Addictive disorders, psychiatric symptoms, and potentially traumatic events in individuals with disabilities.

Background/Objectives: Individuals with disabilities (IWD) have a higher risk of potentially traumatic events (PTEs) either in childhood or adulthood, increasing the risk of suicide attempts, mental disorders, and substance use disorder. The aim of this study was to explore the association between substance use, psychiatric symptoms and suicidal behavior with PTEs. A Multisite cross-sectional study was conducted. Materials and methods: The sample includes 1,098 participants with any type of disability (motor, intellectual, visual, and mixed) located in Mexico City. Traumatic events, violence, discrimination, addictive disorders, and psychiatric disorders were examined. Multivariate logistic regression models were conducted. Data was collected between September-October 2014. Results: People with motor or visual disability have a higher prevalence in nicotine use disorder (NUD), generalize anxiety disorder (GAD), mayor depression disorder (MDD), want to be dead, and lifetime suicide attempts. Intellectual disability group only presents GAD and MDD. All disability groups have a high prevalence of PTEs. Verbal violence in childhood, sexual abuse, discrimination and serious accidents had a strong impact in the development of NUD, psychiatric symptoms and suicidal behavior. Conclusion: These findings show the relevance of develop specific tools for detection, referral and treatment, in order to improve the mental health of people with disabilities.

Developing an App to Screen for Dual Disorders: A Tool for Improving Treatment Services in Mexico.

Background: Previous studies in Mexico undertaken at residential facilities for treating substance use disorders (SUDs) reported that the prevalence of Dual Disorders (DDs) is over 65%. DDs pose a major challenge for the Mexican health system, particularly for community-based residential care facilities for SUDs, due to the shortage of certified professionals to diagnose and treat these patients. Moreover, the lack of standardized algorithms for screening for and evaluating DDs to refer patients to specialized services (whether private or public) hinders timely care, delaying the start of integrated treatment. The use of new technologies provides a strategic opportunity for the timely detection of DDs through the development of standardized digital applications for the timely detection of DDs. Objective: To develop an app to screen for DDs, which will contribute to referral to specialized services in keeping with the level of severity of psychiatric and addictive symptomatology, and be suitable for use by community-based residential care facilities for SUDs. Method: The research project was implemented in two stages. Stage 1 involved obtaining the psychometric properties of the Dual Diagnosis Screening Interview (DDSI). Stage 2 consisted of two steps to test the Beta version of the app and the quality of version 1.0. Results: The DDS obtained sensitivity and specificity scores above 85%. The app and its algorithm to screen for and refer DDs proved to be efficient and easy to apply with satisfactory community acceptance. Conclusion: The app promises to be a useful screening tool at residential addiction treatment centers.

Characterization of dual disorders in addiction treatment-seekers at mexican outpatient centers.

In Mexico, very few studies have been published on dual disorders (DD) at specialized treatment centers describing actual treatment needs and even fewer have been undertaken at addiction treatment centers in the public system. The objective of this study was therefore to analyze DD and other clinical characteristics in people seeking treatment at outpatient addiction centers in the public system.

Caracterización de la patología dual en personas que buscan tratamiento de adicciones en centros ambulatorios mexicanos / Characterization of dual disorders in addiction treatment-seekers at mexican outpatient centers

INTRODUCCIÓN: En México son pocos los estudios publicados sobre la patología dual (PD) en centros de tratamiento espe­cializados que describan las necesidades reales de tratamiento y menos aún que se hayan realizado en centros de tratamiento de adicciones del sistema público. Por esto, el objetivo de pre­sente estudio fue analizar la PD y otras características clínicas en personas que buscan tratamiento en centros ambulatorios de adicciones del sistema público. MÉTODO: Estudio transversal multisede. Se analizó una muestra de 148 pacientes de cen­tros de tratamiento. Se evaluaron trastornos psiquiátricos con la Mini Entrevista Neuropsiquiátrica Internacional, conductas sexuales de riesgo con la Escala de Comportamiento de Riesgo de VIH, consumo de drogas inyectables, y la calidad de vida con el Cuestionario de Calidad de Vida. Se realizaron análisis univariados mediante chi cuadrado para determinar diferen­cias estadísticas entre personas con y sin PD, así como regre­sión lineal para calidad de vida y regresión logística binomial para determinar el riesgo para presentar consumo de drogas inyectables, uso de condón y conducta suicida. RESULTADOS: La cocaína fue la droga de impacto con mayor prevalencia (33.8%). El grupo de personas con trastorno por consumo de alcohol + trastorno por consumo de drogas presentó mayor comorbilidad con el trastorno depresivo mayor (25.7%), tras­torno antisocial (27.7%), déficit de atención (11.5%) e intento suicida (17.6%). El grupo con PD presentó mayor consumo de drogas inyectables (OR= 1.67), no uso de condón con pareja primaria (OR= 3.66), más intentos de suicidio (OR= 4.2) y una menor calidad de vida en comparación con aquellos sin PD. CONCLUSIÓN: Caracterizar a los pacientes con PD, permite iden­tificar con precisión sus necesidades de tratamiento y desarro­llar programas de mejora continua para optimizar los recursos y mejorar el éxito de la atención

