Adicciones: Retos de la investigación para informar a las políticas públicas. Dra. Medina-Mora

Miércoles 14 de agosto, 12:00hrs

Auditorio de la Unidad de Posgrado 

Serie de Conferencias Magistrales organizadas por la Coordinación de Estudios de Posgrado de la UNAM

"No se ha podido controlar el consumo del tabaco ni del alcohol por la falta de condiciones" - Dr. Cano Valle

Sería irracional y adictos rebasarían capacidad sanitaria, advierte la Conadic



El coordinador del Consejo Nacional contra las Adicciones (Conadic), Fernando Cano Valle, reiteró ayer la advertencia de que “sería irracional” legalizar la mariguana, pues por la magnitud de los daños que ésta provoca el país carece de capacidad sanitaria para la demanda de atención y de recursos económicos para la rehabilitación de los adictos a la misma.

En el país –dijo— no se ha podido controlar el consumo del tabaco ni del alcohol por la falta de condiciones; sin embargo, esto no se toma en cuenta en el debate a favor de la legalización de la mariguana.

Cano Valle hizo declaraciones luego de la inauguración del primer seminario internacional “La justicia terapéutica, una alternativa en desarrollo”.

Añadió:

“No hay control del tabaco en México. No hay control del alcohol en México y ahora se quiere incorporar una adicción que es la marihuana, con un propósito, cualquiera que sea… pero no es razonable desde el punto de vista de la salud”.

Más información aquí

SBIRT For Adolescents - IRETA's Webinar Wednesdays

Wednesday, August 14, 2013
1:00 PM - 4:00 PM Eastern
SBIRT For Adolescents
Overview: Substance use by adolescents is a significant public health problem and is associated with both acute and long term health problems. The American Academy of Pediatrics and other organizations recommend routine screening and brief intervention to prevent or reduce substance use as part of routine care for adolescents. This presentation will 1) review the impact of substance use on the developing brain with particular focus on alcohol and marijuana; 2) review the use of validated screening tools for adolescent substance use and present a brief motivational intervention strategy targeted at reducing substance use by high risk adolescents.

Objectives: After this presentation, participants will be able to
1. Identify the impacts of alcohol and marijuana on the developing brain
2. Use appropriate screening tools to identify risk levels associated with adolescent substance use
3. Propose steps and recommended language for an appropriate intervention for each

More

Register

10th Annual Conference of INEBRIA

Conference: "Brief interventions on alcohol and other drugs: improving health and the quality of health services provision"

19th - 20th September 2013
More information here

Lifecourse Socioeconomic Position and Alcohol Use in Young Adulthood: Results from the French TEMPO Cohort Study

1. Ahmed Yaogo, 
2. Eric Fombonne, 
3. Seni Kouanda, 
4. France Lert, 
5. Maria Melchior

1. 1. Alcohol and Alcoholism (2013)

      
      

      First published online: July 30, 2013
      July/August 2013 48 (4)

1. 
   

1. http://alcalc.oxfordjournals.org/content/early/2013/07/29/alcalc.agt128.short?rss=1

1. Aims: The aim of the study was to examine the relationship between lifetime socioeconomic position and alcohol use in young adults.

1. Methods: The participants (n = 1103, age 22–35 years in 2009) were the French TEMPO cohort, offspring of employees (all French nationals) of the French national gas and electricity company (GAZEL) who were in a previous cohort study. Alcohol use was assessed by the WHO AUDIT questionnaire (none, low or intermediate alcohol use, alcohol abuse). Childhood socioeconomic position was measured using parental income documented in the GAZEL study in 1989 (low: ≤2592€/month vs. intermediate/high: >2592€/month). Adult socioeconomic position was measured by participants' educational level (≤high school degree vs. >high school degree). Combining family income and educational attainment, we ascertained participants' social trajectory (stable high, upward, downward and stable low). Data were analyzed using multinomial regression analyses controlled for demographic, social, psychological and family characteristics. 

