Intervenção Breve para uso de Substâncias Psicoativas no Brasil: revisão sistemática / Brief Intervention for Psychoactive Substance use in Brazil: a systematic review

RESUMO As Intervenções Breves têm sido preconizadas há mais de 20 anos pela Organização Mundial da Saúde como uma estratégia de prevenção aos problemas relacionados ao uso de Substâncias Psicoativas, tendo como prioridade a aplicação nos serviços de atenção primária à saúde visando a diminuição dos riscos relacionados a esse fenômeno. Diante disso, o objetivo do presente estudo foi mapear e descrever as evidências científicas existentes na literatura sobre o uso de Intervenção Breve para o uso de Substâncias Psicoativas desenvolvidas no Brasil. Trata-se de revisão sistemática. As buscas foram realizadas em sete fontes de informações, em agosto de 2021. Todos os estudos foram desenvolvidos com abordagem quantitativa. O álcool esteve presente na maioria dos estudos, seguido da maconha e nicotina. O cenário predominante foi a unidade básica de saúde, com público de adultos de ambos os sexos e universitários. A maioria apresentou como proposta a Intervenção Breve grupal presencial e somente dez indicaram o referencial norteador da Intervenção Breve utilizada. No Brasil, as Intervenções Breves são incipientes e os estudos apresentados não destacam com exatidão o referencial norteador da intervenção utilizada.

ABSTRACT Brief Interventions have been recommended for more than 20 years by the World Health Organization as a strategy to prevent problems related to the use of Psychoactive Substances, with priority being applied in primary health care services in order to reduce the risks related to this substance. phenomenon. Therefore, the objective of the present study was to map and describe the existing scientific evidence in the literature on the use of Brief Intervention for the use of Psychoactive Substances developed in Brazil. This is a systematic review. Searches were carried out in seven sources of information in August 2021. All studies were developed with a quantitative approach. Alcohol was present in most studies, followed by marijuana and nicotine. The predominant scenario was the basic health unit, with a public of adults of both sexes and university students. The majority presented a brief face-to-face group intervention as a proposal and only ten indicated the guiding reference of the Brief Intervention used. In Brazil, Brief Interventions are incipient and the studies presented do not accurately highlight the guiding reference for the intervention used.

Motivação para mudança no consumo de bebidas alcoólicas: intervenção breve como estratégia motivacional / Motivation for change in alcohol consumption: brief intervention as a motivational strategy / Motivación para el cambio en el consumo de alcohol: la intervención breve como estrategia motivacional

RESUMO Objetivo: analisar o efeito da intervenção breve na motivação para mudança do consumo de bebidas alcoólicas. Método: estudo experimental, de follow-up, realizado com 43 participantes em duas Unidades Básicas de Saúde. Foi aplicado o Alcohol Use Disorders Identification Test, a Régua de Prontidão para Mudança e um questionário socioeconômico. Resultados: o grupo experimental apresentou mediana igual a 10 pontos (fase de manutenção) no início e após 30 dias. No segmento, mediana igual a oito pontos (estágio de ação). O grupo- controle, mediana igual a oito pontos no início e após 30 dias (fase de ação). No segmento, a mediana igual a sete pontos (fase de planejamento). Na avaliação intermediária de 30 dias, notou-se que houve diferença estatística na motivação entre os dois grupos (p=0,029). Conclusão: concluiu-se que a Intervenção Breve foi eficaz para manter a motivação nos estágios de ação e manutenção da mudança no consumo de bebidas alcoólicas.

ABSTRACT Objective: to analyze the effect of brief intervention on motivation to change alcohol consumption. Method: experimental, follow-up study, conducted with 43 participants in two Basic Health Units. The Alcohol Use Disorders Identification Test, the Change Readiness Ruler, and a socioeconomic questionnaire were applied. Results: The experimental group showed a median equal to 10 points (maintenance stage) at the beginning and after 30 days. In the segment, the median was equal to eight points (action stage). The control group had a median equal to eight points at the beginning and after 30 days (action stage). In the segment, median equal to seven points (planning stage). In the 30-day intermediate evaluation, it was noted that there was a statistical difference in motivation between the two groups (p=0.029). Conclusion: it was concluded that the Brief Intervention was effective in maintaining motivation in the stages of action and maintenance of change in the consumption of alcoholic drinks.

