores en dos hospitales de tercer nivel de Lima, Perú. Resultados. La codificación temática de los grupos focales y las entrevistas revelaron tres dimensiones principales de barreras: 1) el desconocimiento acerca del consumo de sustancias en las PVVS; 2) limitaciones de espacio y tiempo que dificultan las intervenciones breves durante las visitas de rutina, y 3) insuficientes servicios con capacidades para el tratamiento el uso de sustancias apropiadas donde puedan ser referidos los pacientes con estos problemas. Conclusiones. Múltiples barreras, incluyendo el desconocimiento por los problemas de consumo de sustancias, limitaciones de espacio y tiempo de los profesionales, y carencia de servicios especializados a donde referir los pacientes para un cuidado especializado, haría difícil implementar SBIRT en un contexto como el del sistema de salud peruano.

ABSTRACT Objectives. Screening and treatment for substance use among people living with HIV/AIDS (PLWHA) is highly recommended. Nevertheless, in Peru healthcare for PLWHA does not include a standardized or systematic assessment to identify substance use. The aim of this study was to assess the feasibility of implementing screening, brief intervention and referral to treatment (SBIRT) in healthcare settings attending people living with PLWHA. Materials and methods. After providing training in SBIRT for PLWHA's healthcare personnel (including nurses and physicians) focus groups were conducted to explore knowledge, beliefs and perceived barriers to implementation and interviews were conducted to assess the barriers and facilitators of two tertiary hospitals in Lima, Peru. Results. focus groups and interviews' thematic coding revealed three dimensions: 1) the unknown extent of substance use within PLWHA, 2) space and time limitations hinder completion of brief interventions during routine visits, and 3) insufficient access to substance use treatment appropriate for HIV patients. Conclusions. Multiple barriers, including lack of awareness of substance use problems, limited space and time of providers, and lack of specialized services to refer patients for treatment make it difficult to implement SBIRT in the Peruvian healthcare system.

Entrevista motivacional en consumidores excesivos de alcohol: intervenciones efectivas para el aumento en la disposición al cambio / Motivational Interviewing in Excessive Alcohol Consumers: Effective Interventions to Increase Change

El objetivo de esta investigación fue determinar las intervenciones verbales del terapeuta que se asocian con el aumento en la disposición al cambio en consultantes que consumen alcohol excesivamente. Para esto se grabaron dos sesiones en audio de 10 participantes de un programa para la moderación del consumo de alcohol basado en la entrevista motivacional, se transcribieron las intervenciones del consultante y del terapeuta y se categorizaron de acuerdo al MISC 2.0. El estudio analizó 272 tríadas conformadas por la expresión pre del consultante, intervención del terapeuta y expresión post del consultante. Los resultados indican que las intervenciones que se asocian con el aumento en la disposición al cambio son: devolución de la resistencia, reformulación y acuerdo con un giro para la resistencia; enfatizar el control y la elección personal, reformulación, aumento de la discrepancia y escucha reflexiva para la ambivalencia; y pregunta evocadora y resumir para las frases automotivadoras.

The objective of this research was to determine the therapist's verbal interventions that are associated with increased willingness to change in clients who use alcohol excessively. For this audio recorded two sessions of 10 participants of a program for moderate alcohol consumption based on motivational interviewing, interventions were transcribed consultant and therapist and categorized according to the MISC 2.0. The study analyzed 272 triads formed by the consultant's pre speech, speech therapists and the consultant intervention post. The results indicate that interventions that are associated with increased willingness to change are: return of the resistance, reformulation and according to a turning point for the resistance; stress control and personal choice, reformulation, increased discrepancy; and listen reflexive for ambivalence, and evocative question and summarize for self-motivation phrases.

The promotion of older adults' sense of coherence through Person-Centered Therapy: A randomized controlled pilot study

