Introducción

En las ciencias de la salud, el concepto que subyace al consumo de drogas ha sido controversial en su construcción histórica; a su vez, la sociedad parece entenderlo como una conducta socialmente reprobable. ¿Tendrá diferente significado e implicaciones para el uso de los servicios de salud el hecho de que el término se use para aludir a una enfermedad o un vicio de la población usuaria de drogas? Diferentes estudios coinciden al señalar que el término vicio provoca reacciones afectivas que obstaculizan el uso de los servicios. En cambio, visualizarlo como enfermedad parece proponer una intervención para solucionarlo. En este sentido, ¿qué imágenes prevalecen entre la población usuaria y qué ideas y creencias se relacionan con el uso de los servicios de salud? El estudio de las imágenes proviene de la psicología social francesa. Mosco-vici las concibe como una especie de sensaciones mentales, impresiones de los objetos y de las personas que se mantienen vivas porque ocupan espacios en la memoria. Desde esta perspectiva, el objetivo de este trabajo fue describir las imágenes que construyeron sobre la adicción los adolescentes usuarios de drogas ilegales, que acudían a tratamiento, y sus padres.

Método

Se diseñó un estudio cualitativo orientado hacia la teoría de las representaciones sociales. Participaron 15 adolescentes poliusuarios de drogas ilegales que asistían a tratamiento a Centros de Integración Juvenil en Guadalajara, Jalisco, en 2002, acompañado cada uno de sus respectivos padres. Para la recolección de datos, se utilizaron entrevistas individuales a profundidad. El análisis incluyó codificación temática, categorización y análisis interpretativo. Se solicitó consentimiento informado y se modificó la identidad de los participantes.

Resultados

Hubo consenso en denominar la adicción como un vicio, en la que se destacó la voluntad del sujeto en su inicio y, por lo tanto, también para su cese. Una vez que el usuario experimentó problemas asociados con el consumo, se redefinió como un problema que ameritaba ayuda, por lo que se emprendían estrategias para cesar el consumo. Los adolescentes buscaban alejarse de la influencia de los amigos y del ambiente, mientras que los padres creían que bastaba la voluntad. Una vez que consideraban la adicción como un problema que no podían resolver con sus propios medios, se habilitaban razonamientos que redefinían la adicción como un problema que ameritaba ayuda. En esta redefinición se sustituía la imagen de la adicción-vicio por la de enfermedad y se habilitaban procesos cognitivos para usar los servicios de salud. En la imagen de enfermedad se destacaban problemas asociados al consumo, y se redefinía el deseo de consumir como un síntoma propio de la dependencia. Sin embargo, esta redefinición de la adicción-enfermedad no parecía ser estable, ya que aún prevalecían huellas de la imagen como vicio. Este hallazgo sugiere que la imagen de la enfermedad funcionaba como un puente de unión entre la adicción-vicio y el acceso a un tratamiento. Sin embargo, la adicción-vicio y la adicción-enfermedad no parecen ser imágenes antagónicas, sino parte de un continuo en que coexisten.

Discusión

Los hallazgos indican que el concepto presente en el pensamiento de la población era el de la adicción-vicio al inicio del consumo y, una vez que aparecían los problemas asociados, se reconocía la adicción como enfermedad sin desvincularla de la noción de vicio. Esto coincide en parte con lo reportado previamente. Por nuestra parte, sugerimos que no deriva de una creencia, sino de una cons trucción más elaborada que le da permanencia en la sociedad, y a la que Moscovici se refirió como 'imagen". La función que cumple una imagen es el elemento más importante y, en este caso, la función de la imagen del vicio era la de rechazar un comportamiento que se consideraba socialmente desviado. Por el contrario, la imagen como enfermedad no se mantenía estable en el pensamiento social, porque en realidad no se trataba de una imagen elaborada por ellos, sino la adopción de la imagen para tener acceso a un tratamiento. Las imágenes antagónicas y excluyentes, que se presentan al inicio del consumo coexisten en un continuo dependiendo de su función.

Introduction

Through time, the concept underlying drug consumption has been a matter of much controversy in the health sciences field. Here, it has been referred to using different definitions, but society seems to perceive it mostly as a vice, associated to socially unacceptable behavior. The addiction-vice notion implies a moral concept which goes beyond health issues and induces affective reactions that seem to hinder the use of health care services. In contrast, when addiction is considered as a disease and the inability to control consumption is acknowledged, it all seems to lead to an intervention meant to solve the problem. Does the temí "addiction" -as used by drug users to refer either to a disease or vice- have any influence on stopping or promoting the use of health care services? And if so: Which are the cognitive processes supporting the images of addiction-vice and addiction-disease? Reports from different studies agree on the fact that adolescents and their parents only look for the help of health care services when they feel frustrated because they find themselves unable to control the drug use and feel at risk because of certain beliefs, attitudes or intentions.

