Urgencias en consumidores de Cannabis en Barcelona / Emergencies in cannabis users in Barcelona, Spain

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Substance use among non-fatally injured patients attended at emergency departments in Spain.

AIMS: To describe the prevalence of recent use of alcohol, medication, and illegal drugs among patients who attended emergency departments (EDs) as a result of suffering an injury due to any external mechanism and to identify factors associated with alcohol and drug use. METHODS: A cross-sectional study was conducted in eight university hospitals in Spain. Participants were adult patients admitted to a trauma ED. Oral fluid was used to test for psychoactive substances analyzed by gas chromatography-mass spectrometry. Socio-demographic data and information on circumstances of the injury were collected through interviews. RESULTS: The analysis included 1579 patients admitted to the EDs (56.4% men). Among young people (< 40 years), 21.4% of men and 8.5% of women were positive for any illegal substance, primarily cannabinoids or cocaine; 24.7% of men and 14.8% of women were positive for alcohol. Among patients > or = 40 years, 7.4% of men and 1.6% of women were positive for any illegal substance, and 16.3% and 11.0% respectively for alcohol. Prevalence of substance detected varied across mechanism of injury, gender and age group. Night-time injury was associated with substance use. CONCLUSIONS: A high proportion of injured patients who were treated in an EDs tested positive for psychoactive drugs. Routine testing at trauma departments would maximize the identification of patients who may benefit from referral to specialized addiction treatment centers, or brief interventions.

Young people's perceptions of traffic injury risks, prevention and enforcement measures: a qualitative study.

The purpose of this qualitative study is to investigate young people's perceptions, in Barcelona, Spain, about the evolution, magnitude, causes and determinants of traffic crashes, to describe their opinions on road safety regulations, and to explore their suggestions and proposals. Interviews were conducted with 43 key informants and 12 focus groups involving 98 participants. Discussion guides were designed to get insight on perceptions of relevance and trends in road traffic injuries, determinants of these, regulations and enforcement, as well as to gather their own ideas for reducing traffic injuries. Young people are aware that traffic injuries are a relevant and increasingly serious problem. The main determinants identified are: driving under the influence of drugs and alcohol, fatigue, night driving, unsafe infrastructures, age of drivers and lack of public transport alternatives. Young people admit that fines, speed cameras and alcohol breath testing reduce risky driving. They prefer community work to fines. They have a poor image of public administrations in charge of prevention of traffic injuries. They demand information on traffic regulations and politicians' decisions, and a considerable increase in weekend and night time public transport. Effectiveness of interventions to reduce traffic injuries can be improved by taking the recipients' perceptions into account.

Simple advice for injured hazardous drinkers: an implementation study.

AIM: To evaluate the implementation of a screening and intervention procedure for hazardous drinkers in the routine praxis of an emergency service, without increasing the ED (emergency department) staff. METHODS: Four stages of the implementation process were undertaken: exploration and adoption, programme installation, and initial implementation. Two hospitals participated, with a coordinator, four trainers and all the emergency nursing staff. Eligible patients were males over age 15 presenting at the weekend with a traffic injury. Screening was performed with five questions (the three items of alcohol use disorders identification test (AUDIT-C) plus two questions about drinking within 6 h before the crash). Hazardous drinkers and drivers who had driven while intoxicated were offered simple advice. The programme implementation was evaluated by reviewing the patients' forms and by interviews and surveys of the nursing staff. RESULTS: The study lasted for 27 weeks. Knowledge and compliance with the programme were good. However, only 25% of the eligible patients were identified. Simple advice was accomplished by 94.7% of those in need of it. Although the majority of nurses felt at ease performing the intervention, 75% considered the programme as a work overload and only 21% reckoned that it was feasible for the emergency service. CONCLUSION: The emergency setting poses important barriers to the implementation of brief interventions.

Does the short form of the Alcohol Use Disorders Identification Test (AUDIT-C) work at a trauma emergency department?

The accuracy of the consumption items of AUDIT (AUDIT-C) was analyzed, using the full AUDIT score as gold standard, in 120 traffic casualties (78% men and 22% women), median age 27 years (IQR = [22-34]), entering an urban emergency room between 2001 and 2003, with (67%) and without (33%) a positive blood alcohol level (> or =0.2 g/L). Sensitivity, specificity, predictive value, overall accuracy, and receiver operating characteristics of AUDIT-C were measured. Diagnostic accuracy was 0.79, using cutoff indices of > or =5 for males and > or =4 for females. AUDIT-C may be useful in emergency departments for a stepwise screening. Further validation of this test with larger samples and different settings is warranted.