1. Results: Compared with participants with a stable high social trajectory, those with an upward, downward or low social trajectory were more likely to abstain from alcohol (compared with a stable high social trajectory, sex and age-adjusted ORs: OR = 2.22, 95% CI 1.35–3.65 for an upward social trajectory; OR = 3.20, 95% CI 1.78–5.73 for a downward social trajectory; OR = 3.27, 95% CI 1.75–6.12 for a stable low social trajectory). Additionally, participants with a downward social trajectory were disproportionately likely to abuse alcohol (sex- and age-adjusted OR: 1.48, 95% CI 0.89–2.48). In multivariate analyses, social trajectory remained associated with alcohol use. 

1. Conclusion: Lifelong socioeconomic position may shape patterns of alcohol use early in life.

Alterations in affective behavior during the time course of alcohol hangover

Analía 

G. Karadayian, 

María J. Busso, 

Carlos Feleder, 

Rodolfo A. Cutrera

Behavioural Brain Research

Volume 253, 15 September 2013, Pages 128–138

Alcohol hangover is a temporary state described as the unpleasant next-day effects after binge-like drinking. Hangover begins when ethanol is absent in plasma and is characterized by physical and psychological symptoms. Affective behavior is impaired during the acute phase of alcohol intoxication; however, no reports indicate if similar effects are observed during withdrawal. The aim of this work was to study the time-extension and possible fluctuations in affective behavior during a hangover episode. Male Swiss mice were injected i.p. either with saline (control group) or with ethanol (3.8 g/kg BW) (hangover group). Anxiety, fear-related behavior and despair phenotype were evaluated at a basal point (ZT0) and every 2 h up to 20 h after blood alcohol levels were close to zero (hangover onset). Also, anhedonia signs and pain perception disabilities were studied. Mice exhibited an increase in anxiety-like behavior during 4 h and 14 h after hangover onset when evaluated by the elevated-plus maze and open field test respectively (p < 0.05). Fear-related behavior was detected in hangover animals by the increase of freezing and decrease of line crossings and rearing frequency during 16 h after hangover onset (p < 0.001). Depression signs were found in hangover mice during 14 h (p < 0.05). Hangover mice showed a significant decrease in pain perception when tested by tail immersion test at the beginning of hangover (p < 0.05). Our findings demonstrate a time-extension between 14 and 16 h for hangover affective impairments. This study shows the long lasting effects of hangover over the phase of ethanol intoxication.

Keywords

• Alcohol hangover; 
• Anxiety-like behavior; 
• Depression; 
• Anhedonia; 
• Nociception

Alcohol hangover: Type and time-extension of motor function impairments

Analía G. Karadayian, 

Rodolfo A. Cutrera

Behavioural Brain Research

Volume 247, 15 June 2013, Pages 165–173

Alcohol hangover is defined as the unpleasant next-day state following an evening of excessive alcohol consumption. Hangover begins when ethanol is absent in plasma and is characterized by physical and psychological symptoms. During hangover cognitive functions and subjective capacities are affected along with inefficiency, reduced productivity, absenteeism, driving impairments, poor academic achievement and reductions in motor coordination. The aim of this work was to study the type and length of motor and exploratory functions from the beginning to the end of the alcohol hangover. Male Swiss mice were injected i.p. either with saline (control group) or with ethanol (3.8 g/kg BW) (hangover group). Motor performance, walking deficiency, motor strength, locomotion and exploratory activity were evaluated at a basal point (ZT0) and every 2 h up to 20 h after blood alcohol levels were close to zero (hangover onset). Motor performance was 80% decreased at the onset of hangover (p < 0.001). Hangover mice exhibited a reduced motor performance during the next 16 h (p < 0.01). Motor function was recovered 20 h after hangover onset. Hangover mice displayed walking deficiencies from the beginning to 16 h after hangover onset (p < 0.05). Moreover, mice suffering from a hangover, exhibited a significant decrease in neuromuscular strength during 16 h (p < 0.001). Averaged speed and total distance traveled in the open field test and the exploratory activity on T-maze and hole board tests were reduced during 16 h after hangover onset (p < 0.05). Our findings demonstrate a time-extension between 16 to 20 h for hangover motor and exploratory impairments. As a whole, this study shows the long lasting effects of alcohol hangover.

http://www.sciencedirect.com/science/article/pii/S0166432813001782

The Patterns of Drug and Alcohol Use and Associated Problems Over 30 Years in 397 Men

Alcoholism: Clinical and Experimental Research

1. Marc A. Schuckit, 
2. Tom L. Smith, 
3. Jelger A. Kalmijn

Article first published online: 29 JUL 2013

Background

Alcohol and drug use disorders (AUDs and SUDs) and their combination are relatively common and often occur together. However, the relationships of potential early life correlates of alcohol and drug disorders to the combined diagnoses have rarely been evaluated in long-term prospective studies or in populations at high risk of one of these diagnoses but not the other.

