Cómo mejorar las tasas de retención en los tratamientos de drogodependencias

Autores/as

  • R. Secades Villa Profesores Titulares del Departamento de Psicología. Universidad de Oviedo.
  • J. R. Fernández Hermida Profesores Titulares del Departamento de Psicología. Universidad de Oviedo.

DOI:

https://doi.org/10.20882/adicciones.646

Palabras clave:

abandono, retención, estrategias de intervención

Resumen

La alta tasa de abandonos de los programas de tratamiento es uno de los problemas más graves en el ámbito de las drogodependencias. En la mayoría de las ocasiones, el abandono de un paciente significa la recaída en el consumo de drogas y el empeoramiento de otras áreas del estilo de vida de éste. En este artículo se revisan las tasas de abandono, los factores relacionados con la retención y, sobre todo, las estrategias de intervención para incrementar los niveles de retención en los programas de tratamiento. Se proponen tres tipos de estrategias: las relacionadas con los pacientes, con los parámetros del tratamiento y las que tienen que ver con los terapeutas. Los estudios empíricos han demostrado que estos procedimientos pueden ser muy eficaces a la hora de reducir las tasas de abandono y, por tanto, de mejorar los resultados de la intervención independientemente de la modalidad del programa.

Citas

Addenbrooke, W.M. y Rathod, N.H. (1990). Relationship between waiting time and retention in treatment amongst substance abusers. Drug and Alcohol Depende, 26, 255-264.

Aron, W.S. y Daily, D.W. (1976). Graduates and splitees from therapeutic community drug teratment programs: A comparison. International Journal of the Addictions, 11, 1-18.

Aszalos, R., McDuff, D.R., Weintraub, E., Montoya, I. y Schwartz, R. (1999). Engaging hospitalized heroin-dependent patients into substance abuse treatment. Journal of Substance Abuse Treatment, 17, 149-158.

Baekeland, F. y Lundwall, L. (1975). Dropping out of treatment: A critical review. Psychological Bulletin, 5, 738-783.

Berger, H. y Smith, M.J. (1978). Voluntary versus prescribed termination of methadone maintenance. British Journal of Addiction, 73, 178-180.

Bien, T.H., Miller, W.R. y Tonigan, J.S. (1993). Brief interventions for alcohol problems: A review. Addiction, 88, 305-325.

Brooner, R.K., Kidorf, M., King, V.L. y Bigelow, G.E. (1997). Using behaviorally contingent pharmacotherapy in opioid abusers enhances treatment outcome. En L.S. Harris (Ed.), Problems of drug dependence 1996 (NIDA Research Monograph, 174). Washington, DC: US Deparment of Health and Human Services.

Carroll, K.M. (1997). Enhancing retention in clinical trials of psychosocial treatments: Practical strategies. En L.S. Onken, J.D. Blaine, y J.J. Boren (Eds.), Beyond therapeutic alliance: Keeping the drug-dependent individual in treament (NIDA Research Monograph, nº 165. Rockville, MD: US Department of Health and Human Services.

Carroll, K.M., Nich, C., Ball, S.A., McCance, E. y Rounsavile, B.J. (1998). Treatment of cocaine and alcohol dependence with psychotherapy and disulfiram. Addiction, 93, 713-727.

Conner, K.R., Shea, R.R., McDermott, M.P., Grolling, R., Tocco, R.V. y Baciewicz, G. (1998). The role of multifamily therapy in promoting retention in treatment of alcohol and cocaine dependence. American Journal of Adicctions, 7, 61-73.

Craig, R.J. (1985). Reducing the treatment drop out rate in drug abuse programs. Journal of Substance Abuse Treatment, 2, 209-219.

Craig, R.J. y Olson, R.E. (1988). Differences in psychological need hierarchy between program completers and dropouts from a drug abuse treatment program. American Journal of Drug and Alcohol Abuse, 1, 89-96.

