Efectos del confinamiento en el hogar debido a la pandemia por COVID-19 en el consumo en pacientes en tratamiento en un programa de deshabituación de alcohol / Effects of the lockdown due to the COVID-19 pandemic on alcohol consumption in patients under treatment in an alcohol relapse prevention programme

Durante la pandemia producida por la infección por el Covid-19 se produjeron una serie de cambios sociosanitarios excepcionales para evitar su propagación como el confinamiento en el hogar y la supresión de los servicios asistenciales sanitarios habituales. Se consideró que estos cambios podrían implicar un incremento en el consumo de alcohol y un mayor riesgo de recaídas para los pacientes en tratamiento. El objetivo de este estudio fue valorar los cambios en el consumo durante el período de confinamiento (marzo a mayo de 2020) en los pacientes en tratamiento en el programa de alcohol del Hospital Doce de Octubre de Madrid. Fueron valorados 311 pacientes mediante entrevista telefónica dentro de la práctica clínica habitual durante ese período. Un 76 % de los pacientes no presentaron cambios en su situación de consumo, un 9,2% de estos cesaron en el consumo, algunos de ellos con cuadros de abstinencia graves, y un 7,5% recayeron. El sexo femenino, el consumo en solitario o en el hogar, en atracón, o el de otras drogas de forma concomitante y el no estar en terapia grupal o no asistir a grupos de las asociaciones de ayuda mutua por videoconferencia durante el confinamiento fueron factores predictores de mal pronóstico. Un 31,6% presentó alteraciones psicopatológicas debidas al confinamiento, sobre todo, aquellos pacientes con comorbilidad psiquiátrica. Por lo tanto, en situaciones similares a esta, la mayoría de los pacientes en tratamiento no modifican el patrón de consumo, pero, ciertas características identifican un subgrupo de sujetos más vulnerables. (AU)

During the COVID-19 pandemic, several exceptional measures were put in place in order to avoid virus propagation, such as lockdown and the discontinuation of usual health care assistance services. It was considered that these changes might be associated with an increase in alcohol consumption and a higher risk of relapse for patients under treatment. The aim of this study was to assess changes in alcohol consumption during the lockdown period (between March and May, 2020) in patients following treatment under the Alcohol Use Disorders Programme at the “Hospital 12 de Octubre” in Madrid. A total of 311 patients were assessed through interviews carried out by telephone in accordance with usual clinical practice during that period. 76% of the total number of patients did not experience changes in their alcohol consumption, 9.2% stopped drinking and some experienced severe withdrawal syndrome, while 7.5% relapsed. The risk factors found for worsening the prognosis of the patients were: being female, drinking alcohol alone or at home, binge drinking, concomitant substance misuse and failure to attend therapy groups or self-help groups online during the lockdown. 31.6% of the sample described psychopathological symptoms due to the lockdown, especially those who already had psychiatric comorbidities. For this reason, we can conclude that during the lockdown as a result of the pandemic, most of our alcohol dependent patients did not modify their drinking patterns, but specific factors enabled us to identify a more vulnerable subgroup. (AU)

Effects of the lockdown due to the COVID-19 pandemic on alcohol consumption in patients under treatment in an alcohol relapse prevention programme. / Efectos del confinamiento en el hogar debido a la pandemia por COVID-19 en el consumo en pacientes en tratamiento en un programa de deshabituación de alcohol.

During the COVID-19 pandemic, several exceptional measures were put in place in order to avoid virus propagation, such as lockdown and the discontinuation of usual health care assistance services. It was considered that these changes might be associated with an increase in alcohol consumption and a higher risk of relapse for patients under treatment. The aim of this study was to assess changes in alcohol consumption during the lockdown period (between March and May, 2020) in patients following treatment under the Alcohol Use Disorders Programme at the "Hospital 12 de Octubre" in Madrid. A total of 311 patients were assessed through interviews carried out by telephone in accordance with usual clinical practice during that period. 76% of the total number of patients did not experience changes in their alcohol consumption, 9.2% stopped drinking and some experienced severe withdrawal syndrome, while 7.5% relapsed. The risk factors found for worsening the prognosis of the patients were: being female, drinking alcohol alone or at home, binge drinking, concomitant substance misuse and failure to attend therapy groups or self-help groups online during the lockdown. 31.6% of the sample described psychopathological symptoms due to the lockdown, especially those who already had psychiatric comorbidities. For this reason, we can conclude that during the lockdown as a result of the pandemic, most of our alcohol dependent patients did not modify their drinking patterns, but specific factors enabled us to identify a more vulnerable subgroup.