El objetivo del estudio que se informa fue explorar si una intervención individual de terapia centrada en la persona (TCP) en personas adultas mayores puede promover su sentido de coherencia, en comparación con un grupo control (lista de espera). Se plantea que los participantes asignados al azar a TCP informarían mejoras en SDC de pre y post-intervención en comparación con el grupo control. Un grupo de 87 participantes de 65 a 86 años (M = 72.4; DE = 5.15) fue evaluado con la Escala de Sentido de Coherencia (ESDC) y el cuestionario sociodemográfico en tres momentos diferentes: al inicio del estudio (t1), post-tratamiento (t2) y a los 12 meses de seguimiento (t3). Los resultados indicaron que los participantes en TCP evidenciaron un aumento significativo en cuanto a su SDC (16.7%), mientras que en el grupo control se encontró una disminución significativa (-2.7%), entre el inicio del estudio y el momento de seguimiento. El tamaño del efecto en el grupo TCP fue alto (n²p= .776). En concreto, tanto en la post-intervención como en el momento del seguimiento, los participantes que se sometieron a TCP tenían un SDC significativamente mayor (M = 3.84, DE = .219). Se encontraron diferencias significativas entre el grupo de intervención y el grupo control en la post-intervención y en el seguimiento. Se concluye que los cambios en SDC fueron positivos y mantenidos, por lo tanto, los resultados sugieren que la TCP es favorable a la mejora de SDC. Por otra parte, ya que la SDC se asocia con el bienestar relacionado con la salud de las poblaciones de mayor edad, hay que enfatizar el desarrollo de SDC en la vejez.

Sense of Coherence (SOC) derived from the salutogenic approach and seems to be a health promoting resource, which strengthens resilience and develops a positive subjective state of health. Older adults' SOC is often challenged by specific issues in later adulthood such as grieving for losses, illness, feelings of worthless and solitude, retirement, disability and death, which require distinctive consideration. To our best knowledge, there are no previous studies that indicated the relation between a person-centered therapy (PCT) and older adults' SOC. Therefore, this study aims to explore if a brief eight-session individual PCT intervention on older adults can promote their SOC, as compared with a control group (waiting list). Specifically, this is a randomized controlled pilot study designed to explore the promotion of SOC through an individual-based PCT intervention. We posited that participants randomized to PCT would report improvements in SOC from the pre- to the post-intervention moments when compared to those on the waiting list. The Orientation to Life Questionnaire (OtLQ) and demographics were assessed at the baseline (t1), post-treatment (t2) and at the 12-month follow-up (t3), in a group of 87 participants between 65 - 86 years (M = 72.4; SD = 5.15), from community and health centers in the Great Lisbon area, in Portugal. Participants were mostly women (59.8%), married (65.5%) and professionally inactive (63.2%). The Cronbach's Alpha coefficients for SOCS were .878, .989, and .988, in the three moments, respectively. Inclusion criteria determined their eligibility to participate in the study. No participant with a compromised cognitive function integrated the sample. All potential participants were given a brief description of the study and gave their informed consent. After the baseline assessment, participants were randomly assigned to one of the two groups. The eight-session intervention was conducted in an adequate setting and with a weekly frequency. Comparisons between the three assessments (t1, t2 and t3) for the two groups were done using Repeated Measures ANOVA. Post-hoc Fisher's Least Significant Difference (LSD) test for mean differences was used to compare the three assessments for the SOC, in each group (PCT and waiting list). After the intervention, a significant increase of 17.3% (M = 3.86, SD = .218) was observed in the participants who did the PCT. The SOC evidence dat follow-up (t3) (M = 3.84, SD = .219) by these participants was significantly higher (16.7%) in comparison to the baseline score (M = 3.29, SD = .245). Conversely, participants in the control group experienced a minor decrease between baseline (M = 3.28, SD = .236) and follow-up (M = 3.19, SD = .244) (- 2.7%). The effect size in the PCT group was high (n²p = .776). Significant differences between the intervention group and the control group were found at the post-intervention and follow-up. Findings also showed that participants in PCT experienced an increment in the three dimensions of SOC. The highest increase was observed in the Comprehensibility dimension (71.2%). Manageability and Meaningfulness sub-scales showed an increase of 32.9% and 12.1%, respectively. Changes in SOC were positive and maintained, thus, findings suggest that PCT is favorable to enhancing SOC. In particular, for the participants who did PCT, the significant increase of their SOC was mainly due to the high increase of the comprehensibility of events. This study contributed to filling a gap in gerontological literature and this intervention has the potential to offer a reasonably low-cost self-regulatory approach to the SOC. In this context, PCT is also a personal resource to promote SOC, in late adulthood. Moreover, since SOC is associated with health-related well-being among older populations, SOC development in old age should be stressed.

