Fases de la recuperación psicológica en pacientes dependientes del alcohol tras un tratamiento intensivoun seguimiento de 4 años
- Francisco Arias 1
- Ana Sion 1
- Regina Espinosa 2
- Rosa Jurado-Barba 1
- Marta Marin 1
- Andrés Martínez Maldonado 1
- Gabriel Rubio 1
- 1 Hospital 12 de Octubre, Madrid. España.
- 2 Universidad Camilo José Cela, Madrid. España.
ISSN: 0214-4840
Argitalpen urtea: 2023
Alea: 35
Zenbakia: 1
Orrialdeak: 21-32
Mota: Artikulua
Beste argitalpen batzuk: Adicciones: Revista de socidrogalcohol
Laburpena
El objetivo de este trabajo es comprobar si las recaídas dificultan la secuencia de la recuperación psicológica y reconstruir la secuencia de la recuperación de pacientes graves que solicitan tratamiento. Los participantes fueron 159 pacientes tratados durante dos años en un programa ambulatorio intensivo y tras ser dados de alta fueron seguidos durante cuatro años. En función de la presencia o no de recaída durante el seguimiento se configuraron dos grupos, el de abstinentes (n = 80) y el de pacientes que recaen (n = 79). Las evaluaciones se realizaron: basal, al alta del tratamiento, al 2.º y 4.º año de seguimiento. Las variables fueron: conductas de evitación, ansiedad, depresión, impulsividad y sentido de la vida. Se incluyó un grupo de control (n = 74) que fue evaluado con la misma cadencia que los pacientes. Los resultados indican una recuperación más lenta en el grupo con recaídas frente a los abstinentes, en todas las dimensiones psicológicas y los períodos estudiados. A los dos años de seguimiento, los pacientes abstinentes obtuvieron puntuaciones en depresión similares a los controles, además de puntuaciones superiores en sentido de la vida (MiL) a partir del final del tratamiento. Al menos en pacientes con dependencia grave del alcohol, nuestros resultados apoyan una secuencia de recuperación que podría continuar más allá de los cuatro años de seguimiento. Se inicia con la evitación de situaciones de riesgo y continúa con el resto de las dimensiones (ansiedad, depresión, impulsividad).
Erreferentzia bibliografikoak
- American Psychiatric Association (2000). DSM-IV-TR: diagnostic and statistical manual of mental disorders (4th ed). Washington, DC: American Psychiatric Association. doi:10.1007/978-3-642-28753-4_1094.
- Amodeo, M., Kurtz, N. y Cutter, H. S. (1992). Abstinence, reasons for not drinking, and life satisfaction. The International Journal of the Addictions, 707-716. doi:10.3109/10826089209068762.
- Ando, B., Must, A., Kurgyis, E., Szkaliczki, A., Drotos, G., Rozsa, S., … Almos, P. Z. (2012). Personality traits and coping compensate for disadvantageous decision-making in long-term alcohol abstinence. Alcohol and Alcoholism, 18-24. doi:10.1093/alcalc/agr144.
- Beracochea, D., Mons, N. y David, V. (2019). Targeting the glucocorticoid receptors during alcohol withdrawal to reduce protracted neurocognitive disorders. Frontiers in Psychiatry, 10, 580. doi: 10.3389/fpsyt.2019.00580.
- Blonigen, D. M., Timko, C., Finney, J. W., Moos, B. S. y Moos, R.H. (2011). Alcoholics Anonymous attendance, decreases in impulsivity and drinking and psychosocial outcomes over 16 years: Moderated-mediation from a developmental perspective. Addiction, 106, 2167-77. doi:10.1111/j.1360-0443.2011.03522.x.
- Blonigen, D. M., Timko, C., Moos, B. S. y Moos, R. H. (2009). Treatment, Alcoholics Anonymous, and 16-year changes in impulsivity and legal problems among men and women with alcohol use disorders. Journal of Studies on Alcohol and Drugs, 70, 714-725. doi:10.15288/jsad.2009.70.714.
- Brown, S. A., Irwin, M. y Schuckit, M. A. (1991). Changes in anxiety among abstinent male alcoholics. Journal of Studies on Alcohol, 52, 55-61. doi:10.15288/jsa.1991.52.55.
