Characterization of dual disorders in addiction treatment-seekers at mexican outpatient centers.

In Mexico, very few studies have been published on dual disorders (DD) at specialized treatment centers describing actual treatment needs and even fewer have been undertaken at addiction treatment centers in the public system. The objective of this study was therefore to analyze DD and other clinical characteristics in people seeking treatment at outpatient addiction centers in the public system.

Caracterización de la patología dual en personas que buscan tratamiento de adicciones en centros ambulatorios mexicanos / Characterization of dual disorders in addiction treatment-seekers at mexican outpatient centers

INTRODUCCIÓN: En México son pocos los estudios publicados sobre la patología dual (PD) en centros de tratamiento espe­cializados que describan las necesidades reales de tratamiento y menos aún que se hayan realizado en centros de tratamiento de adicciones del sistema público. Por esto, el objetivo de pre­sente estudio fue analizar la PD y otras características clínicas en personas que buscan tratamiento en centros ambulatorios de adicciones del sistema público. MÉTODO: Estudio transversal multisede. Se analizó una muestra de 148 pacientes de cen­tros de tratamiento. Se evaluaron trastornos psiquiátricos con la Mini Entrevista Neuropsiquiátrica Internacional, conductas sexuales de riesgo con la Escala de Comportamiento de Riesgo de VIH, consumo de drogas inyectables, y la calidad de vida con el Cuestionario de Calidad de Vida. Se realizaron análisis univariados mediante chi cuadrado para determinar diferen­cias estadísticas entre personas con y sin PD, así como regre­sión lineal para calidad de vida y regresión logística binomial para determinar el riesgo para presentar consumo de drogas inyectables, uso de condón y conducta suicida. RESULTADOS: La cocaína fue la droga de impacto con mayor prevalencia (33.8%). El grupo de personas con trastorno por consumo de alcohol + trastorno por consumo de drogas presentó mayor comorbilidad con el trastorno depresivo mayor (25.7%), tras­torno antisocial (27.7%), déficit de atención (11.5%) e intento suicida (17.6%). El grupo con PD presentó mayor consumo de drogas inyectables (OR= 1.67), no uso de condón con pareja primaria (OR= 3.66), más intentos de suicidio (OR= 4.2) y una menor calidad de vida en comparación con aquellos sin PD. CONCLUSIÓN: Caracterizar a los pacientes con PD, permite iden­tificar con precisión sus necesidades de tratamiento y desarro­llar programas de mejora continua para optimizar los recursos y mejorar el éxito de la atención

INTRODUCTION: In Mexico, very few studies have been published on dual disorders (DD) at specialized treatment centers describing actual treatment needs and even few­er have been undertaken at addiction treatment centers in the public system. The objective of this study was therefore to analyze DD and other clinical characteristics in people seeking treatment at outpatient addiction centers in the public system. Method. Cross-sectional multi-site study. A sample of 148 patients from treatment centers was analyzed. Psychi­atric disorders were evaluated with the Mini International Neuropsychiatric Interview, risky sexual behaviors with the HIV Risk Behavior Scale, injection drug use, and quality of life with the Quality of Life Questionnaire. Univariate chi-square analyses were performed to determine statistical dif­ferences between subjects with and without DD, while linear regression was used to calculate quality of life and binomial logistic regression to determine the risk of injection drug use, condom use, and suicidal behavior. RESULTS: Cocaine was the impact drug with the highest prevalence (33.8%). The group of subjects with alcohol use disorder + drug use disorder presented greater comorbidi­ty with major depressive disorder (25.7%), antisocial disor­der (27.7%), attention deficit (11.5%) and suicide attempt (17.6%). The group with DD presented higher injection drug use (OR = 1.67), non-use of condoms with a primary part­ner (OR = 3.66), more suicide attempts (OR = 4.2) and lower quality of life than those without DD. CONCLUSION: Characterizing patients with DD enables the accurate identification of their treatment needs and the development of continuous improvement programs to opti­mize resources and improve the success of care

Trends and patterns of marijuana use in men and women seeking drug treatment / Tendencias y patrones de consumo de mariguana en hombres y mujeres solicitantes de tratamiento