Dual Parallel Process in Crisis Situations: Motivational Foundation / El Doble Procesamiento Paralelo en Situación de Crisis: Fundamentación Motivacional / O Dobro Processamento Paralelo em Situação de Crise: Fundamentação Motivacional

The objective of this paper is to present a cognitive-behavioral model that makes it possible to explain the crisis situation (CS) in terms of intense motivational involvement, and to propose a brief motivational intervention proposal in CS. The CS requires the person to implement coping strategies focused on the management of objective damage, as well as on the search for emotional relief, a consideration that gives rise to the name of dual parallel processing in CS (DPP-CS). Brief intervention is understood as the involvement of motivational processes to enable the person to make decisions regarding emotional and instrumental coping which move her in the direction of emotional relief or solution of the crisis. The paper concludes with a summary of the three basic sources taken from the psychological literature to inform the design of the DPP-CS: the dual extended parallel process model, the cognitive theory of stress and coping, and the formulation by levels in cognitive therapy.

El objetivo de este artículo es presentar un modelo cognitivo-conductual que permite explicar la situación de crisis (SC) en términos de intensa afectación motivacional y sustentar, a partir de ahí, una propuesta de intervención motivacional breve en SC. La SC exige a la persona implementar estrategias de afrontamiento centradas en el manejo del daño objetivo, así como en la búsqueda del alivio emocional, consideración que da origen a la denominación doble procesamiento paralelo en SC (DPP-SC). La intervención breve afecta los procesos motivacionales, para facilitar que la persona adopte decisiones de afrontamiento que la coloquen en dirección al alivio emocional o a la solución de la crisis. Se concluye con una síntesis sobre las tres fuentes fundamentales procedentes de la literatura psicológica, para inspirar el diseño del DPP-SC: el doble procesamiento paralelo extendido, la teoría cognitiva sobre el estrés y el afrontamiento, y la formulación por niveles en terapia cognitiva.

O objetivo deste artigo é apresentar um modelo cognitivo-comportamental que permita explicar a situação de crise (SC) em termos de intensa afetação motivacional e sustentar, a partir disso, uma proposta de intervenção motivacional breve em SC. A SC exige, da pessoa, implementar estratégias de afrontamento centradas no manejo do dano objetivo, assim como na busca do alívio emocional, consideração que dá origem à denominação dobro processamento paralelo em SC (DPP-SC). A intervenção breve afeta os processos motivacionais para facilitar que a pessoa adote decisões de afrontamento que a coloquem em direção ao alívio emocional ou à solução da crise. Conclui-se com uma síntese sobre as três fontes fundamentais procedentes da literatura psicológica para inspirar o desenho do DPP-SC: o dobro processamento paralelo estendido, a teoria cognitiva sobre o estresse e o afrontamento, e a formulação por níveis em terapia cognitiva.

La búsqueda de moderación en el consumo de alcohol: Adaptación de los conocimientos a la práctica / Searching moderation in alcohol consumption adjusting knowledge to practice

