Scielo RSS <![CDATA[Salud mental]]> http://www.scielo.org.mx/rss.php?pid=0185-332520070004&lang=pt vol. 30 num. 4 lang. pt <![CDATA[SciELO Logo]]> http://www.scielo.org.mx/img/en/fbpelogp.gif http://www.scielo.org.mx <![CDATA[<strong>Ramón de la Fuente: valor indiscutible de la intelectualidad mexicana</strong>]]> http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0185-33252007000400001&lng=pt&nrm=iso&tlng=pt <![CDATA[Neurotransmisores del sistema límbico. Hipocampo, GABA y memoria. Primera parte]]> http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0185-33252007000400007&lng=pt&nrm=iso&tlng=pt resumen está disponible en el texto completo<hr/>Summary: Introduction. The entire hippocampus is derived from the telencephalon. Embryologically, it is made up of the most archaic cortices. Through special phylogenetic and ontogenetic telencephalization processes, it will arrive at its particular mesial basal position. This structure has three components: a) Retrocommisural hippocampus, or hippocampus proper (RH). b) Supracommisural hippocampus (SH). c) Precommisural hippocampus (PH). The RH is situated in the most medial part of the 5th temporal gyrus (5 TG). The outer/upper face of the RH is to be found in the temporal recess of the lateral ventricle. It is called pes hippocampi or albeus. Inwards, it is limited by the choroid fissure, outwards and downwards by the parenchyma of the 5th TG, forwards, by the amygdala of the striatal body and, backwards, by the isthmus. The fornix is a continuation of efferent pathways from CA3, CA1 and the subiculum. By means of a circular course, it ascends over the thalamus and, descending in front of Monro's foramina and traversing the hypothalamus, reaches the mammillary bodies. It consists of fimbria, posterior pillars and a body and anterior pillars. The latter pass behind the anterior white commisure (AWC), and make up the anterior portion of Monro's foramina. The SH originates in the RH. At the level of the splenium of the corpus callosum (CC), the fornix produces two striae, medial and lateral, and the dentate gyrus turns from fasciola cineria into induceum griseum. These structures are to be found in both hemispheres and, traveling over the CC, will reach the preoptic and hypothalamic septal areas, as well as the PH. The PH is a small fiber contingent which stems from the fornix at the level and in front of the AWC. Memory. General aspects. There is general agreement that the main role of the hippocampus is that of creating new memories relative to experienced events (episodic or autobiographic memory). Some researchers, however, prefer to think of the hippocampus as part of a major medial temporal lobe memory system responsible for declarative memory. This memory would include, besides episodic memory, memory of events. Another very important hippocampal function would relate to storage of semantic (conceptual) memories. Engrams. Memory and synaptic plasticity. Engrams are hypothetical means whereby memory traces are stored as physical or chemical changes in the brain in response to external stimuli. The existence of engrams has been proposed by diverse scientific theories which try to explain the persistence of memory and how some memories are stored in the brain. The term engram was coined by Sermon and explored by Pavlov Lashley tried to locate the engram and failed in finding a sole biological locus for the same which made him think that memories were not localized in any particular part of the brain, but distributed throughout the cerebral cortex. Afterwards, in 1949, Hebb, a student of Lashley's, published his empiricist theories in The Organization of Behavior. Hebb referred to Lorente de Nó's reverberating circuits to propose a mechanism for maintaining activity in the cerebral cortex after the external stimulus had ceased: the so called central autonomous process. This led him to consider the cellular assembly, a complex reverberating circuit which could be assembled by experience. Changes in synaptic resistance with experience were eventually named Hebb's, or the Hebbian, synapse. Hebbian theory describes a basic mechanism for synaptic plasticity by means of which an increment in synaptic efficacy stems from repetitive and persistent stimulation of the post-synaptic cell. This theory receives the name of Hebb's rule. The fact that memory is persistent stresses the relevance of understanding those factors which maintain synaptic strength and prevent undesired synaptic changes. There is evidence that recurrent inhibitory connections in region CA1 of Ammon's horn of the hippocampus might contribute in this sense by modulating the ability to induce long-term potentiation (LTP) or long-term depression (LTD) of synaptic activity, given by a sequence of high-or low-frequency stimulations, respectively. The hippocampus seems to be able to select the most relevant from the least relevant aspects of a definite experience in order to transform them into long-term memory. According to the concept of Emotional Tagging, for example, through the activation of the amygdala by emotionally suggestive events, the experience will be tagged as important and synaptic plasticity promoted in other cerebral regions, such as the hippocampus. Recently, it has been shown that activation of the amygdala transforms transient plasticity into long-term plasticity. This finding directly relates to the afore mentioned hypothesis of emotional tagging, since activation of this organ could trigger neuromodulatory systems, further reduce the activation threshold of the synaptic marker and facilitate transformation of early into late memory at the level of the hippocampus via direct amygdalar action on the latter organ. γ-aminobutyric acid. γ-aminobutyric acid (GABA), together with its different receptor subunits, functions as an inhibitor neurotrans-mitter in hippocampus and memory activities. GABA and memory. LTP has been a widely studied mechanism of synaptic plasticity and, as we have mentioned, it is intimately related to diverse memory and learning processes in mammals. It has been observed in pyramidal cells of area CA1 of the hippocampus of young C57BL/6 mice that the pairing of pre-synaptic stimulation with just one post-synaptic action potential will be sufficient to induce LTP, whereas in the adult animal this stimulation must be paired with several post-synaptic action potentials to achieve such induction. This change might result from a modification during maturation of GABAergic inhibitory processes. A bath of muscimol, a GABAA agonist, given to sections of hippocampal area CA1 will increase the range of frequencies inducing LTD, while in the presence of picrotoxin, a GABAA antagonist, LTD will be induced only at very low stimulation frequencies. The resulting recurrent inhibition appears to stem from GABAergic input to pyramidal neurons of CA1. In this way, post-synaptic spike activity could increase GABAergic feedback inhibition, and thus favor LTD. However, in experiments in which the pairing of stimulating action potentials is set apart in time, LTD, LTP or no plasticity may be observed. An explanation for these results could be that, in the presence of picrotoxin, and therefore GABA inhibition, the first action potential may have a greater tendency to "back propagate", so that only one spike would be enough to cause LTP instead of LTD, and affect memory processes differently. <![CDATA[Variables associated with the risk of eating disorders in adolescence]]> http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0185-33252007000400016&lng=pt&nrm=iso&tlng=pt Summary: It is very important to specify the generic affirmation that eating disorders mainly affect the female population, especially during adolescence. This study examined three variables associated with the risk of eating behaviour disorders (EBDs): age (early and late adolescence), physical self-concept and engagement in physical activity, as well as the interaction between these factors. This study, to be precise, aimed to clarify the following questions regarding the risk to the non-clinical adolescent population of suffering eating disorders: 1. Whether the risk is higher in the 15-18 age range