- Brown, S. A., Vik, P. W., Patterson, T. L., Grant, I. y Schuckit, M. A. (1995). Stress, vulnerability and adult alcohol relapse. Journal of Studies on Alcohol, 56, 538-545. doi:10.15288/jsa.1995.56.538.
- Chapman, R. (1991). Middle recovery: An introspective journey. Addiction & Recovery, Sept-October, 8-12.
- Chow, P. I., Portnow, S., Zhang, D., Salemink, E., Wiers, R. W. y Teachman, B. A. (2018). Comorbid interpretation and expectancy bias in social anxiety and alcohol use. Anxiety, Stress and Coping, 31, 669-685. doi:10.1080/10615806.2018.1521958.
- Courtney, K. E., Arellano, R., Barkley-Levenson, E., Galvan, A., Poldrack, R. A., Mackillop, J., Jentsch, J. D. y Ray, L. A. (2012). The relationship between measures of impulsivity and alcohol misuse: An integrative structural equation modeling approach. Alcoholism: Clinical and Experimental Research, 923-931. doi:10.1111/j.1530-0277.2011.01635.x.
- Crews, F. T. (2008). Alcohol-related neurodegeneration and recovery: Mechanisms from animal models. Alcohol Research & Health, 31, 377-388. doi:10.1093/alcalc/agn079.
- Crews, F. T., Buckley, T., Dodd, P. R., Ende, G., Foley, N., Harper, C., … Sullivan, E. V. (2005). Alcoholic neurobiology: Changes in dependence and recovery. Alcoholism: Clinical and Experimental Research, 29, 1504-1513. doi:10.1097/01.alc.0000175013.50644.61.
- Crews, F. T. y Nixon, K. (2009). Mechanisms of neurodegeneration and regeneration in alcoholism. Alcohol and Alcoholism, 115-127. doi:10.1093/alcalc/agn079.
- Dyer, M. L., Heron, J., Hickman, M. y Munafò, M.R. (2019). Alcohol use in late adolescence and early adulthood: The role of generalized anxiety disorder and drinking to cope motives. Drug and Alcohol Dependence, 204, 107480. doi:10.1016/j.drugalcdep.2019.04.044.
- Federación de Alcoholicos de la Comunidad de Madrid. (2016). Ayúdate-Ayúdanos.Programa para pacientes y familiares de personas con problemas por el alcohol u otras drogas. Madrid: Ediciones Mapa. ISBN 978-84-608-9611-1.
- Freyer-Rose, K. (1991). Late recovery: A process of integration. Addiction & Recovery, Nov-December, 20-23.
- García González, R. y Alonso Suárez, M. (2002). Evaluación en programas de prevención de recaída: Adaptación española del inventario de habilidades de afrontamiento (cbi) de litman en dependientes del alcohol. Adicciones, 14, 455-463. doi:10.1080/02791072.2002.10399968.
- Ghorbani, F., Khosravani V., Bastan, F. S. y Ardakani, R. J. (2017). The alexithymia, emotion regulation, emotion regulation difficulties, positive and negative affects, and suicidal risk in alcohol-dependent outpatients. Psychiatry Research, 252, 223-230. doi: 10.1016/j.psychres.2017.03.005.
- Góngora, V. y Castro Solano, A. (2011). Validación del cuestionario de significado de la vida mlq en población adulta y adolescente argentina. Interamerican Journal of Psychology, 45, 395-404.
- Gorski, T. T. (1990). The cenaps model of relapse prevention: Basic principles and procedures. Journal of Psychoactive Drugs, 22, 125-133. doi:10.1080/02791072.1990.10472538.
- Hamilton, M. (1959). The assesment of anxiety states by rating. British Journal of Medical Psychology, 50-55. doi:10.1111/j.2044-8341.1959.tb00467.x.
- Hamilton, M. (1967). Development of a rating scale for primary depressive illness. British Journal of Social and Clinical Psychology, 6, 278-296. doi:10.1111/j.2044-8260.1967.tb00530.x.
- de Hooge, I. E., Zeelenberg, M. y Breugelmans, S. M. (2010). Restore and protect motivations following shame. Cognition and Emotion, 24, 111-127. doi:10.1080/02699930802584466.
- IBM Corporation (2013). IBM SPSS Statistics for Windows, Version 22.0. Armonk, New York: IBM Corporation.