Abstract Introduction Marijuana is the world's most widely used illegal drug. In Mexico, it is the drug of choice for both male and female users of all ages, and there has been a recent increase in its use. Objective To describe drug use trends in people seeking treatment by sex and age range, and to explore different patterns. Method To provide a description of trends and rates of increase for the population attended between 2005 and 2016 and to make a comparative analysis of patterns of use in a sample of 11 595 marijuana users who received treatment in 2016. Results In general, there has been a greater increase in use in the group ages twelve to seventeen. The greatest increase in lifetime use was reported among women in this age range. The greatest increase in marijuana use in the past month was found among women aged eighteen to thirty-five. Women use a greater variety of substances, and a higher number of younger women report using cocaine, methamphetamines, benzodiazepines and hallucinogens than men. Discussion and conclusion Significant increases in marijuana use have been registered among girls under 18 and women in recent years. The differences in trends and patterns of use for men and women are being reduced and reconfigured.

Resumen Introducción La mariguana es la droga de mayor consumo en el mundo. En México, es la droga preferida por ambos sexos y en todos los grupos de edad, y en su consumo ha habido un incremento desde hace varios años. Objetivo Describir las tendencias del uso de mariguana en solicitantes de tratamiento, por sexo y rango de edad, y explorar diferencias en el patrón de consumo, según sexo. Método Se describieron tendencias y tasas de crecimiento en población atendida entre 2005 y 2016 y se realizó un análisis comparativo del patrón de consumo con una muestra de 11 595 usuarios de mariguana recibidos para tratamiento en 2016. Resultados En general, se registran mayores tasas de crecimiento en el grupo de 12 a 17 años. El mayor incremento del uso alguna vez en la vida corresponde a las mujeres de este rango; el del uso en el último mes y como droga de mayor impacto, a las de 18 a 35 años. Las mujeres consumen un mayor número de sustancias. Las de menor edad refieren el uso de cocaína, metanfetaminas, éxtasis, benzodiacepinas y alucinógenos en mayor proporción que los hombres. Discusión y conclusión Los menores de edad y las mujeres tienen un mayor peso en el aumento del uso de mariguana registrado en los últimos años. Las diferencias en las tendencias y el patrón de consumo entre sexos se están reduciendo y reconfigurando.

Motivational enhancement treatment in outpatient addiction centers: A multisite randomized trial / Intervención de incremento motivacional en centros ambulatorios para las adicciones: un ensayo aleatorizado multicéntrico

Background/Objectives: Motivational Enhancement Treatment in Spanish (METS) is a brief intervention aimed at resolving patient ambivalence towards behavior change that has demonstrated efficacy in substance use disorder treatment to reduce use and increase treatment engagement in different populations. In order to have evidence for its implementation in Mexico, a multi-site, randomized, two-arm, controlled clinical trial was conducted at three outpatient addiction treatment centers in the country to compare the effect of METS with Counseling as Usual (CAU). Method: One hundred and twenty patients were randomized to receive three sessions of METS (n = 54) or CAU (n = 66) during the first four weeks of treatment and were assessed during the following 12 weeks. Primary outcome measures were self-reported days of substance use and of treatment services utilization, which were tested using Generalized Estimating Equations. Results: Results associated both conditions with significant changes in substance use over, whereas there were no differences between conditions in substance use or in service utilization. Conclusions: Findings do not support the hypothesis that METS is more effective than CAU, but suggest that brief interventions at treatment initiation may improve patient outcomes (AU)

Antecedentes/Objetivos: La Intervención de Incremento Motivacional (METS) es una intervención breve para resolver la ambivalencia del paciente con respecto a su comportamiento y ha demostrado eficacia en distintas poblaciones para reducir el consumo de sustancias e incrementar la asistencia al tratamiento en adicciones. Con el objetivo de generar evidencia para su implementación en México, se desarrolló un ensayo clínico controlado, multisede, aleatorizado, de dos brazos en tres centros de tratamiento ambulatorio para adicciones, para comparar el efecto de METS con el del tratamiento usual (CAU). Método: Ciento veinte pacientes fueron aleatorizados a tres sesiones de METS (n = 54) o CAU (n = 66) durante las primeras cuatro semanas de tratamiento y evaluados durante las siguientes doce. Se midieron resultados mediante autoinforme de días con consumo de sustancias y días de utilización de servicios, los cuales fueron analizados mediante ecuaciones de estimación generalizadas. Resultados: Los resultados asociaron ambas condiciones a cambios significativos en uso de sustancias a lo largo del tiempo, pero no demostraron diferencias entre condiciones en el uso de sustancias o en la utilización de servicios. Conclusiones: Los hallazgos contradicen la hipótesis de superioridad de METS sobre CAU, pero sugieren que las intervenciones breves al inicio del tratamiento pudieran mejorar la respuesta del paciente (AU)

Motivational enhancement treatment in outpatient addiction centers: A multisite randomized trial.