De Leon, G. (1991). Retention in drug-free therapeutic communities. En R.W. Pickens, C.G. Leukefeld y C.R. Schuster (Eds.), Improving drug abuse treatment. NIDA Research Monograph Series, nº 106. Rockville, MD: US Department of Health and Human Services.

De Leon, G. y Jainchill, N. (1986). Circumstances, motivation, readiness and suitability (CMRS) as correlates of treatment tenure. Journal of Psychoactive Drugs, 8, 203-208.

De Leon, G., Melnick, G. y Kressel, D. (1997). Motivation and readiness for therapeutic community treatment among cocaine and other drug abusers. American Journal of Drug and Alcohol Abuse, 23, 169-189.

De Leon, G., Melnick, G., Kressel, D. y Jainchill, N. (1994). Circumstances, motivation, readiness, and suitability (the CMRS) scales: Predicting retention in therapeutic community treatment. American Journal of Drug and Alcohol Abuse, 20, 495-515.

De Leon, G. y Schwartz, S. (1984). Therapeutic Communities: What are the retention rates. American Journal of Drug Abuse, 10, 267-284.

Del Rio, M., Mino, A. y Perneger, T.V. (1997). Predictors of patient retention in a newly established methadone maintenance treatment programme. Addiction, 92, 1353-1360.

Des Jarlais, D.C., Joseph, H. y Schmeidler, J. (1983). Predicting postreatment narcotic use among patients termination from methadone maintenance. Harwoth Press.

D´Ippoliti, D., Davoli, M., Perucci, C.A., Pasqualini, F. y Bargagli, A.M. (1998). Retention in treatment of heroin users in Italy: The role of treatment type and of methadone maintenance dosage. Drug and Alcohol Dependence, 52, 167-171.

Erickson, J.R., Stevens, S., McKnight, P. y Figueredo, A.J. (1995). Willingness for treatment as a predictor of retention and outcomes. Journal of Addictive Diseases, 14, 135-150.

Festinger, D.S., Lamb, R.J., Kountz, M.R., Kirby, K.C. y Marlowe, D. (1995). Pretreatment dropout as a function of treatment delay and client variables. Addictive Behaviors, 20, 111-115.

Garfield, S.L. (1994). Research on client variables in psychotherapy. En A.E. Bergin y S.L. Garfield (Ed.), Handbook of psychotherapy and behavior change. New York: John Wiley & Sons.

González-Saiz, F., De Leon, G., Macías, C.G., Lillo, P., Varela, L., Castro, E., Gómez, E., Ruiz, N., Montañés, M. y Salvador-Carulla, L. (1998). La motivación y las actitudes ante el tratamiento como predictores de abandono precoz en Comunidad Terapéutica: datos preliminares de la adaptación de la escala CMRS. V Encuentro Nacional sobre drogodependencias y su Enfoque Comunitario. Cádiz.

Gossop, M. (1978). Drug dependence: A study of the relationship between motivational, cognitive, social and historical factors, and treatment variables. The Journal of Nervous and Mental Disease, 166, 44-50.

Gutiérrez, M., Ballesteros, J., González-Oliveros, R. y Ruiz de Apodaka, J. (1995). Tasa de retención en dos programas de naltrexona para heroinodependientes en Vitoria, España. Revista de Psiquiatría de la Facultad de Medicina de Barcelona, 22, 215-225.

Higgins, S.T., Budney, A.J., Bickel, W.K. y Badger, G.J. (1994a). Participation of significant others in outpatient behavioral treatment predicts greater cocaine abstinence. American Journal of Drug and Alcohol Abuse, 20, 47-56.

Higgins, S.T., Budney, A.J., Bickel, W.K., Foerg, F.E., Donham, R. y Badger, G.J. (1994b). Incentives improve outcome in outpatient behavioral treatment of cocaine dependence. Archives of General Psychiatry, 51, 568-576.

Higgins, S.T., Budney, A.J., Bickel, W.K., Hughes, J.R., Foerg, F. y Badger, G. (1993). Achieving cocaine abstinence with a behavioral approach. American Journal of Psychiatry, 150, 763-769.

