Cribado de problemas de alcohol e intervención breve en los servicios de urgencias: una oportunidad para la prevención
DOI:
https://doi.org/10.20882/adicciones.367Palabras clave:
alcohol, cribado, intervención breve, servicio de urgenciasResumen
Se ha comprobado una fuerte asociación entre consumo de alcohol y lesiones. Dos recientes estudios internacionales han analizado la implicación del alcohol en las lesiones, teniendo en cuenta variables contextuales. Los pacientes con alcoholemia positiva o que informaron haber consumido alcohol antes de la lesión tenían mayor probabilidad de ser admitidos en urgencias por lesiones que los pacientes no traumáticos, y las pautas perjudiciales de consumo predecían, a nivel individual, el riesgo relacionado con el alcohol y la probabilidad de atribuir la lesión al consumo de dicha sustancia. Los servicios de urgencias (SU) están en una posición privilegiada para identificar e intervenir sobre individuos con consumo de riesgo o que ya han desarrollado problemas relacionados con el alcohol, pues se encuentran en un “momento receptivo” tras el evento impactante. Se han analizado diferentes instrumentos de cribado para la identificación de los problemas de alcohol en los pacientes que acuden a urgencias. Se propone la utilización del cuestionario RAPS4-QF (Rapid Alcohol Problems Screen, 4 ítems + 2 preguntas de cantidad-frecuencia) por su óptimo rendimiento en el marco de los SU. Diversos estudios han puesto de manifiesto el buen resultado de la intervención breve entre estos pacientes, con una reducción del consumo no siempre significativa frente al grupo control, y una reducción significativa de los problemas relacionados con el alcohol (por ejemplo, nuevas lesiones e ingresos hospitalarios), comparada con el grupo control. Sin embargo, identificación precoz e intervención breve siguen siendo una asignatura pendiente en los SU de todo el mundo.Citas
Antti-Poika, I., Karaharju, E., Roine, R. & Salaspuro, M. (1988). Intervention of heavy drinking- a prospective and controlled study of 438 consecutive injured male patients. Alcohol Alcohol 23,115-121.
Babor, T., Caetano, R., Casswell, S., Edwards, G., Giesbrecht, N., Graham, K. et al. (2003). Alcohol: no ordinary commodity. Oxford University Press.
Bernstein, E., Bernstein, J. & Levenson, S. (1997). Project ASSERT: an ED based intervention to increase access to primary care, preventive services, and the substance abuse treatment system. Ann. Emerg Med, 30, 181-189.
Conigrave, K.M., Burns, F.H., Reznik ,R.B. & Saunders, J.B. (1991). Problem drinking in emergency department patients: the scope for early intervention. Med J Aust 15 , 801-805.
Chafetz, M.E., Blane, H.T., Abram, H.S., Golner, J., Lacey, E.,Mc Court, W:F. et al. (1962). Establishing treatment relations with alcoholics. J Nerv Ment Dis, 134, 395-409.
Cherpitel, C. J. (1993a). Alcohol and injuries: A review of international emergency room studies. Addiction, 88, 923-937.
Cherpitel, C. J. (1993b). Alcohol consumption among emergency room patients: Comparison of county/community hospitals and an HMO. Journal of Studies on Alcohol, 54, 432-440.
Cherpitel, C. J. (1995a). Alcohol and casualties: Comparison of county-wide emergency room data with the county general population. Addiction, 90(3), 343-350.
Cherpitel, C. J. (1995b). Screening for alcohol problems in the emergency department. Annals of Emergency Medicine, 26(2), 158-66.
Cherpitel, C. J. (1995c). Screening for alcohol problems in the emergency room: A rapid alcohol problems screen. Drug and Alcohol Dependence, 40, 133-137.
Cherpitel, C. J. (2002). Screening for alcohol problems in the U.S. general population: comparison of the CAGE, and RAPS4, and RAPS4-QF by gender, ethnicity, and services utilization. Alcoholism: Clinical & Experimental Research, 26(11), 1686-1691.
Cherpitel, C. J. (2005). The Rapid Alcohol Problems Screen: methods and application. In V. R. Preedy & R. R. Watson (Eds.), Comprehensive Handbook of Alcohol Related Pathology, (Vol. 3, Selective Methods Used in Alcohol Research, pp. 1415-1427). London, UK: Academic Press/Elsevier Science.
