Harm reduction behaviors among young polysubstance users at raves.

BACKGROUND: Raves may be considered recreational settings in which drug use and health risks related to polydrug use are higher than in others. Harm reduction behaviors implemented by ravers are of particular relevance in reducing such risks. This study analyzes harm reduction behaviors and their relationship to raver polysubstance use patterns. METHODS: Cross-sectional study of 248 ravers recruited at underground raves in Andalusia (Spain). A questionnaire was developed to collect information about their sociodemographics, drug use, and harm reduction behaviors. RESULTS: The results show that ravers employ harm reduction behaviors for minimizing drug-related harm. Nevertheless, only a small minority of the participants frequently employed harm reduction behavior for polysubstance use as well. Ravers identified as high polysubstance users protected themselves significantly less than those identified as low polysubstance users. CONCLUSIONS: This study provides empirical information that may be useful for harm reduction intervention in a hidden and hard-to-reach population like rave attendees. The results point to the need to inform and increase harm reduction behavior specifically aimed at polysubstance use by ravers, especially among more frequent users. Future directions for research are also suggested.

[Relationship between psychopathological comorbidity and outcomes variables in-treatment cocaine dependent subject in therapeutic community]. / Relación entre la comorbilidad psicopatológica y las variables de resultados en dependientes de cocaína tratados en comunidad terapéutica.

Over the last years, the therapeutic community treatment with people who have cocaine problems and psychopathological comorbidity has been increasing and it is important to know more about the success of these treatments. The aim of this paper is to study the psychopathological profile of cocaine-dependent patients and its association with outcome variables. It is interviewed by the Psychiatric Research Interview for Substance and Mental Disorders (PRISM-IV) and the Conners' Adult ADHD Diagnostic Interview for DSM-IV (CAADID) a total sample of 218 patients who sought treatment at any of the six public therapeutics community of Andalusia (Spain). The results show that the retention rate after three months of 68.3% (149), 43.5% that leaves the resource with a therapeutic discharge and 52.8% with clinically significant changes. Besides, the 57.8% have psychopathological comorbidity. Finally, there is a higher treatment success (measured by days of stay, type of discharge and therapeutic community outcome clinical impression) among people without psychopathological comorbidity. These data show the need to adapt the therapeutic communities to treat people with comorbid psychopathology and, thus, improve therapeutic success.

Diagnosing adult attention deficit/hyperactivity disorder in patients with cocaine dependence: discriminant validity of Barkley executive dysfunction symptoms.

OBJECTIVE: To estimate the prevalence of adult attention deficit/hyperactivity disorder (ADHD) in a sample of cocaine-dependent patients, and to examine the discriminant validity of the Barkley's executive dysfunction scale in differentiating cocaine-dependent patients with and without ADHD. METHODS: A cross-sectional design was used. A total of 166 cocaine-dependent subjects were assessed. The assessment instruments included: Conners' Adult ADHD Diagnostic Interview for DSM-IV (CAADID), Psychiatric Research Interview for Substance and Mental Disorders (PRISM-IV) and 9 items from Current Behavior Scale Self-Report by Russell A. Barkley. RESULTS: 14.5% (CI95%: 9.2-19.8%) prevalence of ADHD was observed in our sample. The Barkley's executive dysfunction items showed statistically significant differences between cocaine-dependent patients with ADHD and those patients without ADHD diagnosis. CONCLUSIONS: The study data support Barkley's model - which posits the relevance of executive dysfunction among ADHD patients within a sample of cocaine dependents, and provides evidence of the discriminant validity of the Current Behavior Scale Self-Report for identifying ADHD symptoms in cocaine users.

[Ten contributions to the use of qualitative methodology in an audit of internal communication in primary care]. / Diez aportaciones del empleo de la metodología cualitativa en una auditoría de comunicación interna en Atención Primaria.

Qualitative methodology, originally belonging to the Social Sciences domain, has progressively incorporated to Health Research to the scepticism of many and the admiration of others. Nowadays, validity and fiability of these qualitative techniques is still questioned by a great amount of health researchers and their use provokes doubt among reviewers and other members of the scientific community. This article presents as a fundamental measure for the validity of the qualitative methodology its precise use to approach determinate research objectives specific to them and, echoing the extra issue of the Health Services Research on December 1999 on this methodology, gathers the contribution of the use of these techniques from a complementary point of view, in a Internal Communication Audit conducted in the Primary Care Services of four Regional Health Systems: Area II of the INSALUD (National Health Institute), Basque Health System, Canary Health System and Andalusian Health System.

Psychiatric comorbidity in a sample of opiate-dependent patients treated with sublingual buprenorphine in a therapeutic community regime.