[Why is it so difficult to legislate on alcohol in Spain?]. / Por qué es tan difícil legislar sobre alcohol en España?

Wine belongs to the Mediterranean culture. Drinking alcohol is part of our social life, and its negative consequences have often been minimised, blame being apportioned rather to the individual, who doesn't know how to drink, than to the agent causing the harm. In recent years, road accidents and binge-drinking among young people have put alcohol on the political agenda. Adolescents and young adults have increased their consumption, and a pattern of binge-drinking has developed based on the open-air 'fiesta' nightlife, where groups of young people drink large bottles in the streets and squares (botellón). Educational campaigns and material have been mounted and produced, but two consecutive draft laws on measures for the prevention of alcohol-related harm have failed to be approved, coming up on both occasions against the same vested interests. This editorial reviews the ambivalence of society towards regulations on alcohol and the current state of the art. The first draft law (2002) was about preventing alcohol problems in the general population; the second (2006) was limited to the question of prevention among minors. Nobody could oppose it, not even the industry. However, an interested bias put the accent on wine--which allegedly should be considered not as alcohol but rather as food, and consequently removed from the law--so that discussion of the draft law became a 'wine war', with predictable consequences. Once again, a draft law on alcohol was shelved sine die and tossed into a corner to gather dust. WithIn this pessimistic scene, though, there are still some positive signs. No economic or political motives should constitute an obstacle to the protection of minors, at the very least.

Políticas para reducir el daño causado por el consumo de alcohol: una aproximación desde la salud pública / Policies to reduce harm caused by alcohol use: a public health perspective

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Do young heroin users in Madrid, Barcelona and Seville have sufficient knowledge of the risk factors for unintentional opioid overdose?

To identify the self-perceived reasons for unintentional opioid overdose of young heroin users in three Spanish cities and their agreement with objective risk factors for overdose. Computer-Assisted Personal Interviews (CAPI) were held with 991 street-recruited current heroin users aged 18-30. The general reasons for overdose and the reasons for the last overdose suffered were explored with open-ended (OEQs) and pre-coded questions (PCQs). Limited knowledge of overdose risk factors was defined as mention of fewer than two objective risk factors for unintentional overdose in the OEQ. Univariate, bivariate, and logistic regression methods were used. 77.8% (Seville), 64.9% (Madrid) and 57.2% (Barcelona) of participants have limited knowledge of overdose risk factors. Residence in Seville and not having attended courses or meetings on overdoses were significantly associated with limited knowledge, after adjusting for other factors. The most frequently identified general reasons in OEQ or PCQ were using heroin in large amounts (66.8%), together with tranquilizers (62.0%), adulterated (60.7%), or purer than usual (57.6%). Most reasons were selected more frequently in PCQ than in OEQ, especially rapid injection of the entire dose and using heroin shortly after using tranquilizers or alcohol, by injection, or after a period of abstinence. The results were similar for overdoses suffered by participants. Most young heroin users do not have sufficient knowledge of overdose risk factors, especially the use of heroin by injection, after a period of abstinence, or together with alcohol or methadone. Specific informational or educational programs adapted to the local context are critically needed.

[New and old addictions: implications for public health]. / Nuevas y viejas adicciones: implicaciones para la salud pública.

According to certain authors, any pleasure giving behaviour may become a habit, and depending on the circumstances, an addiction. The objective of this study is to examine the situation of addictions in Spain and the responses generated by health policies. In recent years, both the type and pattern of drug consumption in Spain, has undergone a noticeable change. Studies of the evolution of tobacco consumption suggest that the peak has passed, even though prevalence is still high. Alcohol consumption per capita has fallen by 25% in the last 25 years. During the same period, pattern of consumption has been modified. Sporadic drinking, in episodes of binging and drinking away from meals, is one of the patterns on the rise. According to the European Monitoring Centre for Drugs and Drug Addiction, in Spain, 27.8% of the population between 15- 64 years old has consumed an illegal drug at least once in their lives, with the prevalence rising to 38% among the 15- 34 year olds. Cannabis is the most consumed (29% among 1564 age group), followed by cocaine (5.9%), and ecstasy (4.6%). Spain, comparing with other countries of European Union, is the third in cannabis, ecstasy, and amphetamine and the first in cocaine consumption. With respect to the so-called behavioral addictions, no consensus in the field of psychiatry has been reached. The only psychological addiction with clear diagnostic criteria is gambling. The rest (Internet, sex, etc.), perhaps for their novelty, continue to be the object of controversy. New addictions, as much to addictive substances as to addictive behaviors, run parallel to the development of industrialized societies, leisure, free time, and a new way of life. This is the new challenge for Public Health.