Alcohol abuse in Mexico has an enormous impact on people's health. This problem has led authorities to undertake actions to combat and reduce both consumption levels and their consequences. The interventions, focusing on handling problem drinkers -people who already show symptoms of dependence and consume more than one drug, including alcohol-, have proved their effectiveness in various scenarios. In the work setting, this problem is no exception and has also been a focus of concern and the implementation of actions to prevent excess alcohol consumption and provide care for persons beginning to display problems. However, implementing programs in the workplace has proved complicated. Other countries have found that many programs are not correctly evaluated or simply not evaluated, making it impossible to determine their effectiveness in solving the problems for which they were designed. Moreover, the personnel that implement them are not properly trained, programs are expensive to implement, and conflicts of interest tend to arise. In Mexico, low-cost, effective actions have been implemented for this population. However, the time available for undertaking preventive activities is limited, while the length of workers' shifts means that they do not have enough time for these activities. One current challenge is the Translation of Research as a tool for the development of efficient, simpler, more practical, and safer interventions, without ignoring the discovery of new information regarding health and disease prevention, as well as creating more efficient treatments and improving existing ones. Within this perspective, researchers worked to produce a brief intervention to reduce harmful alcohol consumption among the working population. It is based on the principles of cognitive social theory put forward by Bandura, in which alcohol consumption is regarded as learned behavior, that causes problems and may be replaced by healthy behaviors, provided dependence has not developed. Another of the components included is motivational theory, according to which the effectiveness of a particular form of treatment is related to individuals' motivation to continue it. The aim of this article is to describe the process of translation of research, derived from the implementation of cognitive social and motivational theories to adapt an intervention program designed in a comic book format that is easy to read and understand to teach workers with excess alcohol consumption to moderate their consumption. Method The work was carried out in two stages: Phase 1. Adaptation of a brief intervention to a comic book format. A comic was produced using the elements of a brief intervention. In order to ensure that the concepts put forward in the base theory were accessible to the target population, they were subjected to a process of cognitive laboratories following the methodology proposed by Beatty. The comic was produced to make the material easier to read and understand. The process began with a scriptwriter who translated the theoretical contents, together with the terms obtained in the cognitive laboratories into a story that would reflect the target population. This version was subjected to an evaluation described in stage 2. Phase 2. Evaluation of language, characters, contents, and format of comic. Participants: Researchers worked with 49 subjects from various firms and states in Mexico, 59.2% of whom were men, mostly between the ages of 24 and 42, and over half of whom were married (61.2%). Half had only completed high school or less. Instrument: The questionnaire contained demographic questions and indicators to evaluate the comic for: format, understanding of contents, characters, language, and perceived usefulness for reducing problem drinking, among other things. Procedure: Participants attended a training course during which they were asked to evaluate the comic. Each one was given a printed copy and a questionnaire. The subjects volunteered to participate and were guaranteed the confidentiality of the information they provided. Results Over 85% said that they were used to reading on a daily to weekly basis. Most of them thought that the illustrations were attractive and felt that the characters reflected the role they played in the story. They did not like the length of the comic or the fact that the drawings were extremely detailed, with too much text. They also disliked the font and the type of language used. Nearly 80% thought that the reading material was neither tedious nor dull. Most rated the story good or very good and thought that the title encouraged people to read it and that they would use it if they had drinking problems. They also identified themselves with the characters and the situations described in the comic. What they liked best was the way the topic was dealt with in a comic, the way the problem was highlighted, the type of language used (colloquial), the message given, the goal setting, the way they became involved in the reading, and the link between users and the family environment. Finally, the evaluations of the comic showed that some drawings were regarded as aggressive, the children's language did not match their parents', and the order of the dialogues was confusing. This moment in the translation of the intervention made it possible to make changes in several aspects included in the final version. The comic was given to a proofreader to correct spelling mistakes while maintaining the colloquial tone. Discussion This activity resulted in a comic in which the characters guide the workers through a series of strategies to reduce consumption. This complies with the principles of translating research by adapting the concepts derived from social and motivational cognitive theory, which have proved their effectiveness in dealing with addictive behaviors. The inclusion of experts from various areas made it possible to adapt knowledge, by incorporating strategies from the latter into a script that included the dialogues and sketched the characters that would form part of the story. The experts continued to participate during the evaluation process until the final version, with the definitive images, and final dialogues and exercises. Having the workers targeted by the intervention try out various aspects of the material made it possible to adjust the language, contents and the story told, the characters' performance and appearance and the way the exercises and dialogues were carried out. This also made it possible to see how useful the workers found it in reducing their own consumption or helping the people around them -family, co-workers and friends- to do so. In order to produce this sort of material, it is essential to use colloquial language that will be understood by the target population, which is the most delicate stage of the process since it involves the correct use of technical assumptions, since otherwise, one would work from a totally different perspective. This material can reach men of productive age, who are those that make less use of health services, meaning that it is a tool that covers this inaccessible sector of the population. However, the workers were also given the possibility of seeking help from specialists if they failed to achieve their objectives, in which case the comic achieves the objective of raising awareness. Lastly, one of the limitations of the material concerns the fact that the subject himself has to follow up his own progress, meaning that the adaptation must be carried out as rigorously as possible. It also implies that the material must be evaluated through an analysis of the changes that take place in workers as a result of using it. The next stage will therefore be to test the intervention through the comic in a controlled test and to evaluate its efficiency in reducing alcohol abuse problems, as well as the subject's possible progression to severe dependence.