Methods

Data were analyzed from 397 males (half with an alcohol-dependent father) who had no AUDs or SUDs at age 20 and who were followed approximately every 5 years for 3 decades. Early life correlates and the course of AUDs, SUDs, and combined disorders were evaluated for 4 groups of subjects based on subsequent alcohol and/or drug diagnoses.

Results

While the overall rates of the development of AUDs and SUDs were 41 and 21%, respectively, the rates of the second substance-related diagnosis were almost 2-fold higher for individuals who had the first condition. Among potential risk factors, scores for externalizing traits were elevated for men with AUDs, SUDs, and their combination, but a low level of response (low LR) to alcohol was associated only with the risk of AUDs, even when observed in the context of SUDs. The same earlier life characteristics that related to AUDs and to SUDs also related to the combination of these diagnoses in the same person. Finally, in this prospective study, subjects with both AUDs and SUDs had a more severe course than subjects with either condition alone.

Conclusions

This prospective evaluation of a group at high risk of AUDs confirmed the selective impact of the low LR on the risk of AUDs, the relationship of externalizing characteristics to both AUDs and SUDs and confirmed the more severe clinical course for both conditions when seen together

Keywords:

• Alcoholism;
• Drug Dependence;
• Comorbidity;
• Level of Response to Alcohol;
• Externalizing Clinical Course

Alcohol consumption in late adolescence and early adulthood – where is the problem?

Published 25 July 2013, doi:10.4414/smw.2013.13826

Emmanuel Kuntsche, Gerhard Gmel

Risky single-occasion drinking (RSOD) is more common in late adolescence and early adulthood (approximately between the ages of 16 and 30) than in any other period in life. This is also the age when young people in Switzerland and many other European countries are legally allowed to buy and drink alcohol, but they usually do not yet have adult responsibilities. This paper reviews evidence from the international literature and provides examples of studies conducted in Switzerland demonstrating that (a) RSOD is by far most prevalent on Saturday evenings followed by Friday evenings, usually because young people go out and do not have any work or study responsibilities the next day; (b) RSOD results from drinking in private before going out (“predrinking”) and accelerating the pace of drinking (i.e. increasing the number of drinks consumed per hour); (c) RSOD is often not accidental but purposeful,. to seek excitement, to have fun and to feel the effects of alcohol; (d) RSOD occurs predominantly outside the home, mostly in bars, pubs, discos or at special events and festivals; (e) RSOD often results in intended and unintended injuries and other acute consequences, which are leading risk factors for mortality and morbidity in this age group. Effective prevention strategies should include attempts to reduce opportunities to engage in heavy drinking as well as strategies to reduce its harmful consequences.

Keywords: Risky drinking; predrinking; injuries; adolescence; young adults; harm reduction

Full article

Use of evidence to influence alcohol policy: Case studies, the Alcohol Industry...

Jim McCambridge on 'Use of evidence to influence alcohol policy': 

Case studies, the Alcohol Industry and Minimum Unit Pricing

Watch video

Jim McCambridge leads two presenatations. In the first one he discusses a paper, which was published in 2013: 'Industry use of evidence to influence alcohol policy: A case study of submissions to the 2008 Scottish Government Consultation'. Jim examines how research evidence is used in alcohol industry submissions made to a Scottish Government consultation in 2008 to advocate policies in line with their commercial interests. Moreover, he argues that industry actors consistently oppose the approaches found in research to be most likely to be effective at a population level without actually engaging with the research literature in any depth.

In the second talk he discusses another paper 'Alcohol Industry influence on Public Policy: A case study of minimum pricing', where he focuses on corporate political activity. Whilst much of the literature on alcohol policy exhibits a clear assumption that industry actors are extremely powerful, there is relatively little about the processes through which alcohol policy is made and the specific role played by industry actors in these processes. This project aimed to fill this gap by examining the debates around pricing and promotions policy in England and Scotland. 