Durante la pandemia producida por la infección por el Covid-19 se produjeron una serie de cambios sociosanitarios excepcionales para evitar su propagación como el confinamiento en el hogar y la supresión de los servicios asistenciales sanitarios habituales. Se consideró que estos cambios podrían implicar un incremento en el consumo de alcohol y un mayor riesgo de recaídas para los pacientes en tratamiento. El objetivo de este estudio fue valorar los cambios en el consumo durante el período de confinamiento (marzo a mayo de 2020) en los pacientes en tratamiento en el programa de alcohol del Hospital Doce de Octubre de Madrid. Fueron valorados 311 pacientes mediante entrevista telefónica dentro de la práctica clínica habitual durante ese período. Un 76 % de los pacientes no presentaron cambios en su situación de consumo, un 9,2% de estos cesaron en el consumo, algunos de ellos con cuadros de abstinencia graves, y un 7,5% recayeron. El sexo femenino, el consumo en solitario o en el hogar, en atracón, o el de otras drogas de forma concomitante y el no estar en terapia grupal o no asistir a grupos de las asociaciones de ayuda mutua por videoconferencia durante el confinamiento fueron factores predictores de mal pronóstico. Un 31,6% presentó alteraciones psicopatológicas debidas al confinamiento, sobre todo, aquellos pacientes con comorbilidad psiquiátrica. Por lo tanto, en situaciones similares a esta, la mayoría de los pacientes en tratamiento no modifican el patrón de consumo, pero, ciertas características identifican un subgrupo de sujetos más vulnerables.

Efectos de la integración de grupos de ayuda mutua sobre la adherencia al programa de continuidad en el cuidado a pacientes con dependencia del alcohol realizado en Atención Primaria / Effects of including mutual aid groups in the adherence of a continuing care programme of alcohol dependent patients carried out in a Primary Care setting

OBJETIVO: Comprobar los efectos de integrar las asociaciones de ayuda mutua en el programa de continuidad de cuidados de pacientes dependientes del alcohol realizado por equipos de Atención Primaria. EMPLAZAMIENTO: Equipos de Atención Primaria del área de influencia del Hospital Universitario 12 de Octubre de Madrid. PARTICIPANTES: Se incluyeron 207 participantes dependientes del alcohol y tratados ambulatoriamente de forma intensiva en el hospital en un programa de continuidad de cuidados llevado a cabo por los equipos de Atención Primaria durante cuatro años. INTERVENCIONES: Los pacientes fueron aleatorizados a dos modalidades de continuidad de cuidados diferentes. Un grupo fue seguido con la modalidad de tratamiento conocida como monitorización de la recuperación (Grupo A, n = 97) y los participantes del otro grupo, además de esta intervención, acudían a las asociaciones de ayuda mutua de la Federación de Alcohólicos de la Comunidad de Madrid (FACOMA) en las que se llevaba a cabo el programa Ayúdate-Ayúdanos (Grupo B, n = 112). MEDICIONES PRINCIPALES: Abandono de las sesiones para monitorizar la recuperación de su dependencia alcohólica y de las otras patologías médicas comórbidas. RESULTADOS: Los pacientes del grupo B tenían mayores porcentajes de adherencia terapéutica al programa (47,9% vs. 14,7%, p < 0,01), así como para los problemas médicos comórbidos. CONCLUSIONES: La integración de las asociaciones de ayuda mutua que siguen el programa Ayúdate-Ayúdanos mejora los resultados de adherencia terapéutica de pacientes dependientes del alcohol atendidos por los equipos de Atención Primaria

OBJECTIVES: To demonstrate the effects of including mutual aid associations into a continuing care programme for patients with alcohol dependence carried out by Primary Care teams. SITE: Primary Care Teams belonging to the attendance area of the University Hospital 12 de Octubre at Madrid. PARTICIPANTS: 207 participants with alcohol dependence treated in an intensive hospital outpatient-setting programme were included in a continuing care programme carried out by a Primary Care team for a four-year period. INTERVENTIONS: Patients were randomised into two intervention modalities. The first group was followed up while receiving a treatment modality known as «monitoring recovery» (Group A, n = 97). The other group, in addition to the above-mentioned intervention, attended to a mutual aid association included in the Federation of Alcoholics of the Community of Madrid (FACOMA) in which the programme «Help Yourself-Help Us» was carried out (Group B, n = 112). MAIN OUTCOMES: Dropout rates on the sessions designed to monitor their recovery from their alcohol dependence and other comorbid medical conditions. RESULTS: Patients in Group B reached higher rates of therapeutic adherence to the programme (47.9% vs. 14.7%, p < 0.01), as well as for the comorbid medical issues when compared to Group A. CONCLUSIONS: Including mutual aid associations that carried out the «Help yourself-Help Us» programme for a four-year period improves outcomes related to therapeutic adherence in patients with alcohol dependence attending Primary Care teams

[Effects of including mutual aid groups in the adherence of a continuing care programme of alcohol dependent patients carried out in a Primary Care setting]. / Efectos de la integración de grupos de ayuda mutua sobre la adherencia al programa de continuidad en el cuidado a pacientes con dependencia del alcohol realizado en Atención Primaria.

