Rodrigo Marín-Navarrete

Estudio sobre la experiencia de hombres atendidos en centros residenciales de ayuda mutua para la atención de las adicciones

SUMMARY Addictive disorders and behaviors have increased in the past years in Mexico. These behaviors and disorders are considered a public health issue because of the social and economic strains they generate. However, the state is unprepared to attend such high demands. Non government organizations have arisen in order to fulfill this demand, but it is known that many of them do not regard federal health regulations and often they have infringed the basic human rights. The present study has for objective to analyze the experience of men who have been atended in self-help residential substance abuse attention centers. Fifteen focalized interviews were carried out with men of different characteristics, all of them having been attended in at least two centers. The results help to understand the consumption dynamic, usually linked to family abandonment and anger. It further analyzes the unhealthy and inhuman services offered in many of these centers such as poor feeding and hygiene services; many of the men are admitted violently and against their will. It is concluded that even though these centers respond to the demand that addictive disorders have, they do not professionally and skillfully support a rehabilitation process. It is thus of utter importance to guarantee the training and proffessionalization of these centers’ staff through an observation and regulation process.

Experiences of Power and Violence in Mexican Men Attending Mutual-Aid Residential Centers for Addiction Treatment

Fundamental elements of hegemonic masculinity such as power and violence are analyzed through characteristics of 12-step programs and philosophy immersed in Mutual-Aid Residential Centers for Addiction Treatment (CRAMAAs). CRAMAAs are a culturally specific form of substance abuse treatment in Mexico that are characterized by control and violence. Fifteen interviews were carried out with men of varied sociodemographic characteristics, and who resided in at least two of these centers. Results identify that power is expressed through drug abuse and leads them to subsequent biopsychosocial degradation. Residency in CRAMAAs is motivated by women, but men do not seek the residency and are usually admitted unwillingly. Power through violence is carried out inside CRAMAAs where men are victims of abuse. From a 12-step philosophy, this violence is believed to lead them to a path of recovery but instead produces feelings of anger and frustration. The implications of these centers on Mexican public health are discussed.

Co-Occurring Disorders: A Challenge for Mexican Community-Based Residential Care Facilities for Substance Use

ABSTRACT Objective: In Mexico, specialized treatment services for people with co-occurring disorders are limited within public health services, while private options are deemed too costly. More than 2,000 community-based residential care facilities have risen as an alternative and are the main source of treatment for individuals with substance use disorders; however, suboptimal practices within such facilities are common. Information on the clinical characteristics of patients receiving care in these facilities is scarce and capacity to provide high-quality care for co-occurring disorders is unknown. The aims of this study were to examine the prevalence of co-occurring disorders in patients receiving treatment for substance use in these community-based residential centers and to assess whether the presence of co-occurring disorders is associated with higher severity of substance use, psychiatric symptomatology, and other health risks. Methods: This study was conducted with 601 patients receiving treatment for substance use disorders at 30 facilities located in five Mexican states, recruited in 2013 and 2014. Patients were assessed with self-report measures on substance use, service utilization, suicidality, HIV risk behaviors, psychiatric symptomatology, and psychiatric disorder diagnostic criteria. Results: The prevalence of any co-occurring disorder in this sample was 62.6%. Antisocial personality disorder was the most prevalent (43.8%), followed by major depressive disorder (30.9%). The presence of a co-occurring disorder was associated with higher severity of psychiatric symptoms (aB = .496, SE = .050, p < .05); more days of substance use (aB = .219, SE = .019, p < .05); current suicidal ideation (aOR = 5.07, 95% CI [2.58, 11.17]; p < .05), plans (aOR = 5.17 95% CI [2.44, 12.73]; p < .05), and attempts (aOR = 6.43 95% CI [1.83, 40.78]; p < .05); more sexual risk behaviors; and more contact with professional services (aOR = 1.77, 95% CI [1.26, 2.49], p < .05). Conclusions: Co-occurring disorders are highly prevalent in community-based residential centers in Mexico and are associated with significantly increased probability of other health risks. This highlights the need to develop care standards for this population and the importance of clinical research in these settings.

