Therapeutic Communities In Latin America: An International Descriptive Study In Different Countries Across Latin America / Comunidades terapéuticas en Latinoamérica: un estudio descriptivo en varios países de Latinoamérica

ABSTRACT Objective: In Latin America is not known for certain the quantity or quality of therapeutic communities (TCs) available in the region. The objective of this study is to describe and quantify the quantity and quality of the existing TCs in 5 different countries. Design: A multicenter quantitative description of the TCs was conducted in Argentina, Brazil, Colombia, Mexico and Peru. Methods: A survey was realized through the TCs regulatory entities of each country that accepted to participate in the study. Results: Of the 285 TCs identified in the 5 countries, 176 (62%) accepted to participate in this study. The TCs quality vas evaluated according to the scoring system stablished by De Leon, finding that 70% of the facilities have scores of 11/12 or 12/12 using these criteria. We also found that the majority of the De Leon criteria are known by more than 90% of the institutions, however, the dimensions of "separation of the community" and "encounter groups between residents" were the least known with 63 and 85% respectively. The main reasons for abandonment of TCs were "not accepting the rules of the institution", "lack of money" and "not feeling comfortable with the facilities". 98% of the TCs provided services to other substance abuse problems, 94% for alcohol and 40% for other types of substances. Conclusions: The majority of the TCs identified in our sample meet the quality criteria stablished by De Leon, mostly providing services for substance abuse. However, they should put in place additional policies to improve the unfulfilled conditions and investigate the reasons for the dissatisfaction and abandonment of these institutions.

RESUMEN Objetivo: En Latinoamérica no se conoce a ciencia cierta la cantidad o la calidad de las comunidades terapéuticas disponibles en los distintos países de la región. El objetivo de este estudio es identificar y describir la cantidad y la calidad de las comunidades terapéuticas existentes en 5 países de la región. Diseño: Se realizó un estudio multicéntrico descriptivo cuantitativo de las comunidades terapéuticas en Argentina, Brasil, Colombia, México y Perú. Métodos: Mediante las entidades reguladoras de las comunidades terapéuticas de cada país, se realizó una encuesta a las que aceptaran participar en el estudio. Resultados: De las 285 comunidades terapéuticas identificadas en los 5 países, 176 (62%) aceptaron participar en el estudio. La calidad de las comunidades terapéuticas se evaluó por las puntuaciones establecidas con los criterios de De León; se encontró que el 70% de las instituciones tienen puntuaciones de 11/12 o 12/12 según estos criterios. También se encontró que cumplen la mayoría de los criterios de De León más del 90% de las instituciones; sin embargo, las dimensiones «separación de la comunidad¼ y «grupos de encuentro entre residentes¼ fueron los menos cumplidos (el 63 y el 85% de las comunidades respectivamente). Las principales razones de abandono de las comunidades terapéuticas fueron no aceptar las normas de la institución, falta de recursos económicos y no sentirse a gusto con ella. El 98% de las comunidades terapéuticas prestaban servicios para problemas de abuso de otras sustancias, el 94% para abuso de alcohol y el 40% para otros tipos de abusos. Conclusiones: La mayoría de las comunidades terapéuticas identificadas en nuestra muestra cumplen los criterios de calidad establecidos por De León, y en su gran mayoría prestan servicios para abuso de sustancias, pero deben instaurarse políticas para mejorar las condiciones no cumplidas e indagar los motivos de las disconformidades y el abandono de estas instituciones.

Therapeutic Communities In Latin America: An International Descriptive Study In Different Countries Across Latin America.

OBJECTIVE: In Latin America is not known for certain the quantity or quality of therapeutic communities (TCs) available in the region. The objective of this study is to describe and quantify the quantity and quality of the existing TCs in 5 different countries. DESIGN: A multicenter quantitative description of the TCs was conducted in Argentina, Brazil, Colombia, Mexico and Peru. METHODS: A survey was realized through the TCs regulatory entities of each country that accepted to participate in the study. RESULTS: Of the 285 TCs identified in the 5 countries, 176 (62%) accepted to participate in this study. The TCs quality vas evaluated according to the scoring system stablished by De Leon, finding that 70% of the facilities have scores of 11/12 or 12/12 using these criteria. We also found that the majority of the De Leon criteria are known by more than 90% of the institutions, however, the dimensions of "separation of the community" and "encounter groups between residents" were the least known with 63 and 85% respectively. The main reasons for abandonment of TCs were "not accepting the rules of the institution", "lack of money" and "not feeling comfortable with the facilities". 98% of the TCs provided services to other substance abuse problems, 94% for alcohol and 40% for other types of substances. CONCLUSIONS: The majority of the TCs identified in our sample meet the quality criteria stablished by De Leon, mostly providing services for substance abuse. However, they should put in place additional policies to improve the unfulfilled conditions and investigate the reasons for the dissatisfaction and abandonment of these institutions.