OBJECTIVES: To demonstrate the effects of including mutual aid associations into a continuing care programme for patients with alcohol dependence carried out by Primary Care teams. SITE: Primary Care Teams belonging to the attendance area of the University Hospital 12 de Octubre at Madrid. PARTICIPANTS: 207 participants with alcohol dependence treated in an intensive hospital outpatient-setting programme were included in a continuing care programme carried out by a Primary Care team for a four-year period. INTERVENTIONS: Patients were randomised into two intervention modalities. The first group was followed up while receiving a treatment modality known as «monitoring recovery¼ (Group A, n = 97). The other group, in addition to the above-mentioned intervention, attended to a mutual aid association included in the Federation of Alcoholics of the Community of Madrid (FACOMA) in which the programme «Help Yourself-Help Us¼ was carried out (Group B, n = 112). MAIN OUTCOMES: Dropout rates on the sessions designed to monitor their recovery from their alcohol dependence and other comorbid medical conditions. RESULTS: Patients in Group B reached higher rates of therapeutic adherence to the programme (47.9% vs. 14.7%, p < 0.01), as well as for the comorbid medical issues when compared to Group A. CONCLUSIONS: Including mutual aid associations that carried out the «Help yourself-Help Us¼ programme for a four-year period improves outcomes related to therapeutic adherence in patients with alcohol dependence attending Primary Care teams.

Inclusion of Alcoholic Associations Into a Public Treatment Programme for Alcoholism Improves Outcomes During the Treatment and Continuing Care Period: A 6-Year Experience.

AIMS: To investigate whether inclusion of self-help groups into the hospital treatment programme improves the prognosis of alcohol dependence through the treatment period; and to examine therapeutic adherence and prognosis during continuing care. METHOD: Patients attending the treatment programme at the 'Hospital 12 de Octubre' were randomized into two groups. In Group A (n = 123), patients received the usual treatment included in our programme, whereas in Group B (n = 126), patients also attended self-help groups. Patients were assessed with psychological scales at baseline, at the end of the treatment period and after completing the continuing care visits. Data were collected over a total of 6 years. RESULTS: During the treatment period, patients in Group B accumulated more months of abstinence and dropped out less. During continuing care, patients in Group B accumulated more months of abstinence and therapeutic adherence was higher. Variables that were associated with these results during the continuing care period were: visits to the GP, scores on anxiety, impulsivity and meaning of life scales, and belonging to the group that attended the alcoholic associations. CONCLUSIONS: Mutual help groups incorporated into a public treatment programme appear to improve outcomes during treatment and on into continuing care. This experience supports cooperation between public health centres and alcoholic associations in treating alcoholism. SHORT SUMMARY: Including alcoholic associations into the public treatment programme for alcoholism of the 'Hospital 12 de Octubre' in Madrid was shown to be associated with better outcomes in terms of months of accumulated abstinence, dropout rates and therapeutic adherence, during the treatment and continuing care periods.

The Modulation of the Startle Reflex as Predictor of Alcohol Use Disorders in a Sample of Heavy Drinkers: A 4-Year Follow-Up Study.

BACKGROUND: Previous studies demonstrated that patients with alcohol use disorders (AUDs) show altered startle reflex responses to alcohol-related stimuli. However, there is little information about the role of these altered responses in the development of AUDs. This study examined the startle reflex response to different visual stimuli and the role of these patterns in the development of AUDs in a 4-year follow-up. METHODS: Two hundred and thirty-nine (nondependent) heavy-drinking participants were selected. In the baseline period, the startle reflex responses to alcohol-related, aversive, appetitive, and neutral pictures were assessed. Startle reflex responses to these pictures were used as predictive variables. Status drinking (alcohol dependence and nondependence) assessed at 4-year follow-up was used as outcome measure. RESULTS: At the 4-year follow-up assessment, 46% of participants fulfilled DSM-IV alcohol abuse or dependence criteria. Alcohol dependence status was predicted by an attenuated startle reflex response to alcohol-related and aversive pictures. CONCLUSIONS: This study revealed that an attenuated modulation of startle reflex response to alcohol-related and aversive stimuli could be used as a clinical marker to predict the development of AUDs in participants with previous alcohol consumption.

Psychopathologic differences between cannabis-induced psychoses and recent-onset primary psychoses with abuse of cannabis.

The study aims to identify psychopathologic variables in cannabis-induced psychosis and recent-onset primary psychoses using the Symptom Checklist-90-R and the Psychiatric Research Interview for Substance and Mental Disorders. A sample of 181 subjects with psychotic symptoms and cannabis use referred to the psychiatry inpatient units of 3 university general hospitals were assessed. The final sample included 50 subjects with a diagnosis of cannabis-induced psychotic disorder (CIPD) and 104 subjects with primary psychotic disorders. Using receiver operating characteristic curves, the most efficient psychopathologic variables for classifying CIPD were interpersonal sensitivity, "depression," phobic anxiety, and Scale to Assess Unawareness of Mental Disorders subscales. The area under the receiver operating characteristic curve of the model including depression and "misattribution" scores was 96.78% (95% confidence interval, 94.43-99.13). Depressive symptoms could be used to distinguish CIPD from other primary psychotic disorders. Clinical variables related to "neurotic" symptoms could be involved in the susceptibility to cannabis-induced psychosis.