Alcohol, drogues i addiccions comportamentals: reptes abans i després de la COVID-19

Coronavirus SARS-CoV-2; COVID-19; 2019-nCoV; Drogues; Addiccions comportamentals; Benestar emocionalCoronavirus SARS-CoV-2; COVID-19; 2019-nCoV; Drogas; Adicciones comportamentales; Bienestar emocionalCoronavirus SARS-CoV-2; COVID-19; 2019-nCoV; Drugs; Behavioral addictions; Emotional well-beingComunicació sobre les conseqüències negatives de la pandèmia i de les mesures per contenir els rebrots en el benestar emocional, a partir dels resultats de l'enquesta de "Salut durant el confinament". A més, es reflexiona sobre com abordar el repte que aquest context suposa per la implementació del Nou Pla de Drogues i Addiccions Comportamentals i l'elaboració de la nova Llei d'Addiccions

Treatment for alcohol dependence in Catalonia: health outcomes and stability of drinking patterns over 20 Years in 850 patients

Dependència de l'acohol; Estudi d'evolucióDependencia del alcohol; Estudio de evoluciónAlcohol dependence; Evolution studyAims: The aim of this study was to evaluate long-term outcomes in alcohol-dependent patients following outpatient treatment and gender differences in drinking outcome and mortality. Methods: A 20-year longitudinal prospective study was done with interim analyses at 1, 5 and 10 years. Of the original sample of 850 patients, 767 (90%) were located 20 years later and 393 of these were interviewed. 273 (32%) patients died during the intervening period and 101 (12%) no longer wished to participate in the study. Drinking status was assigned based on the 12 months prior to the follow-up interview. Results: At the 20-year follow-up, 277 (32.6%) of the 393 patients for whom drinking status could be assigned were abstinent (defined never drinking or drinking on less than occasion per month and never more than four drinks/drinking occasion.), 29 (3.4%) were controlled drinkers and 87 (10.2%) were heavy drinkers. Controlled drinking was the least stable category, with 23% continuing from year 5 to year 10 in that category, and 10% continuing in that category from year 10 to year 20. Mortality was higher (39.1%) in those who had been categorized at year 5 as heavy drinkers compared to those who had been categorized as controlled drinkers or abstinent. Abstinent patients reported fewer alcohol-related problems and better psychosocial functioning than heavy drinkers. Women achieved higher abstinence rates (47.2% versus 29.0%, P = 0.005) and had lower mortality (22.4% versus 34.5%, P = 0.03) than men. Conclusions: Over the long-term, abstinence is the most frequent and stable drinking outcome achieved and is associated with fewer problems and better psychosocial functioning. Controlled drinking is rarely achieved and sustained. Women appear to do better than men in the long term.Funding for this study was provided by a grant from the Department of Health, Government of Catalonia, Spain

La actualización de los límites de bajo riesgo del alcohol: una oportunidad para mejorar la implementación de las estrategias de identificación precoz e intervención breve en España

Alcohol; Alfabetización; Prevención; Epidemiología; Políticas públicasAlcohol; Alfabetització; Prevenció; Epidemiologia; Polítiques públiquesAlcohol; Health literacy; Prevention; Epidemiology; Public policiesEste trabajo pone en contexto la reciente actualización para España de los límites de bajo riesgo del consumo de alcohol, que se sitúa en los 20 g/día en el caso de los hombres, y en 10 g/día en el caso de las mujeres. En este sentido, se resumen algunos datos sobre el impacto en la salud individual y los costos sociales del consumo alcohol. Así mismo, plantea los retos que se derivan en relación a la alfabetización en salud de la población y de los profesionales de la salud en cuanto a los riesgos del consumo de alcohol. El artículo también repasa las implicaciones de la nueva definición en cuanto a las políticas más rentables para disminuir los daños asociados al consumo de alcohol. Este repaso se hace desde una perspectiva de salud pública, haciendo especial hincapié en cómo aprovechar la oportunidad para promover mejor la implementación de las estrategias de identificación precoz e intervención breve en el consumo de alcohol en el ámbito de la atención primaria de salud en nuestro país.This work places in context Spain’s recent update of the defined limits for low risk alcohol consumption to 20g/day for men and 10g/day for women, and summarizes data on the impact on individual health and the social costs of alcohol consumption. Furthermore, it considers the challenges that arise related to awareness of the risks of alcohol consumption, in the general population and among health professionals. The paper also reviews the implications of the new definitions in relation to the most effective policies for reducing alcohol-related harm. It looks at this from a public health perspective with particular emphasis on how to seize the opportunity to better promote the implementation of strategies for early identification and brief interventions in primary care in this country

