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PREVALENCIA Y FACTORES DE RIESGO EN PACIENTES TRATADOS POR TOXICOMANIAS

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Mediante la identificación de los factores que intervienen en el deterioro durante el tratamiento o después de él, en pacientes tratados por adicciones, se logró generar un índice con valor predictivo para determinar a priori que pacientes están en riesgo de desmejorar con la terapia.
moosr.jpg Autor:
Rudolf h. Moos
Columnista Experto de SIIC
Artículos publicados por Rudolf h. Moos
Coautor
Bernice S. Moos* 
B. S., Center for Health Care Evaluation. Department of Veterans Affairs and Stanford University School of Medicine, Palo Alto, California, EE.UU.*

PREVALENCIA Y FACTORES DE RIESGO EN PACIENTES TRATADOS POR TOXICOMANIAS

Resumen
Dos estudios dirigidos a identificar pacientes con problemas de adicción, cuyos síntomas empeoraron durante o poco después del tratamiento, fueron conducidos con el objetivo de implementar un índice de factores de riesgo para la individualización de tales pacientes y especificar las características de la atención que permitieran reducir la posibilidad de la exacerbación de los síntomas. En ambos estudios se seleccionaron grupos de pacientes comparables de una muestra mayor basada en el resultado del tratamiento (deteriorado versus estable o mejorado). Más del 10% de los pacientes mostraron algún deterioro de sus síntomas. Los factores de riesgo para exacerbación incluyeron menor edad, soltería, falta de estabilidad habitacional, uso de drogas desde hace largo tiempo, arrestos previos, tratamiento anterior por etilismo, adicción simultánea a alcohol y drogas, adicción o uso de cocaína, problemas con drogas autocalificadas como más severos y problemas psiquiátricos.Los pacientes de alto riesgo que obtuvieron un período más prolongado de atención de salud mental tuvieron menores probabilidades de empeorar. Por consiguiente, a su ingreso al tratamiento, los médicos pueden identificar los pacientes cuyos síntomas de uso de sustancias de adicción puede exacerbarse; la atención más prolongada de tales pacientes podría lograr incrementos en la probabilidad de que sus síntomas mejoren.

Palabras clave
Adicción, toxicomanía, alcohol, drogas, deterioro


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Deterioration during treatment: prevalence and risk factors among patients with substance use disorders

Abstract
Two studies were conducted to identify patients with substance use disorders whose symptoms get worse during or shortly after treatment, to develop an index of risk factors to identify these patients, and to specify characteristics of care that may reduce the likelihood of symptom exacerbation. In both studies, matched groups of patients were selected from a larger sample based on their treatment outcome (deteriorated versus stable or improved). More than 10% of the patients showed some deterioration in their symptoms. Risk factors for symptom exacerbation included younger age, non-married status, and residential instability; long-term use of drugs, prior arrests, prior alcohol treatment, alcohol and drug abuse or dependence diagnoses, cocaine abuse or dependence, and more severe self-rated drug problems; and psychiatric problems. High-risk patients who obtained a longer episode of mental health care were less likely to get worse. Accordingly, at entry to treatment, clinicians can identify patients whose substance use symptoms are likely to exacerbate, and, by providing these patients a longer duration of care, may enhance the likelihood that these patients\' symptoms will improve.

Key words
Adicción, toxicomanía, alcohol, drogas, deterioro


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Especialidades
Principal: Toxicología
Relacionadas: Medicina Interna, Salud Mental, Salud Pública



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