ABSTRACT
OBJECTIVE: The purpose of this study was to asess the efficacy of an intensive outpatient treatment (IOT) for substance use disorder (SUD) using a multidimensional approach. METHODS: All the patients consecutively admitted to a private institution between May 2019 and May 2020 were invited to participate in the study. The program consisted in a 12-month set of psychosocial, medical and recreative interventions requiring an attendance of at least 9 hours per week. Efficacy was evaluated at admission and every three months by the Addiction Severity Index (ASI). Quality of life was evaluated at admission and at the end of the treatment by the WHOQOL-Bref questionnaire. A comparison of parameters obtained at admission between the group that completed and the one that abandonned the treatment was also performed to detect potential predictors of early dropout. Six months after the end of the treatment, the participants were contacted in order to repeat an evaluation through the ASI and the WHOQOL-Bref scales. RESULTS: 41 participants (73% male, age 42.8 ± 16 years) were included. 14 participants dropped out at a median time of 88 days. Among those who completed the treatment improvements were observed in different clinical dimensions: in alcohol and drug consumption (3 months), in medical problems (6 months), in family/social relationships (9 months), in psychological scores (12 months) and in the four dimensions of WHOQOL-Bref. No changes were observed in legal problems and in the employment status. Only legal problems and family/social relationships at admission were significantly different among patients who completed versus those who dropped-out. Six months after discharge, no differences in WHOQOL-Bref scores were observed in the 15 participants who could be located and accepted the assessment. A little but statistically significant worsening was observed in the psychological problems dimension of the ASI in post-discharge follow-up. The rest of the ASI dimensions remained unchanged 6 months after concluding the treatment. CONCLUSION: This is one of the few studies performed in a latinamerican setting assessing the efficacy of a long-term IOT for SUD. It confirms previous works from developed countries, showing the potential benefits of IOTs implementation in our region.
OBJETIVO: Evaluar la eficacia de un tratamiento ambulatorio intensivo (TAI) para el trastorno por uso de sustancias (TUS) utilizando un enfoque multidimensional. Métodos: Se incluyeron todos los pacientes admitidos consecutivamente en una institución privada entre mayo de 2019 y mayo de 2020. El programa duró 12 meses y consistió en un conjunto de intervenciones médicas, psicosociales y recreativas, con una intensidad ≥ 9 horas/semana. La eficacia fue evaluada comparando los puntajes en el Índice de Severidad de Adicción (ASI) a lo largo del programa y en el cuestionario WHOQOL-Bref al inicio y al finalizar. En 15 pacientes se realizó una nueva medición seis meses después de concluido el tratamiento. MÉTODOS: Se incluyeron todos los pacientes admitidos consecutivamente en una institución privada entre mayo de 2019 y mayo de 2020. El programa duró 12 meses y consistió en un conjunto de intervenciones médicas, psicosociales y recreativas, con una intensidad ≥ 9 horas/semana. La eficacia fue evaluada comparando los puntajes en el Índice de Severidad de Adicción (ASI) a lo largo del programa y en el cuestionario WHOQOL-Bref al inicio y al finalizar. En 15 pacientes se realizó una nueva medición seis meses después de concluido el tratamiento. RESULTADOS: Se incluyeron 41 participantes (73% hombres, edad 42,8 ± 16 años). 14 participantes abandonaron (media 88 días). En los participantes que completaron el tratamiento, se observaron mejoras en los índices de alcohol y drogas (a los 3 meses), en problemas médicos (a los 6 meses), en las relaciones sociales y familiares (a los 9 meses) y en problemas psicológicos (a los 12 meses) así como en las cuatro dimensiones del WHOQOL-Bref. Estas mejoras persistieron en la evaluación 6 meses post-alta cuando sólo un empeoramiento leve en la dimensión de problemas psicológicos del ASI fue objetivado. Conclusión: Este es uno de los pocos estudios realizados en un ámbito latinoamericano que evalúa la eficacia de un TAI para el TUS. Confirma trabajos previos de países desarrollados, mostrando los beneficios potenciales de la implementación de TAIs en nuestra región. CONCLUSIÓN: Este es uno de los pocos estudios realizados en un ámbito latinoamericano que evalúa la eficacia de un TAI para el TUS. Confirma trabajos previos de países desarrollados, mostrando los beneficios potenciales de la implementación de TAIs en nuestra región.
Subject(s)
Outpatients , Substance-Related Disorders , Humans , Male , Adult , Middle Aged , Female , Quality of Life/psychology , Argentina , Aftercare , Patient Discharge , Substance-Related Disorders/therapy , Substance-Related Disorders/psychology , Surveys and QuestionnairesABSTRACT
INTRODUCTION: The current COVID-19 pandemic highlights the different difficulties that healthcare workers have to face in this context. In order to quantify some aspects of the current working situation, the Asociación de Psiquiatras Argentinos (APSA) designed a survey for Mental Healthcare workers. The goal was to: measure and know what are the working conditions of those working in Mental Health in Argentina, in this pandemic context. METHODS: Cross sectional descriptive study. Convenience sample. The survey was designed and sent in a digital format, thru APSA means of communication. The survey had 27 questions and one comments option. Questions explored sociodemographic variables, worked related aspects and discrimination suffered by participants. RESULTS: The survey, in its digital format, was answered by 710 participants. 32% of those in the public sector pointed out that people needed to bring their own personal protective equipment, compared to 56% in the private sector. For protocols in place, nearly 82% of public sector responses said there is a protocol for COVID-19 compatible symptoms in patients, compared to 58% in the private sector. And for new patients in an inpatient facility, responses showed that more than 50% had a protocol in the public sector, vs less than half in the private setting. CONCLUSIONS: This survey and the results allows to know and have evidence on which were the working conditions at the beginning of the pandemic. Having a plan considering what is known and what is available, allows a more appropriate approach, for both the workers and those who depend on them for care.
Subject(s)
COVID-19 , Pandemics , Argentina/epidemiology , Cross-Sectional Studies , Health Personnel , Humans , SARS-CoV-2ABSTRACT
The Substance Use Disorder (SUD) alters the patient's social, family and working performance significantly, together with mental and physical health. The Dispositivo Pavlovsky (DP) is an outpatient and intensive treatment modality for users/ clients that do not require an inpatient facility but do need a more intensive approach than traditional/classic outpatient treatment. The DP has a battery of therapeutic proposals protocolized within a pre-established framework and adapted to the patient's needs. Given the intensity of treatment, it provides a better psychical support and promotes abstinence among the users/clients, who, because of their pathology, present common features of ambivalence towards suspending the consumption of the problematic substance. Overall, the therapeutic proposal is characterized by offering and promoting the use of tools and strategies for the daily life, such as intensive Group Therapy Setting, Individual Therapy, Psychiatric Consultation, Toxicology consultation, attendance to workshops, creating a participatory network, that provides a group setting support oriented towards psychoeducation, and accompaniment of the patience. The DP has interdisciplinary teams with diverse theoretical frameworks. These professionals keep a fluid communication, with formal exchange settings, intervening in the directionality of the treatment in general and delving deep in each particular case.
