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Salud mental

versão impressa ISSN 0185-3325

Salud Ment vol.30 no.3 México Mai./Jun. 2007

 

Artículos originales

Modelo integral de satisfacción cotidiana en usuarios dependientes de alcohol y otras drogas

Lydia Barragán Torres* 

Marlene Flores Mares* 

Ma. Elena Medina-Mora** 

Héctor Ayala Velázquez

* Centro Acasulco. Facultad de Psicología, UNAM. Cerrada Acasulco 18, Col. Oxtopulco-Universidad. Coyoacán. 04318 México, DF. Tel:(55) 5658 3011. e.mail: lydipepe@prodigy.net.mx

** Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz.


Resumen

El objetivo de esta investigación fue evaluar la solidez de un modelo conceptual para explicar el consumo y la abstinencia en usuarios con dependencia del alcohol y otras drogas; identificar, en ambas condiciones, la asociación y la configuración de las variables cognitivo-conductuales que lo integran, y detectar las que pudieran funcionar como predictoras de la abstinencia.

Los modelos cognitivo-conductuales que explican desde una perspectiva integral la dependencia del consumo, son el Dinámico Regulatorio de Niaura y el de la Teoría del Aprendizaje Social que integran los fundamentos del condicionamiento clásico, operante y vicario.

En este estudio, se evaluó el Modelo Integral de Satisfacción Cotidiana en dos momentos: Inicialmente, cuando los usuarios con dependencia de sustancias adictivas presentaban consumo y posteriormente, cuando éstos se orientaron hacia la abstinencia. El modelo propuesto se estructuró considerando críticas previas, como la necesidad de utilizar medidas de observación directa de diferentes y específicas habilidades de afrontamiento que se pueden utilizar ante situaciones cotidianas; evaluar cambios en las variables del Modelo, al momento en el que el usuario presenta consumo y ante el cambio en el que éste se orienta hacia la abstinencia; evaluar la variable satisfacción cotidiana y su asociación con otras variables, debido a que ha sido poco estudiada, y no ha sido valorada en su funcionamiento en modelos conceptuales, ni su impacto en el proceso terapéutico a pesar de estar asociada con la obtención de logros en diferentes escenarios del funcionamiento cotidiano.

Por lo anterior, las variables que se incluyeron en el Modelo Integral de Satisfacción Cotidiana fueron: consumo, precipitadores, autoeficacia, satisfacción cotidiana, comunicación, solución de problemas, rechazo del consumo, depresión y ansiedad. Estas variables se evaluaron en una muestra intencional no probabilística de 20 usuarios con dependencia de sustancias adictivas, antes y después de la intervención cognitivo-conductual que se orienta hacia la abstinencia en el consumo. Se utilizaron registros videograbados de ocurrencia para evaluar ensayos conductuales en las variables: rechazo del consumo, solución de problemas y comunicación.

En el momento del consumo, el Modelo mostró solidez al explicar 96% de la varianza mediante el análisis de escalamiento; se asociaron significativamente los precipitadores, la ansiedad y la autoeficacia. La diversidad e intensidad de los precipitadores y la disminución de habilidades de enfrentamiento propició decremento para resistirse al consumo, incrementó el nivel de ansiedad y decrementó la satisfacción cotidiana. El incremento en ansiedad, fue un indicador del síndrome de abstinencia en usuarios con dependencia; a su vez, la ansiedad, al funcionar como precipitador, corrobora lo sustentado en el modelo del retiro condicionado. En el momento del consumo, las variables de rehusarse a consumir, comunicación y solución de problemas no se asociaron significativamente, lo que señaló la necesidad, en estos usuarios, de ampliar su repertorio conductual al adquirir, desarrollar y utilizar consistentemente estas habilidades.

En el momento de la abstinencia, el modelo mostró solidez ya que el análisis de escalamiento explicó 96% de la varianza entre sus variables: los usuarios incrementaron su seguridad para resistirse al consumo, su satisfacción respecto al funcionamiento cotidiano y su habilidad para rehusar el consumo, y disminuyeron las situaciones de riesgo que les precipitaron al consumo, así como sus niveles de ansiedad y depresión, con un decremento en el consumo. La autoeficacia fue mediadora entre lo conductual y lo emocional; la satisfacción cotidiana se asoció a variables cognitivo-emocionales como autoeficacia, ansiedad y depresión y funcionó como advertencia temprana de recaídas, por lo que su evaluación constante en el proceso terapéutico permite anticiparlas y evitarlas.

Las variables predictoras de la abstinencia explicaron 73.2% de varianza en los precipitadores, la satisfacción cotidiana, la autoeficacia y el rehusar consumo; en cambio, la depresión no resultó significativa en el análisis de regresión con el método enter. La dirección y asociación entre las variables del Modelo favorecen la abstinencia.

Palabras clave: Modelos cognitivo-conductuales; consumo dependiente; satisfacción cotidiana; abstinencia

Summary

The objective of this study was to evaluate a conceptual model to explain alcohol and drugs abstinence in persons that meet the DSM-IV dependence criteria.