INTRODUCTION: In Mexico, very few studies have been published on dual disorders (DD) at specialized treatment centers describing actual treatment needs and even few­er have been undertaken at addiction treatment centers in the public system. The objective of this study was therefore to analyze DD and other clinical characteristics in people seeking treatment at outpatient addiction centers in the public system. Method. Cross-sectional multi-site study. A sample of 148 patients from treatment centers was analyzed. Psychi­atric disorders were evaluated with the Mini International Neuropsychiatric Interview, risky sexual behaviors with the HIV Risk Behavior Scale, injection drug use, and quality of life with the Quality of Life Questionnaire. Univariate chi-square analyses were performed to determine statistical dif­ferences between subjects with and without DD, while linear regression was used to calculate quality of life and binomial logistic regression to determine the risk of injection drug use, condom use, and suicidal behavior. RESULTS: Cocaine was the impact drug with the highest prevalence (33.8%). The group of subjects with alcohol use disorder + drug use disorder presented greater comorbidi­ty with major depressive disorder (25.7%), antisocial disor­der (27.7%), attention deficit (11.5%) and suicide attempt (17.6%). The group with DD presented higher injection drug use (OR = 1.67), non-use of condoms with a primary part­ner (OR = 3.66), more suicide attempts (OR = 4.2) and lower quality of life than those without DD. CONCLUSION: Characterizing patients with DD enables the accurate identification of their treatment needs and the development of continuous improvement programs to opti­mize resources and improve the success of care

Development of an evidence-based model of rapid testing, counseling and referral patients with HIV, HVC and other STDs in Mexican addiction treatment centers / Desarrollo de un modelo basado en evidencia de pruebas rápidas, orientación y derivación de pacientes con VIH, VHC y otras ITS en centros mexicanos de tratamiento de adicciones

Abstract Introduction Efforts to identify new cases of HIV, HVC and other STIs, through the application of quick tests, focus on people who inject drugs, without taking into account the fact that the use of alcohol and other drugs of abuse inhibits decision making, increasing the transmission of STIs through risky sexual practices. Accordingly, it is necessary to have detection algorithms that consider people who use multiple drugs to improve the identification of new cases and their subsequent linkage with health services. Objective This paper describes the development process of the OPB-APR model for the detection, counseling and referral of people with HIV and other STIs at addiction treatment centers. Method The procedure is divided into three phases: 1. A literature review to identify the basic concepts of HIV and other STIs, substance use, risky sexual behaviors, quick tests, and specialized psychological counseling; 2. A feasibility study in which a health professional is trained to implement the OPB-APR model; 3. Drafting of the final version. Results The final version of the OPB-APR model was obtained, which describes standardized procedures for detection, counseling and referral to health services. Discussion and conclusions The OPB-APR model aims to strengthen the public health system by increasing the coverage of services for the detection of HIV, HCV and other STIs. The above through the implementation of standardized procedures among specialized and non-specialized health professionals of addiction care centers.