Atenció a les drogodependències a Catalunya els anys 2015 i 2016

Drogodependències; Abús de substàncies; NotificacióDrogodependencias; Abuso de sustancias; NotificaciónDrug addiction; Substance abuse; NotificationIntroducció: Es presenten els resultats principals de l’activitat del Sistema d’informació sobre drogodependències de Catalunya (SIDC) corresponents als anys 2015 i 2016. Material i mètodes: Les dades es van obtenir a partir de la notificació d’inici de tractament per abús i dependència de les drogues als centres d’atenció i seguiment de la Xarxa d’atenció a les drogodependències de Catalunya (XADC) i de l‘activitat d’altres serveis de la XADC. Resultats: Els anys 2015 i 2016 es van notificar a Catalunya 13.779 i 14.093 inicis de tractament ambulatori per trastorn per ús de substàncies (TUS), respectivament. Les substàncies causants dels tractaments més freqüents van ser alcohol (47,4% i 45,3%), cocaïna (17,9% i 20,3%), derivats del cànnabis (13,8% i 13,2%) i heroïna (12,2% i 11,1%). La mitjana d’edat dels casos notificats és de 40,9 i 41,1 anys, per als anys 2015 i 2016 respectivament, amb predomini dels homes (76,5% i 76,7%) sobre les dones (23,5% i 23,3%). El 37,7% i 31,5% de les persones que van iniciar el tractament per TUS el 2015 i 2016 eren persones a l’atur i el 10,5% i 10,3%, persones que no havien completat l’educació primària. Al llarg d’aquests dos anys van ingressar en unitats hospitalàries de desintoxicació 780 i 905 pacients els anys 2015 i 2016 respectivament, mentre que a finals de cada any hi havia 7.452 i 7.670 persones en programes de manteniment amb metadona. Pel que fa a les sales de consum supervisat, es van atendre més de 100.000 consums l’any 2015 i gairebé 110.000 l’any 2016, i es van repartir més de 745.000 xeringues l’any 2015 i 749.000 l’any 2016.Introducción: Se presentan los resultados principales de la actividad del Sistema de información sobre drogodependencias de Cataluña (SIDC) correspondientes a los años 2015 y 2016. Material y métodos: Los datos se obtuvieron principalmente a partir de la notificación de inicio de tratamiento por abuso y dependencia de las drogas en los centros de atención y seguimiento de la Red de atención a las drogodependencias de Cataluña (XADC) y de la actividad de otros servicios de la XADC. Resultados: Durante los años 2015 y 2016 se notificaron en Cataluña 13.779 y 14.093 inicios de tratamiento ambulatorio por trastorno por uso de sustancias (TUS), respectivamente. Las sustancias causantes de los tratamientos más frecuentes fueron el alcohol (47,4% i 45,3%), cocaína (17,9% i 20,3%), derivados del cannabis (13,8% i 13,2%) y heroína (12,2% i 11,1%). La media de edad de los casos notificados es de 40,9 i 41,1 años, para los años 2015 y 2016 respectivamente, con predominio de los hombres (76,5% i 76,7%) sobre las mujeres (23,5% i 23,3%). El 37,7% i 31,5% de las personas que iniciaron el tratamiento por TUS en el 2015 y 2016 eran persones en el paro y el 10,5% i 10,3%, personas que no habían completado la educación primaria. A lo largo de estos dos años ingresaron en unidades hospitalarias de desintoxicación 780 y 905 pacientes en los años 2015 y 2016 respectivamente, mientras que a finales de cada año había 7.452 y 7.670 personas en programas de mantenimiento con metadona. Con respecto a las salas de consumo supervisado, se atendieron más de 100.000 consumos el año 2015 y casi 110.000 el año 2016, y se repartieron más de 745.000 jeringas el año 2015 y 749.000 el año 2016.Background: The results of the activity of the Drug Addiction Information System (SIDC) for 2015 and 2016 are presented. Material and methods: Data were mainly obtained from the Catalan Drug Abuse Care Centre Network’s (XADC) abuse and drug treatment admissions. Outcomes: In 2015 and 2016, 13,779 and 14,093 outpatient treatment admissions were notified in Catalonia respectively for substance use disorders (SUD). Substances causing most frequent treatment admissions were alcohol (47.4% and 45.3%), cocaine (17.9% and 20.3%), cannabis derivatives (13.8% and 13.2%), and heroin (12.2% and 11.1%). The average age of reported cases was 40.9 and 41.1 years, for 2015 and 2016, respectively, with predominance of men (76.5% and 76.7%) over women (23.5% and 23.3%). A total of 37.7% and 31.5% of persons admitted to treatment were unemployed, and 10.5% and 10.3% corresponded to persons that had not completed primary education. Over these years, 780 and 905 patients were admitted in hospital detoxification units in 2015 and 2016, respectively, and 7,452 (at the end of 2015) and 7,670 (at the end of 2016) were in methadone maintenance programmes. Regarding drug consumption rooms, more than 100,000 consumptions in 2015 and almost 110,000 in 2016 were performed. Needle and Syringe programmes distributed 745,000 syringes in 2015 and 749,000 in 2016