than in the 12-14 one; 2. the relationship between risk and physical self-concept; 3. the relationship between risk and physical activity; and 4. whether the risk is always higher in women than in men, regardless of the three aforementioned variables (age, self-concept and sporting activity). There were 740 adolescent participants, 366 men (49.46%) and 374 women (50.54%), aged between 12 and 18 years ( X - = 14.33; SD=1.41). Three measurements were applied: the Eating Disorders Inventory (EDI), by Garner and Olmsted, the Cuestionario de Autoconcepto Físico (CAF) by Goñi, Ruiz de Azúa and Rodríguez (2006), and a questionnaire on physical activity. Results confirm that, as indicated by significantly higher scores in the EDI, the risk of suffering from eating disorders is higher among women than men, in the 15-18 age range than in the 12-14 one, in those with a low physical self-concept and in those who engage only sporadically rather than regularly in some kind of physical activity. Therefore, age, self-concept and physical activity therefore become modulating variables of the risk of suffering from eating disorders. Improvement in self-concept and the acquisition of active life habits, factors which modulate the usual gender differences in eating disorders, are the objects of educational intervention; this intervention is particularly important for adolescent females aged between 15 and 18 years. Consequently, physical self-concept should be included not only in the designs of research projects focusing on the self-perception of the physical-self, but also in the designs of guidance programmes; special attention should be given to those who have developed a low self-perception of both their physical condition and physical attractiveness. Furthermore, moderate physical activity is clearly better than a sedentary lifestyle; engaging in regular physical activity is highly recommendable, in general, as a way of preventing eating disorders. Finally, the group most in need of educational support in this field is the population of female adolescents aged between 15 and 18 years. Two criteria are important: a) the promotion of regular physical activity may be one resource, although not the only one, since by itself is not effective enough to eradicate the risk of eating disorders; b) special attention should be given to those who have developed a low self-perception of both their physical condition and physical attractiveness.<hr/>Resumen: Es bien conocido que los trastornos de la conducta alimentaria (TCAs) afectan ante todo a la población femenina, muy especialmente durante la adolescencia. Ahora bien, ¿hasta qué punto cambia el riesgo de que la población adolescente no clínica padezca tales trastornos en función de variables que pueden ser objeto de atención preventiva? Este estudio pretendía esclarecer si dicho riesgo: 1. es mayor en el grupo de edad de 15-18 años que en el de 12-14 años; 2. si guarda relación con el autoconcepto físico; 3. si se relaciona con la actividad física practicada; 4. si es siempre mayor en las mujeres adolescentes que en los adolescentes varones con independencia de las tres variables citadas arriba. Participaron en el estudio 740 adolescentes, 366 hombres (49.46%) y 374 mujeres (50.54%), con edades comprendidas entre los 12 y 18 años ( X - =14.33; DT=1.41). Todos los participantes respondieron al Eating Disorders Inventory (EDI), de Garner y Olmsted, un cuestionario destinado a evaluar conductas y pensamientos propios de los TCAs. Todos completaron también un cuestionario acerca de sus hábitos de actividad física. Además, una parte de esta muestra, concretamente 347 sujetos (172 hombres y 175 mujeres), contestó el Cuestionario de Autoconcepto Físico (CAF), de Goñi, Ruiz de Azúa y Rodríguez. Se llevaron a cabo diferentes análisis estadísticos mediante el programa SPSS 11.5 para Windows: análisis de la varianza factorial, ANOVA de un factor, contraste de medias, análisis de gráficos de perfil para interacciones, así como comparaciones múltiples de Bonferroni. Los resultados obtenidos permiten afirmar que el riesgo de padecer trastornos alimentarios, tal como lo indican unas puntuaciones significativamente superiores en el EDI, es mayor en las mujeres que en los hombres, en el grupo de edad de 15-18 años que en el de 12-14 años, en personas con autoconcepto físico bajo y en quienes realizan actividad físico-deportiva de forma esporádica en comparación con quienes la practican de forma habitual. La insatisfacción corporal y las conductas bulímicas se incrementan, en efecto, en el segundo tramo de la adolescencia con independencia de que la práctica deportiva se realice de forma esporádica o habitual. La insatisfacción corporal, igualmente, aparece asociada con puntuaciones bajas en el autoconcepto físico (tanto en la dimensión de condición física como en la de atractivo físico), pero tal asociación no es significativa en el grupo de 12 a 14 años. Las chicas de entre 15 y 18 años muestran un riesgo significativamente mayor que los chicos. Asimismo, las diferencias de género en trastornos alimentarios, que no son significativas en el grupo de 12-14 años, vuelven a ser claras en éste. Estos datos reclaman prestar atención al grupo de edad de entre 15 y 18 años como etapa particularmente crítica, al menos con respecto a la primera adolescencia (12-14 años). Por otro lado, se confirma que los trastornos de alimentación conforman una patología propia de mujeres. La percepción del atractivo físico propio tiene, por ejemplo, un comportamiento diferente de un género a otro: no se correlaciona con los trastornos en el caso de los varones pero sí en el de las mujeres. De todos modos, estas consabidas diferencias de género no son las mismas, como ya se ha dicho, en distintos grupos de edad ni tampoco cuando tanto los chicos como las chicas realizan actividad física de forma habitual. En este último supuesto persisten las diferencias entre ambos pero se reducen. La edad y el autoconcepto se convierten, en consecuencia, en variables moduladoras del riesgo de padecer trastornos alimentarios, así como la actividad física. De los resultados del estudio se desprende que la actividad física moderada se correlaciona con menor incidencia de patología alimentaria, por lo que se convierte en altamente recomendable. No obstante, entre los asuntos que precisan más investigación figura el de la relación entre distintas modalidades e intensidades de actividad física y el bienestar psicológico, más allá de la clasificación dicotómica en adolescentes poco activos versus adolescentes activos utilizada en este estudio. El riesgo, evaluado mediante el EDI, de padecer trastornos alimentarios se ha mostrado fuertemente asociado con el autocon-cepto físico medido con el CAF, lo que invita a incluir este último constructo no sólo en los diseños de investigación sobre la autoper-cepción del yo físico sino también en los programas de orientación, por dos razones básicas. De un lado, la utilización de cuestionarios como el CAF que miden autoconcepto físico puede convertirse en una forma rápida y económica de detectar precozmente sujetos con riesgo de padecer trastornos alimentarios entre población adolescente no clínica. De otro, una forma viable de educar con respecto a los TCAs consiste en fomentar el desarrollo del autoconcepto físico por medio de programas de intervención adecuados. <![CDATA[¿Explica la esquizotipia la discordancia entre informantes de alteraciones conductuales adolescentes?]]