Comorbilidad de los trastornos por consumo de sustancias con otros trastornos psiquiátricos en Centros Residenciales de Ayuda-Mutua para la Atención de las Adicciones

La comorbilidad de los trastornos por consumo de sustancias con otros trastornos mentales presenta una importante prevalencia; se ha reportado que esta es mayor en los centros de tratamiento psiquiatrico (20-50%) y para las adicciones (50-75%) en comparacion con la poblacion abierta. Una modalidad de Ayuda-Mutua para la atencion de las adicciones comun en Mexico es la de los Centros Residenciales y Casas de Recuperacion para las adicciones, tambien llamados “anexos”. El objetivo del estudio fue estimar la prevalencia de comorbilidad de los trastornos por consumo de sustancias con otros trastornos psiquiatricos en una muestra de participantes de sexo masculino adscritos a los Centros Residenciales de Ayuda-Mutua para la Atencion de las Adicciones (CRAMAA). Se capto a un total de 535 participantes, de los cuales 346 cumplieron los criterios de inclusion y fueron evaluados. La evaluacion diagnostica de los trastornos por uso de sustancias y los 17 trastornos psiquiatricos comorbidos se realizo con la Entrevista Internacional Diagnostica Compuesta (WMH-CIDI). Los resultados mostraron que 75.72% cumplia con criterios diagnosticos para algun trastorno psiquiatrico comorbido, siendo los mas prevalentes los trastornos por deficit de atencion y comportamiento perturbador, seguidos por los trastornos de ansiedad, la ansiedad por separacion, los trastornos afectivos, los trastornos por control de impulsos y con menor frecuencia los trastornos de la conducta alimentaria. En la mayoria de los casos (83.59%), los trastornos psiquiatricos comorbidos precedieron a los trastornos adictivos. Este estudio constituye una aportacion que puede considerarse para futuras propuestas en politicas publicas, que se traduzcan en acciones para ofertar servicios que atiendan las adicciones y los trastornos psiquiatricos de manera integral.

Characteristics of a Treatment-Seeking Population in Outpatient Addiction Treatment Centers in Mexico

Background: Baseline patients’ characteristics are critical for treatment planning, as these can be moderators of treatment effects. In Mexico, information on treatment seekers with substance use disorders is scarce and limited to demographic characteristics. Objective: This paper presents and analyses demographic characteristics, substance use related problems, clinical features, and addiction severity in a sample of treatment seekers from the first multi-site randomized clinical trial implemented in the Mexican Clinical Trials Network on Addiction and Mental Health. Methods: A total of 120 participants were assessed prior randomization. Chi square or F-tests were used to compare sites across variables. Spearman correlation was used to associate negative consequences of substance use and motivation to change. Results: The majority of participants were men, and the most prevalent substances reported were alcohol, marijuana, and cocaine. Participants were predominantly on the contemplation or action stage of change, and this was correlated with the perception of the negative consequences associated with substance use. Participants reported a high prevalence of substance use related problems. Conclusions: Substance use related problems, clinical features, and addiction severity reported by treatment seekers are important characteristics to take into account when planning treatment as they facilitate tailoring treatment to meet patients’ needs.