El abuso en el consumo de alcohol en México es un problema de salud pública por lo que se han realizado diferentes acciones para reducir los niveles de consumo y las consecuencias derivadas de éste. Entre estas acciones hay intervenciones que han probado su eficacia en diferentes escenarios. En el ambiente laboral, sin embargo, ha sido complicado instrumentarlas, por el rechazo, el poco apoyo y el desinterés de funcionarios e instituciones, porque los empleados no disponen de tiempo en sus jornadas y por la falta de espacios para realizar actividades de prevención. Por esta razón es importante adaptar el conocimiento científico para el desarrollo de intervenciones eficientes, más simples, más prácticas y más seguras. Actualmente el proceso de traducción de la investigación es una vía para lograrlo. El objetivo de este artículo es describir este proceso mediante la adaptación de una intervención basada en las teorías cognitiva social y motivacional, cuyos conceptos se presentan en forma de estrategias guiadas por personajes en una historieta -de fácil lectura y comprensión- con la finalidad de que trabajadores que presentan consumo nocivo de alcohol aprendan a moderarlo. Método El trabajo se realizó en dos fases: Fase 1. Se creó la historieta para lograr que los conceptos planteados en la teoría base fueran accesibles a la población objetivo en un formato fácil de leer y entender. Fase 2. Evaluación de lenguaje, personajes, contenidos y formato de la historieta. Participantes: Cuarenta y nueve sujetos voluntarios de diferentes empresas y Estados de la República Mexicana, 59.2% hombres, la mayoría de entre 24 y 43 años, más de la mitad casados y con escolaridad de preparatoria o menos. Instrumento: Un cuestionario que contenía preguntas demográficas e indicadores para evaluar la historieta. Procedimiento: Los participantes se encontraban en un curso de capacitación, ahí se les dio una historieta y un cuestionario invitándolos a que ayudaran para evaluarla. La participación fue voluntaria y se garantizó la confidencialidad de la información proporcionada. Resultados En su mayoría las ilustraciones les resultaron agradables, consideraron a los personajes acordes con el papel que desempeñan en la historia, que la lectura del material no era tediosa o cansada, mencionaron que la historia era buena o muy buena y que el título motivaba a la lectura, que usarían la guía si tuvieran problemas con su consumo de alcohol, además de sentirse identificados con los personajes y las situaciones descritas. Lo que más les agradó es el modo en que se trató el tema en una historieta, el lenguaje utilizado, el mensaje que se les da, el planteamiento de metas, la forma de involucrarlos en la lectura, la relación del consumidor y la familia, cómo los van motivando, lo que sucede en la recaída y cómo se recupera el usuario. La información recabada fue utilizada para realizar la versión final de la historieta. Discusión El resultado fue un material de fácil lectura que permite su utilización individual, en momentos y lugares que cada persona deseé utilizar. Cumple con los principios de la traducción de la investigación al adaptar conceptos derivados de la teoría. Para lograrlo fue importante el uso de lenguaje coloquial que facilitó su lectura y la apropiación de los conocimientos por la población objetivo, esto implicó incluir cuidadosamente los supuestos teóricos para no distorsionar la perspectiva planteada originalmente. Esta intervención permite además llegar a grupos de difícil acceso como los hombres en edad productiva, que acuden poco a servicios de salud. Es necesario probar la intervención mediante la historieta, por ello la siguiente etapa será hacerlo mediante un ensayo controlado para evaluar su eficiencia para reducir los problemas de abuso de alcohol, así como la eventual progresión a la dependencia grave.

Evaluación de un programa de intervención breve motivacional para fumadores: resultados de un estudio piloto / Evaluation of a brief motivational intervention program for smokers: results of a pilot study

Tobacco consumption is a world-wide public health problem that has been associated with different types of cancer, cardiovascular and respiratory diseases, alterations in the reproductive system, dental problems and some eye diseases. In Mexico the National Survey of Addictions (2002) reported that 26.4% of the urban population between 12 and 65 years and 14.3% of the rural population are smokers. The Secretary of Health indicated that more than 53000 people died from diseases related to tobacco consumption. The consumption of tobacco stands among the ten first causes of morbidity and mortality in Mexico. In this sense, smoking is considered as one of the main public health problems in Mexico. Several organisms and institutions have undertaken actions in an attempt to solve it, such as the development of educative programs directed to the general population and programs to help smokers to quit this habit. Some of the main strategies to reduce cigarette consumption include nicotine replacement therapy, therapy not based on nicotine (antidepressants, some opiate antagonists and anxiolytic drugs), psychological programs, and the combination of some of them. Regarding psychological treatments, behavioral and cognitive behavioral techniques for smoking cessation hold empirical evidence about their efficacy for reducing the abuse of substances. In Mexico, psychological, nicotinic and non-nicotinic treatments to stop smoking are used. Nevertheless, the methodological and theoretical grounds of the psychological interventions are not well-established and there are no specific data about the changes in the consumption pattern after the application of the interventions and whether the effects of the treatment stay through the time. Specifically, the information about the efficacy of the brief interventions on smokers in the Mexican population is scarce. Although different studies have demonstrated that the brief motivational interventions are more effective to reduce the abuse of different substances than intensive interventions or no interventions at all, the techniques are not widely used in the treatment of tobacco consumption in Mexican population. With this evidence, the National Autonomous University of Mexico (UNAM) developed the Brief Motivational Intervention Program to treat smokers. The Brief Motivational Intervention is based in the Social Cognitive Theory, the Prevention of Relapses Model, in techniques of motivational interview and self-control techniques. Therefore, the goal of the present research is to evaluate a brief motivational intervention program for smokers. In order to achieve this aim, 10 individuals between 19 and 55 years old participated in the program; five individuals showed low nicotine dependence and five severe nicotine dependence according to the Questionnaire of Fagerström Tolerance. There was a public invitation and the participants consent to participate voluntarily in the <