Atenció a les drogodependències a Catalunya lʼany 2013

Epidemiologia; Tractament; Abús de substànciesEpidemiology; Treatment; Substance abuseEpidemiología; Tratamiento; Abuso de sustanciasIntroducció: Es presenten els resultats principals de lʼactivitat del Sistema dʼinformació sobre drogodependències (SID) de Catalunya corresponents a lʼany 2013. Material i mètodes: Les dades es van obtenir principalment a partir de la notificació dʼinici de tractament ambulatori per abús i dependència de les drogues a centres de la Xarxa dʼAtenció a les Drogodependències (XAD). Resultats: Lʼany 2013 es van notificar a Catalunya 12.922 inicis de tractament ambulatori per abús o dependència de les drogues, principalment alcohol (47,02%), cocaïna (22,13%), heroïna (13,17%) i derivats del cànnabis (12,01%). La mitjana dʼedat de dels casos notificats és de 40,09 anys, amb predomini dels homes (76,5%) sobre les dones (23,5%). Un percentatge elevat de persones estaven a lʼatur (47,6%) i un percentatge important de casos no van completar lʼeducació primària (11%). Els centres de la XAD, van declarar un total de 306.201 visites individuals, 43.452 assistències de pacients a grups terapèutics, 6.568 assistències a grups de discussió i suport per a familiars de drogodependents, 5.578 desintoxicacions ambulatòries i 114.122 determinacions analítiques de drogues en orina.Introduction: We present the results of the activity of Drug Addiction Information System (SID) of Catalonia for the year 2013. Material and methods. Data were mainly obtained from the notification of outpatient treatment admissions into the Catalan Network Care Drug Addiction (XAD). Results. In 2013, 12,922 treatment admissions were reported in Catalonia. Primary substances involved were alcohol (47.02%), cocaine (22.13%), cannabis derivatives (12. 01%) and heroin (13.17%). Cases reported in 2013 had an average age of 40.09 years, predominance of men (76.5%) versus women (23.5%), a high percentage of the unemployed (47.6%) and a significant percentage of cases having not completed primary education (11%). In 2013, drug treatment centres also notified 306,201 individual visits, 43,452 attendances to therapeutic groups, 6,568 attendances to family groups, 5,578 outpatient detoxifications and 134,835 drug urine analyses.Introducción. Se presentan los principales resultados de la actividad del Sistema de información sobre drogodependencias (SID) de Cataluña correspondientes al año 2013. Material y métodos. Los datos se obtuvieron principalmente a partir de la notificación de inicio de tratamiento ambulatorio por abuso y dependencia de las drogas en centros de la Red de Atención a las Drogodependencias (XAD). Resultados. En el año 2013 se notificaron en Cataluña 12.922 inicios de tratamiento ambulatorio por abuso o dependencia de las drogas, principalmente alcohol (47,02%), cocaína (22,13%), heroína (13,17%) y derivados del cannabis (12,01%). La edad media de los casos notificados es de 40,09 años, con predominio de los hombres (76,5%) sobre las mujeres (23,5%). Un elevado porcentaje de personas estaban en el paro (47,6%) y un importante porcentaje de casos no completaron la educación primaria (11%). Los centros de la XAD declararon un total de 306.201 visitas individuales, 43.452 asistencias de pacientes a grupos terapéuticos, 6.568 asistencias de familiares a grupos de discusión, 5.578 desintoxicaciones ambulatorias y 114.122 determinaciones de drogas en orina

Alcohol Consumption and Inpatient Health Service Utilization in a Cohort of Patients With Alcohol Dependence After 20 Years of Follow-up