> http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0185-33252007000400024&lng=pt&nrm=iso&tlng=pt resumen está disponible en el texto completo<hr/>Summary: Introduction. Behavioural alterations are a quite potent predictor for schizophrenia. Very often, apparently healthy adolescents (who will later develop schizophrenia) present altered conducts similar to those manifested by schizophrenic subjects and as predictors for the disorder. There are studies that describe the relationship between these behavioural alterations and the features found in schizotypical personality disorder or schizophrenic symptoms. In this way, it has been established that those subjects who obtain high scores in schizotypy present more behavioural alterations. Concretely, the different behavioural alterations have been differentially related to the positive and negative subtypes of the schizotypical personality, suggesting continuity between the nature of premorbid conducts and the adult symptoms patterns in which the illness develops. On the other hand, comparing adolescents that will later develop schizophrenia with those who will not, it has been found that the best schizophrenia predictor is a poor behavioural adjustment. Moreover, if the teachers' reports are examined, there can be certain aspects such as the early behavioural patterns which will identify children who, for instance, will develop schizophrenia thirty years later, or even differential patterns according to the gender of the subjects. Therefore, if we want to carry out a schizophrenia prediction according to these behavioural criteria, knowing which informants are more useful and how their opinions match among them is of a great interest. Until this moment, the majority of studies have pointed out at the ability of teachers to identify conducts that can be used to select people at risk for schizophrenia. However, having into account that numerous studies conclude that there is a lack of agreement between these and other different informants for behavioural alterations in adolescents, the importance of studying the variables that can be influencing this matter must be raised. Following with the line of our research group a question is raised. We wonder if the presence of schizotypical personality traits makes the adolescents behaviour more ambiguous, with the consequent difficulty to define it in a coincident way from different evaluators and from themselves. Objectives. To analyse the influence of the schizotypical personality (assessed with the Oxford-Liverpool Inventory of Feelings and Experiences), the demographic variable gender and the interaction between them, in the discordance of different informants (parents, teachers and adolescents) when they inform about behavioural problems in adolescents (assessed with the Achenbach's scales). Methodology. This is an analytic transversal study that can be framed into a longitudinal study of 2 cohorts from the general population, which started on 2000 and has been then followed-up ("Psychoeducation program and early detection of schizophrenic disorders of adolescent onset"). Participants. 160 triads of parents, teachers and adolescents from 13 to 16 years old selected from 7 schools of Barcelona took part in the study. Instruments. The three forms of the Achenbach scale for the measure of behavioural alterations were applied: Youth Self- Report, Child Behaviour Checklist/4-18 and Teacher's Report Form. These forms contain 8 scales which are invariant throughout informants: Withdrawn, somatic complaints, anxious/depressed, social problems, thought problems, attention problems, delinquent behaviour and aggressive behaviour. Some of them are grouped in second order factors: Internalizing, externalizing and total. To evaluate the psychometrical schizotypical personality of adolescents we used the Oxford-Liverpool Inventory for Feelings and Experiences. It consists of an autoadministered inventory with 159 items that includes four schizotypical scales. The Unusual Experiences scale reflects the positive dimension of schizotypy and includes items of unusual perception aberrations and magical thinking. The Introvert Anhedonia Scale reflects the negative dimension of schizotypy and consists of items assessing restricted affect, social isolation and anhedonia. The Cognitive Disorganization Scale refers to disorganized aspects of the psychosis and it is composed of items assessing difficulties in concentration and decision-making. Finally, the Impulsive Nonconformity Scale reflects the characteristics of impulsive-type personality, social anxiety and maladjusted behaviours. Statistical proceed. Multiple regression analyses were carried out in order to revise the influence of the schizotypical personality, the demographic variable gender and the interaction between them as possible explicative variables, in the discordance between different informants about behavioural problems of adolescents. The dependent variable was a measure of the level of discordance between the three groups of informants. Results. A major discordance between informants of behavioural problems was found as schizotypy was higher. Concretely, a larger number of unusual experiences in adolescents increase the discordance for thought and internalizing problems. Discordance is also higher in aggressiveness and anxiety/depression as cognitive disorganization increases. Also, the higher the introverted anhedonia, the higher the discordance is for social problems, anxiety/depression, attention, externalizing problems, and for the total. To finish, a high score in non-conformity impulsivity increases the discordance for attention, delinquency and aggressive problems. About the influence of gender, discordance between informants for anxiety/depression is higher for females than for males. However, this varies when the interaction effects found are considered. In this way, a differential effect for the increase of non-conformity impulsivity and introvert anhedonia can be observed in males and females. Therefore, discordance between informants is higher when evaluating anxiety/ depression in males when non-conformity impulsivity is high. Just the opposite happens for girls. In addition, the discordance for the internalizing subscale increases just as the introverted anhedonia raises for females, but it decreases when evaluating males. Discussion. It seems clear that no source of data can be substituted for any other when evaluating behavioural problems in adolescents and much less when attention is centred in those adolescents who score high in schizotypy. Specifically, when evaluating the behaviour of those subjects who score high in the positive dimension of schizotypy, the agreement between informants decreases for thought and internalizing problems; and, when the behaviour of those who are defined for a more negative schizotypy is evaluated, the agreement decreases for social problems, anxiety/ depression, externalizing and total. Having all this into account and adding information that other authors have found related to each schizotypy subtype (which, besides, are the ones which more concordance show), some conclusions could be raised. It can be assumed as evident that schizotypical personality (and each trait type) and the subjacent conduct in these subjects can generate a difficulty in perceiving certain conducts which are not predominant in the subject, with the consequent discordance between informants. For future studies, it would be very interesting to carry out studies examined which group of informants augurs the behavioural predisposition for schizophrenia and its dimensions in the most accurately way possible. Conclusions. A most exact and objective method to assess behavioural problems as well-demonstrated predictor to schizophrenia, is necessary in order to select vulnerable teenagers to the illness and to develop programs of early intervention. <![CDATA[Versión computarizada para la aplicación del Listado de Síntomas 90 (SCL 90) y del Inventario de Temperamento y Carácter (ITC)]]> http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0185-33252007000400031&lng=pt&nrm=iso&tlng=pt resumen está disponible en el texto completo<hr/>Summary: Psychometric tests are effective to measure psychological characteristics, including personality, motivation, intellectual abilities and psychopathological traits. The Psychopathological diagnostic could be supported on some of these psychometric tests, which ideally should be of simple and fast application. Two of the most common tests are the Symptom Check List 90 (SCL 90) and the Temperament and Character Inventory (TCI). SCL 90, developed by Derogatis, Lipman and Covi in 1973, is a 90-item self-report inventory that assesses the level of distress experienced by the subject. Items are comprised in nine dimensions: somatization, obsessive-compulsive, interpersonal sensitivity, depression, anxiety, hostility, phobic