RESUMEN Objetivo: analizar el efecto de una intervención breve sobre la motivación para el cambio en el consumo de alcohol. Método: Estudio experimental, de seguimiento, realizado con 43 participantes en dos Unidades Básicas de Salud. Se aplicó el Alcohol Use Disorders Identification Test, la Regla de Disposición al Cambio y un cuestionario socioeconómico. Resultados: el grupo experimental mostró una mediana igual a 10 puntos (fase de mantenimiento) al principio y después de 30 días. En el segmento, la mediana era igual a ocho puntos (etapa de acción). El grupo de control tenía una mediana igual a ocho puntos al principio y después de 30 días (etapa de acción). En el segmento, la mediana es igual a siete puntos (fase de planificación). En la evaluación intermedia de 30 días, se observó que había una diferencia estadística en la motivación entre los dos grupos (p=0,029). Conclusión: se concluyó que la Intervención Breve fue eficaz para mantener la motivación en las etapas de acción y mantenimiento del cambio en el consumo de alcohol.

Investigación en intervención breve y consumo de alcohol durante la gestación: productividad e impacto

Objetivo: Describir la producción científica de las Intervenciones Breves (IB) para disminuir el consumo de alcohol durante la gestación y cuantificarla mediante indicadores bibliométricos. Método: Se realizó un estudio de investigación secundaria con un diseño de revisión estructurada que consistió en búsquedas sistemáticas en las bases de datos Lilacs, PsycINFO, PubMed, Scielo y Scopus. Para el análisis se accedió al documento completo y se registraron características y procedimientos de aplicación de IB de los documentos seleccionados. Resultados: Se analizaron 45 artículos, la mayoría de los Estados Unidos. La primera publicación fue en 1999 registrándose un incremento progresivo hasta la actualidad. La revista con más publicaciones fue Obstetrics and Gynecology y el idioma predominante el inglés. El 52% de los artículos corresponden a trabajos empíricos, y el resto a trabajos de reflexión y revisiones que en su mayoría, promueven la abstinencia durante la gestación. En los trabajos experimentales se compararon dos grupos, intervención y control, y se registraron dos modalidades: vía web y cara a cara (71%). Para tamizar consumo de alcohol el T-ACE fue el instrumento más recomendado y utilizado, junto con preguntas de cantidad y frecuencia. Conclusiones: La necesidad de contar con estrategias efectivas para evitar el consumo de alcohol durante la gestación está siendo cada vez más reconocida. Se espera que en los próximos años el crecimiento del número de publicaciones impacte en nuestro contexto latinoamericano donde hay escasez de publicaciones, aparentemente nulas en habla hispana, y donde existe una relevante necesidad de evidencia sobre estrategias efectivas en esta población.

Aims: To describe the scientific production of the Brief Interventions (BI) to reduce alcohol consumption during pregnancy and quantify it by bibliometric indicators. Method: A secondary research study was conducted with a structured design review. A systematic search of Lilacs, PsycINFO, PubMed, Scopus and Scielo databases was made. For the analysis, we accessed to the full document and then concentrated on the application and procedures of the BI characterized in the articles. Results: Forty-five articles, most from the United States were analyzed. In 1999 was the first publication and it has been a gradual increase until today. The journal which published more was Obstetrics and Gynecology and the language of all publications was above all English. Half of the articles were empirical works, and the rest, opinion articles, and reviews. Most of them promote alcohol abstinence during pregnancy. In all experimental works, two groups were compared: intervention and control and the BI was implemented by two procedures: via web or face to face (71%). Among all the alcohol consumption screening instruments, the most recommended and used was the T-ACE, along with quantity and frequency questions. Conclusions: The need for effective strategies to prevent alcohol consumption during pregnancy is being increasingly recognized. It is expected that in coming years the growth in the number of publications have an impact on our Latin American context, where there is a lack of publications, apparently null in Spanish speaking, and where there is a significant need for evidence on effective strategies in this population.