Diagnóstico y tratamiento psicosocial del tabaquismo / Smoking cessation: Diagnosis and psychosocial intervention

Tobacco dependence is an addictive chronic disease, characterized by its trend to the recurrence, in which the relapses are part of the process of smoking cessation. It is recommended a complete clinical evaluation, including the application of certain tests that can allow level of dependence, motivation and psychiatric comorbidities evaluation. The current treatment of smoking has two pillars: psycho-social intervention and pharmacological therapy. The current interventions are based on two theoretical models that try to understand changes of smoking behavior: The Stages of Change and PRIME Theory. Brief intervention is a strategy internationally approved because of its population impact on smoking cessation. The methodology used is named "5A's": Ask, Advise, Asses, Assist and Arrange follow-up. For not motivated patients at the intervention time it can be used the "5R 's" methodology: Relevance, Risks, Rewards, Roadblocks and Repetition. The actual approach used in smokers management, is Motivational Interview, which tries to produce the behavioral change from inside and not imposing it. Its four tools are: express empathy, develop discrepancy, roll with resistance and support self efficacy. The useful psychosocial strategies, in which exists consensus, are: 1) Give practical counseling of problem solving and skills training to face risky situations; 2) Intra-treatment support, encouraging attempts of smoking cessation and communicate caring and concern.

El tabaquismo es una enfermedad crónica adictiva, caracterizada por su tendencia a la recurrencia, en que las recaídas son parte del proceso de dejar de fumar. Se recomienda una evaluación clínica completa de los fumadores, incluyendo la aplicación de algunos tests que permitan evaluar nivel de adicción, motivación y comorbilidad psiquiátrica. El tratamiento actual del tabaquismo tiene dos pilares: intervención psicosocial y terapia farmacológica. las intervenciones actuales, se basan en dos modelos teóricos que intentan comprender los cambios de la conducta de fumar de las personas: las Etapas de Cambio y la Teoría PRIME. la Consejería Breve es una estrategia aprobada internacionalmente por su impacto poblacional en dejar de fumar. la metodología que utiliza se denomina las 5 A: Averiguar, Aconsejar, Acordar, Ayudar y Acompañar. Para los pacientes no motivados al momento de la intervención se utiliza la metodología de las 5 R: Relevancia, Riesgos, Recompensas, Resistencias y Repetición. El enfoque actualmente utilizado en el manejo de los fumadores, es la Entrevista Motivacional, que intenta producir el cambio conductual desde dentro y no imponiéndolo. Sus cuatro herramientas son: expresar empatia, desarrollar las discrepancias, lidiar con las resistencias y mejorar la autoeficacia. Hay consenso en que las estrategias psicosociales útiles son: 1) la entrega de consejos prácticos para resolución de problemas y desarrollo de habilidades para enfrentar situaciones de riesgo; 2) el apoyo intratratamiento, incentivando los intentos por dejar de fumar y trasmitiendo preocupación y apoyo.

Resultados preliminares del Programa de Intervención Breve para Adolescentes que Inician el Consumo de Alcohol y otras Drogas / Preliminary study of a brief intervention program for adolescents who initiate alcohol and other drugs consumption