anxiety, paranoid ideation and psychoticism. The SCL 90 has been translated into several languages and has been successfully applied in Argentina and Spain. In Mexico, Cruz-Fuentes et al. and Lara et al. considered that this test can be well used as a psychometric instrument in clinical research. Due to its efficiency and brief time to response (12-15 min.), the SCL 90 has been administered to support psicopathological diagnostics and to complement the research of epilepsy, social-behavior disorders, physical disorders, pharmacological treatment and for the comparison of psychological features in crosscultural studies. The TCI is a self-applied test that describes personality according to Clonninger's psychobiological model. In this model temperament is described as highly heritable and stable during lifetime, and it is divided in four dimensions: novelty seeking, harm avoidance, reward dependence, and persistence. Character is described as being determined by the individual's experience and is modifiable during life-time. It is divided in to three dimensions self-directedness, cooperativeness and self-transcendence. The TCI has been used to correlate personality features to genetics variability and to complement clinical studies that involves psychiatric disorder, such as, obsessive-compulsive disorder, anxiety and depression. This test has been translated and administered in American, French, German, Korean and Spanish populations. In Mexico, Sánchez-Carmona, Páez, López and Nicolini considered that the TCI constitute a psychometric test that can be used to develop the clinical research in Mexican populations. In recent years, research and clinical evaluation in several countries, such as United States and France, have successfully designed and applied computerized versions of the SCL 90 and TCI. These versions provide a quicker rate of testing and a permanent storage of data. In this work, we analyze the validity of viability to apply a computerized version of the SCL 90 and the TCI in Spanish. This computerized version was previously developed at the Instituto de Neurobiología de la Universidad Nacional Autónoma de México. This version involves a computer program in Java language, which give an easy access to the users and is compatible with any computational environment. The sequence to answer the computerized version involves five steps: a) accessing the main control program, b) writing the user's identification data, c) answering SCL 90 test, d) answering TCI test, e) forming the database. The formats employed in these computerized versions are similar to those in paper-and-pencil original versions. Its rate sequences were formed according to the SCL 90 and the TCI's application manuals. The information stored in the computerized program of SCL 90 and TCI, can be imported to the Excel program. By this way, it is possible to import the results to any database in any statistical analysis program. Method. Computerized versions of the SCL 90 and the TCI were administered in different sessions for two 30 participants sample (15 men, 15 women, mean= 30, S.D. 8 years old). Paper-and-pencil versions of both tests were administered, in two different sessions, to a sample within the same sex and age range. Samples were formed by students of the Universidad Nacional Autónoma de México and the Universidad Autónoma de Querétaro. Statistical analysis involved a Student's t test to identify differences between data obtained in computerized and paper-and-pencil versions. Graphic comparisons were made to show the similarity of the results obtained in computerized versions and those of reference samples published in Mexico by Cruz-Fuentes et al. (2005), Lara et al. (2005) and Sánchez de Carmona et al. (1996). Results. The average time invested in both computerized and paper-pencil version for SCL 90 was 15 min. and 25 min. for TCI. No significant differences were founded in the items at any dimensions of the SCL 90 and TCI between the computerized and the paper-and-pencil versions. Graphic distribution of data in SCL 90 and central tendencies measures in the TCI, were similar in both computerized and pa-per-and-pencils reference samples versions. Discussion. The average of time invested to response the computerized versions of both test was similar to that reported in paper-and-pencil versions: 15 min. for SCL 90 and 35 min. for TCI. So, then the time required to administer computerized versions is not higher than required in paper-and pencil versions. The results sustain that the computerized administration of the SCL 90 and TCI in Spanish do not differs from the original paper-and-pencils Spanish versions in any of the test's dimensions. Besides, there are equivalent results in computerized versions and results showed in the reference samples. This allows us to consider that computerized versions of SCL 90 and TCI evaluate the features what were designed for. Even the complete evaluation through SCL 90 and TCI requires a final individualized interpretation, the automatically rating trough computerized version, could decrease human mistakes during the account of answers and items. It allows the elaboration of permanent and extensive database that can be easily used to compare epidemiological and longitudinal behavioral research. Furthermore it could complement neurobiological studies, for example, to evaluate population in neuroimaging studies such functional magnetic resonance studies. We conclude that computerized versions of the Symptom Check List 90 and Temperament and Character Inventory show a good validity to be useful as a psychometric tool. <![CDATA[Uso de drogas en la Ciudad de México: Sistema de Reporte de Información en Drogas (Srid)]]> http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0185-33252007000400041&lng=pt&nrm=iso&tlng=pt Resumen: Introducción. El Sistema de Reporte de Información en Drogas (SRID) proporciona un panorama diagnóstico de los cambios ocurridos en el consumo de drogas en la Ciudad de México. Se actualiza dos veces al año (junio y noviembre), y sus resultados dan una estimación de la trayectoria del problema desde una perspectiva de salud. El SRID inició su funcionamiento en 1986 y sus resultados sirven además de fundamento para diseñar programas de prevención adecuados a la población mexicana. Objetivo. Presentar una síntesis de los resultados más relevantes del consumo de sustancias en la Ciudad de México recopilados por el SRID entre 1987 y 2005, en instituciones de salud y de justicia. Quienes se benefician de la información que se obtiene son: - Las autoridades a cargo de diseñar políticas y acciones de intervención en virtud de que el SRID funciona como un sistema de monitoreo permanente, así como de alerta temprana. - Los investigadores, dado que el SRID funciona como ventana para identificar las áreas donde es necesario mayor conocimiento desde una perspectiva de salud. - El público en general, para quien el SRID es una herramienta que describe la evolución y el estado actual de las tendencias de la farmacodependencia. Método. La información se obtiene de una cédula individual sobre consumo de drogas, que se aplica dos veces por año en 44 instituciones del sector salud y procuración de justicia. El diseño de la muestra es no probabilístico de tipo intencional. Resultados. La información analizada corresponde a 19350 casos identificados entre 1987 y 2005. Lo más destacado de las tendencias de consumo de sustancias ha sido el notable incremento de la cocaína durante el periodo evaluado. Igualmente significativa ha sido la tendencia a la baja del consumo de inhalables, que se hizo más evidente a partir de 1999. El consumo de mariguana, una de las tres drogas consumidas con más frecuencia en el país, ha mostrado cierta estabilidad al igual que el resto de las sustancias evaluadas. Conclusiones. El mayor número de usuarios de cocaína son adolescentes. Asimismo, respecto a los patrones de consumo, llama la atención que el perfil del usuario para todas las drogas estudiadas sea alto: 20 o más veces por mes, en 45% de los casos. Ambas situaciones son objeto de preocupación por los efectos físicos y emocionales de las sustancias, y porque no se observan indicadores que sugieran un decremento en el consumo.