Resumen Introducción Los esfuerzos para la identificación de nuevos casos de VIH, VHC y otras ITS, mediante la aplicación de pruebas rápidas, se centra en personas que se inyectan drogas, sin considerar que el consumo de alcohol y otras drogas de abuso inhiben la toma de decisiones incrementando el riesgo de contagio de ITS durante prácticas sexuales de riesgo. Por este motivo, es necesario contar con algoritmos de detección que consideren a personas con múltiples consumos para incrementar la identificación de nuevos casos y su posterior vinculación a servicios de salud. Objetivo Describir el proceso de desarrollo del modelo OPB-APR para la detección, orientación y referencia de personas con VIH y otras ITS en centros de tratamiento de adicciones. Método El procedimiento se dividió en tres fases: 1. Revisión de literatura para identificar conceptos básicos sobre el VIH y otras ITS, consumo de sustancias, conductas sexuales de riesgo, pruebas rápidas, y orientación psicológica especializada; 2. Estudio de factibilidad en el que se entrenó a profesionales de la saludpara implementar el modelo OPB-APR; 3. Integración de la versión final. Resultados Se obtuvo la versión final del modelo OPB-APR el cual describe procedimientos estandarizados para la detección, orientación y referencia a servicios de salud. Discusión y conclusión El modelo OPB-APR pretende fortalecer al sistema público de salud al incrementar la cobertura de servicios para la detección del VIH, VHC y otras ITS. Lo anterior mediante la implementación de procedimientos estandarizados entre los profesionales de la salud especializados y no especializados de centros para la atención de adicciones.

Effect of substance use on condom use in the Theory of Planned Behavior: Analysis of differential item functioning / Efecto del consumo de sustancias en la Teoría de la Conducta Planeada en Uso de Condón: Análisis del funcionamiento diferencial de los ítems

Abstract Introduction. Substance use is one of the factors associated with lower condom use in young adults, which increases the likelihood of HIV infection. The Theory of Planned Behavior (TPB) is one of the most useful models for explaining this phenomenon since it considers the aim of engaging in a behavior based on attitudes, subjective norms and self-efficacy. Objective. To develop a questionnaire and to evaluate the Differential Item Functioning (DIF) caused by substance use in TPB indicators, using the Multiple Indicators Multiple Causes Analysis (MIMIC). Method. The study was conducted in two phases with Mexico City college students age 18 to 25. Results. Adequate goodness of fit was obtained in all three models of the TPB: attitudes χ2S-B(2) = 3.902, p < .001; CFIs = .999; TLIs = .996; RMSEAs = .037, 90% CI ≤ .001-.095; subjective norms χ2S-B(7) = 9.103, p < .245; CFIs = .999; TLIs = .998; RMSEAs = .022, 90% CI ≤ .001-.056; and self-efficacy χ2S-B(25) = 65.115, p < .001; CFIs = .982; TLIs = .974; RMSEAs = .050, 90% CI = .036-.066; in one item in attitudes and two items in subjective norms a DIF effect was observed, while no item proved significant regarding self-efficacy. Discussion and conclusion. There is little evidence in the detection of DIF due to substance use in TPB indicators in condom use, and this is the first study to conduct this type of analysis. Items presenting DIF open the door to future research due to the importance of assessing how the indicator behaves with a population displaying a particular trait.

Resumen Introducción. El consumo de sustancias es uno de los factores asociados a un menor uso de condón en jóvenes adultos, lo cual aumenta la probabilidad de contagio de VIH. La Teoría de la Conducta Planeada (TCP) es uno de los modelos más útiles para explicar este fenómeno ya que considera la intención de llevar a cabo una conducta basándose en actitudes, normas subjetivas y autoeficacia. Objetivo. Desarrollar un cuestionario y evaluar el Funcionamiento Diferencial de los Ítems (DIF) ocasionado por el consumo de sustancias en los indicadores de la TCP, utilizando el análisis Múltiples Ítems Múltiples Causas (MIMIC). Método. El estudio se llevó a cabo en dos etapas con estudiantes universitarios de 18 a 25 años de la Ciudad de México. Resultados. Se obtuvo una adecuada bondad de ajuste en los tres modelos de la TCP: actitudes χ2S-B(2) = 3.902, p < .001; CFIs = .999; TLIs = .996; RMSEAs = .037, 90% IC ≤ .001-.095; normas subjetivas χ2S-B(7) = 9.103; p < .245; CFIs = .999; TLIs = .998; RMSEAs = .022, 90% IC ≤ .001-.056; y autoeficacia χ2S-B(25) = 65.115; p < .001; CFIs = .982; TLIs = .974; RMSEAs = .050, 90% IC = .036-.066; un ítem en actitudes y 2 ítems en normas subjetivas se observó un efecto DIF, y en autoeficacia ningún ítem salió significativo. Discusión y conclusión. Existe poca evidencia en la detección de DIF por uso de sustancias en los indicadores de la TCP en uso de condón, siendo éste el primer estudio que lleva a cabo este tipo de análisis. Los ítems que presenten DIF abren la puerta a futuras investigaciones, debido a la importancia de evaluar cómo se comporta el indicador con una población que tenga un rasgo en particular.