Nuevas y viejas adicciones: implicaciones para la salud pública / New and old addictions: implications for Public Health

Según algunos autores, cualquier conducta placentera podría ser susceptible de convertirse en hábito y, según las circunstancias, en dependencia. El objetivo de este trabajo es realizar un repaso de la situación de las adicciones en España y de las respuestas en políticas de salud que se han desplegado. En los últimos años España ha experimentado un notable cambio en el tipo y en los patrones de consumo de sustancias psicoactivas. La evolución del consumo del tabaco sugiere que el pico de la epidemia ya ha pasado, aunque la prevalencia es aún alta. El consumo per cápita de alcohol en los últimos 25 años se ha reducido en un 25%. Durante el mismo período, el patrón de consumo se ha modificado. El consumo esporádico, en episodios de «atracones» y la ingesta fuera de las comidas, se ha revelado como uno de los patrones en alza. Según el Observatorio Europeo de las Drogas y las Toxicomanías, en España el 27,8% de la población comprendida entre los 15 y los 64 años ha consumido una droga ilícita al menos una vez en su vida y esta prevalencia era del 38% en la población de 15 a 34 años. El cannabis es la sustancia más consumida (29% de la población de 15-64 años), seguida por la cocaína (5,9%) y el éxtasis (4,6%). España es el tercer país de la Unión Europea en consumo de cannabis, éxtasis y anfetaminas y el primero en consumo de cocaína. Con respecto a las denominadas adicciones comportamentales, no existe consenso en el campo de la psiquiatría. La única adicción psicológica con criterios diagnósticos claros es el juego patológico, el resto (Internet, sexo, etc.), probablemente por su novedad, sigue siendo objeto de controversia. Las nuevas adicciones, tanto las producidas por nuevas sustancias como las del comportamiento, van en paralelo al desarrollo de las sociedades industrializadas, al ocio, al tiempo libre y a una nueva forma de vida. Éste es un nuevo reto para la salud pública (AU)

According to certain authors, any pleasure giving behaviour may become a habit, and depending on the circumstances, an addiction. The objective of this study is to examine the situation of addictions in Spain and the responses generated by health policies. In recent years, both the type and pattern of drug consumption in Spain, has undergone a noticeable change. Studies of the evolution of tobacco consumption suggest that the peak has passed, even though prevalence is still high. Alcohol consumption per capita has fallen by 25% in the last 25 years. During the same period, pattern of consumption has been modified. Sporadic drinking, in episodes of binging and drinking away from meals, is one of the patterns on the rise. According to the European Monitoring Centre for Drugs and Drug Addiction, in Spain, 27.8% of the population between 15- 64 years old has consumed an illegal drug at least once in their lives, with the prevalence rising to 38% among the 15- 34 year olds. Cannabis is the most consumed (29% among 15–64 age group), followed by cocaine (5.9%), and ecstasy (4.6%). Spain, comparing with other countries of European Union, is the third in cannabis, ecstasy, and amphetamine and the first in cocaine consumption. With respect to the so-called behavioral addictions, no consensus in the field of psychiatry has been reached. The only psychological addiction with clear diagnostic criteria is gambling. The rest (Internet, sex, etc.), perhaps for their novelty, continue to be the object of controversy. New addictions, as much to addictive substances as to addictive behaviors, run parallel to the development of industrialized societies, leisure, free time, and a new way of life. This is the new challenge for Public Health (AU)

Morbimortalidad asociada al consumo de drogas / Drug related morbidity and mortality