Estados con Altas Tasas de Incidencias por Intoxicación Aguda (2005 - 2012)

Las 5 Entidades Federativas con mayor promedio anual en Tasa de Incidencia de Intoxicación Aguda por Alcohol (F10.0) entre 2005 y 2012 son:

1. Yucatán: 583.4

2. Zacatecas: 90.8

3. Aguascalientes: 70.4

4. Quintana Roo: 65.2

5. Campeche: 63.7

Mapa 1.  Estados con altas Tasas de Incidencia de F10.0 y sus promedios regionales en 2012.

Gráficas.  Distribución de Tasas de Incidencia: 2005 - 2012.

Tabla 1.  Tasas de Incidencia de F10.0 por entidad. 2005 - 2012.

Información proveniente de los Anuarios de Morbilidad (2005-2011) y del Reporte Mensual de la Notificación Semanal (2012) de la Dirección General de Epidemiología de la Secretaría de Salud, México.

¿En qué estados de México se intoxican más con alcohol?

Con base en los Anuarios de Morbilidad (2005-2011) y al Reporte Mensual de la Notificación Semanal (2012) de la Dirección General de Epidemiología de la Secretaría de Salud, las 5 Entidades Federativas con mayor promedio anual de nuevos casos de Intoxicación Aguda por Alcohol (F10.0) reportados al sistema de salud  entre 2005 y 2012 son:

1. Yucatán: 10,950

2. Jalisco: 4,160

3. Guanajuato: 2,635

4. Nuevo León: 2,665

5. Distrito Federal: 2,302

Tabla 1.  Número de casos de F10.0 por entidad. 2005 - 2012.

Embriaguez - Imágenes sobre Alcohol

Images from the History of Medicine: http://www.nlm.nih.gov/hmd/ihm/

Alcoholismo por Gustave Philippon

Paris, France : Fils d'Émile Deyrolle, [191-?]

Alcohol: Políticas públicas. Curso en línea de la OPS

Curso virtual sobre políticas de salud pública

en materia de consumo de alcohol.

Más información aquí

Overcoming Addictions, a Web-Based Application...

Overcoming Addictions, a Web-Based Application, and SMART Recovery, an Online and In-Person Mutual Help Group for Problem Drinkers, Part 1: Three-Month Outcomes of a Randomized Controlled Trial

Reid K Hester, Kathryn L Lenberg; William Campbell; Harold D Delaney

http://www.jmir.org/2013/7/e134/

Background: Overcoming Addictions (OA) is an abstinence-oriented, cognitive behavioral, Web application based on the program of SMART Recovery. SMART Recovery is an organization that has adapted empirically supported treatment strategies for use in a mutual help framework with in-person meetings, online meetings, a forum, and other resources.

Objective: To evaluate the effectiveness of OA and SMART Recovery (SR) with problem drinkers who were new to SMART Recovery. Our experimental hypotheses were: (1) all groups will reduce their drinking and alcohol/drug-related consequences at follow-up compared to their baseline levels, (2) the OA condition will reduce their drinking and alcohol/drug-related consequences more than the control group (SR), and (3) the OA+SR condition will reduce their drinking and alcohol/drug-related consequences more than the control group (SR only).

Methods: We recruited 189 heavy problem drinkers primarily through SMART Recovery’s website and in-person meetings throughout the United States. We randomly assigned participants to (1) OA alone, (2) OA+attend SMART Recovery (SR) meetings (OA+SR), or (3) attend SR only. Baseline and follow-ups were conducted via GoToMeeting sessions with a Research Assistant (RA) and the study participant. We interviewed significant others to corroborate the participant’s self-report. Primary outcome measures included percent days abstinent (PDA), mean drinks per drinking day (DDD), and alcohol/drug-related consequences.