Higgins, S.T., Delaney, D.D., Budney, A.J., Bickel, W.K., Hughes, J.R., Foerg, F. y Fenwick, J.W. (1991). A behavioral approach to achieving cocaine abstinence. American Journal of Psychiatry, 148, 1218-1224.

Howell, E.M., Heiser, N. y Harrington, M. (1999). A review of recent findings on substance abuse treatment for pregnant women. Journal of Substance Abuse Treatment, 16, 195-219.

Hubbard, R.L., Rachal, J.V., Craddok, S.G.Y. y Cavanaugh, E.R. (1984). Treatment outcome prospective Study (TOPS): Client characteristics and behaviors before, during and after treatment . En J.F. Tims y J.P. Ludorf (Eds.), Drug abuse treatment evaluation: strategies progress and prospects. Maryland: NIDA.

Hughes, P.H., Coletti, S.D., Neri, R.L., Urmann, C.F., Stahl, S., Sicilian, D.M. y Anthony, J.C. (1995). Retaining cocaineabusing women in a therapeutic community: The effect of a child live-in program. American Journal of Public Health, 85, 1149-1152.

Joe, G.W., Simpson, D.D. y Broome, K.M. (1998). Effects of readiness for drug abuse treatment on client retention and assessment of process. Addiction, 93, 1177-90.

Kooyman, M. (1993/1996). La Comunidad Terapéutica para Drogodependientes. Bilbao. Mensajero. Lang, J.M. (1990). The use of a run-in to enhance compliance. Statistics in Medicine, 9, 87-95.

Machado, M.J. y Girón, S. (1993). Perfil psicosocial y retención de heroinómanos en tratamiento ambulatorio. Adicciones, 2, 109-125.

MacNair, R.R. y Corazzini, J.G. (1994). Client factors influencing group therapy dropouts. Psychotherapy, 31, 352-362.

McCaul, M.E. y Svikis, D.S. (1991). Improving client compliance in outpatient treatment: counselor-targeted interventions. En R.W. Pickens, C.G. Leukefeld y C.R. Schuster (Eds.), Improving drug abuse treatment. NIDA Research Monograph Series, nº 106. Rockville, MD: US Department of Health and Human Services.

Melnick, G., De Leon, G., Hawke, J., Jainchill, N. y Kressel, D. (1997). American Journal of Drug and Alcohol Abuse, 23, 485-506.

Miller, R.R. y Rollnick, S. (1991). Motivational Interviewing. Preparing people to change addictive behavior. New York: The Guilford Press.

Ochoa, E., Arias, F., Somoza, J.C., Vicente, N. Y Jordá, L. (1992). Retención en un programa de tratamiento con naltrexona: dos años de seguimiento. Adicciones, 4, 207-212.

O’Malley , J.E., Anderson, W.H. y Lazare, A. (1972). Failure of outpatient treatment of drug abuse: I. Heroin. American Journal of Psychiatry, 128, 865-868.

Preston K.L., Silverman K., Umbricht A., De Jesus A., Montoya I.D. y Schuster, C.R. (1999). Improvement in naltrexone treatment compliance with contingency management. Drug and Alcohol Dependence, 54, 127-135.

Prochaska, J.O. y DiClemente, C.C. (1986). Toward a comprehensive model of change. En W.R. Miller y N. Heather (Eds.), Treating addictive behaviors: Processes of change. New York: Plenum Press.

Prochaska, J.O., DiClemente, C.C. y Norcross J.C. (1992). In search of how people change. Applications to addictive behaviors. American Psychologist, 47, 1102-1114.

Sánchez-Carbonell, J., Camí, J. y Brigos, B. (1988). Follow-up of heroin addicts in Spain (EMETYST project): Results 1 year after treatment admision. British Journal of addiction, 83, 1439-1449.

Sánchez, L. y Matellanes, M. (1993). La especialización de los recursos para la atención de las drogodependencias. Adicciones, 2, 127-140.