Según la OMS, en España el tabaco explicaría el 16,8% de la mortalidad, el alcohol el 3% y las drogas ilegales el 0,6%. Respecto a la carga de enfermedad, el tabaco explicaría el 12,3%, el alcohol el 7,6% y las drogas ilegales el 3,9%. En los últimos años España ha experimentado un notable cambio en el tipo y en los patrones de consumo de sustancias psicoactivas, lo cual ha ocasionado un cambio en la morbimortalidad asociada. Dentro de las drogas ilegales, la heroína ha representado la principal causa de mortalidad. Si bien ha descendido desde 199 6, sigue representando, entre los hombres jóvenes, en el año 2000 el 16% de la mortalidad por todas las causas. La cocaína, desde finales de los 90, es la sustancia ilegal que más problemas de morbilidad ha ocasionado, siendo la primera droga consignada en las urgencias por consumo de drogas ilegales. En el caso de la mortalidad por reacción aguda adversa a drogas (sobredosis) también se ha observado un aumento de la presencia de cocaína y actualmente el 50% de los fallecidos presentan cocaína en la sangre. Respecto a la morbimortalidad asociada al consumo de alcohol y tabaco, esta ha experimentado un ligero descenso desde mediados de los 90, probablemente asociado al cambio en la prevalencia y los patrones de consumo

According to the World Health Organization (WHO), 16.8% of mortality in Spain is caused by tobacco, while alcohol causes 3% and illegal drugs, 0.6%. Regarding the burden of disease, 12.3% results from smoking, 7.6% from alcohol and 3.9% from illegal drug use. In recent years in Spain, there has been a notable change in both the type and pattern of consumption of psycho-active substances, producing a corresponding change in associated morbidity and mortality. Among illegal drugs, heroin has been the principal cause of death. Even though mortality has fallen since 199 6, its use was responsible for 16% of overall deaths among young men in 2000. Since the 90s, cocaine has been the illegal substance resulting in greater morbidity; it is the number one illegal drug occasioning emergency and treatment demands. Cocaine has also been observed to be ever more present in cases of fatal overdose, with as many as 50% of mortalities showing cocaine in blood samples. As far as morbidity and mortality associated with alcohol and tobacco consumption goes, a slight drop, which may be linked to the change in prevalence and patterns of consumption, has been recorded since the middle of the 90s

Cribado de problemas de alcohol e intervención breve en los servicios de urgencias: una oportunidad para la prevención / Screening for alcohol problems and Brief Intervention in the emergency department: opportunity for prevention

Se ha comprobado una fuerte asociación entre consumo de alcohol y lesiones. Dos recientes estudios internacionales han analizado la implicación del alcohol en las lesiones, teniendo en cuenta variables contextuales. Los pacientes con alcoholemia positiva o que informaron haber consumido alcohol antes de la lesión tenían mayor probabilidad de ser admitidos en urgen cias por lesiones que los pacientes no traumáticos, y las pautas perjudiciales de consumo predecían, a nivel individual, el riesgo relacionado con el ,alcohol y la probabilidad de atribuir la lesión al consumo de dicha sustancia. Los servicios de urgencias (SU) están en una posición privilegiada para identificar e intervenir sobre individuos con consumo de riesgo o que ya han desarrollado problemas relacionados con el alcohol, pues se encuentran en un "momento receptivo" tras el evento impactante. Se han analizado diferentes instru mentos de cribado para la identificación de los problemas de alcohol en los pacientes que acuden a urgencias. Se propone la utilización del cuestionario RAPS4-0F (Rapid Alcohol Problems Screen, 4 ítems + 2 preguntas de cantidad-frecuencia) por su óptimo rendimiento en el marco de los SU. Diversos estudios han puesto de manifiesto el buen resultado de la intervención breve entre estos pacientes, con una reducción del consumo no siempre significativa frente al grupo control, y una reducción significativa de los problemas relacionados con el alcohol (por ejemplo, nuevas lesiones e ingresos hospitalarios), comparada con el grupo control. Sin embargo, identificación precoz e intervención breve siguen siendo una asignatura pendiente en los SU de todo el mundo

Alcohol is one of the most important risk factors for disease and disability, with a strong association found between alcohol and injury. Two recent international studies have analysed the involvement of alcohol in injuries, taking into account contextual variables. Blood alcohol level (BAL) positive patients and those reporting drinking before the injury were more likely to be admitted to the emergency department (ED) with an injury compared to a non-injury problern, and detrimental patterns of drinking predicted the individual's alcohol-related risk and the likelihood of attributing the injury to alcohol. Emergency departments are in a privileged position to identify and intervene with patients who are at risk or have developed problems beca use of their drinking, for these patient find themselves in a teachable moment after the critical event. Different screening instruments have been investigated for identifying alcohol use disorders in emergency department patients. The RAPS4-0F (Rapid Alcohol Problems Screen, 4 items + 2 quantity frequency items) is proposed for its optimal performance at the ED setting. A number of studies have shown good results of brief intervention among these patients. Most studies show a significant reduction in the consumption of alcohol, although not always significant compared with control patients, and a significant reduction in alcohol-related problems (e.g. new injuries and hospital admissions) compared with controls. Nevertheless, early identification and brief intervention are still a pending subject in emergency departments throughout the world

[Short-term effectiveness of brief interventions in alcohol-positive traffic casualties]. / Efectividad a corto plazo de las intervenciones breves realizadas en pacientes lesionados por accidente de tráfico con alcoholemia positiva.