- Kelly, J. F. y Yeterian, J. (2013). Mutual-help groups for alcohol and other substance use disorders. En McCrad, B. S. y Epstein, E. E. (Eds.). Addictions: A comprehensive guidebook (p. 500–525). New York: Oxford University Press.
- Kelly, J. F., Greene, M. C. y Bergman, B. G. (2018). Beyond abstinence: Changes in indices of quality of life with time in recovery in a nationally representative sample of u.s. Adults. Alcoholism: Clinical and Experimental Research, 42, 770-780. doi:10.1111/acer.13604.
- Kelly, J. F., Hoeppner, B., Stout, R. L. y Pagano, M. (2012). Determining the relative importance of the mechanisms of behavior change within alcoholics anonymous: A multiple mediator analysis. Addiction, 107, 289-99. doi:10.1111/j.1360-0443.2011.03593.x.
- Kelly, J. F. y Hoeppner, B. B. (2013). Does alcoholics anonymous work differently for men and women? A moderated multiple-mediation analysis in a large clinical sample. Drug and Alcohol Dependence, 130, 186-193. doi:10.1016/j.drugalcdep.2012.11.005.
- Kelly, J. F., Stout, R. L., Magill, M., Tonigan, J. S. y Pagano, M. E. (2010a). Mechanisms of behavior change in alcoholics anonymous: Does alcoholics anonymous lead to better alcohol use outcomes by reducing depression symptoms? Addiction, 105, 626-636. doi:10.1111/j.1360-0443.2009.02820.x.
- Kelly, J. F., Stout, R. L., Tonigan, J. S., Magill, M. y Pagano, M. E. (2010b). Negative affect, relapse, and alcoholics anonymous (aa): does aa work by reducing anger? Journal of Studies on Alcohol and Drugs, 71, 434-444 doi:10.15288/jsad.2010.71.434.
- Kwasnicka, D., Dombrowski S. U., White, M. y Sniehotta, F. (2016). Theoretical explanations for maintenance of behaviour change: A systematic review of behaviour theories. Health Psychology Review, 10, 277-296. doi:10.1080/17437199.2016.1151372.
- Laudet, A. B., Becker, B., J. y White, W. L. (2009). Don’t wanna go through that madness no more: Quality of life satisfaction as predictor of sustained remission from illicit drug misuse. Substance Use & Misuse, 44, 227-252. doi:10.1080/17437199.2016.1151372.
- Laudet, A. B. y White, W. L. (2008). Recovery capital as prospective predictor of sustained recovery, life satisfaction, and stress among former poly-substance users. Substance Use and Misuse, 43, 27-54. doi:10.1080/10826080701681473.
- Litman, G. K., Stapleton, J., Oppenheim, A. N. y Peleg, B. M. (1983). An instrument for measuring coping behaviours in hospitalized alcoholics: Implications for relapse prevention treatment. British Journal of Addiction, 78, 269-276. doi:10.1111/j.1360-0443.1983.tb02511.x.
- Marlatt, G. A. (1990). Cue exposure and relapse prevention in the treatment of addictive behaviors. Addictive Behaviors, 15, 395-399. doi:10.1016/0306-4603(90)90048-3.
- Marlatt, G. A. y Gordon, J. (1985). Relapse prevention. Maintenance strategies in the treatment of addictive behaviors. New York: The Guilford Press.
- Marlatt, G. A. y Witkiewitz, K. (2005). Relapse prevention for alcohol and drug problems. En: Marlatt, A., Donovan, D. M (Eds), Relapse prevention: maintenance strategies in the treatment of addictive behaviors (2nd Ed), 1-44.
- Mons, N. y Beracochea, D. (2016). Behavioral neuroadaptation to alcohol: From glucocorticoids to histone acetylation. Frontiers in Psychiatry, 7, 16. doi:10.3389/fpsyt.2016.00165.
- Oquendo, M., Baca-García, E., Graver, R., Morales, M., Montalvan, V. y Mann, J. (2001). Spanish adaptation of the Barratt impulsiveness scale (BIS-11). European Journal of Psychiatry,15, 147-55.
- Patton, J. H., Stanford, M. S. y Barratt, E. S. (1995). Factor structure of the Barratt impulsiveness scale. Journal of Clinical Psychology, 51, 768-774. doi:10.1002/1097-4679(199511)51:6<768::AID-JCLP2270510607>3.0.CO;2-1.