During the last two decades, alcohol, tobacco and illicit drug consumption among young people has come to be regarded as a serious public health problem, both in Mexico and internationally. This recognition has resulted from a trend toward higher levels of use, greater diversification of the types of drugs used and abused, and increased drug marketing. Epidemiological data show that most users initiate drug use when they are about 16 years old. However, the age of first drug experimentation appears to be decreasing, with recent reports indicating an average age 12 or 13 years at present. The societal costs of adolescent drug use cut across different domains including physical and mental health, car crashes, and morbidity and mortality related to substance misuse. The personal costs of teen drug use include school failure, drop-out, and truancy. Moreover, aggressive behavior and crime, risky sexual behaviour, and many other behavioural problems have been shown to be associated with adolescent drug use. Research from many different disciplines has increased knowledge about (a) important dimensions of adolescent substance use and (b) the processes and variables related to the origin and maintenance of addictive behavior among teenagers. Despite this growing body of knowledge, few current prevention and treatment programs are based on empirical investigation. Moreover, many current intervention programs have not been adequately evaluated in regard to effectiveness. A recent development in the addiction field is brief intervention (BI). BIs have been demonstrated to be effective in the treatment of addictive behavior among adult problem drinkers, with the most successful programs based on the Theory of the Social Learning. Only recently have BIs been tried with adolescent populations. While promising, little empirical research exists about the effectiveness of brief treatment with adolescents. The primary goals of BIs are to (a) reduce or eliminate substance consumption and (b) to mitigate the adverse effects of using alcohol or other drugs (i.e., harm reduction). While the goals of BIs are clear, the effectiveness of such programs with adolescents, despite their promise, is not well researched. For this reason, it is important to develop and empirically test BI programs for adolescents demonstrating problematic alcohol or other drug consumption. Schools represent a particularly good place to access adolescents who would benefit from BIs, and BIs represent an attractive alternative to the typical strategies used by school to address student substance use (i.e., suspension or expulsion). The main goal of this investigation was to develop and to evaluate a brief intervention program for teenagers with substance abuse (but who have not developed substance dependence) between 14 and 18 years old. The intervention program tries to: (a) promote a change in drug consumption through establishing consumption goals (in the case of the alcohol, moderation or abstinence; in the case of illegal drugs, abstinence); (b) identify high-risk situations in which use is probable; and (c) develop alternative strategies to these situations. The theorical bases of the intervention include Self-control Theory, Motivational Interviewing, Relapse Prevention and <>. Our brief intervention program consisted of six steps: 1. case detection, which involved the identification of adolescents who abuse alcohol or another drugs, by means of teacher's reports, legal and psychology personnel, trained by the investigators; 2. screening, which involved determining whether adolescents met inclusion criteria; 3. assessment, which addressed the frequency and amount of consumption and self-confidence to suitably face situation of probable drug; 4. induction to the program, the objective of which was to sensitize the adolescents about the importance of attending treatment; 5. intervention; and, 6. one, three and six months follow-up assessments. The intervention program consisted of four individual sessions with the participants in which they chose their own substance reduction goals, identified their high risk situations, developed coping plans for each high risk situation, and appraised the impact of their substance use on their own life-goals success. The researchers used a single-case design with 25 participants, 17 of whom had alcohol problems and eight of whom had marijuana problems. The age average of participants was 16 years (SD = 1.8), and 19 were male and six were female. The average age of first consumption was 14 years old (SD = 1.72); the average duration of substance use was 18 months. From the complete sample, 45% reported consumption one or twice per week, 22% reported daily consumption, and the remainder consumed once a month. Results indicated that from the 25 participants, 24 demonstrated changes from the baseline in their consumption pattern (measured by frequency and quantity) during intervention and at follow-up assessments. Self-efficacy levels (self-perceptions about the capability to abstain or use moderately in high risk situations) changed as well. Specifically, among the adolescents who consumed alcohol a one-way ANOVA revealed significant changes in average consumption between the baseline, treatment, and follow-up phases F(2.48) = 17.691, p < .001. Bonferroni's post-hoc tests showed differences between baseline ( = 8.89, SD = 3.55) and treatment ( = 4.46, SD = 3.27), and between baseline and the follow-up ( = 3.29, SD = 1.35). Student's t tests for each subject showed that 16 adolescents significantly reduced their alcohol consumption from the baseline to the follow-up. Only one participant demonstrated increased use (from five standard drinks per drinking occasion at the baseline to 5.90 standard drinks at the follow-up). Regarding consumers of marijuana, a one-way ANOVA showed significant changes in consumption across the baseline, treatment and follow-up phases F(2.21) = 8.219, p = .002. Bonferroni's post-hoc tests showed significant differences between the baseline ( = 18.23, SD = 16.62) treatment phases ( = 1.07, SD = 0.77), and between the baseline and the follow-up phases ( = 1.59, SD = 1.06). An additional one-way ANOVA revealed significant changes in self-efficacy. Specifically, participants demonstrated increased self-efficacy in situations including: Unpleasant emotions, Pleasant emotions, Testing personal control, Conflict with others, Social pressure, and Pleasant time with others (all p < .01), F(2.78) = 24.30, 12.47, 11.34, 11.02, 16.91 and 25.62, respectively. Self-efficacy in regard to Physical discomfort and Urges and temptations to drink also showed significant changes, but at p < .05 F(2.78) = 3.97 and 3.26, respectively. Finally, in order to evaluate the impact of the intervention on problems that participants associated with their alcohol use (or other drugs), seven areas were examined: School, Health, Cognitive, Interpersonal, Family, Legal and Economic. At the end of the treatment, there was a reduction in the number of problems related to these seven areas, compared with the baseline.

