Evaluación de un modelo de intervención breve para familiares de usuarios de alcohol y drogas. Un estudio piloto

• Autores: Marcela Tiburcio Sainz, Guillermina Natera Rey
• Localización: Salud mental, ISSN 0185-3325, Vol. 26, Nº. 5, 2003, págs. 33-42
• Idioma: español
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• Dialnet Métricas: 3 Citas
• Resumen
  • español

    La alta prevalencia actual del consumo de alcohol y otras drogas indica que la convivencia con un usuario de estas substancias es una situación que se da cada vez con más frecuencia entre la población mexicana. En estas circunstancias, la diversidad de los problemas sociales y de salud que se asocian con el consumo, se convierte en importante fuente de tensión y malestar para los miembros de la familia.

    Al interior de la familia y en el ambiente sociocultural existen mitos, valores, tradiciones y creencias que limitan la posibilidad de que los afectados reciban ayuda externa para hacer frente a los problemas relacionados con el consumo de substancias. Por otra parte, las alternativas para atender los problemas de salud de los familiares de los consumidores son escasas y poco accesibles. De ahí la necesidad de contar con un modelo de intervención que contribuya a que los familiares logren un mejor estado de salud física y psicológica.

    En este trabajo se documenta la evaluación de un modelo de intervención basado en la aproximación estrés-enfrentamiento-salud. Esta propuesta sugiere que las personas que conviven cotidianamente con usuarios de substancias están expuestas a diversas experiencias desagradables que se manifiestan a nivel psicológico y físico. El conjunto de respuestas naturales a dicha tensión se conoce como enfrentamiento.

    Con base en los hallazgos resultantes de una amplia investigación sobre este tema, se desarrolló un modelo de intervención dirigido a propiciar que los familiares identifiquen y reflexionen respecto a las formas en que le han hecho frente a este problema y a sus consecuencias para que logren reaccionar de formas más efectivas que ayuden a reducir su tensión.

    La intervención consta de 5 pasos: 1) escuchar y explorar las percepciones y las circunstancias sobre cómo afecta el consumo a la familia; 2) proporcionar información objetiva y relevante sobre las sustancias y sus efectos; 3) identificar los mecanismos naturales de enfrentamiento y analizar sus ventajas y desventajas; 4) explorar el apoyo recibido, y 5) canalización hacia fuentes de ayuda especializada.

    Se llevó a cabo un estudio piloto con el objeto de evaluar la efectividad del modelo de intervención. El estudio consistió en la aplicación de los cinco pasos del modelo, en la comparación de las formas de enfrentamiento, y de la presencia de sintomatología física y psicológica, antes y 3 meses después de la intervención. En el estudio participaron 28 familiares de usuarios de alcohol y otras drogas a los que se contactó en un centro de atención psicológica, un centro comunitario y un centro especializado en el tratamiento de las adicciones.

    El análisis de datos toma en cuenta a los casos que completaron los cinco pasos de la intervención. Los resultados mostraron que los informes sobre la frecuencia en el uso de las formas de enfrentamiento, de tolerancia y de involucramiento se redujeron. Se observó asimismo un incremento en el empleo de algunas formas de enfrentamiento, relacionadas con el retiro, lo que en estudios previos se había identificado como un rasgo saludable. Los hallazgos muestran también una disminución en la frecuencia con que los participantes experimentaron síntomas físicos y psicológicos. La diferencia entre ambas mediciones (antes y después de la intervención) tiene significancia estadística en los reactivos ¿mareado o débil¿ (z = -2.646, p < 0.05) y ¿presión en la cabeza¿ ( z = 2.460, p < 0.05). En cuanto a la satisfacción respecto a la orientación recibida, los participantes indicaron que fue de mucha utilidad y que habían experimentado cambios tanto en su vida como en su relación con el usuario de alcohol o de drogas, a partir de que recibieron di ha orientación.