BACKGROUND/OBJECTIVES: Motivational Enhancement Treatment in Spanish (METS) is a brief intervention aimed at resolving patient ambivalence towards behavior change that has demonstrated efficacy in substance use disorder treatment to reduce use and increase treatment engagement in different populations. In order to have evidence for its implementation in Mexico, a multi-site, randomized, two-arm, controlled clinical trial was conducted at three outpatient addiction treatment centers in the country to compare the effect of METS with Counseling as Usual (CAU). METHOD: One hundred and twenty patients were randomized to receive three sessions of METS (n = 54) or CAU (n = 66) during the first four weeks of treatment and were assessed during the following 12 weeks. Primary outcome measures were self-reported days of substance use and of treatment services utilization, which were tested using Generalized Estimating Equations. RESULTS: Results associated both conditions with significant changes in substance use over, whereas there were no differences between conditions in substance use or in service utilization. CONCLUSIONS: Findings do not support the hypothesis that METS is more effective than CAU, but suggest that brief interventions at treatment initiation may improve patient outcomes.

Antecedentes/Objetivos: La Intervención de Incremento Motivacional (METS) es una intervención breve para resolver la ambivalencia del paciente con respecto a su comportamiento y ha demostrado eficacia en distintas poblaciones para reducir el consumo de sustancias e incrementar la asistencia al tratamiento en adicciones. Con el objetivo de generar evidencia para su implementación en México, se desarrolló un ensayo clínico controlado, multi-sede, aleatorizado, de dos brazos en tres centros de tratamiento ambulatorio para adicciones, para comparar el efecto de METS con el del tratamiento usual (CAU). Método: Ciento veinte pacientes fueron aleatorizados a tres sesiones de METS (n = 54) o CAU (n = 66) durante las primeras cuatro semanas de tratamiento y evaluados durante las siguientes doce. Se midieron resultados mediante autoinforme de días con consumo de sustancias y días de utilización de servicios, los cuales fueron analizados mediante ecuaciones de estimación generalizadas. Resultados: Los resultados asociaron ambas condiciones a cambios significativos en uso de sustancias a lo largo del tiempo, pero no demostraron diferencias entre condiciones en el uso de sustancias o en la utilización de servicios. Conclusiones: Los hallazgos contradicen la hipótesis de superioridad de METS sobre CAU, pero sugieren que las intervenciones breves al inicio del tratamiento pudieran mejorar la respuesta del paciente.

Initiation to methamphetamine use in a binational sample of women at the US-Mexico border.

This article examines comparative risk behaviors associated with methamphetamine use in a binational sample of women in the border cities of Tijuana, Mexico, and San Diego, California. Specifically, the study examined the differences and similarities in drug use and sexual risk behavior and the patterns of initiation to methamphetamine use. The binational pilot sample consisted of 70 adult women in Tijuana and 55 women in San Diego. Although there were important differences in the presentation of risk behavior and patterns of initiation between the two binational samples, women on both sides of the US-Mexico border also showed remarkable similarities in their risk profile. Results from this study suggest that despite significant cultural and socioeconomic differences between the study cities, certain specific substance abuse patterns (e.g., methamphetamine use) in border regions with an increasing demographic exchange and integration are emerging as an "equalizer" of risk, capable of dissolving context-based differentiating factors, and creating a more homogenous subpopulation of substance users.