Transferencia tecnológica en el área de adicciones: El programa de intervención breve para adolescentes, retos y perspectivas / Technology transfer in the field of addictions: The brief intervention program for adolescents challenges and prospects

Los conocimientos que proporciona la psicología deben dar respuesta a diferentes problemáticas, lo que sólo puede lograrse cuando los hallazgos obtenidos por evidencia científica son asequibles a otros grupos científicos, y núcleos sociales, a fin de que éstos logren apropiarse y usarlos para solucionar problemas, mejorar su calidad de vida o prevenir una situación potencial de riesgo. Sin embargo, con frecuencia se observan diferentes barreras para la utilización efectiva de los conocimientos. Además, se tiene la falsa impresión de que la investigación en las ciencias de salud resulta una actividad poco responsiva ante las necesidades de los actores sociales que podrían beneficiarse de su uso. En este contexto, en el presente artículo se presenta una revisión general del concepto de transferencia tecnológica, los modelos que se han desarrollado para llevar a cabo ésta y un ejemplo de cómo se ha iniciado la transferencia de un programa de intervención en el ámbito de las adicciones en México y cuáles son sus retos para el avance de dicho proceso y su posible adopción en centros de atención a las adicciones. Se concluye que, para cumplir con la incorporación de tratamientos en instituciones de atención de adicciones, hace falta evaluar la efectividad del programa de intervención breve en escenarios clínicos, cumplir con todos los indicadores CONSORT de los ensayos clínicos aleatorizados e integrar al proceso de transferencia cuatro aspectos principales: 1. propiciar un mayor acercamiento con los profesionales de la salud; 2. permitir la "reinvención" del programa dentro de un contexto de colaboración entre los actores involucrados y evaluar dicho proceso; 3. considerar limitaciones, recursos, objetivos y prácticas de la institución donde se pretende transferir el programa y 4. ofrecer seguimiento a largo plazo para evaluar el éxito de la adopción de la innovación.

The knowledge provided by psychology should respond to different problems, which can only be achieved when the findings from scientific evidence become available to other scientific groups and social nuclei, in order to achieve them appropriately and use them to solve problems, improve their quality of life, or prevent a potentially hazardous situation. However, various barriers to the effective use of knowledge are often observed. In addition, there exists the false impression that research in the health sciences is an activity that rarely meets the needs of the social actors who might benefit from its use. In this context, this paper presents a general overview of the concept of technology transfer, the models that have been developed to perform this and an example of how the transfer of an intervention program in the field of addictions in Mexico has been started and what the challenges are to advancing this process and its possible adoption in addiction centers. The authors conclude that in order to comply with the incorporation of treatments at addiction treatment institutions, it is essential to evaluate the effectiveness of the brief intervention program in clinical settings, adhere to all the CONSORT indicators for randomized clinical trials and incorporate four main aspects into the transfer process: 1. foster closer relations with health professionals; 2. allow the "reinvention" of the program within a context of collaboration between stakeholders and evaluate this process; 3. consider the constraints, resources, objectives and practices of the institution to which the program is to be transferred, and 4. provide long-term monitoring to assess the success of the adoption of the innovation.

Intervenções breves para uso problemático de álcool: potencial de aplicação na prática do enfermeiro / Brief interventions on problematic alcohol consumption: potential for application in nursing practice / Intervenciones breves para uso problemático de alcohol: potencial de aplicación en la práctica del enfermero

O controle do uso problemático de álcool é uma das prioridades da saúde pública mundial. O objetivo deste manuscrito foi apresentar a finalidade, os principais elementos e a aplicabilidade das intervenções breves para o uso problemático de álcool, bem como refletir sobre seu potencial de aplicação na prática do enfermeiro. Para tanto, conduziu-se uma revisão narrativa de artigos científicos selecionados na Biblioteca Virtual em Saúde. Pela oportunidade de atuação do enfermeiro em diversos cenários, ele pode utilizar as intervenções breves durante a consulta de enfermagem assistindo seus pacientes no processo de tomada de decisão e em seus esforços para reduzir ou cessar o consumo de álcool. Assim o enfermeiro agirá preventivamente, exercendo sua autonomia profissional de maneira crítica e ativa, em direção a uma prática profissional cada vez mais responsável e autônoma.

Controlling problematical alcohol consumption is a public health priority worldwide. This manuscript presents the objectives, key elements and applicability of brief interventions on problematic alcohol consumption, as well as thinking about their potential applications to nursing practice. To this end, a narrative review was conducted of selected scientific articles in the Virtual Health Library. As nurses provide care in various different settings, they can use brief interventions during nursing to assist their patients in making decisions and in their efforts to reduce or cease alcohol consumption. In that way, nurses can act preventively, exercising their professional autonomy actively and critically, towards increasingly responsible and independent practice.

