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Síndrome de dependencia al alcohol: comparación entre hombres y mujeres

  • Autores: María Elena Medina-Mora Icaza, M.C. Mariño, Shoshana Berenzon Gorn
  • Localización: Salud mental, ISSN 0185-3325, Vol. 28, Nº. 4, 2005, págs. 33-39
  • Idioma: español
  • Enlaces
  • Resumen
    • español

      El presente trabajo tiene como objetivo principal conocer la forma en que se presenta el Síndrome de Dependencia al Alcohol, según los indicadores y criterios propuestos por el DSM-IV, en una muestra de mujeres que acudieron a solicitar ayuda por problemas relacionados con el consumo de alcohol a la Clínica para Atención de Problemas Relacionados con el consumo de alcohol (CAPRA) del Hospital General de México. Después se hizo una comparación con los resultados obtenidos en un proyecto llevado a cabo con anterioridad entre 211 pacientes del sexo masculino de este mismo centro de tratamiento.

      Método: Se entrevistó una muestra de 100 mujeres que acudieron a la CAPRA, que fueran mayores de 18 años, estuvieran en condiciones tanto físicas como mentales para contestar el cuestionario y hubieran bebido alcohol en el año previo. El instrumento utilizado para medir el Síndrome de Dependencia al Alcohol fue la Composite Internacional Diagnostic Interview, Módulo de Abuso de Sustancias (CIDI-SAM).

      Resultados: De las pacientes entrevistadas, 50% cumple con el criterio de dependencia, en comparación con 82% de los 211 hombres entrevistados en este mismo centro, con una diferencia estadísticamente significativa (x2= 34.22; p = 0.000). Al hacer una revisión del número de indicadores reportados por cada muestra, se encuentra que las diferencias más importantes se presentan en los extremos del continuo, donde las mujeres que no reportan ningún indicador son 7.6 veces más que los hombres, y 2.3 veces menos que los hombres que reúnen los 7 indicadores presentes. Las diferencias se vuelven cada vez menos marcadas conforme se acercan a la mitad del número de indicadores.

      Al hacer un análisis más minucioso de los síntomas de dependencia según el grado de gravedad de la misma, medida por medio de los indicadores presentes en cada muestra (0-2, 3-4, 5-7), se encontró que en todos los grupos el síntoma más frecuente es el relacionado con los problemas de salud y psicológicos. Sin embargo, dentro de los pacientes que no son dependientes (menos de 3 criterios), se observaron importantes diferencias por sexo. En el caso de los hombres, los síntomas más frecuentes, después de los relacionados con problemas de salud y psicológicos, fueron los asociados con la abstinencia y la pérdida de control. Por su parte, las mujeres reportaron síntomas relacionados con los esfuerzos inútiles por dejar de beber y la abstinencia. Entre el grupo de mujeres con dependencia de gravedad baja (3-4 criterios), los síntomas con los porcentajes más altos fueron los mismos que entre los no dependientes. A su vez, los hombres con este grado de dependencia presentaron principalmente un abandono o reducción de las actividades (sociales, recreativas o laborales) por estar bebiendo y los síntomas de abstinencia.

      Dentro de los grupos con gravedad alta (5 a 7 criterios), las diferencias entre hombres y mujeres se hacen menos evidentes. En estos casos sobresale de manera independiente la falta de control sobre la bebida en ambos grupos y, en el caso particular de las mujeres, el abandono o reducción de actividades para poder tomar.

      Conclusiones: La información que se presenta en este documento muestra las diferencias entre los hombres y las mujeres que buscan ayuda por sus problemas con el alcohol. También hace evidente la necesidad de realizar estudios específicos entre mujeres considerando sus condiciones, no sólo sociales, sino biológicas y psicológicas, que reflejen la realidad de éstas y que sean tomadas en cuenta para proporcionar un tratamiento adecuado y eficaz que llene las expectativas y necesidades que requiere su condición de género.