This study incorporated and evaluated the conceptual proposal of the Integrated Model of Everyday Satisfaction. The structure of this model is based on the Niaura’s Dynamic Regulatory Model and the Social Learning Theory that included the classical conditioning, the operant and the vicar to explain the dependent-consumption and incorporated some of the criticisms to the different cognitive-behavioral models, as the need to measure, by means of a direct observation, the specific type of skills used by the consumption-dependent users when facing everyday situations; as well as identifying changes of the functioning of the variables making up the model at the moment of turning towards abstinence; it also considered the indicators that the variable everyday satisfaction has been poorly studied and not been included in the study of conceptual models.

Thus, the proposed conceptual model: Integrated Model of Everyday Satisfaction, included the following variables: consumption, precipitators, self-efficacy, everyday satisfaction, as well as variables measuring the facing of specific situations: communication, problem-solving, refusal of consumption, depression and anxiety.

These variables were evaluated in an intentional, non-probabilistic sample with 20 dependent users of addictive substances, before and after the cognitive-behavioral intervention adapted to the Mexican population. This intervention model included the following components: Functional Analysis, Demonstration of Non-Consumption, Daily Life Goals, Communication, Problem Solving, Consumption Refusal, Marriage Guidance, Employment Searches, Recreational and Social Skills, Emotional Self-Control and Prevention of Relapses.

The pre-post-test evaluation methods were: Retrospective Baseline, Situational Confidence Scale and/or Drug Consumption Self Confidence Scale, Daily Life Satisfaction Scale, Inventories of Drug Consumption Situations and/or Inventories of Alcohol Consumption Situations, Beck´s Inventories for Depression and Anxiety. Occurrence records were used to assess the video-filmed behavioral assays of consumption refusal, problem-solving and communication. The didactic techniques used in the training were: verbal instruction, modeling, behavioral trials and feedback.

In the scaled analysis, the Model showed, at the moment of consumption, solidity accounting for 95% of the variance. At this moment, significantly related to the variables: risk situations, selfefficacy to avoid consumption, everyday satisfaction and anxiety. Dependent consumers, showed bigger diversity and intensity of risk situations previously associated to consumption, reduction of facing skills that caused their insecurity to refuse consumption, increased of their physical symptoms of anxiety and decreased of everyday satisfaction related with their poor functioning in different areas of daily living.

The increase of anxiety was an indicator of manifested abstinence syndrome, and confirmed that the used filter criterion, showed sensitivity to attract target population; in turn, anxiety as precipitator confirmed, was sustained by the conditioned withdrawal model.

Refusal of consumption, communication and problem-solving at the moment of consumption in the user prior to the training were not significantly associated, indicating the need to acquire and develop these skills in the behavioral repertoire.

Eighteen from the twenty dependent users showed in the analysis of interrupted time series, that the amount and frequency of the consumption was significantly changed toward abstinence after their participation in the cognitive-behavioral intervention.

The scaled analysis indicates that it was a solid model in terms of abstinence accounting for 96% of the variance. In the final configuration of the Model variables with regard to its proximity to abstinence, identified the proximity between the: decreased of consumption, the more skills for facing risk situations, and refusal of consumption were detected with major proximity; subsequently, more everyday satisfaction and more self-efficacy to avoid consumption; then less anxiety and depression; and eventually, more communication and problem-solving skills.

The following variables were significantly associated, during abstinence: the More Everyday Satisfaction from the functioning in daily living, more skills and variety of behavioral alternatives to cope risk situations, more self-efficacy to avoid consumption at coping different risk situations, less anxiety and depression, also more skills to consumption refusal, and decrease of substance consumption. Self-efficacy worked as mediator between behavior and emotion; everyday satisfaction was associated to cognitive variables: self-efficacy and emotional self-control; anxiety and depression. This study detected that it may work as an early advice of relapse, and as antecedent of abstinence.

The variables that acted as predictor of abstinence, accounted for 73.2% of the variance and were: coping risk situations with alternative behaviors, getting everyday satisfaction from their performance in activities of different areas of daily living, self-efficacy to resist consumption at risk situations and refusal of consumption in front of persons modeling consumption and invitations and pressure to consume; depression was not significant with the Enter method regression model.

The measuring of problem-solving did not include the efficacy of application in everyday life, so that it was not directly associated to consumption.

One limitation was not having evaluated the generalization behavior of variables: communication and problem-solving in natural settings; and the lack of physiological measures in order to evaluate the emotional self-control. In another study, it is suggested to assess the variables during follow-up to detect changes in its functioning in this other moment.

It may be concluded that the relationship between the diversity of variables inserted in this Model during the organism-environment interaction, is favorable to the abstinence, everyday satisfaction, facing non-consumption, behavior entails, flexibility and integration of a number of cognitive-behavioral skills.

The functioning of Everyday Satisfaction as early warning of relapse is an important finding to be considered by the therapist who, when applying the intervention on these users, will have to perform subsequent evaluations of this variable in the process of change in order to anticipate and avoid relapses.

Key words: Cognitive-behavioral models; everyday satisfaction; abstinence; dependent consumers

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