El control del consumo problemático de alcohol es una de las prioridades de la salud pública mundial.  El objetivo de este trabajo fue presentar la finalidad, los principales elementos y la aplicabilidad de las intervenciones breves para el uso problemático de alcohol, bien como reflexionar  sobre su potencial de aplicación en la práctica del enfermero. Para tanto, se condujo una revisión narrativa de artículos científicos seleccionados en la Biblioteca Virtual en Salud. Por la oportunidad de actuación del enfermero en diversos escenarios, él puede utilizar las intervenciones breves durante la consulta de enfermería asistiendo a sus pacientes en el proceso de tomar decisiones y en sus esfuerzos para reducir o cesar el consumo de alcohol. De esta forma el enfermero actuará preventivamente, ejerciendo su autonomía profesional de forma crítica y activa, en dirección a una práctica profesional cada vez más responsable y autónoma.

Efectos de la entrevista motivacional sobre la motivación autónoma en jóvenes consumidores de alcohol / The effect of motivational interviews on young drinkers' autonomous motivation

Objetivo Evaluar los cambios en la motivación autónoma y controlada en un grupo de adolescentes consumidores en riesgo y consumidores excesivos de alcohol, que recibió una intervención basada en la Entrevista Motivacional (EM). Métodos Se implementó una intervención grupal basada en la EM para observar sus efectos sobre los tipos de motivación. Se conformaron dos grupos, un grupo experimental, y un grupo control en un diseño pretest-postest. Participaron en total 63 adolescentes, 31 conformaron el grupo experimental, (80 % hombres) y 32 el grupo control (68 % hombres). La motivación autónoma y la motivación controlada se evaluaron mediante el TSRQ. Resultado El análisis de varianza muestra que los puntajes de la motivación autónoma no presentaron cambios estadísticamente significativos después de la intervención, mientras que la motivación controlada sí los presentó (p<.05), sugiriendo que la intervención promovió este tipo de regulación hacia el consumo moderado, expresada en términos de controles externos, por ejemplo, la aprobación social. Conclusión Estos resultados sugieren que la EM es una técnica promisoria para la intervención con adolescentes colombianos ya que tiene efectos positivos cuantificables sobre los dos tipos de motivación y probablemente la orientación motivacional hacia el control medió los resultados. Es importante considerar en el futuro la orientación motivacional individual y el género.

Objective Assessing changes in autonomous and controlled motivation in a group of young at risk consumers and excessive alcohol consumers receiving motivational interviewing-based (MI) Intervention. Methods MI-based group intervention was put into practice to observe its effects on types of motivation. Two groups were formed (an experimental and a control group) using pretest-posttest design. 63 adolescents participated: 31 formed the experimental group (80 % male) and 32 the control group (68 % male). The treatment self-regulation questionnaire (TSRQ) was used to evaluate autonomous and controlled motivation. Results Analysis of variance revealed that autonomous motivation scores had no statistically significant change after the brief intervention, whereas this was so with controlled motivation (p<.05), suggesting that brief intervention had promoted this type of regulation towards moderate consumption expressed in terms of an external control, such as gaining social approval. Conclusion The above results suggested that MI is a promising technique for intervention with Colombian adolescents as it had measurable positive effects on both types of motivation and motivational orientation toward control probably mediated the results. Individual motivational orientation and gender should be considered in the future.

Intervenciones breves con adolescentes estudiantes rurales que consumen alcohol en exceso / Brief interventions with adolescent rural students who drink alcohol in excess

Debido a la falta de programas dirigidos a prevenir y tratar el consumo excesivo de alcohol en adolescentes de comunidades rurales, se evaluaron dos modalidades de corta intervención: a) programa breve de cinco sesiones y b) sesión de consejo breve. En una primera fase se realizó un estudio exploratorio, obteniendo un cuadro descriptivo del consumo de alcohol en adolescentes de tres comunidades rurales, mientras que en un segundo momento, mediante un diseño de grupos de comparación, se determinaron los efectos de ambas intervenciones sobre el patrón de consumo y otras variables psicosociales en 24 adolescentes rurales del estado de Aguascalientes (México). Se concluyó que ambas modalidades de intervención son efectivas para el trabajo con adolescentes rurales usuarios de alcohol.