- Rubio, G., Marín, M., Arias, F., López-Trabada, J. R., Iribarren, M. Alfonso, S.,… de Fonseca, F. R. (2018). Inclusion of alcoholic associations into a public treatment programme for alcoholism improves outcomes during the treatment and continuing care period: A 6-year experience. Alcohol and Alcoholism, 32, 1681-1687. doi:10.1093/alcalc/agx078.
- Rubio, G., Urosa, B. y Santo Domingo, J. (1998). Validación de la escala de intensidad de la dependencia al alcohol. Psiquiatría Biológica, (Supl 1), 44-47.
- Substance Abuse and Mental Health Services Administration. (2011). SAMHSA announces a working definition of “recovery” from mental disorders and substance use disorders. Recuperado de https://store.samhsa.gov/sites/default/files/d7/priv/pep12-recdef.pdf.
- Sobell, L. C., Sobell M. B., Leo, G. I. y Cancilla, A. (1988). Reliability of a timeline method: Assessing normal drinkers’ reports of recent drinking and a comparative evaluation across several populations. British Journal of Addiction, 83, 393-402. doi:10.1111/j.1360-0443.1988.tb00485.x.
- Stautz, K. y Cooper, A. (2013). Impulsivity-related personality traits and adolescent alcohol use: A meta-analytic review. Clinical Psychology Review, 33, 574-592. doi:10.1016/j.cpr.2013.03.003.
- Steger, M. F., Frazier, P., Kaler, M. y Oishi, S. (2006). The meaning in life questionnaire: Assessing the presence of and search for meaning in life. Journal of Counseling Psychology, 53, 80-93. doi:10.1037/0022-0167.53.1.80.
- Stockwell, T., Murphy, D. y Hodgson, R. (1983). The severity of alcohol dependence questionnaire: Its use, reliability and validity. British Journal of Addiction, 78, 145-155. doi:10.1111/j.1360-0443.1983.tb05502.x.
- Tonigan, J. S., McCallion, E. A., Frohe, T. y Pearson, M. R. (2017). Lifetime alcoholics anonymous attendance as a predictor of spiritual gains in the relapse replication and extension project (RREP). Psychology of Addictive Behaviors, 31, 54-60. doi:10.1037/adb0000235.
- Ugochukwu, C., Bagot, K. S., Delaloye, S., Pi, S., Vien, L., Garvey, T.,… Ishak, W. W. (2013). The importance of quality of life in patients with alcohol abuse and dependence. Harvard Review of Psychiatry, 21, 1-17. doi:10.1097/hrp.0b013e31827fd8aa.
- Venner, K. L., Matzger, H., Forcehimes, A. A., Moos, R. H., Feldstein, S. W., Willenbring, M. L. y Weisner, C. (2006). Course of recovery from alcoholism. Alcoholism: Clinical and Experimental Research, 30, 1079-1090. doi:10.1111/j.1530-0277.2006.00121.x.
- White, W. L. (2012). Recovery/remission from substance use disorders: An analysis of reported outcomes in 415 scientific reports, 1868–2011 (Drug & Alcohol findings Review Analysis). Pittsburgh, PA: Philadelphia Department of Behavioral Health and Intellectual Disability Services and the Great Lakes Addiction Technology Transfer Center.
- Wilcox, C. E., Pearson, M. R. y Tonigan, J. S. (2015). Effects of long-term aa attendance and spirituality on the course of depressive symptoms in individuals with alcohol use disorder. Psychology of Addictive Behaviors, 29, 382-391. doi:10.1037/adb0000053.
- Witkiewitz, K., Wilson, A. D., Pearson, M. R., Montes, K. S., Kirouac, M., Roos, C. R.,… Maisto, S. A. (2019). Profiles of recovery from alcohol use disorder at three years following treatment: Can the definition of recovery be extended to include high functioning heavy drinkers? Addiction, 14, 69-80. doi:10.1111/add.14403.
- Worley, M. J., Tate, S. R. y Brown, S. A. (2012). Mediational relations between 12-step attendance, depression and substance use in patients with comorbid substance dependence and major depression. Addiction, 107, 1974-1983. doi:10.1111/j.1360-0443.2012.03943.x.