Results: The intent-to-treat analysis of the 3-month outcomes supported the first hypothesis but not the others. Participants in all groups significantly increased their percent days abstinent from 44% to 72% (P<.001), decreased their mean drinks per drinking day from 8.0 to 4.6 (P<.001), and decreased their alcohol/drug-related problems (P<.001). Actual use relationships were found for the OA groups, between SR online meetings and improvement in PDA (r=.261, P=.033). In addition in the OA groups, the number of total sessions of support (including SR & other meetings, counselor visits) was significantly related to PDA (r=.306, P=012) and amount of improvement in alcohol-related problems (r=.305, P=.012). In the SR only group, the number of face-to-face meetings was significantly related to all three dependent variables, and predicted increased PDA (r=.358, P=.003), fewer mean DDD (r=-.250, P=.039), and fewer alcohol-related problems (r=-.244, P=.045), as well as to the amount of improvement in all three of these variables. Six-month follow-ups have been completed, and the results are currently being analyzed.

Conclusions: These results support our first experimental hypothesis but not the second or third. All groups significantly increased their PDA and decreased both their mean DDD and their alcohol-related problems, which indicates that both interventions being investigated were equally effective in helping people recover from their problem drinking.

Preferences Regarding Treatment for Alcohol Problems

Sven Andréasson, Anna-Karin Danielsson and Sara Wallhed-Finn




Alcohol and Alcoholism (2013). 
First published online: July 10, 2013








http://alcalc.oxfordjournals.org/content/early/2013/07/09/alcalc.agt067.abstract

1. Aims: The aim of the study was to investigate preferences in the general population regarding type of treatment for alcohol problems and the preferred setting for delivery of treatment and reasons for not seeking treatment for alcohol problems. 

   
   

   Method: Data were from a random, cross-sectional, interview survey of 9005 of the Swedish general population. Proportions of respondents preferring a certain treatment and source of treatment, and reasons suggested for why people do not seek treatment, were analysed in relation to number of standard drinks, employment status, education and income. 

   
   

   Results: Most frequently endorsed forms of treatment were alcoholics anonymous or similar support groups and psychotherapy. More than 50% preferred psychiatric or addiction specialist treatment. Around 10% preferred primary health care and around 20% the occupational health services. About 5% preferred the social services. Respondents rated ‘feeling ashamed’ as the most important reason why people would not seek help for alcohol problems.

   
   

   Conclusion: Large majorities of the respondents preferred treatment in the health care services and few in the social services. Internet-based treatment and pharmacological treatment attracted few respondents, the majority preferring more traditional forms of treatment. Alcohol treatment remains a stigmatized field, evidenced by shame being the most commonly reported reason for not seeking treatment.

Stigma among health professionals towards patients with substance use disorders... Systematic review

• Leonieke C. van Boeke
, 
• Evelien P.M. Brouwers
, 
• Jaap van Weeghel
, 
• Henk F.L. Garretsen

• Drug and Alcohol Dependence
    Volume 131, Issue 1 , Pages 23-35, 1 July 2013

• http://www.drugandalcoholdependence.com/article/S0376-8716(13)00067-7/abstract

Background

Healthcare professionals are crucial in the identification and accessibility to treatment for people with substance use disorders. Our objective was to assess health professionals’ attitudes towards patients with substance use disorders and examine the consequences of these attitudes on healthcare delivery for these patients in Western countries.

Methods

Pubmed, PsycINFO and Embase were systematically searched for articles published between 2000 and 2011. Studies evaluating health professionals’ attitudes towards patients with substance use disorders and consequences of negative attitudes were included. An inclusion criterion was that studies addressed alcohol or illicit drug abuse. Reviews, commentaries and letters were excluded, as were studies originating from non-Western countries.

Results

The search process yielded 1562 citations. After selection and quality assessment, 28 studies were included. Health professionals generally had a negative attitude towards patients with substance use disorders. They perceived violence, manipulation, and poor motivation as impeding factors in the healthcare delivery for these patients. Health professionals also lacked adequate education, training and support structures in working with this patient group. Negative attitudes of health professionals diminished patients’ feelings of empowerment and subsequent treatment outcomes. Health professionals are less involved and have a more task-oriented approach in the delivery of healthcare, resulting in less personal engagement and diminished empathy.

Conclusions

This review indicates that negative attitudes of health professionals towards patients with substance use disorders are common and contribute to suboptimal health care for these patients. However, few studies have evaluated the consequences of health professionals’ negative attitudes towards patients with substance use disorders.