Estudio de la relación entre consumo de drogas y migración a la frontera norte de México y Estados Unidos

resumen está disponible en el texto completo

Abstract: Since the beginning of the XX Century, migration has played an important role in the relations between Mexico and the United States. The main reasons behind most of these migration movements are to improve life conditions and already established social-familiar networks. It is estimated that approximately 390,000 Mexican people migrate each year to the United States. In 2002, Mexicans represented the biggest immigrant group, with 9.5 million people. Among the main elements that cause this migrating movement are: the increasing Mexican demographic population in prime working age, the insufficient creation of jobs, low salaries, as well as the high demand that exists for manpower in the United States, specially in the agricultural, industrial and service areas. There have been important changes in the migrating process, which modify usual behaviors, habits, values, attitudes and points of view by migrants, their families, their home town and their new environment. These changes can facilitate the development of some problems, at a public health level. Some such problems include stress, depression, risky sexual behavior, AIDS contagion, or increase in the abuse of alcohol and drugs. The Community Epidemiology Work Group and NIDA has reported that South and South East areas of the United States show a high cocaine, heroine, methamphetamine, and ecstasy abuse. Most such areas are located at the Mexican border, and this problem seems to affect both countries the same. Method. The study involved following transversal, ex post facto comparisons of migrant and no migrant users drugs. The main objectives included: a) To identifiy abuse levels of migrating drug users, and compare these results with those of Mexican resident drug abusers (non migrating); b) To identify abuse levels in migrating people before and after they moved into the United States and/ or Mexican border cities, and their degree of abuse upon returning to Mexico; c) To explore any relationships between migrating and increased drug consumption, such as heroine and methamphetamine. The participant selection procedure involved intentional, sampling by using pairs. Inclusion criteria included using ilegal drugs, being new patient in the Treatment area of Centros de Integración Juvenil (CIJ), and having migrated to any Mexican border cities and/or the United States in the last five years, and stayed for a period of three months or more. The CIJ operating units that participated in the study included those in Cancán, Celaya, Chihuahua, Ciudad Juárez, Colima, Guadalajara, Hermosillo, Laguna, La Paz, León, Los Mochis, Monterrey, Puebla, Zacatecas and Zamora. These units were selected because of their high number of patients who are methamphetamine or heroine abusers, as well as for including a considerable rate of migrating people to the United States. The groups included 92 drug abusers, of which 46 went to the mexican north border or to the United States cities, and 46 non migrants. Data was gathered through the application of a questionnaire. Main findings. Some of the results revealed that 97.8% of the participants were male, with an average age of 26 years old (SD=7.5), and 80% had studied elementary school or higher. 1. Characteristics of the migrating process. Drug abusers, who migrated to the northern Mexican border, mainly went to Baja California and Chihuahua states. The ones who went to the United Stated were living in California, Texas, Arizona and Illinois. Among the main reasons for migrating were personal development, getting a job or improving it. Migrants also stated that they were "seeking adventure", and, those who went to the United States, said that their purpose was to solve family problems, or to follow tradition. Most of them had planned to stay at their new home for just one season, although a majority stayed over one year. 2. Drug abuse. All participants had consumed alcohol and almost 90% of them had smoked tobacco at least once in their lives. The illegal substances consumed by both migrating and non migrating participants included, in decreasing frequency order: cocaine, marijuana, inhalants, methamphetamines and sedatives. Prevalence among the migrating abusers was higher. Non migrating abusers, also consumed tranquilizers, heroine and other opiates. On the other hand, migrating abusers, had consumed, at least once in a lifetime one or more of the following substances: ecstasy, crack, basuco, methamphetamine, amphetamines, LSD and PCP. Migrants showed a higher percentage of those who had used central nervous system inhibitors (except methamphetamine), and most of them had used a combination of drugs. Those migrating to the United States predominantly consumed drugs to stimulate the central nervous system or to produce hallucinations, and also used some other non specified substances. Drug preference perception. Both groups reported a preference towards marijuana and cocaine. However, migrating abusers showed an additional preference for methamphetamine use. Migrating abusers stated that the reason for consuming this drug was mainly seeking stimulation, just to feel active and euphoric. The ones who migrated to the United States mentioned that they consume methamphetamine because of labor reasons, such as to be more productive and alert. Drug abuse before, during and after migrating. Eighty percent of migrating abusers had already used drugs before leaving their home town. During the migrating process the drug abuse pattern changed by increasing the use of some other drugs. Migrating abusers mentioned that they had used cocaine at their home place, but that during the migrating process, its consumption was significantly higher. They also mentioned that they continued using cocaine when they came back home, although at a lower rate. There was no record of opiates' use such as morphine, darvon, nubain or methadone when these abusers were in their home town, before migrating. They started using these drugs when they arrived to the north of Mexico or to the United States, and they continued using them when they returned. Only some abusers had used methamphetamine, crack, heroine and PCP before migrating. However, when they arrived to their migrating place, the use of these drugs was highly increased although it was reduced considerably when they returned home. LSD was consumed only at the migrating places. The use of tranquilizers and mushrooms was slightly decreased during the migrating process, but it increased when abusers returned home. In the case of those who went to the border, heroine abuse increased, and it decreased as abusers returned home. Only some of them used methamphetamine and ecstasy at their migrating places. On the other hand, those migrating abusers that went to the United States increased their use of methamphetamine, ecstasy, cocaine, and crack, although it decreased when they returned home. Some migrating abusers started using heroin when they arrived to the border, and only continued consuming it when they came home.