OBJECTIVES: To investigate the effectiveness of brief interventions to reduce alcohol intake in traffic casualties with a positive blood alcohol concentration. METHODS: Nine hundred forty-eight eligible casualties (97.6% of eligible casualties within a universe of 1106) were screened for alcohol and 126 (13.3%) were identified as positive. Interventions were performed in 85, randomly allocated to a minimal intervention (simple advice) or a brief intervention (motivational intervention). Telephone follow-up was scheduled for months 3, 6 and 12. The present study reports the results of follow-up at month 3. RESULTS: Fifty-seven patients (67%) were followed up at month 3. A total of 73.7% had reduced their alcohol intake and this percentage was greater in the group who underwent the brief intervention (p = 0.06; effect size 0.5) and among heavy drinkers (p < 0.05). CONCLUSIONS: The data indicate the effectiveness of the brief intervention, although the sample size does not allow definitive conclusions to be drawn.

Efectividad a corto plazo de las intervenciones breves realizadas en pacientes lesionados por accidente de tráfico con alcoholemia positiva / Short-term effectiveness of brief interventions in alcoholpositive traffic casualties

Objetivos: Investigar la efectividad de las intervenciones breves para reducir el consumo de alcohol en los pacientes lesionados por accidente de tráfico con alcoholemia positiva. Métodos: Se cribó la presencia de alcohol en 948 lesionados en accidente de tráfico (el 97,6% de los elegibles de un universo de 1.106), con 126 (13,3%) positivos. Se intervino en 85 individuos, aleatoriamente distribuidos en intervención mínima (consejo simple) e intervención breve (intervención de tipo motivacional), y se programó un seguimiento telefónico a los 3, 6 y 12 meses. En este trabajo se presentan los resultados del seguimiento a los 3 meses. Resultados: A los 3 meses se ha seguido a 57 pacientes (67%). EL 73,7% ha reducido el consumo, porcentaje que fue mayor en el grupo intervención breve (p = 0,06; tamaño del efecto, 0,5) y en los incluidos en la categoría de los bebedores de riesgo (p < 0,05). Conclusiones: Se registró la efectividad de la intervención breve, aunque el tamaño de la muestra no permite establecer conclusiones definitivas

Objectives: To investigate the effectiveness of brief interventions to reduce alcohol in take in traffic casualties with apositive blood alcohol concentration. Methods: Nine hundred forty-eight eligible casualties (97.6%of eligible casualties with in a universe of 1106) were screened for alcohol and 126 (13.3%) were identified as positive. Interventions were performed in 85, randomly allocated to a minimal intervention (simple advice) or a brief intervention (motivational intervention). Telephone follow-up was scheduled for months 3, 6 and 12. The present study reports the results of follow-up at month 3. Results: Fifty-seven patients (67%) were followed up at month 3. A total of 73.7% had reduced their alcohol intake and this percentage was greater in the group who underwent the brief intervention (p = 0.06; effect size 0.5) and among heavy drinkers(p < 0.05).Conclusions: The data indicate the effectiveness of the brief intervention, although the sample size does not allow definitive conclusions to be drawn

[Characteristics of road accident victims with positive blood alcohol levels]. / Características de los lesionados por accidente de tráfico con alcoholemia positiva.

OBJECTIVE: To identify the differential features of positive blood alcohol level (BAL) in people injured in road crashes who were attended an acute care service. METHODS: Cross-sectional study of persons aged 18 years old or older injured in motor vehicle crashes who were attended in the Traumatology Emergency Department of Vall d'Hebron Hospital (Spain) between July 2001 and February 2002. RESULTS: The study sample included 431 patients. A positive alcohol test was found in 13.7% of the sample. A statistically significant and independent association was found between positive BAL and male sex (odds ratio [OR] = 2.5 [95% CI, 1.3-5.4]), hospital admission (OR = 2.7 [95% CI, 1.3-5.4]), being attended on a weekend (OR = 3.7 [95% CI, 2.0-6.9]) and being attended during the night and early morning (OR = 4.6 [95% CI, 2.0-10.3]) or in the morning (OR = 3.6 [95% CI, 1.5-8.4]). CONCLUSIONS: The present study identifies a subgroup of people injured in motor vehicle crashes with a greater likelihood of positive BAL, in whom more active screening and secondary prevention activities should be implemented within traumatology and acute care settings.