<hr/>Summary: Introduction. The Information Reporting System on Drugs (IRSD) provides diagnostic information about changes in drug use in Mexico City. This information is updated twice a year (June and November), and an estimation of the main trends of drug use is thus obtained. The IRSD was implemented in 1986, and its results offers grounds for the design of preventive programs suited for the Mexican population from a health perspective. Objetive. To present a synthesis of the most relevant results of substance use in México City compiled by the IRSD between 1987 and 2005. The following are the benefit from data obtained: - Authorities in charge of designing policies and intervention actions, by virtue of which the SRID works as a system of permanent monitoring and early warning. - Investigators, since the SRID works as a window to identify the areas where greater knowledge is necessary. From a health perspective, the public in general, for whom the SRID is a tool that describes the evolution and current state of drug tendencies. Method. The information is obtained from an individual schedule on drug use that is applied twice a year in 44 agencies of the health and law enforcement sector. The design of the sample is non probabilistic. Results. In the period 1987-2005, 19350 cases have been evaluated. The most outstanding trend in substance use has been the remarkable increase of cocaine from 1987 to 2005. Equally significant has been the decrease tendency of solvents-inhalants use, which has become more evident since 1999. Marihuana use is among the three most used drugs in the country. It shows a trend to remain stable as is the case for the other substances evaluted. Conclusions. Most cocaine users are adolescents. At the same time, 45% of the users of all the substances have a use pattern defined as "high": 20 or more times a month. Both situations are a matter of concern due to the important physical and psychological consequences of substance use. In addition, up to this moment, there is no indication suggesting that the level of use will decrease. <![CDATA[La familia y el maltrato como factores de riesgo de conducta antisocial]]> http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0185-33252007000400047&lng=pt&nrm=iso&tlng=pt resumen está disponible en el texto completo<hr/>Summary: Antisocial behavior emerges as the result of different factors such as scholar problems, drug consumption, alcoholism, antisocial peer relationships, emotional problems, etc., which may in turn predispose to the individual to develop a pattern of antisocial behavior. The present work aims to determine the association of antisocial behavior between the factors of a bad family environment and mistreatment, and to determine if they can predict the presence of antisocial behaviors in adolescents. Family plays a primary role in the development of a person, especially in adolescent. In recent times, several problems of family disintegration and inadequate parent-child relationships are observed, and it has been described that antisocial personalities may arise from environments with child abuse, economical problems, humiliation, physical punishment and family disintegration. The experience of such emotions during childhood may lead to a severe impairment in the conformation of an emotionally-adapted personality, and may promote a tendency for the commitment of delictive behaviors in the future. It is necessary to close the vicious cycle where mistreated parents mistreat their own children and avoid that the parents who lived unpleasant experiences of hostility, rejection, lack of communication, inestability, etc., repeat these patterns with their children. It is important to revalorize the role of family, its functions and characteristics and the most important, its determinant influence on young people that have behavior problems as antisocial behavior. It is vital to create conscience about the harm that some children, adolescents and even adults have from their negative familial experiences of hostility, aggression, and mistreatment, because these experiences increase the possibilities of delictive behavior in these individuals. Objective. In this context, the present research has its main interest in showing the relationship between past experiences of mistreatment or inadequate familial environments and the presence of antisocial behaviors in adolescents. Method. The present research is supported on results of the Mexico City Survey on drug consumption in 7 th to 12 th grade population carried on October 2003. The total sample of the survey comprised 10659 students. For this research we used 3603 students, that corresponds to the number of students that completed the Form A of the questionnaire, that contained the areas of interest of the study. The questionnaire was previously validated an its main indicators have shown adequate stability in different surveys. This instrument was applied in three different times due to its extension. Total time for its application was of 75 minutes. Raters were trained for the application of the questionnaire. The course lasted 12 hours and included all the theoretical aspects related to addictions, objectives of the study, management of the questionnaire and the instructions for its application in the groups. Results. First of all, a comparative analysis by gender was performed. It was observed that antisocial behaviors were more frequent in men than in women. It is important to mention that men committed this acts in a double frequency than women, specially in terms of severe acts, where 10% of men committed them in contrast to the 3.3% observed in women. Additionally, two factor ANOVA was performed (gender and antisocial behaviors) with the variables of this study, mistreatment and family environment, to determine if there were differences between groups (p&lt;0.05) and significant differences were observed in all the areas of family environment. The interaction analysis of the two factors: gender, act-non acts with family environment showed that for the area of hostility and rejection there were significant differences where women that committed antisocial acts were the ones that reported higher levels of hostility and rejection. In terms of communication of the son/daughter, women that committed antisocial acts were also the ones that reported a lower level of communication. In the area of parent support, women that committed antisocial acts were also the ones that reported the lower levels. In the areas of parent communication and support to the son/daughter, men and women that committed antisocial acts reported less communication and support, respectively. For the area of mistreatment, women reported higher levels of prosocial discipline and negative discipline when compared to men. No significant differences emerged between men an women in the area of severe negative discipline. Also, no significant differences emerged between adolescents that committed antisocial acts and adolescents than do not committed these acts, in terms of prosocial discipline. Nevertheless, adolescents that committed antisocial acts reported higher levels of severe negative discipline. For the analysis of the interaction of the factors gender, acts-non acts in the area of mistreatment, no differences emerged in the area of negative discipline. Significant differences emerge for prosocial discipline, where men that do not committed antisocial acts reported the lowest levels of prosocial discipline. For severe negative discipline, both men and women that committed antisocial acts reported the highest levels. Finally, using logistic regression, we find that the main predictors of antisocial behavior were the presence of high hostility, low level of communication from the children, less child support and the presence of higher negative discipline and negative severe discipline. Communication, parent support and prosocial discipline were not predictive variables for antisocial behavior. Our results support what is described in other studies where family is the main agent of socialization as family teaches the ways of social