Cherpitel, C. J. & Bazargan, S. (2003). Screening for alcohol problems: comparison of the AUDIT, RAPS4, and RAPS4-QF among African American and Hispanic patients in an inner city emergency department. Drug & Alcohol Dependence, 71, 275-280.
Cherpitel, C. J., Bond, J., Ye, Y., Borges, G., Macdonald, S. & Giesbrecht, N. A. (2003). A cross-national meta-analysis of alcohol and injury: data from the Emergency Room Collaborative Alcohol Analysis Project (ERCAAP). Addiction, 98, 1277-1286.
Cherpitel, C. J., Bond, J., Ye, Y., Borges, G., Macdonald, S., Stockwell, T., et al. (2003). Alcohol-related injury in the ER: a cross-national meta-analysis from the Emergency Room Collaborative Alcohol Analysis Project (ERCAAP). Journal of Studies on Alcohol, 64,
-649.
Cherpitel, C. J., Bond, J., Ye, Y., Room, R., Poznyak, V., Rehm, J., et al. (in press). Clinical assessment compared to breathalyzer readings in the ER: concordance of ICD-10 Y90 and Y91 codes. A research report from the WHO Collaborative Study on Alcohol
and Injuries. Emergency Medicine Journal.
Cherpitel, C. J., Ye, Y. & Bond, J. (2004). Alcohol and injury: multi-level analysis from the Emergency Room Collaborative Alcohol Analysis Project (ERCA AP). Alcohol and Alcoholism, 39(6), 552-558.
Cherpitel, C. J., Ye, Y., Bond, J. & Borges, G. (2003). The causal attribution of injury to alcohol consumption: a cross-national meta-analysis from the Emergency Room Collaborative Alcohol Analysis Project. Alcoholism: Clinical & Experimental Research, 27(11), 1805-1812.
Crawford, M.J., Patton, R., Touquet, R., Drummond, C., Byford, S., Barett, B. et al (2004). Screening and referral for brief intervention of alcohol-misusing patients in an emergency department: a pragmatic randomised controlled trial. Lancet, 364, 1334-1339.
Dill, P.L., Wells-Parker, E. & Soderstrom, C.A. (2004). The emergency care setting for screening and intervention for alcohol use problems among injured and high-risk drivers: a review. Traffic Inj Prev, 5: 278-291.
Dinh-Zarr, T., Goss, C., Heitman, E., Roberts, I.. & Di Guiseppi, C. (2004). Interventions for preventing injuries in problem drinkers. Cochrane Database Syst Rev. 2004, (3):CD001857.
Ewing, J.A. (1984). Detecting alcoholism: CAGE questionnaire. JAMA 252,1905-1907.
Forsberg, L., Ekman, S., Halldin, J. & Ronnberg, S. (2000) Brief intervention for risk consumption at an emergency surgical ward. Addict Behav 25 (3), 471-475.
Gentilello, L.M., Rivara, F.P., Donovan, D.M., Jurkovich, G.J., Daranciang, E., Dunn, C.H., Villaveces, A., Copass, M. & Ries, R.R. (1999) Alcohol Interventions in a trauma center as a means of reducing the risk of injury recurrence. Annals of Surgery, 230, 473-483.
Hungerford, D.W., Pollock, D.A. & Todd, K.H. (2000). Acceptability of emergency department-based screening and brief intervention for alcohol problems. Academic Emergency Medicine, 7 (12),1383-1392.
Longabaugh, R., Minugh, P.A., Nirenberg, T.D., Clifford, P.R., Becker,.B. & Woolard, R. (1995). Injury as a motivator to reduce drinking. Academic Emergency Medicine, 2, 817-2,825.
Longabaugh, R., Woolard, R.F., Nirenberg, T.D., Minugh, A.P., Becker, B., Clifford, P.R. et al. (2001). Evaluating the effects of a brief motivational intervention for injured drinkers in the emergency department. Journal of Studies on Alcohol, 62, 806-816.
Miller, W.R. & Rollnick, S. (1991). Motivational Interviewing: Preparing People to Change Addictive Behavior. New York: Guilford, 1991.
Monti P.M.,Colby, S.M., Barnett, N.P., Spirito, A., Rohsenow, D.J., Myers, M. et al. (1999). Brief intervention for harm reduction with alcohol-positive older adolescents in a hospital emergency department. Journal of Consulting and Clinical Psychology, 67, 989- 994.
