Intervención psicológica en mujeres drogodependientes: una revisión teórica

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Abstract

El consumo de drogas sigue siendo en la actualidad uno de los problemas de salud que más preocupa a la sociedad. Según los datos epidemiológicos estatales más recientes, las mujeres cada vez consumen más. Sin embargo, en cuanto a la asistencia a tratamiento no es tanta la incidencia y cuando asisten hay una dificultad de adherencia al tratamiento y el abandono del mismo suele ser frecuente. Es tal la importancia de cubrir las necesidades particulares de las mujeres drogodependientes, que queda recogido como elemento integral en el último Plan de Acción sobre Drogas español 2013-2016 (Plan Nacional Sobre Drogas, 2013a). En este sentido, a nivel empírico, se han iniciado algunos trabajos de investigación para tratar de indagar las posibles diferencias que puedan presentar hombres y mujeres en el tratamiento de las drogodependencias, así como de proponer algunos para tratamientos específicos para mujeres. El objetivo de este trabajo de revisión teórico es analizar los elementos que caracterizan a las mujeres drogodependientes, establecer qué aspectos hay que tener en cuenta en la intervención con ellas a partir de las investigaciones que se han realizado o se están estudiando y proponer su aplicación a nivel práctico, además de señalar futuras direcciones de investigación.

Translated abstract

Drug use remains today one of the health problems of greatest concern to society. According to the most recent state epidemiological data, women's consumption continuously increases, becoming more and more similar to that of men. However, this same trend does not occur in terms of access to treatment, and when women seek treatment, there is a marked difficulty in adherence to treatment as abandoning it is often the case. Such is the importance of meeting the specific needs of substance-abusing women, that it is even highlighted as a priority and an integral element of the latest Action Plan on Drugs 2013-2016 (Plan Nacional Sobre Drogas, 2013a). In this sense, at the empirical level, researchers have started to study the possible differences men and women may present in drug treatment, as well as the development of a gender-specific treatment. The aim of this theoretical review paper is to analyze the elements that characterize drug dependent women, establishing what aspects should be taken into account in the intervention with women from previous research or from on-going research, suggesting its implementation and future research directions.

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Most cited references 132

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Shelly F Greenfield, Audrey Brooks, Susan M. Gordon … (2007)

This paper reviews the literature examining characteristics associated with treatment outcome in women with substance use disorders. A search of the English language literature from 1975 to 2005 using Medline and PsycInfo databases found 280 relevant articles. Ninety percent of the studies investigating gender differences in substance abuse treatment outcomes were published since 1990, and of those, over 40% were published since the year 2000. Only 11.8% of these studies were randomized clinical trials. A convergence of evidence suggests that women with substance use disorders are less likely, over the lifetime, to enter treatment compared to their male counterparts. Once in treatment, however, gender is not a significant predictor of treatment retention, completion, or outcome. Gender-specific predictors of outcome do exist, however, and individual characteristics and treatment approaches can differentially affect outcomes by gender. While women-only treatment is not necessarily more effective than mixed-gender treatment, some greater effectiveness has been demonstrated by treatments that address problems more common to substance-abusing women or that are designed for specific subgroups of this population. There is a need to develop and test effective treatments for specific subgroups such as older women with substance use disorders, as well as those with co-occurring substance use and psychiatric disorders such as eating disorders. Future research on effectiveness and cost-effectiveness of gender-specific versus standard treatments, as well as identification of the characteristics of women and men who can benefit from mixed-gender versus single-gender treatments, would advance the field.

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Karen Cohen, G Miele, L Litt … (2004)

The authors' goal was to compare the efficacy of a manualized cognitive behavior therapy that addresses both posttraumatic stress disorder (PTSD) and substance abuse (seeking safety) with a manualized cognitive behavior therapy that addresses only substance abuse (relapse prevention) and with standard community care for the treatment of comorbid posttraumatic stress disorder (PTSD) and substance use disorder. One hundred seven women from an urban, low-income population who had comorbid PTSD and substance use disorder were randomly assigned to receive the two kinds of cognitive behavior therapy or received standard community treatment. Participants were recruited from both community and clinical populations and evaluated with structured clinical instruments. Forty-one women received seeking safety therapy, 34 received relapse prevention therapy, and 32 received standard community care. At the end of 3 months of treatment, participants in both cognitive behavior therapy conditions had significant reductions in substance use, PTSD, and psychiatric symptoms, but community care participants worsened over time. Both groups receiving cognitive behavior therapy sustained greater improvement in substance use and PTSD symptoms at 6-month and 9-month follow-ups than subjects in the community care group. Seeking safety and relapse prevention are efficacious short-term treatments for low-income urban women with PTSD, substance use disorder, and other psychiatric symptoms.