SUMMARYSubstance use disorders have a high degree of comorbidity with other psychiatric disorders; it has been reported that the prevalence of comorbidity is higher in psychiatric (20-50%) and addiction (50-75%) treatment settings than in household or student populations. Because of limited treatment alternatives and greater treatment needs, MutualAid groups have become relevant in the last decades. A modality of Mutual-Aid for addiction treatment that has proliferated in Mexico has taken the form of residential Mutual-Aid centers called "anexos" in Spanish. The objective of this study was to estimate the prevalence of lifetime comorbidity between substance use disorders and psychiatric disorders in those who attended these residential Mutual-Aid centers. The initial sample consisted of 535 male participants diagnosed with a substance use disorder, but only 346 fulfilled the inclusion criteria to continue with the evaluation. Only males were included as the participating centers only admit males. Psychiatric diagnosis was evaluated with the Composite International Diagnostic Interview (WMH-CIDI) using DSM-IV criteria. The results showed that 75.72% met criteria for any comorbid psychiatric disorder, the most frequent being attention deficit and conduct disorders, followed by anxiety disorders, separation anxiety disorders, mood disorders, impulse control disorders and least frequently eating disorders. While the study is limited by its nonrepresentative sample, the findings provide valuable information for a hidden population for which there is a dearth of information and points to the need for integrative services which address both addiction and comorbid psychiatric disorders simultaneously.Key words: Addiction, treatment settings, comorbidity, psychiatric disorders. RESUMENLa comorbilidad de los trastornos por consumo de sustancias con otros trastornos mentales presenta una importante prevalencia; se ha reportado que ésta es mayor en los centros de tratamiento psiquiátrico (20-50%) y para las adicciones (50-75%) en comparación con la población abierta. Una modalidad de Ayuda-Mutua para la atención de las adicciones común en México es la de los Centros Residenciales y Casas de Recuperación para las adicciones, también llamados "anexos". El objetivo del estudio fue estimar la prevalencia de comorbilidad de los trastornos por consumo de sustancias con otros trastornos psiquiá-tricos en una muestra de participantes de sexo masculino adscritos a los Centros Residenciales de Ayuda-Mutua para la Atención de las Adicciones (CRAMAA). Se captó a un total de 535 participantes, de los cuales 346 cumplieron los criterios de inclusión y fueron evaluados. La evaluación diagnóstica de los trastornos por uso de sustancias y los 17 trastornos psiquiátricos comórbidos se realizó con la Entrevista Internacional Diagnóstica Compuesta (WMH-CIDI). Los resultados mostraron que 75.72% cumplía con criterios diagnósticos para algún trastorno psiquiátrico comórbido, siendo los más prevalentes los trastornos por déficit de atención y com...
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.
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.
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.
RESUMENIntroducción: la patología dual se refiere a la concurrencia de un trastorno por consumo de sustancias con otro trastorno psiquiátrico. Estudios epidemiológicos en población general reportan una alta prevalencia de patología dual. Sin embargo, la información disponible sobre el tema en poblaciones especiales es limitada. Objetivo: revisar la evidencia disponible sobre la epidemiología, la atención y los aspectos relevantes para la salud pública acerca de la patología dual en las siguientes poblaciones especiales: personas en situación de indigencia, en prisión, con VIH, VHB y VHC, mujeres y adultos mayores. Método: búsqueda en bases de datos bibliográficos (PubMed, Science Direct, EBSCO y OVID) de reportes de investigación enfocados en la prevalencia y el tratamiento de patología dual en las poblaciones mencionadas. Resultados: la prevalencia de la patología dual se presenta de manera diferenciada en estas poblaciones, en comparación con la población general; además está altamente asociada con mayores tasas de morbilidad y mortalidad. La mayoría de los estudios específicos sobre patología dual y las poblaciones especiales, tanto de epidemiología como de tratamientos, se ha realizado en países de alto ingreso. Discusión y conclusiones: se requiere de políticas públicas que contemplen la medición epidemiológica de la patología dual en estas poblaciones, sobre todo en países de mediano y bajo ingreso, e incluyan intervenciones integradas adecuadas a las necesidades específicas de cada población.Palabras clave: patología dual; grupos minoritarios; epidemiología; revisión. ABSTRACTBackground: dual disorders is a term that refers to the co-occurrence of a substance use disorder with other mental disorders. Epidemiological studies have reported a high prevalence of dual disorders in the general population. However, information on dual disorders in special population is limited. Objective: to give an overview of the available evidence on the epidemiology, care and other relevant aspects for public health of dual disorders in the following special populations: homeless, prison inmates, people with sexually-transmitted infections, and the elderly. Method: search in peer-review publication databases (PubMed, Science Direct, EBSCO and OVID) for research reports on the epidemiology and treatment of dual pathology in the aforementioned populations. Results: prevalence of dual disorders in these populations appears to be different than in the general population; and it is highly associated with higher mortality and morbidity rates. The majority of studies aimed specifically on the epidemiology and treatment of dual disorders and special populations has been conducted in high-income countries. Discussion and conclusions: there is a need for public policies that consider the epidemiological assessment of dual disorders in special populations, specially in low-and middle-income countries, and include integrated care interventions adequate to the specific needs of each population.
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