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Salud mental

versión impresa ISSN 0185-3325

Resumen

MARTINEZ MARTINEZ, Kalina Isela et al. Preliminary study of a brief intervention program for adolescents who initiate alcohol and other drugs consumption. Salud Ment [online]. 2008, vol.31, n.2, pp.119-127. ISSN 0185-3325.

During the last two decades, alcohol, tobacco and illicit drug consumption among young people has come to be regarded as a serious public health problem, both in Mexico and internationally. This recognition has resulted from a trend toward higher levels of use, greater diversification of the types of drugs used and abused, and increased drug marketing. Epidemiological data show that most users initiate drug use when they are about 16 years old. However, the age of first drug experimentation appears to be decreasing, with recent reports indicating an average age 12 or 13 years at present. The societal costs of adolescent drug use cut across different domains including physical and mental health, car crashes, and morbidity and mortality related to substance misuse. The personal costs of teen drug use include school failure, drop-out, and truancy. Moreover, aggressive behavior and crime, risky sexual behaviour, and many other behavioural problems have been shown to be associated with adolescent drug use. Research from many different disciplines has increased knowledge about (a) important dimensions of adolescent substance use and (b) the processes and variables related to the origin and maintenance of addictive behavior among teenagers. Despite this growing body of knowledge, few current prevention and treatment programs are based on empirical investigation. Moreover, many current intervention programs have not been adequately evaluated in regard to effectiveness. A recent development in the addiction field is brief intervention (BI). BIs have been demonstrated to be effective in the treatment of addictive behavior among adult problem drinkers, with the most successful programs based on the Theory of the Social Learning. Only recently have BIs been tried with adolescent populations. While promising, little empirical research exists about the effectiveness of brief treatment with adolescents. The primary goals of BIs are to (a) reduce or eliminate substance consumption and (b) to mitigate the adverse effects of using alcohol or other drugs (i.e., harm reduction). While the goals of BIs are clear, the effectiveness of such programs with adolescents, despite their promise, is not well researched. For this reason, it is important to develop and empirically test BI programs for adolescents demonstrating problematic alcohol or other drug consumption. Schools represent a particularly good place to access adolescents who would benefit from BIs, and BIs represent an attractive alternative to the typical strategies used by school to address student substance use (i.e., suspension or expulsion). The main goal of this investigation was to develop and to evaluate a brief intervention program for teenagers with substance abuse (but who have not developed substance dependence) between 14 and 18 years old. The intervention program tries to: (a) promote a change in drug consumption through establishing consumption goals (in the case of the alcohol, moderation or abstinence; in the case of illegal drugs, abstinence); (b) identify high-risk situations in which use is probable; and (c) develop alternative strategies to these situations. The theorical bases of the intervention include Self-control Theory, Motivational Interviewing, Relapse Prevention and <<The First Contact>>. Our brief intervention program consisted of six steps: 1. case detection, which involved the identification of adolescents who abuse alcohol or another drugs, by means of teacher's reports, legal and psychology personnel, trained by the investigators; 2. screening, which involved determining whether adolescents met inclusion criteria; 3. assessment, which addressed the frequency and amount of consumption and self-confidence to suitably face situation of probable drug; 4. induction to the program, the objective of which was to sensitize the adolescents about the importance of attending treatment; 5. intervention; and, 6. one, three and six months follow-up assessments. The intervention program consisted of four individual sessions with the participants in which they chose their own substance reduction goals, identified their high risk situations, developed coping plans for each high risk situation, and appraised the impact of their substance use on their own life-goals success. The researchers used a single-case design with 25 participants, 17 of whom had alcohol problems and eight of whom had marijuana problems. The age average of participants was 16 years (SD = 1.8), and 19 were male and six were female. The average age of first consumption was 14 years old (SD = 1.72); the average duration of substance use was 18 months. From the complete sample, 45% reported consumption one or twice per week, 22% reported daily consumption, and the remainder consumed once a month. Results indicated that from the 25 participants, 24 demonstrated changes from the baseline in their consumption pattern (measured by frequency and quantity) during intervention and at follow-up assessments. Self-efficacy levels (self-perceptions about the capability to abstain or use moderately in high risk situations) changed as well. Specifically, among the adolescents who consumed alcohol a one-way ANOVA revealed significant changes in average consumption between the baseline, treatment, and follow-up phases F(2.48) = 17.691, p < .001. Bonferroni's post-hoc tests showed differences between baseline ( = 8.89, SD = 3.55) and treatment ( = 4.46, SD = 3.27), and between baseline and the follow-up ( = 3.29, SD = 1.35). Student's t tests for each subject showed that 16 adolescents significantly reduced their alcohol consumption from the baseline to the follow-up. Only one participant demonstrated increased use (from five standard drinks per drinking occasion at the baseline to 5.90 standard drinks at the follow-up). Regarding consumers of marijuana, a one-way ANOVA showed significant changes in consumption across the baseline, treatment and follow-up phases F(2.21) = 8.219, p = .002. Bonferroni's post-hoc tests showed significant differences between the baseline ( = 18.23, SD = 16.62) treatment phases ( = 1.07, SD = 0.77), and between the baseline and the follow-up phases ( = 1.59, SD = 1.06). An additional one-way ANOVA revealed significant changes in self-efficacy. Specifically, participants demonstrated increased self-efficacy in situations including: Unpleasant emotions, Pleasant emotions, Testing personal control, Conflict with others, Social pressure, and Pleasant time with others (all p < .01), F(2.78) = 24.30, 12.47, 11.34, 11.02, 16.91 and 25.62, respectively. Self-efficacy in regard to Physical discomfort and Urges and temptations to drink also showed significant changes, but at p < .05 F(2.78) = 3.97 and 3.26, respectively. Finally, in order to evaluate the impact of the intervention on problems that participants associated with their alcohol use (or other drugs), seven areas were examined: School, Health, Cognitive, Interpersonal, Family, Legal and Economic. At the end of the treatment, there was a reduction in the number of problems related to these seven areas, compared with the baseline.

Palabras llave : Adolescent; alcohol and drug abuse; brief intervention; cognitive-behavioral treatment.

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