En las últimas décadas, el abuso de drogas legales e ilegales en los jóvenes ha sido considerado como un serio problema de salud pública, tanto en el ámbito internacional como en nuestro país. Los estudios epidemiológicos indican que la mayoría de los consumidores experimentan por primera vez con drogas alrededor de los 16 años, pero esta experimentación continúa disminuyendo presentándose en promedio a los 12 o 13 años. Esto representa altos costos para la sociedad y el individuo. Por ejemplo, en áreas de la salud se incrementan los costos de la atención médica, los servicios de salud mental y los tratamientos especializados, además de aumentar la probabilidad de accidentes y muertes relacionadas con el abuso; en el área escolar se presenta el fracaso y/o la deserción escolar, y la expulsión de los estudiantes por parte de las instituciones; y en el área social se pueden presentar conductas agresivas y/o delictivas, contacto sexual de riesgo y otros problemas de conducta relacionados con el consumo de sustancias. De los diferentes programas existentes, resaltan las intervenciones breves en el tratamiento de usuarios que abusan pero que no dependen de las sustancias. Este tipo de intervenciones se basan en la Teoría del Aprendizaje Social y están diseñadas para reducir los patrones de abuso de alcohol u otras drogas. Sin embargo, la aplicación de las intervenciones breves se ha realizado principalmente en adultos, y es hasta últimas fechas que éstas se han adaptado a población adolescente que abusa de las sustancias, sin tenerse todavía resultados concluyentes. Es por esto que es fundamental desarrollar programas de intervención breve como una alternativa para adolescentes que inician el abuso de alcohol u otras drogas. Otro punto que requiere atención es el desarrollo de estrategias para detectar los casos en las escuelas, con la finalidad de ofrecer los servicios de atención en las propias instituciones educativas sin que el adolescente tenga consecuencias como la suspensión o la expulsión. Ante este fenómeno se ha recomendado fortalecer acciones que se basan en la identificación temprana de patrones de consumo que ponen en riesgo al adolescente a diferentes problemas relacionados con el abuso de las drogas. Estos programas se deben caracterizar por ser costo-eficientes, breves y capaces de instrumentarse en una variedad de escenarios, así como de aplicarse a una variedad de culturas. Por lo tanto, el objetivo de esta investigación fue desarrollar y evaluar un programa de intervención breve para adolescentes de entre 14 y 18 años de edad, estudiantes de nivel medio y medio superior, que consumen alcohol en exceso u otras drogas, y que presentan problemas relacionados con este patrón de consumo pero sin cubrir los síntomas físicos de la dependencia. Para realizar la evaluación se utilizó un diseño de caso único con 25 réplicas, 17 casos de consumo de alcohol y 8 casos de consumo de mariguana. De los 25 adolescentes que participaron en el estudio, 24 mostraron una disminución en el patrón de consumo (cantidad y frecuencia de consumo), al comparar las mediciones de los datos recabados en las fases de línea base, tratamiento y seguimiento. Así mismo, se dieron cambios en el nivel de auto-eficacia (percepción de la capacidad de los sujetos para controlar sus situaciones de consumo), es decir, al finalizar el tratamiento los adolescentes se percibieron a sí mismos con mayor capacidad para controlar la cantidad de consumo en situaciones de riesgo. Además, al final del tratamiento los sujetos reportaron una reducción del número de problemas relacionados con su consumo. Esta investigación es uno de los primeros esfuerzos por demostrar el impacto de las intervenciones breves en el patrón de consumo de los adolescentes. Las limitaciones del estudio fueron que no se determinó el efecto específico de cada uno de los componentes del programa ni tampoco se evaluó la presencia de otras conductas problemáticas (comorbilidad). Sin embargo, esta investigación ofrece un apoyo empírico a los programas de intervención breve en población adolescente de nuestro país.