Due to the lack of programs designed to prevent and treat problems related to alcohol consumption in adolescents in rural communities, two brief intervention modalities were evaluated: a) a brief program with five sessions and, b) a brief advice session. During the first stage, an exploratory study was undertaken, on the basis of which a descriptive chart of alcohol consumption among adolescents in three rural communities was obtained, while in the second stage, comparison groups were designed to determine the effects of both interventions on consumption patterns and other psychosocial variables in a sample of 24 rural adolescents of the state of Aguascalientes, Mexico. The conclusion was that both interventions are effective in working with rural adolescent alcohol users.

Eficacia de un programa de intervenciones terapéuticas en estudiantes universitarios diagnosticados con dependencia al alcohol / Efficacy of a therapeutic intervention program among Mexican college students diagnosed with alcohol dependence

In recent years, consumption of alcoholic beverages has become a common practice among young adults attending higher education institutions in Mexico. Over the past two decades, prevalence of alcohol consumption in this population has doubled. In campuses located in Mexico City, 70-90% of undergraduate students have consumed alcoholic beverages during the past year and approximately 25% have engaged in binge drinking. Past year prevalence of Alcohol Dependence (AD) has been estimated in 4.6% and 18.4%. Higher education institutions around the world have implemented programs aimed at reducing students' drinking that have included educational interventions and/or psychosocial treatments delivered individually or in group format. In this regard, the available evidence suggests that programs that have included elements of the Motivational Enhancement Therapy (MET) or components of the Cognitive Behavioral Therapy (CBT) have shown the greatest efficacy in reducing drinking problems in this population. Despite this, there are no studies examining the efficacy of these interventions in Mexico's college student population. In the report presented here, we aim at examining the efficacy of Individual or Group MET and CBT in reducing drinking among undergraduate students diagnosed with AD. We hypothesized that in comparison to CBT, MET would show evidence of a greater reduction in alcohol consumption. To evaluate this hypothesis we examined the treatment effects on the number of consumed drinks, on the number of drinking days, and on the number of drinks per drinking day during the preceding 30 days. Methods We prospectively evaluated during an 8-week treatment phase and during a 12-month follow-up period, 158 undergraduate students who received a diagnosis of AD (ICD-10) at the students' Mental Health and Counseling Center of the National Autonomous University of Mexico (UNAM) in Mexico City. Instruments. In order to screen and to establish the diagnosis of AD we respectively used the Alcohol Use Disorders Identification Test (AUDIT) Mexican version and the Composite International Diagnostic Interview (CIDI). We also used The Alcohol Time line Followback (TLFB) method to retrospectively record the amount and frequency of alcohol consumption. Procedures. Students seeking services at the UNAM Mental Health and Counseling Center, and who had a diagnosis of AD, were invited to participate in the study. After informed consent was obtained, they were randomly assigned to one of four manualized treatment interventions: Individual or Group MET, or Individual or Group CBT. These were delivered in eight weekly sessions lasting one hour. The alcohol TLFB was administered at the beginning and at the end of the 8-week treatment phase, and subsequently monthly for the following 12 months. Statistical analysis. An analysis of variance (ANOVA) for repeated measures was used to examine the treatment effect on drinking during the treatment phase and separately during the 12-month follow-up period. A one-way ANOVA was used to examine differences between treatment groups at specific assessment points. Results Demographic characteristics. In the entire sample the majority of students were men (73.2%), while the mean age was 18.8 [± 2.9] years. There were no differences between intervention groups in their demographic characteristics. Baseline characteristics of alcohol consumption. In the entire sample and separately in each of the intervention groups there was a predominant pattern of weekly heavy drinking. There were no baseline differences between treatment groups in the monthly amount or frequency of drinking, or in the number of drinks consumed during drinking days (all comparisons P>0.50). The average number of Alcohol Dependence symptoms was 6.0 [± 2.6]. There were no differences among groups in the number of these symptoms (P=0.10). Patient Retention during the Treatment Phase and the Follow-up Period. At the end of the 8-week treatment phase, 92% of the students remained in treatment. During this phase, the Individual CBT group had the greatest number of dropouts with 18% of them leaving prematurely (Pearson X² = 15.7, df=3, P = 0.001). During the follow-up period, specifically at the 3, 6 and 12-month follow-up, the retention rates in the study were respectively 91%, 89% and 86%. There were no differences among groups in this variable at any of these follow up points. Alcohol consumption during the treatment phase. In the ANOVA for repeated measures we found that during the treatment phase there was a main effect of time over the three indicators of alcohol consumption (range of F: 7.59-11.81, df=1.142, range of P:0.001-0.007). This reflected the fact that at the end of the four interventions there was a reduction in the amount and frequency of monthly drinking and a reduction in the number of drinks during drinking days. There were no main effects of treatment (range of P:0.07- 0.56) or interactive time X treatment effects (range of P:0.55 to 0.79) on any of the drinking variables. However, at the level of a non-significant trend (F = 2.37, df=3.143, P = 0.07), there was a treatment effect reflecting that in comparison to Individual CBT, there was a trend toward a greater reduction in the frequency of monthly drinking in Group MET (one-way ANOVA: F=2.60, df=3.146, P=0.05, Tukey HSD P=0.07). Alcohol consumption during the follow-up period. In the ANOVA for repeated measures, there was a main effect of time on the amount and frequency of monthly alcohol consumption (range of F: 8.54-9.53, df=3.393, P range: 0.001-0.004), reflecting that during this period there was a reduction in these two drinking variables in the entire sample. This effect was observed mainly during the first six months of follow-up. During the following six months, there was a gradual increase in the amount and frequency of drinking (range of F for the quadratic component of Time: 5.36-10.36, df=1.131, range of P: 0.02-0.002) that approached the levels seen at the end of treatment. There were no main effects of time on the number of drinks consumed during drinking days (P=0.27). There was a treatment X time interaction (F=2.65, df=3.131, P=0.05) on monthly frequency of drinking, indicating that, in comparison to Individual CBT, there was a greater reduction in this drinking variable in Group MET. This effect was specifically observed during the first three months of follow-up (one-way ANOVA: F=3.63, df=3.142, P=0.02, Tukey HSD P=0.007). Subsequently, there were no differences among the intervention groups in this variable for the remaining nine months of follow-up. Finally, there were no main effects attributable to treatment or interactive effects of time X treatment on the number of monthly drinks (P range: 0.49 to 0.65) or on the number of drinks consumed per drinking day (P range: 0.55 to 0.79). Discussion In this sample of alcohol dependent college students, we found that at the end of the 8-week treatment phase there was a comparable reduction in the amount and frequency of alcohol consumption and in the number of drinks consumed during drinking days across the four intervention groups. However, we observed that at the level of a non significant trend (P=0.07), Group MET appeared to be more effective than Individual CBT in reducing the frequency of alcohol drinking.