Persones alcohòliques; Teràpia; Hospitalització; Estudis de cohortsPersonas alcohólicas; Terapia; Hospitalización; Estudio de cohorteAlcoholics; Therapy; Hospitalization; Cohort studyAims: To examine the association between drinking levels and inpatient health service utilization in people with a lifetime diagnosis of alcohol dependence. Methods: A longitudinal prospective study was conducted in a cohort of patients with alcohol dependence who had undergone treatment in 1987. Current results refer to the association between drinking patterns at 20-year follow-up and subsequent inpatient health service utilization. At 20 years after baseline, 530 of 850 patients were alive with administrative data available. Follow-up interview was conducted on 378 patients. There were 88 refusals and 64 could not be traced. Three categories of alcohol consumption were established (abstainers, moderate drinkers and heavy drinkers) depending on the pattern of alcohol use during the last year prior to the evaluation. Health service utilization was based on official statistics, including admissions to general, rehabilitation and psychiatric hospitals. The time period analysed was 5 years after the assessment of drinking patterns. Results: Admission rates were lowest for abstainers compared to people with moderate and heavy drinking. With respect to hospital days, heavy drinking was associated with significantly higher adjusted rates than both abstainers and moderate drinkers. Alcohol-related diagnoses in hospital admissions were more frequent for both moderate and heavy drinkers. Conclusion: Abstinence and moderate alcohol consumption were both associated with lower hospitalization in people with a lifetime diagnosis of alcohol dependence. Thus, not only abstinence-oriented treatment strategies but also those to reduce alcohol intake would reduce inpatient hospitalizations. Short Summary: Abstention and reduced drinking in lifetime alcohol-dependent patients were associated with lower health care utilization compared to heavy drinking. Alcohol treatment strategies for alcohol-dependent patients have a positive impact on the reduction in health care utilization. An increase in treatment rate for alcohol use disorders will consequently have marked population health improvements.This work has also received funding from the RD12/0028/0016 project, Plan Nacional de I+D+I and financed jointly with ISCII-Subdirección General de Evaluación y Fondo Europeo de Desarrollo Regional (FEDER)

Atenció a les drogodependències a Catalunya l'any 2014

Epidemiology; Treatment; Substance abuseEpidemiología; Tratamiento; Abuso de sustanciasEpidemiologia; Tractament; Abús de substànciesIntroducció. Es presenten els resultats principals de l’activitat del Sistema d’informació sobre drogodependències a Catalunya corresponents a l’any 2014. Material i mètodes. Les dades es van obtenir principalment a partir de la notificació d’inici de tractament per abús i dependència de les drogues als centres d’atenció i seguiment de les drogodependències de la Xarxa d’atenció a les drogodependències. Resultats. L’any 2014 es van notificar a Catalunya 13.958 inicis de tractament ambulatori per abús o dependència de les drogues, principalment alcohol (46,17%), cocaïna (18,68%), derivats del cànnabis (12,63%) i heroïna (12,29%). La mitjana d’edat dels casos notificats és de 40,85 anys, amb predomini dels homes (77,3%) sobre les dones (22,7%). Un percentatge elevat de persones estaven a l’atur (29,2%) i un percentatge important de casos no van completar l’educació primària (11,9%). Al llarg de l’any van ingressar en unitats hospitalàries de desintoxicació 1.034 pacients mentre que a finals d’any hi havia 8.062 persones en programes de tractament de manteniment amb metadona. Pel que fa a les sales de consum supervisat, es van atendre més de 97.000 consums i es van repartir més de 779.000 xeringues entre els usuaris. Continua baixant la infecció pel VIH entre aquest col·lectiu.Introducción. Se presentan los resultados principales de la actividad del Sistema de información sobre drogodependencias en Cataluña correspondientes al año 2014. Material y métodos. Los datos se obtuvieron principalmente a partir de la notificación de inicio de tratamiento por abuso y dependencia de las drogas en los centros de atención y seguimiento de las drogodependencias de la Red de atención a las drogodependencias. Resultados. El año 2014 se notificaron en Cataluña 13.958 inicios de tratamiento ambulatorio por abuso o dependencia de las drogas, principalmente alcohol (46,17%), cocaína (18,68%), derivados del cannabis (12,63%) y heroína (12,29%). La media de edad de los casos notificados es de 40,85 años, con predominio de los hombres (77,3%) sobre las mujeres (22,7%). Un elevado porcentaje de personas estaban en el paro (29,2%) y un importante porcentaje de casos que no completaron la educación primaria (11,9%). A lo largo del año ingresaron en unidades hospitalarias de desintoxicación 1.034 pacientes mientras que a finales de año había 8.062 personas en programas de tratamiento de mantenimiento con metadona. Con respecto a las salas de consumo supervisado, se atendieron más de 97.000 consumos y se repartieron más de 779.000 jeringas entre los usuarios. Sigue bajando la incidencia de la infección por el VIH entre este colectivo.Introduction. We present the results of the activity of Drug Addiction Information System (SID) for the year 2014. Material and methods. Data were mainly obtained from the notification of outpatient treatment admissions into the Catalan Network Care Drug Addiction (XAD). Results. In year 2014, 13,958 ambulatory treatment admissions were notified in Catalonia for abuse or dependence from the drugs, mainly alcohol (46.17%), cocaine (18.68%), derivatives of the cannabis (12.63%) and heroin (12.29%). Cases reported had an average of age of 40.85 years, with predominance of the men (77.3%) versus women (22.7%), a high percentage of persons of unemployment (29.2%) and a high percentage of cases that din’t complete the primary education (11.9%). Along the year, 1034 patient was admitted in detoxification unit and at the end of year there were 8062 people in Programs of Methadone Maintenance. Regarding the consumption rooms, these attended more than 97,000 consumptions, and give more than 779,000 syringes. Continuing bringing the data of SIDA down between this collective