    • English

      The main objective of this paper is to describe the way in which the Alcohol Dependence Syndrome is manifested, according to the criteria and indicators proposed by the DSM-IV, in a female sample that sought help at a treatment center due to alcohol consumption-related problems. A comparison was made with the results obtained in a previous 211-male-sample at the same treatment center.

      Method:

      This project is a case study in which a sample of 100 females was interviewed at the Clínica para Atención de Problemas Relacionados con el Alcohol (CAPRA) (Clinic for the Attention of Alcohol Related Problems) at the Hospital General de México (the main general hospital for patients who do not have social security benefits and come from different regions of the country including rural areas).

      The criteria for inclusion were: being aged 18 or over, female, having sought help for the first time (at these centers) due to alcohol problems and being physically and mentally able to answer the questionnaire correctly. Females that had previously been treated were included. However, one of the requisites was that they had to have drunk alcohol during the year before the interview to warrant recent and current consumption, regardless of being exposed to prior treatments, since the questionnaire includes the previous 12 months as a parameter.

      The instrument used to conduct this study was the Composite International Diagnostic Interview, Substance Abuse Module (CIDI-SAM). This instrument has been widely used with excellent results on various population samples in the U.S., as well as on the male population receiving treatment in Mexico. The instrument included the following sections: sociodemographic characteristics, amount and frequency of consumption; physical, psychological and social problems; symptoms of alcohol dependence, and pathways to health services. A few new sections were incorporated with specific characteristics for women, such as the effects of alcohol on women, alcohol consumption during pregnancy and nursing, partner’s alcohol consumption and violent behavior in the couple and their associated risks.

      Results:

      The average age of the women interviewed was 47 years old, ranging from 22 to 91. Thirty-two percent were either married or living with a partner, 20% were divorced, 26% were widows and 22% were single. Seventy-four percent of them had children and they had 4.5 children in average. The average educational level was 4.7 years.

      Fifty-two percent of the respondents reported drinking alcohol every day and 19% almost every day (five or six days a week), with an average of 4.2 drinks per occasion (52% of the women reported having three to four drinks per occasion). The preferred reported beverage was «pulque» (28%), followed by beer (25%) and distilled beverages (21%). Other traditional drinks and «96° proof” alcohol also showed a significant percentage (20%).

      As for the Alcohol Dependence Syndrome, 50% of the women met the dependency criteria proposed by the DSM-IV, compared with 82% of the 211 men interviewed in the same center with a statistically significant difference (X2= 34.22; p = 0.000). Women with alcohol dependence syndrome presented an average of five symptoms.

      A more detailed analysis was carried out based on the severity of the dependence syndrome, measured by the number of reported symptoms (1-2, 3-4, 5-7). The most frequently reported symptom across all levels of severity was the presence of physical and/or psychological problems. In the group of non-dependent women (those who reported less than 3 symptoms), an important difference between men and women was observed. The most frequent symptoms reported by men, after the presence of physical and psychological problems, were withdrawal symptoms (34.2%) and loss of control (15.8%). In the case of the women, unsuccessful efforts to reduce alcohol intake (16%) and withdrawal symptoms (16%) appeared in the second place.

      The group of women with low dependence (three to four criteria reported) presented similar characteristics to those observed in the group of non-dependent women. In men with low levels of dependence, the most frequent symptom presented were: giving up or reducing activities (social, occupational or recreational) in order to drink and withdrawal symptoms. In the groups with the highest severity level (5-7 symptoms), differences between men and women were less evident.

      Conclusions:

      The most important differences in dependence symptoms between men and women are probably related to gender-specific cultural expectations and social norms regarding alcohol use. This situation is reflected in the type of symptoms presented more frequently in women and men. Women reported more symptoms related to unsuccessful efforts to reduce alcohol intake; whereas men presented symptoms related to the time spent drinking or recovering from the effects of alcohol and giving up or reducing activities (social, occupational or recreational) in order to drink.

      The information presented evidences the need to conduct more specific studies that take in consideration biological and psychological, as well as social conditions underlying female alcohol use in order to provide appropriate and effective treatment to meet their gender needs and expectations.


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