Resumen de Las contribuciones del doctor Ramón de la Fuente en el campo de las adicciones
- español
Este trabajo hace un recuento de las contribuciones del doctor Ramón de la Fuente en el campo de las adicciones, quien siempre sostuvo que los avances en el conocimiento sólo podrían lograrse con la integración de las neurociencias y la investigación clínica y social. Su avanzada concepción del problema lo llevó a formar una institución en donde se desarrollaría investigación multidisciplinaria e impulsó las tres áreas en el Instituto que formó hace 28 años.
El doctor de la Fuente pensó que cualquier propuesta de política pública en este campo tendría que estar basada en el conocimiento del problema y de sus tendencias, por lo que impulsó el desarrollo de un área de epidemiología y surgió así un grupo que estudia las adicciones desde una perspectiva social.
Una de las primeras investigaciones epidemiológicas entre estudiantes las hizo el doctor de la Fuente. Este trabajo, publicado en los inicios de los 1970’s, fue el antecedente de los múltiples estudios que seguirían en este campo.
El doctor de la Fuente fue también uno de los primeros en describir los trastornos mentales inducidos por drogas alucinógenas. Durante su ejercicio como director de la unidad de psiquiatría del Hospital Español de México, se trató a los pacientes con este trastorno dual, de una manera integral. Con reconocidas figuras del momento, funda uno de los primeros grupos de autoayuda que existieron en el país, en dicho hospital.
Más tarde, bajo la coordinación del Instituto Nacional de Psiquiatría, promueve la creación de un Centro de Tratamiento para Alcohólicos y sus Familiares (CAAF) que proporciona desde hace 28 años, una ayuda integral bio-psico-social. Incluye un servicio de desintoxicación y de atención a la familia. Integró desde su principio a Alcohólicos Anónimos.
De 1972 a 1979 y nuevamente de 1982 a 1986, fue miembro de la Junta Internacional de Fiscalización de Estupefacientes y Sustancias Psicotrópicas. Defendió siempre su opinión, de que la demanda estimulaba también la oferta y que la solución tenía que venir de propuestas globales. En 1988, fue nombrado miembro del consejo asesor del Diplomado en conducta adictiva del Instituto de Psiquiatría en Londres.
El Instituto Nacional de Psiquiatría es Centro Colaborador de la Organización Mundial de la Salud en Adicciones y Salud Mental. El doctor de la Fuente fue su director durante el período de 1977-1998 y bajo su gestión se desarrolló en forma continua la investigación transcultural y se colaboró en forma permanente en grupos de trabajo internacional.
De 1973 a 1982 y de 1991 a 2000 fue miembro del Comité de Expertos de la Organización Mundial de la Salud. Su visión coincidía con la de ese organismo sobre la necesidad de conceptualizar el problema desde una perspectiva amplia de salud pública. De 1980 a 1982 colaboró en el área de diagnóstico y clasificación de problemas relacionados con trastornos mentales, alcoholismo y farmacodependencia.
El período en que el doctor de la Fuente dirigió el Centro Colaborador de la Organización Mundial de la Salud en Adicciones, su labor fue fundamental en el desarrollo de infraestructura de investigación, en sus primeros años, y en la propuesta de nuevas maneras de entender el problema desde perspectivas socioculturales diferentes a las de los países desarrollados en los que se había hecho la mayor parte de la investigación en este campo.
En el Instituto se hicieron los primeres estudios orientados a evaluar intervenciones breves en bebedores problema, se probó el impacto del consejo breve dado por un médico en un escenario hospitalario.
Durante su mandato se establecieron convenios de colaboración con múltiples instituciones con intereses complementarios entre las que sobresale la Secretaría de Educación Pública con quien se han venido realizando las encuestas de escuelas desde 1978.
Apoyó la creación de maestrías y doctorados en Ciencias Médicas en Psiquiatría y en Ciencias de la Salud en Salud Mental Pública, en colaboración con la UNAM, puesto su interés en incluir en la formación en los campos de la Salud Pública a psiquiatras y profesionistas de las ciencias sociales y de la salud.
En 1985, el Doctor Soberón, entonces Secretario de Salud, solicitó su colaboración en la formulación de los Programas Nacionales contra las Adicciones. Del Instituto salieron los proyectos de los programas contra el abuso de alcohol y alcoholismo, las adicciones y el tabaquismo, que se pusieron a consideración de más de 100 instituciones de los sectores público, social y privado.
El doctor de la Fuente ha causado impacto con su trabajo en muchas generaciones de universitarios; hoy en día es amplio el número de personas que trabajan en el tema con una preparación científica
- English
This paper reviews the publications of doctor Ramón de la Fuente in the field of addictions, the infrastructure he created for the study and treatment of these problems and his contributions to human resource training. Doctor Ramón de la Fuente’s contributions in the field of addictions are both wide-ranging and outstanding, as they were in all issues in which he took interest. They include the development of infrastructure, research and the training of human resources. He thought that advances in knowledge could only be achieved through the integration of neuroscience and clinical and social research.