Alcohol and older people: the European project VINTAGE: good health into older age; design, methods and major results

Consum d'alcohol; Persones grans; Disseny de recercaConsumo de alcohol; Personas mayores; Diseño de investigaciónAlcohol drinking; Aged; Research designObjectives: The European project VINTAGE – Good Health Into Older Age aims at filling the knowledge gap and building capacity on alcohol and the elderly, encouraging evidence- and experience-based interventions. Methods: Systematic review of scientific literature on the impact of alcohol on older people; ad hoc survey and review of grey literature to collect EU examples of good practices for prevention; dissemination of findings to stakeholders involved in the field of alcohol, aging or public health in general. Results: Design and procedures of the VINTAGE project are described, providing also an outline of major results, with particular attention to those related to the dissemination activity. Conclusions: Much more information and research is needed. This issue should be part of both alcohol and healthy ageing policies.The VINTAGE project “Good Health into Older Age” is a project funded by the Executive Agency for Health and Consumers, under the European Commission Second Programme of Community Action in the Field of Health 2008-2013 (Grant Agreement no. 20081203)

Implementing training and support, financial reimbursement, and referral to an internet-based brief advice program to improve the early identification of hazardous and harmful alcohol consumption in primary care (ODHIN): study protocol for a cluster randomized factorial trial

Alcohol; Intervencions breus; Sistema sanitariAlcohol; Intervenciones breves; Sistema sanitarioAlcohol; Brief interventions, Primary healthcareBackground: The European level of alcohol consumption, and the subsequent burden of disease, is high compared to the rest of the world. While screening and brief interventions in primary healthcare are cost-effective, in most countries they have hardly been implemented in routine primary healthcare. In this study, we aim to examine the effectiveness and efficiency of three implementation interventions that have been chosen to address key barriers for improvement: training and support to address lack of knowledge and motivation in healthcare providers; financial reimbursement to compensate the time investment; and internet-based counselling to reduce workload for primary care providers. Methods/design: In a cluster randomized factorial trial, data from Catalan, English, Netherlands, Polish, and Swedish primary healthcare units will be collected on screening and brief advice rates for hazardous and harmful alcohol consumption. The three implementation strategies will be provided separately and in combination in a total of seven intervention groups and compared with a treatment as usual control group. Screening and brief intervention activities will be measured at baseline, during 12 weeks and after six months. Process measures include health professionals’ role security and therapeutic commitment of the participating providers (SAAPPQ questionnaire). A total of 120 primary healthcare units will be included, equally distributed over the five countries. Both intention to treat and per protocol analyses are planned to determine intervention effectiveness, using random coefficient regression modelling. Discussion: Effective interventions to implement screening and brief interventions for hazardous alcohol use are urgently required. This international multi-centre trial will provide evidence to guide decision makers.The research leading to these results or outcomes has received funding from the European Community’s Seventh Framework Program (FP7/2007-2013), under Grant Agreement nº 259268 – Optimizing delivery of healthcare intervention (ODHIN). Radboud University Nijmegen Medical Centre received co-funding from The Netherlands Organisation for Health Research and Development (ZonMW, Prevention Program), under Grant Agreement nº 200310017