interaction, values, habit, etc. Furthermore, several studies that evaluated the relationship of the family and antisocial behavior were performed by analyzing the role of the family as a mediator of behavior and society, on the basis that family teaches children rules, abilities and motivations that in some way constitute their cultural and social patterns. We conclude that family environment and mistreatment are factors associated to the presence of antisocial behavior. We must prevent this problem by improving familial relationships and providing a positive family environment to adolescents. In this way, our adolescents may have an adequate development throughout their lives. If an adequate and positive environment is provided during childhood and is maintained through adolescence, with positive affective family relationships, the adolescent may see his/her parents as a guide; a reasonable not arbitrary discipline allows the adolescent to develop a social behavior that leads to an adequate self-control and self-directedness. On the contrary, if the relationships between parents and children are not favorable, the social behavior of the adolescent may be easily impaired and it is very common that these adolescents exhibit severe difficulties for social adaptation. <![CDATA[Escala de ansiedad ante el envejecimiento de Lasher y Faulkender: propiedades psicométricas en adultos mayores mexicanos]]> http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0185-33252007000400055&lng=pt&nrm=iso&tlng=pt resumen está disponible en el texto completo<hr/>Summary: Lifshitz has documented that conceptualization of old age is influenced by stereotypes. Milligan, Powell, Harley and Furchtgott, made evident that elderly people with poor health have a tendency to see themselves as the stereotype of an "old person", whereas those with better health tend to see themselves as younger people. Lasher and Faulkender have stressed the importance of anxiety in the process of getting old as an important factor adjusting to themselves. Lack of adjustment may manifest in four main dimensions: physical, psychological and social, and transpersonal or spiritual. These four dimensions are synthesized in three specific fears: 1. Fear of the process of aging, 2. fear of the state of being old, and 3. fear or anxiety facing old people. Based on this theoretical frame, the authors developed the Anxiety about Aging Scale, and Watkins, Coates and Ferroni pointed out the need to adapt it in order to apply it on elderly people. The objective of this paper is to evaluate the psychometric properties of the original Lasher and Faulkender scale, as well as presenting an adapted version for Mexican elderly people. Method. Two independent samples of elder adults were used (n=234 and n=151) selected by availability within a government health clinic; on average, they were 63 years old. The original Lasher and Faulkender scale was translated into Spanish following a double blind procedure, using Likert type answer options with four alternatives. Two questionnaires were used, which included the original scale (EAE-O), in one, and the adapted scale (EAE-A) in the other, as well as the sub-scale of attitude facing one's own aging of the Philadelphia Geriatric Center Morale Scale, APE (2), and the Suicidal Ideational Scale (EIS), designed by Roberts (3). Additionally, interviewees were asked: «If you should have to set an age, forgetting a little about what doctors and people say, at what age would you consider that you really start to be "Old"? » and at what age do you think one would get "very old"? The scales were applied to subjects who agreed voluntarily to participate in an anonymous and informed way. Resulting data were analyzed with the system SPSS, v. 11.0. Factorial structure. A factorial analysis with varimax rotation and eigen values greater than 1 produced the following results: EAE-O: The structure obtained was compounded by three factors that explained 53.1% of the variance with Cronbach's alpha of .74 (Fear facing one's own aging, Positive attitude towards old people and Optimism facing one's own aging). EAE-A: The analysis shed a factorial structure compounded by four factors that explained 60.8% of the variance with a general internal alpha consistency of .76 (Positive attitude towards old people, Fear of physical changes, Age and satisfaction with the self and life, and Age and dissatisfaction with the self and life). Concurrent validity. EAE-O. The correlation among the total punctuations of the EAE-O and APE was moderate and significant (r=.481, p&lt;.000). The factors Fear facing one's own aging and Optimism facing one's own aging of the EAE-O, calculated here, obtained a moderate association with the total punctuation of the APE (r=.423, p&lt;.000; r=.333, p&lt;.000, respectively), and the factor of Positive attitude facing old people reported a very low association and no significant (r=.075, p=.252). As expected, the two factors of the APE that seem to evaluate positive and negative attitudes facing aging obtained moderate associations and significant with the two scales of the EAE-O that seem to evaluate the same attitudes (Optimism facing one's own aging, r=.415, p&lt;.000; and Fear facing one's own aging, r=.424, p&lt;.000, respectively). Consequently, a very low association was obtained when relating it with the opposite factor (v.gr. negative vs. positive). EAE-A. Associations between the factors Age and dissatisfaction and Age and satisfaction (similar to the factors of Fear facing one's own aging and Optimism facing one's own aging) and the total score of the APE were moderately high (r =.499, p&lt;.000, and r =.383, p&lt;.000, respectively), as long as the other two factors of the EAE-A presented associations moderately low. As it was to be expected, again were associated in an important way the EAE-A scales with a positive nuance (aging and satisfaction, Positive attitude before old people) with the scale of the APE's Positive attitude, and vice versa. The factors of aging and dissatisfaction and Fear to physical changes were significantly associated with the negative attitude of the APE. The relationship between perceived aging (when is one old?, and when is one too old?) and anxiety before aging; with a marginal meaning, it was found that those people with low levels of anxiety tend to refer an age but remote ( X - =68.2 years, DE= 9.8), than those with high levels of anxiety ( X - =64.47, DE=11.7; t=1.74, gl=57.9, p=.08), to the question of the age that one is "old". Concerning the question when is one too old?, the same tendency it was observed, but this time in a meaningful way (Low Anxiety: X - =80.9 years; DE=9.1; High Anxiety: X - =76.4 years; DE=9.1; t=2.51, gl=128, p=.01). Regarding suicidal ideation, it was found that subjects who score low levels of anxiety before aging according to EAE-A also had lower levels of anxiety of suicidal ideation ( X - = 1.25, DE=1.47), than those with high levels of anxiety ( X - =2.35, DE=2.51; t=2.84, gl=64.45, p=.006). Results contributed by the psicometric analysis of both versions of the EAE have allowed to confirm their utility in Mexican samples. Together, the EAE-O seems to investigate the anxiety before aging as a stage of life; as a state of being, and perhaps could be specially useful on people who are not necessarily elders (old people caretakers, adults between 50 and 60 years old in a frank transition towards the socially conceived old Adulthood, etc.). However, it could be worthwhile to focus on the singular situation of a subject regarding his own aging process (physical or psychosocial), when this is precisely the objective to be investigated; the EAE-A could be useful to this effect. Elderly adults seem to conceptualize "being old" as an event that occurs approximately at 70, and "very old" around 80; this chronological approach seems to obey, at least in part, to the level of anxiety before the aging process; the higher the anxiety, the earlier the beginning of old age. Results allowed to highlight the anxiety facing aging like a variable importantly linked to the psychological imbalance in the old adult, as it was possible to evidence in broadly significant terms with