His critical thought led him to question the scientific basis of many of the programs and recommendations made in the field of addictions. In his view, there was a tendency to ignore the biological basis of the disease and its link with the environment. He also suggested that social processes affected genetics and the functioning of the brain, leaving to science the challenge of determining how these processes occur. His advanced conception of the problem led him to establish an institution where multidisciplinary research would be carried out in neurosciences, clinical and social areas, this being the reason he created and promoted these three departments in the institute he created 27 years ago. Their integration was his challenge and the enormous responsibility he left to those of us who were fortunate enough to collaborate with him in the development of his institutional project.
Doctor de la Fuente thought that any public policy in this field would have to be based on knowledge of the problem and its trends, and thus he proposed the development of epidemiology; a group emerged that studied addictions from a social perspective.
One of the first epidemiological studies of students was conducted by doctor de la Fuente. This study, published in the early 1970s, was the forerunner of several studies that would be undertaken in this field.
Doctor de la Fuente was also one of the first to describe the mental disorders induced by hallucinogenic drugs. During his time as director of the psychiatric unit in the Spanish Hospital in Mexico, patients with this dual disorder were treated in an integral fashion. Together with other well-known personalities of the time, founded one of the first self-help groups that existed in the country, at the Spanish Hospital.
Later on, under the coordination of the National Institute of Psychiatry, he promoted the creation of a Treatment Center for Alcoholics and their Relatives (CAAF). The Center is also designed to help the family. The concept of treatment evolved from regarding the family as a fundamental part in the treatment of the patient to understanding that the family was also sick and required help, regardless of whether the patient wanted or not to be rehabilitated.
The center’s therapeutic orientation was integral, including general medicine, psychiatry, psychology and social work. From the outset, the center incorporated Alcoholics Anonymous in a perfect example of collaboration between professionals and civil society.
From 1972 to 1979 and again from 1982 to 1986, doctor Ramón de la Fuente was a member of the International Narcotics Control Board (INCB). He always defended the position, now internationally acknowledged, that demand also stimulated supply and that the solution would have to come from global perspectives.
The National Institute on Psychiatry is a Collaborative Center of the World Health Organization in Addictions and Mental Health. Doctor de la Fuente was its director during the period from 1977-1998.
In 1988, he was appointed member of the advisory board for the Diploma Course in Addictive Behavior of the Institute of Psychiatry in London.
From 1973 to 1982 and then from 1991 to 2000, he was a member of Experts’ Committee of the World Health Organization, and agreed with this organization’s views on the need to conceptualize the problem of addiction from a broad public health perspective.
From 1980 to 1982, he collaborated in the area of the diagnosis and classification of problems related to mental disorders, alcoholism and drug dependence.
His collaboration in this last issue was extremely significant since it occurred during a period of transition in regard to the way in which the problem was defined and therefore, in how it could be affected. Responsibility for the problem was no longer attributed to a small sector of chronic drinkers, and instead, drinking was regarded as the result of the consumption patterns of the general population. This new conception in turn opened up the possibility of influencing the problem on the basis of public policies capable of affecting the way alcohol is made available to the population and the consumption behavior.
Part of the research that triggered this change of conception was carried out at the National Institute of Psychiatry in its capacity as Collaborative Center of the World Health Organization.
The time when doctor de la Fuente directed the WHO Collaborative Center was crucial to the development of research infrastructure in its early years and to the proposal of new ways of understanding the problem from different socio-cultural perspectives other than those of developed countries where most of the research on this issue had been carried out.
Given the characteristics of the phenomenon that prevailed in Mexico, doctor de la Fuente placed particular emphasis on the study of inhalants, not included in international conventions.
The first studies conducted in Mexico, designed to evaluate brief interventions with problem drinkers, were carried out at the Institute. Researchers measured the impact of a brief advice for the modification of drinking patterns given by a doctor in hospital settings, lasting 5 or 10 minutes including the application of screening tests.
During his mandate, collaboration agreements were established with several institutions with complementary interests, being the most outstanding those with the Public Education Secretariat, with which the Institute has conducted school surveys since 1978.
He supported the creation of master’s and doctoral degree programs in Medical Sciences in Psychiatry and in Health Sciences in Public Mental Health, in collaboration with UNAM, in order to include training in the field of Public Health for doctors, psychiatrists, and other professionals in the health social sciences.
Given doctor de la Fuente’s vast knowledge of the issue and the importance of the research he has undertaken, it is hardly surprising that doctor Guillermo Soberón, then Health Secretary, should have requested his collaboration in the formulation of National Addiction Programs. The Institute designed the projects for programs to combat alcohol abuse and alcoholism, addictions and tobacco, which were submitted for consideration by over 100 institutions in the public, social and private sectors.
Doctor de la Fuente’s work has had an impact on several generations of university students and nowadays on a large number of people with scientific training work in this area.