Introducción Se ha descrito que entre los estudiantes de educación superior de nuestro país la prevalencia del consumo de alcohol se ha duplicado durante las últimas dos décadas. Se han estimado prevalencias durante los últimos 12 meses del diagnóstico de Dependencia al Alcohol (DA) de 4.6%. Aunque se desconoce la magnitud de las consecuencias de estos problemas entre los estudiantes universitarios mexicanos, en Estados Unidos han sido identificados como un problema de salud pública mayor y como el principal problema de salud en las universidades. Para reducir estos problemas, se ha evidenciado que las intervenciones como la Terapia de Incremento de la Motivación (TM) o la Terapia Cognitivo Conductual (TCC) podrían ser igualmente efectivas a largo plazo. Se ha observado una ligera ventaja del formato individual sobre el grupal. Pero al analizar el costo-beneficio, el formato grupal suele ser el más utilizado en las universidades. A pesar de la importancia de los problemas por consumo de alcohol en las universidades y no obstante la efectividad demostrada de estas intervenciones, no hay, hasta lo que sabemos, investigaciones publicadas que comparen la eficacia de la TM y la TCC en el tratamiento de los universitarios con problemas por consumo de alcohol en México o en otros países de habla hispana. Objetivo Examinar los efectos de las intervenciones TM y TCC tanto en su modalidad individual como grupal, en el tratamiento de estudiantes universitarios con diagnóstico de dependencia al alcohol. Material y métodos Se evaluó prospectiva y comparativamente a 158 estudiantes universitarios con diagnóstico de Dependencia al Alcohol. Instrumentos: 1. Alcohol Use Disorders Identification Test (AUDIT); 2. Composite International Diagnostic Interview (CIDI); 3. Línea Base Retrospectiva (LIBARE); 4. Cuestionario de Datos Demográficos. Procedimientos. A los estudiantes con problemas con su manera de beber, se les aplicó el AUDIT; a los que tuvieran respuestas positivas para Dependencia al Alcohol, se les aplicó la sección de <

<>: Programa breve de sensibilización sobre violencia en el noviazgo / <>: Raising awareness of dating violence through a brief intervention