the EAE-A as with the APE, starting from their relationship with the suicidal ideational, and more, when this relationship is found in fellows without current marital commitment and of low educational level. This should be considered in programs of attention to this age sector where these factors of risk are evaluated with a view toward preventing the incidence of suicides. Different studies have highlighted the importance of developing a positive attitude before one's own aging and that of the other ones, in order to achieve a successful aging. This suggests the need to identify methods to promote positive attitudes in young adults toward the elders and the aging process. <![CDATA[La espiritualidad y su relación con la recuperación del alcoholismo en integrantes de Alcohólicos Anónimos (AA)]]> http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0185-33252007000400062&lng=pt&nrm=iso&tlng=pt resumen está disponible en el texto completo<hr/>Summary: In alcoholism research, the exploration of the spirituality have a great importance. Some authors keep distance from this concept and it has been commonly criticized. However, other researchers (Gorsuch, Connors, Tonigan, and Miller) have agreed in pointing out to this and other variables, like religion for example, as important elements that protect individuals from addiction, also as factors that favor treatment and mediate in long abstinence periods. According to Morjaria and Orford, the assumption of a link between spirituality and alcoholism exist because is one of the principles of Alcoholics Anonymous (AA) foundation. In the present, the work of AA is one of the most popular approaches in recovering from alcoholism, within Mexico and in other countries as well, and although its effectiveness over alcohol consumption is still debatable, not well documented and inconclusive. There is evidence suggesting that a regular participation in the group meetings could benefit a lot of individuals; especially those whose participation in all the activities is more enthusiastic and those who develop more beliefs inside the groups. A key element in AA's philosophy is the acceptance of a spiritual strength that comes from a bigger power than themselves (Higher Power: can be understood as a "whole" or the power represented by God), which helps in the recovery process. AA acknowledge the importance of religious thoughts, and the relevance of spiritual tradition in the recovery of each alcoholic, however, the core of the treatment is not placed on these aspects, but it is on spirituality. According to AA, every individual may have his own definition of spirituality and it is outlined by his personal orientation. In that respect, Forcehimes, Kurtz, and Ketchman said that spirituality is a transformation breakthrough marked by a personal experience of "spiritual awakening", all resulting from regular participation to the meetings and from the daily practice of the twelve-step program. The twelve-step program represents one of the most important components in the recovery strategy of AA and reflects the spiritual nature of the program. DiClemente and Gabhainn have noted that the practice of the steps has fundamental implications in reaching and maintaining abstinence, especially for those who practice them on a regular way. However, available evidence about the benefits that each step brings to the alcoholics is still limited and sometimes controversial. There are very few investigations in Mexico about the role of spirituality in the alcoholic recovery process. AA have not been sufficiently studied and there is a lot unknown about their treatment strategies. The objective of this study is to know if the effectiveness of the practice of the 12 steps, the frequency of their practice, and the experience of the "spiritual awakening" (that AA consider as a consequence of practicing the steps) influence on the maintenance of abstinence in members of AA. The sample was non probabilistic and included 192 AA members from traditional groups (or "an hour and a half" groups, named after the time meetings last) from southern Mexico City area. Individuals were divided in two groups: relapsed and not relapsed. The first group included 49 alcoholics (90 percent of males, 10 percent of females) who relapsed after an abstinence period of three or more months within AA (abstinence mean = 2.4 years). The second group included 143 subjects (86 percent of males, 14 percent of females) who have not relapsed since they entered AA or for a ten year period or longer. To determine the influence of the spiritual principles of the 12 steps program, a question was designed to measure the practice of each one of them, as well as a scale to explore the frequency of such practice. Also, since AA considers the "spiritual awakening" as a result of working with the steps, a question about its occurrence was included. Results showed that not relapsed individuals have practiced significantly more steps (mean=9, SD=4.1) than the relapsed ones (mean=7, SD=4.4) (t=2.304, df=190, p=.02). Results also showed that frequency in the practice of: thinking about events that led to alcoholism (steps 4 and 5), humbleness to accept help from a Higher Power (steps 6, 7, and 11), acceptance of responsibility to reduce the consequences of addiction (steps 8, and 9), and helping other alcoholics (step 12), is significantly different between both groups; not relapsed individuals had a more frequent practice of these steps. Since AA assumes that working the steps leads to experience a spiritual conversion or "spiritual awakening" (it implies a change in the self-concept, in the view of the world, and stop being self-centered), a regression analysis was performed to test this assumption. Results suggested that a greater involvement in steps 4 to 12 -usually considered as steps for action and maintenance- increases 10 percent the probability for experiencing the "spiritual awakening" (p=.000). Besides this experience increases two times the probability for staying sober in not relapsed subjects (Exp[B]=2.095, CI=1.032-4.253, p=.04). No statistical differences were found in the practice of steps 13, but this does not mean that they are not important, for these are the most practiced steps in both groups. However, the fact that relapsed alcoholics put great value upon these steps, points out their willingness to stop consuming (apparently they have accepted being powerless before alcohol, and to surrender their will and life to a Higher Power), but it also underlines their difficulty in attaching to some of the beliefs and activities that AA consider as base to complete the practice the steps and to develop spirituality. Several of these activities are related to elements in the program that mean more action and certain degree of confusion and discouragement for those who focus in staying sober only based on a vague idea of what constitutes the Higher Power. AA recognizes the first three steps as the facilitators of abstinence and as the beginning of the path to "spiritual awakening" through an aid that transcends the individual (Higher Power), but they also emphasize that many times this is not enough for the recovery. Paradoxically, they state that this condition could lead to a feeling of false security that could invite the alcoholic to flirt with the idea of having "just one drink". Therefore, it is not casual that relapsed individuals in the sample of this study focus on practicing the first three steps, though more research is needed to further confirmation. These results allow concluding that spacing out the practice of the 12 steps or not practicing them at all, produces low levels of spirituality, which could be the cause of a relapse. Results also showed that a higher level of spirituality (linked to the practice of more steps) has an important influence on the recovery of alcoholics, particularly for those whose practice of the steps is more regular. The sample of this study showed that its particular way to develop spirituality (spiritual awakening) and therefore maintain abstinence requires of a process that involves cognitive, emotional, and behavioral activity (steps 4-12), and not only to embrace the