Readiness and barriers to adopt evidence-based practices for substance abuse treatment in Mexico

Introduction. Evidence shows a lag in adoption of evidence-based practices (EBPs) for substance abuse treatment and supports the need for studying the factors involved in this worldwide problem. Objective. This study aimed to assess the readiness and barriers to adopt EBPs for substance abuse in a sample of outpatient treatment centers of a newly created Mexican Clinical Trials Network. Method. An online survey was administered to directors (n = 8) and clinicians (n = 40) from seven outpatient treatment centers in Mexico. Questions were obtained from two surveys that had been implemented in the US to assess the same objectives. Results. Respondents reported being more ready to adopt Cognitive Behavioral Therapy (CBT, 83.3%) and Motivational Enhancement Therapy (MET, 79.1%), compared to 12 step facilitation (58.3%), couples therapy (56.2%), Brief Strategic Family Therapy (BSFT, 66.6%), and motivational incentives (60.4%). Directors had lower mean resistance to EBPs (11.8 vs. 17.4; p = 0.01) than clinicians. The biggest barriers identified by directors to EBP adoption were not having enough clinical staff, being unable to afford well-trained staff, not enough psychiatric and medical support. Discussion and conclusion. CBT and MET emerged as the most frequently used evidence based practices in the sites that are part of the Mexican Clinical Trials Network. Staff positive attitudes towards EBPs are critical for adoption.

Assessment of neurocognitive disorder in studies of cognitive impairment due to substance use disorder: A systematic review

ABSTRACT Background: Cognitive impairments induced by substance use disorders (SUDs) are broadly documented. Evidence for these effects ought to be considered with regard to the new classification of neurocognitive disorders (NCDs). Failing to assess diagnostic criteria for NCD could be a limitation of studies addressing the effects of SUDs on cognition, resulting in misdiagnosis and inaccurate prevalence estimation. Methods: A systematic search of original articles (2000–2016) was conducted in Web of Knowledge and Science Direct. Key terms were: NCD and associated terms, and SUDs or alcohol, marijuana, cocaine and inhalants. Results: 59 cross-sectional and five prospective studies were reviewed. Criterion A.1 (evaluation of subjective concern of cognitive decline relative to a baseline), and criterion B (evaluation of impairment in daily life activities due to cognitive impairment) were not effectively evaluated in any of the studies. All studies addressed criterion A.2 (objective evidence of cognitive decline) via heterogeneous neuropsychological testing. Criteria C (absence of delirium) and D (absence of other possible etiologies) were frequently considered for control of confounding effects, mostly via methodological procedures (e.g. abstinence before evaluation, and exclusion of participants with comorbid disorders). Conclusion: These findings highlight the need to develop and disseminate standard procedures for assessment of substance-induced NCD.

Ibero-American initiative for dual disorders to improve public treatment programs

Introduction. Dual disorders (DD) are defined as the co-occurrence of substance use disorders with other psychiatric disorders across the lifespan. DD represent a diagnostic dimension with clinical peculiarities and specific healthcare needs, which raises the need to implement integrative treatment algorithms. However, worldwide, most programs address this condition through serial or parallel approaches. In Latin America, as in the rest of the world, there is no health care network that adequately addresses this problem. Objective. To describe the development of the initiative for the integral treatment of DD in Latin America. Method. The Organizacion Panamericana de la Salud (Pan American Health Organization), together with other collaborating organizations, implemented a three-stage plan for developing a regional initiative: 1. meeting of DD experts, 2. review of the literature on DD, and 3. identification of services for DD care in Latin America. Results. The creation of the Iniciativa Iberoamericana para la Patologia Dual (Ibero-American Initiative for Dual Disorders) seeks to implement four lines of action to improve of public services: a) build a theoretical-conceptual consensus on DD, b) propose a treatment model, c) develop skills-based training, and d) create collaborative networks for research on DD. Discussion and conclusion. The following actions include the formation of working groups to create a regional collaborative network, discuss the role of participating organizations and establish guidelines for the implementation of the initiative.

Sexually transmitted infections and substance use disorders: evidence and challenges in Mexico

According to international reports, Mexico has a high prevalence of sexually transmitted infections (STIs), such as human immunodeficiency virus (HIV), hepatitis B virus (HBV) and hepatitis C virus (HCV). There are approximately 34 million people infected with HIV, between 130 and 150 million with HCV, approximately 400 million with HBV, and 12 million infected with syphilis every year.

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.