    Los resultados indican que hubo una reducción de los síntomas expresados por los familiares y también cambios en las formas de enfrentamiento. Por esta razón, el modelo de intervención representa una alternativa viable para el abordaje de los problemas que se originan al vivir con un usuario de alcohol o de drogas

  • English

    The high prevalence of alcohol and other drugs consumption suggests that living with a substance user has become a frequent situation among the Mexican population. The wide range of social and health problems related to consumption represents significant sources of stress and distress for family members. Within the family, as well as in the sociocultural environment, there are myths, values, traditions and beliefs that prevent family members from receiving external help to cope with substanceuse related problems. On the other hand, health care alternatives for families under such conditions are scarce and inaccessible. The previous information underlines the need for intervention models to help families improve their physical and psychological health condition when faced to the substance use of one family member. This paper reports the evaluation of an intervention model based on the stress-coping health approach. This proposal suggests that people living with alcohol and other drugs users are exposed to several unpleasant experiences affecting both physical and psychological levels. Natural responses to such strains are known as coping, which might influence the level of stress experienced, and the consumption problem itself. Research carried out in Mexico and England revealed a threefactor structure of coping with substance abuse: a) engagement, includes the attempts of family members to change excessive drinking or drug taking, some forms of engaged coping are emotional and controlling, some other are supportive or assertive; b) tolerance, which can take the form of inaction, acceptance, self-sacrifice or support, c) withdrawal, includes actions that lead the relative to his/her independence. Further analysis showed that the score on withdrawal is negatively correlated to the presence of symptoms suggesting that withdrawal coping might be considered a healthy trait in the coping repertoire. Based on the results of a broader study about families coping with alcohol and drug abuse, an intervention model was developed aimed at helping family members to identify and reflect around the ways they have coped with consumption and its consequences, in order to find more effective ones that could also reduce the stress they experience.

    Intervention consists of five steps: 1) to listen and to explore the perceptions and circumstances about the way alcohol and drug use affect the family; 2) to provide objective and relevant information about the substance and its effects; 3) to identify the natural coping mechanisms analyzing its advantages and disadvantages; 4) to explore the support the family member has received; 5) to refer to specialized sources of help when needed. A pilot study was carried out in order to evaluate the intervention’s effectiveness. The study consisted in the comparison of the different ways of coping used and the presence of physical and psychological symptoms before and three months after the intervention. The sample included 28 relatives of alcohol and drug users, who were contacted at three different sites located in the Southern area of Mexico City: 1) psychological assistance agency, 2) community agency, and 3) addiction treatment agency. Changes in coping were accounted for through the Coping Questionnaire, while the presence of symptoms was assessed with the Symptom Rating Test. In addition, a questionnaire to explore satisfaction with the orientation received was also administered after completing the intervention. Data analysis considers the cases that completed all five steps included in the intervention model. Before the intervention, the most common ways of coping reported were related to the engaged position, for instance, talking to the user about his/her alcohol or drug consumption, insisting on the subject or starting arguments. Other frequent ways of coping tend to tolerance, such as feeling hopeless and pretend everything is all right when it is not. At follow up the most reported coping actions corresponded again to the engaged position but in a supportive style, for example, to discuss with the user what can be done regarding his/her substance abuse, or explaining to the user the expectations regarding his behavior. The results show that the use of tolerant and engaged ways of coping decreased after the intervention. Likewise, the use of responses related to withdrawal increased after completing the five steps intervention model. This coping position was identified as a healthy sign in previous studies. Results also show that the presence of physical and psychological symptoms decreased. Before intervention all participants reported having experienced symptoms such as “nervous”, “worried” and “unhappy or depressed” from the psychological subscale. Regarding physical symptoms, the more frequently reported were “dizzy or faint” and “feeling tired or lack of energy”. The difference between both measurements (before and after intervention) was statistically significant as to “dizzy or faint” (z=-2.646, p<0.05) and “feelings of pressure or tightness in head” (z=2.460, p<0.05). Regarding satisfaction with the orientation received, participants mentioned it was very useful; after taking part in the study they perceived changes in their lives as well as in the relationship to the alcohol or drug user. According to participants, receiving information about the substance abuse problem constitutes an additional advantage of the intervention. Moreover, five relatives decided to seek more intense help for other family or individual problems. The intervention model represents a feasible alternative to approach the problems derived of living with an alcohol or drug user as the findings show a decrease of symptoms and changes in coping. In general terms, relatives concluded the intervention having a clearer picture of the alternative ways of coping they could use. During follow up the participants mentioned they had practiced those new responses to deal with alcohol or drug abuse. In some cases they noticed changes in the user’s behavior that contributed to reaffirm the notion that seeking help was the right decision. This first approach to evaluation of effectiveness set the basis for future research that should include larger samples and more complex designs in order to compare different groups.