Dependencia alcohólica con y sin trastornos psiquiátricos asociados / Alcohol dependence with or without associated psychiatric disorders

Objetivos: Determinar si la presencia de comorbilidad influye en la respuesta al tratamiento y evolución asi como si es un criterio útil para establecer subtipos dentro de la dependencia alcohólica. Diseño: Se compararon dos submuestras de dependientes del alcohol: A (n = 120) con comorbilidad, B (n = 41) sin comorbilidad, en función de variables sociodemográficas, clínicas, respuesta al tratamiento y evolución 5-7 años. Setting: Programa de tratamiento ambulatorio de problemas relacionados con el alcohol en un servicio de salud mental de Madrid. Participantes: 161 casos nuevos que iniciaron tratamiento entre 1989 y 1991, con un diagnóstico de dependencia alcohólica. Medidas: Criterios diagnósticos DSM III-R, patrones de consumo según Miller y Marlatt, cuestionario de personalidad EPQ (A), tasas de abandono y tasas de abstinencia absoluta como criterios de respuesta al tratamiento y evolución. Hallazgos: Una menor edad en los dependientes del alcohol con comorbilidad. No diferencias en las características clínicas, respuesta al tratamiento y evolución entre dependientes con y sin comorbilidad asociada. Conclusiones: La comorbilidad en su conjunto no influye en la respuesta al tratamiento y evolución ni es un criterio útil para establecer subtipos dentro de la dependencia alcohólica (AU)

¿Son necesarios los programas de reduccion de daños en el tratamiento de la dependencia alcoholica? / Are harm reduction programs necesary in alcohol dependence treatment?

La tendencia a la cronicidad de más de un tercio de los dependientes del alcohol, la estabilidad de los patrones de evolución y la capacidad limitada de los tratamientos para modificar la evolución a largo plazo de este grupo de pacientes, llevan a plantear la necesidad de programas de reducción de daños en el tratamiento de la dependencia alcohólica. Estos programas estarían indicados, fundamentalmente, en aquellos pacientes con latencias muy cortas de recaída: incapaces de mantenerse abstinentes más de cuatro o seis semanas continuadas a lo largo del tiempo, y vendrían definidos por el cambio de prescripción y de objetivo desde la abtinencia absoluta a la reducción del consumo y por la adaptación de los dispositivos asistenciales para intervenir prioritariamente sobre las consecuencias del consumo (AU)

[Alcohol dependent subjects with psychiatric comorbidity: a heterogeneous group]. / Enfermos con dependencia al alcohol y comorbilidad psiquiátrica: un grupo heterogéneo.

METHODOLOGY: In a sample of 161 alcohol dependent outpatients, we carry out three comparative analysis between alcohol dependent subjects with and without associated affective disorders (n= 72); with and without associated personality disorders (n= 60) and with and without associated substance abuse disorders (n= 26) based on sociodemographic, clinical characteristics, treatment response and long-term evolution variables. FINDINGS: As for associated affective disorders, the only difference is that there are more female. As for associated personality disorders, we find that they are younger, there are more female, they have previous treatment background and worse short-term response. As for the group with associated substance abuse disorders, they are younger, have lower educational and social economic level, alcohol dependence onset earlier, more legal complications and worse half-term treatment response. CONCLUSIONS: The alcohol dependent patients with comorbidity are a heterogeneous group which makes the use of it difficult to categorize alcohol dependence.

[A study of psychiatric comorbidity in alcohol dependence]. / Un estudio de la comorbilidad psiquiátrica en la dependencia alcohólica.

We study the existence of associated psychiatric disorders in a sample of 161 alcohol dependent out-patients. 75% of them had suffered from some kind of psychiatric disorder and 66% were still suffering from the associated disorder at the moment of the evaluation. The most frequent associated disorders were affective disorders, personality disorders and other drug related disorders. Women as a whole did not have more psychiatric disorders than men, but affective and personality disorders were more frequent in women. 43.5% of the patients had suffered from a psychiatric disorder before they became alcohol dependent.

[Alcohol dependence and psychiatric comorbidity. II. Clinical and therapeutic implications]. / Dependencia alcohólica y comorbilidad psiquiátrica. II. Implicaciones clínicas y terapéuticas.

We revise the implications that comorbidity presents from a clinical and therapeutical point of view; either in alcohol dependence or in other psychiatric disorders connected with it. From the clinical point of view, comorbidity as a whole does not produce specific consequences but each psychiatric disorder introduces peculiar characteristics in the association. Once the stability of the associated disorder has been proved, after two or three week's withdrawal, the management of comorbidity has to be based on the treatment of every single associated disorder as if they had no connection between them, within the framework of integrated programs.

[Alcohol dependence and psychiatric comorbidity. I. Epidemiology and etiopathogenic involvement]. / Dependencia alcohólica y comorbilidad psiquiátrica. I. Epidemiología e implicaciones etiopatogénicas.

We revise the articles dealing with psychiatric comorbidity of alcohol dependence. This study focuses on the epidemiology and on the etiopathogenic involvement. The epidemiologic studies in community samples show that psychiatric comorbidity in alcohol dependence is twice as big as expected and this excess is common in every psychiatric disorder. However, this excess is bigger in antisocial personality, other substance-related disorders and in schizophrenia. This excess of comorbidity can be due to two factors: how alcohol can cause psychiatric disorders, and how psychiatric symptoms can produce an increases of alcohol consumption which can lead to dependence in people with vulnerability.