conviction of alcoholism as a disease susceptible of being cured (steps 1-3). Finally it is important to indicate that the 12 steps program represent a particular way of expressing spirituality, and that they are limited to specific cognitions and practices; thus, more research is required to replicate these results with other measures of spirituality. <![CDATA[<strong>Sincronización no-luminosa: mecanismos fisiológicos. Segunda parte</strong>]]> http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0185-33252007000400069&lng=pt&nrm=iso&tlng=pt resumen está disponible en el texto completo<hr/>Summary: In alcoholism research, the exploration of the spirituality have a great importance. Some authors keep distance from this concept and it has been commonly criticized. However, other researchers (Gorsuch, Connors, Tonigan, and Miller) have agreed in pointing out to this and other variables, like religion for example, as important elements that protect individuals from addiction, also as factors that favor treatment and mediate in long abstinence periods. According to Morjaria and Orford, the assumption of a link between spirituality and alcoholism exist because is one of the principles of Alcoholics Anonymous (AA) foundation. In the present, the work of AA is one of the most popular approaches in recovering from alcoholism, within Mexico and in other countries as well, and although its effectiveness over alcohol consumption is still debatable, not well documented and inconclusive. There is evidence suggesting that a regular participation in the group meetings could benefit a lot of individuals; especially those whose participation in all the activities is more enthusiastic and those who develop more beliefs inside the groups. A key element in AA's philosophy is the acceptance of a spiritual strength that comes from a bigger power than themselves (Higher Power: can be understood as a "whole" or the power represented by God), which helps in the recovery process. AA acknowledge the importance of religious thoughts, and the relevance of spiritual tradition in the recovery of each alcoholic, however, the core of the treatment is not placed on these aspects, but it is on spirituality. According to AA, every individual may have his own definition of spirituality and it is outlined by his personal orientation. In that respect, Forcehimes, Kurtz, and Ketchman said that spirituality is a transformation breakthrough marked by a personal experience of "spiritual awakening", all resulting from regular participation to the meetings and from the daily practice of the twelve-step program. The twelve-step program represents one of the most important components in the recovery strategy of AA and reflects the spiritual nature of the program. DiClemente and Gabhainn have noted that the practice of the steps has fundamental implications in reaching and maintaining abstinence, especially for those who practice them on a regular way. However, available evidence about the benefits that each step brings to the alcoholics is still limited and sometimes controversial. There are very few investigations in Mexico about the role of spirituality in the alcoholic recovery process. AA have not been sufficiently studied and there is a lot unknown about their treatment strategies. The objective of this study is to know if the effectiveness of the practice of the 12 steps, the frequency of their practice, and the experience of the "spiritual awakening" (that AA consider as a consequence of practicing the steps) influence on the maintenance of abstinence in members of AA. The sample was non probabilistic and included 192 AA members from traditional groups (or "an hour and a half" groups, named after the time meetings last) from southern Mexico City area. Individuals were divided in two groups: relapsed and not relapsed. The first group included 49 alcoholics (90 percent of males, 10 percent of females) who relapsed after an abstinence period of three or more months within AA (abstinence mean = 2.4 years). The second group included 143 subjects (86 percent of males, 14 percent of females) who have not relapsed since they entered AA or for a ten year period or longer. To determine the influence of the spiritual principles of the 12 steps program, a question was designed to measure the practice of each one of them, as well as a scale to explore the frequency of such practice. Also, since AA considers the "spiritual awakening" as a result of working with the steps, a question about its occurrence was included. Results showed that not relapsed individuals have practiced significantly more steps (mean=9, SD=4.1) than the relapsed ones (mean=7, SD=4.4) (t=2.304, df=190, p=.02). Results also showed that frequency in the practice of: thinking about events that led to alcoholism (steps 4 and 5), humbleness to accept help from a Higher Power (steps 6, 7, and 11), acceptance of responsibility to reduce the consequences of addiction (steps 8, and 9), and helping other alcoholics (step 12), is significantly different between both groups; not relapsed individuals had a more frequent practice of these steps. Since AA assumes that working the steps leads to experience a spiritual conversion or "spiritual awakening" (it implies a change in the self-concept, in the view of the world, and stop being self-centered), a regression analysis was performed to test this assumption. Results suggested that a greater involvement in steps 4 to 12 -usually considered as steps for action and maintenance- increases 10 percent the probability for experiencing the "spiritual awakening" (p=.000). Besides this experience increases two times the probability for staying sober in not relapsed subjects (Exp[B]=2.095, CI=1.032-4.253, p=.04). No statistical differences were found in the practice of steps 13, but this does not mean that they are not important, for these are the most practiced steps in both groups. However, the fact that relapsed alcoholics put great value upon these steps, points out their willingness to stop consuming (apparently they have accepted being powerless before alcohol, and to surrender their will and life to a Higher Power), but it also underlines their difficulty in attaching to some of the beliefs and activities that AA consider as base to complete the practice the steps and to develop spirituality. Several of these activities are related to elements in the program that mean more action and certain degree of confusion and discouragement for those who focus in staying sober only based on a vague idea of what constitutes the Higher Power. AA recognizes the first three steps as the facilitators of abstinence and as the beginning of the path to "spiritual awakening" through an aid that transcends the individual (Higher Power), but they also emphasize that many times this is not enough for the recovery. Paradoxically, they state that this condition could lead to a feeling of false security that could invite the alcoholic to flirt with the idea of having "just one drink". Therefore, it is not casual that relapsed individuals in the sample of this study focus on practicing the first three steps, though more research is needed to further confirmation. These results allow concluding that spacing out the practice of the 12 steps or not practicing them at all, produces low levels of spirituality, which could be the cause of a relapse. Results also showed that a higher level of spirituality (linked to the practice of more steps) has an important influence on the recovery of alcoholics, particularly for those whose practice of the steps is more regular. The sample of this study showed that its particular way to develop spirituality (spiritual awakening) and therefore maintain abstinence requires of a process that involves cognitive, emotional, and behavioral activity (steps 4-12), and not only to embrace the conviction of alcoholism as a disease susceptible of being cured (steps 1-3). Finally it is important to indicate that the 12 steps program represent a particular way of expressing spirituality, and that they are limited to specific cognitions and practices; thus, more research is required to replicate these results with other measures of spirituality.