INTRODUCTION: The purpose of this work is to estimate the prevalence of psychiatric cases in a sample of opiate-dependent patients treated with sublingual buprenorphine in a therapeutic community regime, and to describe their progress during the first month of treatment. METHODS: An observational, longitudinal, prospective study was conducted. Of the 119 opiate-dependent patients selected, 46 agreed to start treatment with buprenorphine. For organisational reasons, the psychopathological assessment was carried out on 36 of these patients. The measurement tools used were the MINI, GHQ-28, IPDE and Assessment of the Quality of Life in Psychoactive Substance Addicts (TEQLASP). RESULTS: The prevalence rate of any psychiatric disorder was 78%. The prevalence of Axis I diagnoses was 69.4%. The prevalence of cases in Axis II was 58.3%, and 50% of patients had concomitant Axis I and Axis II disorders. The patients with Axis I psychiatric disorders showed a significant reduction in the mean scores of the GHQ-28 scale, and in the B (anxiety/unease), C (social dysfunction), and D (depression) subscales of the GHQ-28. The differences observed between the patients with no psychiatric disorders after one month of treatment were not significant. An improvement in the quality of life wad observed in both groups, although these changes were of a lower magnitude in the group with psychiatric disorders. DISCUSSION: The results of this study show a very high frequency of psychiatric disorders. For this reason, psychiatric illness must be actively looked for whenever we assess a drug-dependent patient.

Diez aportaciones del empleo de la metodología cualitativa en una auditoría de comunicación interna en Atención Primaria / Ten contributions of the use of qualitative methodology in a Primary Care in-house audit

La metodología cualitativa, propia en su origen de las ciencias sociales, se ha ido incorporando progresivamente a la investigación en salud, ante el escepticismo de muchos y la admiración de otros. Todavía hoy en día la validez y fiabilidad de las técnicas cualitativas de recogida y análisis de datos es cuestionada por una parte importante de los investigadores de ciencias de la salud y su utilización provoca la duda entre revisores y otros miembros de la comunidad científica. Este artículo presenta como medida fundamental de validez de la metodología cualitativa su utilización específica para el abordaje de determinados objetivos de investigación que le son propios y, haciéndose eco del número especial dedicado a esta metodología del número de Health Services Research de diciembre de 1999, recoge la aportación del uso de estas técnicas, desde un punto de vista de la complementariedad, en una Auditoria de Comunicación Interna realizada en los servicios de atención primaria de cuatro sistemas regionales de salud: Área II del Insalud, Servicio Vasco, Servicio Canario y Servicio Andaluz de Salud (AU)

Qualitative methodology, originally belonging to the Social Sciences domain, has been incorporated progressively to Health Research to the scepticism of many and the admiration of others. Nowadays, validity and fiability of these qualitative techniques is still questioned by a great amount of health researchers and their use provokes doubt among reviewers and other members of the scientific community. This article presents as a fundamental measure of the validity of the qualitative methodology its precise use to approach research objectives specific to them and, echoing the extra issue of the Health Services Research journal on December 1999 on this methodology, gathers the contribution of the use of these techniques from a complementary point of view, in an Internal Communication Audit conducted in the Primary Care Services of four Regional Health Systems: Area II of the INSALUD (National Health Institute), Basque Health System, Canary Health System and Andalusian Health System (AU)

Dimensiones emergentes para la creación de una escala de percepción del tratamiento con sustitutivos opiáceos / Emergent dimensions for the construction of an opiate substitute treatment perception scale

La medida de la percepción y satisfacción del tratamiento con los programas de sustitutivos opiáceos se ha centrado principalmente en evaluar las propiedades del servicio ofrecido en los centros de tratamiento. Más allá del contexto sanitario, estos programas requieren una implicación de la vida personal y social para su seguimiento. El objetivo de este trabajo es ofrecer un marco teórico de referencia para la construcción de una escala que mida de forma integral la percepción del tratamiento con sustitutivos opiáceos. Se ha utilizado una muestra de 18 pacientes de un estudio piloto con buprenorfina, transferido desde un programa de tratamiento con metadona, con indicación de retirada del tratamiento –de régimen ambulatorio y residencial-, a los que se les realizó una entrevista semiestructurada. El análisis de los datos se ha realizado mediante la Teoría Fundamentada, y la codificación de las dimensiones y del material se ha triangulado a través de tres analistas especializados. Los resultados obtenidos señalan que la percepción del tratamiento con sustitutivos de los pacientes se vertebra sobre cinco dimensiones principales: el valor salud, la adaptación a la vida cotidiana, el estigma, la retirada del tratamiento y la eficacia percibida. Estos resultados son discutidos con los encontrados en la literatura especializada

The measurement of perception and satisfaction with opiate substitute treatment programmes has concentrated mainly on evaluating the properties of the service offered at treatment centres. Beyond the health-care context, these programmes need to become part of the patient's personal and social life for them to be followed. The purpose of this work is to offer a theoretical frame of reference for the construction of a scale for integral measurement of patient perception of opiate substitute treatments. A sample of 18 outpatient and residential patients in a buprenorphine pilot study, transferred from a methadone treatment programme, who showed indications of abandoning treatment, was given a semi-structured interview. The data analysis was done based on the Grounded Theory, and the dimensions were coded and material triangulated by three specialized analysts. The results show that patient perception of treatment with substitutes is aligned in five main dimensions, value to health, adaptation to daily life, stigma, treatment withdrawal and perceived effectiveness. These results are discussed and compared to those found in specialised literature