Saunders, B., Wilkinson, C. y Allsop, S. (1991). Motivational intervention with heroin users attending a methadone clinic. En W.R. Miller y S. Rollnick (Eds.), Motivational Interviewing: Preparing People to Change Addictive Behavior. New York: Guilford.

Secades Villa, R., Fernández Rodríguez, R. y Fernández Hermida, J.R. (1998). Factores asociados a la retención de heroinómanos en un programa libre de drogas. Adicciones, 10, 53-58.

Secades Villa, R. y Menéndez Cuartas, A. (1997). Factores que determinan la retención de heroinómanos en un centro de día. Revista Española de Drogodependencias, 22, 5-12.

Simpson, D.D. (1984). National treatment system evaluation based on the Drug Abuse Reporting Program (DARP) followup research. En F.M. Tims y J.P. Ludford (Eds.), Drug abuse treatment evaluation: Strategies, progress, and prospects.

NIDA Research Monograph, nº 51. Washington, DC:US Deparment of Health and Human Services. Simpson, D.D., Joe, G.W. y Rowan-Szal, G.A. (1997). Drug abuse treatment retention and process effects on follow-up outcomes. Drug and Alcohol Dependence, 47, 227-235.

Sirotnik, K.A. y Roffe, M.W. (1978). An investigation of the feasibility of predicting outcome indices in the treatment of heroin addiction. International Journal of the Addictions, 12, 755-775.

Sisson, R.W. y Azrin, N.H. (1993). Family-member involvement to initiate and promote treatment of problema drinkers. Journal of Behabior Therapy and Experimental Research, 17, 15-21.

Solomon, J., Zimberg, S. y Shollar, E. (1993/1996). Diagnóstico dual. Barcelona: Ediciones en Neurociencias.

Sorenson, J.L., Gibson, D., Bernal, G. y Deitch, D. (1985). Methadone applicant dropouts: Impact of requiring involvement of friends and family in treatment. International Journal of the Addictions, 20, 1273-1280.

Stanton, M.D., Steier, F., Cook, L. y Tood, T.D. (1984). Narcotic detoxification in a family and home contest: Final report-1980-1983. Rockville, MD: National Institute on Drug Abuse.

Stark, M.J. (1992). Dropping out of substance abuse treatment: A clinically oriented review. Clinical Psychology Review, 12, 93-116.

Stark, M.J., Campbell, B.K. y Brinkerhoff, C.V. (1990). “Hello, May we help you?” A study of attrition prevention at the time of the first phone contact with substance-abusing clients. American Journal of Drug and Alcohol Abuse, 16, 67-76.

Swett, C. y Noones, J. (1989). Factors associated with premature termination from outpatients treatment. Hospital and Community Psychiatry, 40, 947-951.

Szuster, R.R., Rich, L.L., Chung, A. y Bisconer, S.W. (1996). Treatment retention in women´s residential chemical dependency treatment: The effect of admission with children. Substance Use and Misused, 31, 1001-1013.

Tucker, J.A., Vuchinich, R.E. y Harris, C.V. (1985). Determinants of substance abuse relapse. En M. Galizio y S.A. Maisto (Eds.), Determinants of substance abuse: Biological, psychological and environmental factors. New York: Plenum Press.

Vaillant,G.E. (1966). A 12-year follow-up of New York narcotic addicts III. Archives of General Psychiatry, 15, 599-609.

Wells, E.A., Peterson, P.L. y Gaine, R.R. (1994). Outpatient treatment for cocaine abuse: A controlled comparison of relapse prevention and twelve-step approaches. American Journal of Drug and Alcohol Abuse, 20, 1-17.

Wexler, H.K. y De Leon, G. (1977). The Therapeutic Community: Multivariate Prediction of Retention. American Journal of Drug and Alcohol Abuse, 4, 145-151.

Wierzbicki, M. y Pekarik, G.A. (1993). A meta-analysis of psychotherapy dropout. Professional Psychology, Research and Practice, 24, 190-195.

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2000-09-15

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