The study of images comes from the socalled "French social psychology", where Moscovici proposed using the concept of images to define a more complex and logical structure than that of attitudes and/or evaluation results. He considers images as an inner representation of an external reality, as constructions similar to visual experiences: a sort of mental sensations or impressions of objects and persons. According to him, images persist because they are lodged in the memory where they reinforce the sense of both a continuity of the environment and individual and collective experiences. From this theoretical perspective, the following were the aims of this study: to describe addiction-related images built both by adolescent users of illegal drugs, who were undergoing treatment at the time, and their parents.

Method

Based on the theory of social representation, a qualitative study was devised. The sample was composed by fifteen 13 to 19 year-old adolescents, who were users of multiple illegal drugs and were undergoing treatment in the Centros de Integración Juvenil in Guadalajara, Jalisco, Mexico, in 2002, together with their respective accompanying parents. The data were compiled using in-depth recorded interviews. The interpretations consisted of thematic encoding, classification and interpretative analyses. Ethical steps were taken in order to protect the participants' identity and to obtain their informed consent.

Results

In the accounts of both the adolescents and their parents, addiction was consistently referred to as a vice. Here, the voluntary use pathway put forward by the subjects' stood out; so, a voluntary decision would also be required to stop using drugs. In addition, parents perceived addiction as something wrong. Only when drug users started having drug consumption-related difficulties, was this redefined as a problem that they could not solve by their own means. It is worth mentioning here that adolescents did try to avoid the influence of friends and the environment when using drugs.

Parents thought willpower alone would suffice to stop their offspring from using drugs. This was so because parents were not sensitive enough to the influence of tolerance and abstinence regarding the problem. Consequently, there were reasoning processes that redefined addiction as a problem needing the help of specialists. This cognitive re-definition turned the image of addiction-vice into that of addiction-disease.

On the one hand, to look for help in the health care services under the stigma of the vice image meant to be openly recognized as a dissolute person and to be thus socially excluded. On the other, having a disease implied the possibility of solving the mistake of drug-taking and thus being rehabilitated and reinserted into a productive life. Nevertheless, in the addiction-disorder image, drug consumption-related problems still prevailed, such as the inability to control using drugs, together with family, school and work problems. Redefining addiction as a disease did not seem to be stable or permanent in their minds for there were still traces of the vice image. This finding suggests the disease image acted as a sort of link between addiction-vice and the access to treatment when trying to stop the use by their own means failed.

Instead of rejecting the vice image, it seems that the subjects' appropriation of the disorder image represented by health care services in order to look for a specialized treatment was used as an important expectation. This was the case even when in their minds the use of drugs was a vice influenced by willpower and environment. Drugs and addiction-vice and addiction-disease are not antagonistic images in social reasoning, but are a part of a continuum where they coexist.

Discussion

Our findings show that the adolescents interviewed had in their minds an image of addiction-vice as a pathway to drug use. It was also an image where drug use-related problems appeared, and thus they defined addiction as a disease without completely disassociating it from the notion of vice. Although these findings agree partially with those reported on this matter, there is a more elaborated and useful construction giving the problem a continuance in society, and to which Moscovici referred to as "image".

An image has three characteristics accounting for its stability, consistency and continuance in social groups: 1. marginal elements, such as beliefs, cognitions, and judgements, which act as safeguards to protect; 2. the key element of the image, which is in this case addiction as vice, and 3. the social function accomplished by the image. We believe that the latter is the most important characteristic, a feature which was also emphasized by Moscovici.

According to the common sense of the adolescents and parents under study, the function of the addiction-vice image was to reject a behavior considered deviant from accepted social norms. On the other hand, we detected that the addiction-disease image was not stable in the social mind, because this was not an image made up by the population under study, but one that they had appropriated and where health services were included. It is a construction circulating outside these particular social actors, and which is appropriated to carry out the purpose of gaining access to treatment. The images composing the voluntary use pathway seem to be antagonistic and mutually excluding, and they seem to coexist in the mind's continuum when addiction is redefined as a problem deserving help. Consequently, using drugs can be at times viewed either as a vice or disease, or vicedisease, depending on the purpose it fulfills in a given situation. Only common sense can accept such exclusions and alternations, because the reasoning underlying it does not need any verifications regarding its validity. From this viewpoint, addiction represents a big challenge for health services because of the several elements it involves. Results from this study point out to the reasoning used to examine the ideas of both the adolescents and their parents and to explain decisions regarding drug use. The degree of knowledge about the way these individuals think, communicate and take decisions will enable health services professionals to develop more efficient interventions. To a certain extent, we believe the reasoning behind the vice image is accurate enough because, although the use pathway was voluntary, willpower is also important to stop consumption and look for help in the health care services. Finally, we think that it would be appropriate to study these images in populations from other regions in order to evaluate if the same or similar images prevail or not. Further research of these images would help to develop longitudinal studies which would also evaluate, on the one hand, the images through the therapeutic process and, on the other, their link with the effectiveness of any given treatment.