Quality measurers of therapeutic communities for substance dependence: an international collaborative study survey in Latin America.

BACKGROUND: In Latin America, substance related disorders are highly prevalent and one of the treatment strategies is the Therapeutic Communities (TCs), however, in Latin America there is scarce data about this treatment strategies, their quality, drop-out rates and patient satisfaction. METHODS: Based on a previous study in 5 Latin American countries, the TCs who had a score equal or higher than 9 according to the De Leon criteria which are some fundamental items that the TCs should meet, were selected to carry out a descriptive and retrospective study of qualitative and quantitative characteristics of the TCs. RESULTS: Data from 58 TCs in 5 countries were included, with a sample of 1414 patients interviewed, of which most were single men, with no hospitalization history in a therapeutic community. Marijuana was the most commonly substance used in the 30 days prior to hospitalization, with 78% of interviewees referring alcohol consumption in the last 6 months and an average onset of psychoactive substances at 16 years of age. A 79% of the patients interviewed perceived some improvement during their stay in the TCs. The less fulfilled Quality Indicators by the TCs were "Requesting a professional qualification to former addicts that belonged to the program" and "Work as part of the therapeutic program". Among the reasons for discharge found in the database, 44% were due to therapeutic discharge with fulfillment of the treatment plan and 44% withdraws. CONCLUSION: The user satisfaction with TCs, in terms of infrastructure and quality are quite high, as the fulfillment of essential quality items, however, the follow up information to evaluate effectiveness of the treatment is poor or in some cases unknown.

Adaptación del instrumento CAGE / Adaptation of the CAGE instrument

INTRODUCCIÓN Estudios epidemiológicos recientes indican la creciente prevalencia de consumo de sustancias psicoactivas, tanto legales como ilegales, en estudiantes universitarios. El consumo de sustancias psicoactivas es, en alto porcentaje, un acto privado que no es objeto de consulta a menos que se den ciertas condiciones a menudo extremas para el consumidor. Por este motivo es fundamental realizar estudios epidemiológicos con instrumentos eficaces que puedan detectar los diferentes patrones de consumo de sustancias con el fin de orientar procesos y acciones encaminadas hacia la prevención para la población que no es considerada en riesgo. OBJETIVO Adaptar un cuestionario que permita la detección rápida y fiable de los diferentes patrones de consumo problemático de todas las sustancias y que pueda ser utilizado tanto en servicios de Atención Primaria y especializados, así como también por investigadores que traten de estudiar los patrones de consumo. MÉTODOS El universo está compuesto por varones y mujeres, entre 18 a 35 años que concurren a la Facultad de Psicología, UNC, la muestra por N= 750. Se utilizó el estadístico Alfa de Cronbach para evaluar la consistencia interna del instrumento y además se llevó a cabo un análisis factorial para analizar las intercorrelaciones entre datos observables. RESULTADOS Se obtuvo un KMO de .788, indicando una muestra confiable. Dentro del instrumento se identificaron tres factores, los cuales explican el 53% de la varianza. El factor I tiene un índice de confiabilidad de .778; el factor II de .63 y el factor III de .509. DISCUSIÓN Si bien existe correlación entre los ítems, la escala es sensible y medianamente confiable, el poder discriminante entre los que consumen o no, es moderado, es decir que el instrumento tiene poca capacidad para diferenciar el comportamiento de consumo de los individuos. A pesar de estas limitaciones iniciales se ha realizado un buen primer paso en dirección al objetivo de desarrollar un instrumento con adecuada sensibilidad y especificidad

[Preliminary Study on Cognitive Determinants Influencing Argentine Youngsters towards Intensive Alcohol Consumption or Binge Drinking]. / Estudio preliminar de los determinantes cognitivos que influyen en los jóvenes argentinos para realizar un consumo intensivo de alcohol, o binge drinking.

INTRODUCTION: The current alcohol consumption pattern among youngsters and adolescents, characterized by heavy drinking during a few hours, several days a week, or binge drinking (binge drinking, concentrated drinking or long-gulp drinking) is a reality in many countries, including Spain and Argentina. OBJECTIVE: To describe cognitive determinants in the behavior regarding excessive alcohol consumption (binge drinking) in 16-25 year subjects in Argentina. METHODOLOGY: An ad hoc survey was conducted to assess cognitive determinants influencing heavy alcohol consumption, according to I. Ajzen's guidelines. RESULTS: There are significant statistic differences between the group of heavy drinkers and the group that does not reach such level of consumption in relation to behavioral beliefs, and control beliefs. Both groups recognized consumption is noxious and not safe; no differences were observed concerning normative beliefs. CONCLUSIONS: There is a complex interaction mong attitudinal factors, motivational and behavior control factors. Instruments require greater sensitivity and further in-depth analysis is required regardomg short, middle and long consequences generated by binge drinking and its role as a positive or negative reinforment.