Farmacoterapia de los síndromes de intoxicación y abstinencia por psicotrópicos 1997 / Pharmacotherapy of intoxication and abstinence syndromes for psychotropics 1997

El documento proporciona información actualizada para el manejo de los casos de abuso de drogas que deben ser auxiliados en sus fases críticas. Asimismo, se tiene en cuenta los avances recientes en la literatura internacional sobre el tema y los lineamientos de la Ley General de Salud. El contenido se divide en cinco partes: 1) describe los aspectos generales relativos al manejo médico de los distintos estados de intoxicación y abstinencia, independientemente del fármaco responsable del cuadro clínico; 2) describe los síndromes de intoxicación y abstinencia por psicotrópicos e incluye consideraciones relativas a la etiopatogenia, diagnóstico nosológico y esquemas terapéuticos correspondientes; 3) contiene información sobre problemas especiales asociados al consumo de psicotrópicos: embarazo y el período neonatal inmediato; SIDA; 4) incorporan dos glosarios; 5) se hace una descripción de la intervención psicológica de primer nivel en situaciones de crisis, como aquéllas que se presentan inmediatamente después de la intoxicación aguda por sustancias

Teatro trashumante: una técnica para prevenir el uso de drogas / Nomad theater: a technic for preventing the use of drugs

Experiencias adquiridas en la realización de teatro trashumante abordando el tema de la drogadicción. El objetivo: "Esta técnica pretende despertar la conciencia acerca de los motivos que subyacen en el uso y abuso de drogas. De antemano, sabemos que las zonas marginadas están familiarizadas con la drogadicción. Por lo tanto, el objetivo del teatro es develar las condiciones ambientales que llevan a la utilización de drogas explicitando, al mismo tiempo, aquellas situaciones familiares e individuales que la propician. El segundo objetivo básico es involucrar a personas de la comunidad en las acciones preventivas dirigidas hacia la zona en que habitan. Con esto se consigue responsabilizar a la comunidad en la tarea de prevenir la aparición de farmacodependencia, salvamos el posible obstáculo de comunicación que pudiera surgir si el programa lo efectuamos nosotros. Nadie conoce mejor el lenguaje de la comunidad que sus propios integrantes". Por lo que respecta a la técnica, el documento señala: a. Formación de la compañia. b.Creación de la obra. c.La representación. d.La intervención del público y e.La retroalimentación. Y concluye con una "reflexión sobre teatro trashumante o quizas sobre nuestros programas de prevención en general"

Aportaciones teóricas y prácticas para el conocimiento del farmacodependiente / Theorical and practical contributions for the knowledge of the drugdependent

El presente estudio surge como una respuesta de Centros de Integración Juvenil a la necesidad de conocer la evolución que el fenómeno de la farmacodependencia ha tenido en el área metropolitana de la Ciudad de México en los últimos años. Representa el resultado de una investigación documental que resume y compara trabajos epidemiológicos realizados por distintos organismos y personas, durante el período comprendido entre 1970 y 1981. El material se organizó y sistematizó en fichas resumen con los aspectos más importantes: objetivo, metodología y resultados y se sistematizó en fichas de trabajo. Debido a la diversidad de clasificaciones de fármacos utilizada por los investigadores, así como la importancia que por su frecuencia de consumo revisten algunas sustancias, las drogas se agrupan de la siguiente manera: Mariguana, Inhalables, Depresores, Estimulantes, Estupefacientes y Alucinógenos. Se anotan los indices de consumo por cada tipo de droga clasificada y los resultados de las encuestas levantadas en escuelas y hogares