Características de los lesionados por accidente de tráfico con alcoholemia positiva / Characteristics of road accident victims with positive blood alcohol levels

Objetivo: Identificar de las características diferenciales de positividad a alcohol en lesionados en accidentes de tráfico atendidos en un servicio de urgencias hospitalario. Métodos: Estudio transversal con sujetos de 18 años o mayores, lesionados en accidentes de tráfico, atendidos en el servicio de urgencias del Área de Traumatología del Hospital Vall d'Hebron, entre julio de 2001 y febrero de 2002. Resultados: La muestra incluyó a 431 pacientes. El 13,7% resultó positivo a la determinación de alcohol: se hallaron diferencias en los varones (odds ratio [OR] = 2,5; IC del 95%, 1,3-5,4) y los lesionados ingresados (OR = 2,7; IC del 95%, 1,3-5,4) y en los que fueron asistidos en fin de semana o festivo (OR = 3,7; IC del 95%, 2,0-6,9), de noche y madrugada (OR = 4,6; IC del 95%, 2,0-10,3) o durante la mañana (OR = 3,6; IC del 95%, 1,5-8,4). Conclusiones: Se ha determinado la existencia de subgrupos de lesionados en accidentes de tráfico con una mayor probabilidad de alcoholemia positiva, en los cuales deberían aplicarse programas de cribado y prevención secundaria más activos desde los servicios de urgencias y de traumatología (AU)

Objective: To identify the differential features of positive blood alcohol level (BAL) in people injured in road crashes who were attended an acute care service. Methods: Cross-sectional study of persons aged 18 years old or older injured in motor vehicle crashes who were attended in the Traumatology Emergency Department of Vall d'Hebron Hospital (Spain) between July 2001 and February 2002. Results: The study sample included 431 patients. A positive alcohol test was found in 13.7% of the sample. A statistically significant and independent association was found between positive BAL and male sex (odds ratio [OR] = 2.5 [95% CI, 1.3-5.4]), hospital admission (OR = 2.7 [95% CI, 1.3-5.4]), being attended on a weekend (OR = 3.7 [95% CI, 2.0-6.9]) and being attended during the night and early morning (OR = 4.6 [95% CI, 2.0-10.3]) or in the morning (OR = 3.6 [95% CI, 1.5-8.4]). Conclusions: The present study identifies a subgroup of people injured in motor vehicle crashes with a greater likelihood of positive BAL, in whom more active screening an (..) (AU)

La Plinius Maior Society, diez años después / Plinius Maior Society, ten years later

La Plinius Maior Society (PMS) es un grupo de clínicos e investigadores de 11 países europeos que trabajan en el campo de la alcohología. Su objetivo fundamental es alcanzar un concepto terapéutico global para los problemas derivados del consumo de alcohol. El grupo se reúne tres veces al año para profundizar en temas seleccionados que son objeto de estudio e investigaciones conjuntas, ponencias a congresos y publicaciones diversas. En esta línea, la PMS ha elaborado un documento de soporte a la investigación como sus Directrices para la Evaluación del Tratamiento y materiales (diagramas de diagnóstico e intervención) destinados a ayudar al no especialista en su intervención sobre personas con problemas de alcohol, así como materiales de auto- ayuda para pacientes, tratando de llegar a los tres tipos de destinatarios y favorecer la comunicación entre ellos. La trayectoria y producción de la PMS ha encontrado repetidamente el aval de la Organización Mundial de la Salud, con la que se mantienen contactos regulares y procura colaborar con organismos oficiales a diversos niveles para promocionar políticas de alcohol y fomentar tanto el avance de los tratamientos específicos para la dependencia alcohólica como la intervención precoz a cargo de profesionales no especialistas. En estas líneas se ofrece información sobre la trayectoria de esta sociedad en sus primeros 10 años de existencia, los materiales producidos hasta el momento y los proyectos abiertos (AU)