Introduction Dating violence, a recent topic in scientific investigation, has an incidence ranging from 22% to 33% among young people. These findings are supported by a previous study that showed that about one third of high school and college students have experienced physical violence from a dating partner. Similarly, National and international studies (e.g. National Survey on Family Relations Dynamics and the International Dating Violence Study) found an incidence of violence between dating partners ranging from 10% to 45% among college students worldwide. Although there is evidence that men also experience violence perpetrated by women and that violence occurs in same sex relationships, the research continues to show that violence is usually perpetrated by men against women. However, past studies have focused on the occurrence of physical violence which signals the possibility that other types of violence, such as emotional or social, have a higher incidence. Their incidence varies and the harmful physical, emotional, and social consequences that they imply point to the need of creating prevention programs targeted at youth populations. It is important to prevent violence in a first stage by raising youth's awareness of this problem and, ideally, also by achieving a change in their behaviors and attitudes as well as in the social norms that promote its occurrence. In order to address all of these components of prevention, programs have been developed that do not only inform youth about violence, but also facilitate the formation of social skills through active participation and role playing which allows individuals to practice new models of interaction that are violence free. In addition, programs have to consider that many schools lack the disposition or the resources to impart long prevention workshops. For this reason, the development of brief prevention strategies has become imperative. The program «I want to, I can… prevent violence: Raising awareness of dating violence through a brief intervention¼ was developed, implemented, and evaluated with the objective of raising youth's awareness and increasing their knowledge about dating violence, its precursors related to gender and cultural norms and its physical, emotional, and social consequences. Materials and method The program consisted of eight interactive conferences imparted at different public high schools in Mexico. The conferences reached a total of 2250 participants in four different urban areas in the country. The conferences consisted of a presentation and different interaction exercises with a total duration of two hours and thirty minutes. The topics covered in each conference were: life skills (assertive communication, negotiation, decision-making), differentiation of the concepts of sex, sexuality and gender and how these are related to violence, what is and how to recognize violence, types of violence, gender roles and stereotypes, how to recognize violence in a dating relationship, and how to express love in a healthy way. A questionnaire, which included the following sections, was developed to assess participants' attitudes toward violence: a) Ability to recognize violence in everyday interactions: Identifying signs of violence in the behaviors and attitudes of characters presented in eight different cases of interactions between dating partners. b) Attitudes toward violence: Rating levels of agreement with statements that promote or discourage violence. c) Causes of violence: Ten causes of violence related to social norms that encourage men's aggression and promote gender inequality are presented; participants must identify the five that are false and the five that are true. d) Healthy ways of expressing love: Recognition of behaviors and signs in a dating relationship that imply the presence or the lack of love. The impact of the conference was evaluated by applying this brief questionnaire to a random sample of participants before and after the conferences. Across all high schools, a total number of 311 questionnaires were completed by participants before the conferences and 184 were completed after the conferences. Ideally, there should have been a longer term follow-up for which no funds were available. An explanatory model within the framework of the Item Response Theory (IRT) was used to analyze collected data. Results The results showed that the conference improved the participants' ability to identify violence and its causes as well as their understanding of healthy ways of expressing love. Responses also indicated favorable attitudes toward nonviolence both before and after the conference. The findings also suggest that participants might require more time to learn how to fully recognize assertive and violent communication as well as false causes of violence and that, ideally, programs should be undertaken to change behaviors not only create awareness and thus be carried out in smaller groups. An analysis of gender differences in responses to the questionnaire shows that women where better able to recognize violence, its causes, and healthy ways of expressing love. Women also had more favorable attitudes toward nonviolence. Discussion The findings show that raising awareness about dating violence through an interactive conference is an efficient brief first stage prevention strategy because it can promote important changes in participants' attitudes through a brief intervention. Participating adolescents showed an increase in their knowledge and awareness about the subject which allowed them to improve their recognition of violence in everyday life. The increase in their ability to recognize healthy ways of expressing love also points to an understanding of romantic relationships that does not exclude autonomy, assertiveness, and honesty. These changes could facilitate the participants' ability to identify myths and misinformation related to the causes of violence. In addition, awareness-raising can initiate a process of questioning and changing social norms that promote gender inequality, jealousy, and control as acceptable forms of violence within dating relationships. Gender differences in the findings suggest that men might need more time than women to fully understand the problem of dating violence which can be attributed to traditional gender role expectations related to violence and gender relationships. This signals the need to increase prevention programs' focus on masculinity, male roles in dating relationships, and how they can express feelings without violence and without limits related to gender stereotypes. The program's achievements indicate the importance of finding strategies that allow large audiences to learn about dating violence, recognize violence in everyday social interactions and understand how to ask for help. The interactive nature of the program goes beyond giving information to a large number of people as it allows participants to practice relationship skills and promotes reflection on the subject of violence. Throughout the program's implementation, schools demonstrated a great interest in raising awareness about dating violence. It would be convenient to utilize their interest in order to further implement prevention programs. The interactive and brief nature of our program allows schools to resolve the problem of lack of time and resources that might deter their participation. Preventing intimate partner violence must begin during adolescence in order to impede the development of unhealthy patterns of interaction that may become harder to change in adulthood.

Introducción La violencia en el noviazgo es un tema reciente en la investigación científica, cuya incidencia en personas jóvenes va de 22 a 33%. Aun cuando hay evidencias de mujeres que agreden a sus parejas masculinas y también existe violencia entre parejas del mismo sexo, la violencia de pareja sigue siendo predominantemente de control del hombre hacia la mujer. La incidencia de este tipo de violencia y sus consecuencias físicas, emocionales y sociales señalan la necesidad de crear programas de prevención en poblaciones jóvenes. Sin embargo, también debe tomarse en cuenta que en muchas escuelas no existe aún la disposición o los recursos para ofrecer talleres de prevención de larga duración enfocados a esta problemática. Por ello, resulta imperioso contar con estrategias breves que lleven a largo plazo a cambios de conductas en los jóvenes. El primer paso para lograr la prevención es la sensibilización en torno a esta problemática, lo cual permite empezar un proceso de cambio de normas sociales sobre el tema. El programa «Yo quiero, yo puedo… prevenir la violencia: Programa breve de sensibilización sobre violencia en el noviazgo¼ se desarrolló, instrumentó y evaluó con el objetivo de sensibilizar e incrementar la información que tienen las y los jóvenes sobre los antecedentes culturales y de género relacionados con la violencia en el noviazgo y sus consecuencias a nivel físico, emocional y social. Material y métodos Se impartieron ocho conferencias en preparatorias públicas en México; el total de participantes fue de 2250. Se elaboraron una presentación y un guión para impartir conferencias interactivas con duración de dos horas y treinta minutos dirigidas a jóvenes de nivel medio superior. Algunos de los temas incluidos en las conferencias fueron: habilidades para la vida, qué es y cómo reconocer la violencia, tipos de violencia, su relación con estereotipos de género y formas saludables de expresar el amor. Asimismo, se desarrolló un instrumento para evaluar conocimientos sobre y actitudes hacia la violencia, dividido en cuatro secciones. El impacto de la conferencia interactiva se evaluó mediante la aplicación de este instrumento antes y después de la conferencia impartida a una muestra al azar de la población beneficiada. Aunque idealmente se recomienda hacer un seguimiento del impacto del programa a largo plazo, la falta de recursos no lo permitió en este caso. Para el análisis de datos optamos por la aplicación de un modelo explicativo dentro del marco de la Teoría de Respuesta al Ítem (TRI). Resultados Se logró que los participantes tuvieran un mayor reconocimiento de la violencia y de sus causas. También se logró que los participantes identificaran formas saludables de expresar el amor. Asimismo, los resultados demuestran que los alumnos entendieron que en las relaciones de noviazgo se pueden dar situaciones violentas. Discusión Los hallazgos muestran que la estrategia de sensibilización sobre el tema de la violencia, por medio de una conferencia interactiva, es eficiente ya que logra el objetivo planteado. Una conferencia de corta duración puede promover cambios importantes respecto a un mayor conocimiento y sensibilización frente a la problemática de la violencia. Ello facilita la identificación de situaciones de violencia en la vida cotidiana y el abandono de mitos y creencias falsas relacionadas con las causas de la violencia. Este tipo de programas interactivos y breves, que promueven la reflexión y la aplicación de habilidades relacionales, permite resolver problemas de falta de tiempo para la sensibilización en torno a la violencia en el noviazgo. Asimismo, hacerlo con grandes números de alumnos aumenta el beneficio a un menor costo. Las conferencias interactivas como la aplicada en este estudio abren canales de comunicación sobre el tema en los ambientes escolares y propician la formación de redes de ayuda al respecto.