Patton, R., Crawford, M. & Touquet, R (2004). Hazardous drinkers in the accident and emergency department - Who accepts advice? Emergency Medicine Journal, 21, 491-192.
Prochaska, J. & DiClemente, C. (1986). Towards a comprehensive model of change. In Miller, W.R. & Heather, N. (eds). Treating Addictive Behaviors: Processes of Change. New York: Plenum.
Rehm, J., Monteiro, M., Room, R., Gmel, G., Jernigan, D., Frick, U., et al. (2001). Steps towards constructing a global comparative risk analysis for alcohol consumption: determining indicators and empirical weights for patterns of drinking, deciding about theoretical minimum, and dealing with different consequences. European Addiction Research, 7(3), 138-147.
Rehm, J., Rehn, N., Room, R., Monteiro, M., Gmel, G., Jernigan, D. H., et al. (2003). The global distribution of average volume of alcohol consumption and patterns of drinking. European Addiction Research, 9(4), 147-156.
Rodríguez- Martos, A., Santamariña, E., Torralba, L., Escayola, M., Martí, J. & Plasencia, A. (2003) Identificación precoz e intervención breve en lesionados de tráfico con presencia de alcohol: resultados preliminares. Adicciones 15, 191-202.
Rodríguez-Martos, A., Santamariña, E., Torralba, L., Escayola, M., Martí, J. & Plasencia, A. (2005 a). Efectividad a corto plazo de las intervenciones breves sobre lesionados de tráfico con alcoholemia positiva. Gaceta Sanitaria, 19, 45-49.
Rodríguez-Martos, A., Santamariña, E., Escayola, M., Martí, J., Plasencia, A. & Torralba, L.(2005b). ¿Qué puede aportar una intervención breve en lesionados de tráfico con alcohol positivo? Ponencia presentada en las XXXII Jornadas Nacionales de Socidrogalcohol. (Resumen) Adicciones,17 (supl. 1), 47-48.
Rodríguez-Martos, A., Torralba, L., Escayola, M. & Plasència, A.(2005 c) Viabilidad de la identificación e intervención sobre lesionados de tráfico admitidos en urgencias con alcoholemia positiva: ¿una utopía? Emergencias, 17, 3-9.
Runge, J., Garrison, H., Hall, W., Walter, A., and Shen G. (2002) Identification and referral of impaired drivers through emergency department protocols, NHTSA. DOT HS 809 412, National Highway Traffic Safety Administration; Washington, DC.
Saunders, J.B., Aasland, O.G., Babor, T.F., De La Fuente, J.R. & Grant, M. (1983). Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO Collaborative Project on Early Detection of Persons with Harmful Alcohol consumption -- II Addiction, 88, 791-804.
Smith, J., Hodgson, R.J., Bridgeman, K. & Shepherd, J.P. (2003). A randomized controlled trial of a brief intervention after alcohol-related facial injury Addiction 98, 43-52.
Soderstrom, C. A., Dailey, J. T. & Kerns, T. J. (1994). Alcohol and other drugs: An assessment of testing and clinical practices in U.S. trauma centers. Journal of Trauma, 36, 68-73.
Sommers, M.S., Dyehouse, J.M. & Howe, S.R. (2001). Binge drinking, sensible drinking and abstinence after alcohol-related vehicular crashes: the role of intervention versus screening. Annual Proceedings, Association for the Advancement of Automotive
Medicine, 45:317-328.
Sommers, M.S., Dyehouse, J.M., Howe, S.R., Fleming, M.F., Fargo J.D. & Schafer, J.S. (under revision) Effectiveness of brief interventions following an alcohol-related motor vehicle crash: A randomized
controlled trial with injured patients. Journal of Trauma.
Spirito, A., Monti, P.M., Barnett, N.P., Colby, S.M., Sindelar H., Rohsenow D.J. et al. (2004). A randomised clinical trial of a brief intervention for alcohol-positive adolescents treated in an emergency department. The Journal of Pediatrics, 145, 396-402.
Patton, R., Crawford, M. & Toquet, R. (2004). Hazardous drinkers in the accident and emergency department – Who accepts advice? Emergency Medicine, 21, 491- 492.
Waller, J.A. (1990). Management issues for trauma patients with alcohol. Journal of Trauma, 30: 1548-1553.
Watson, H.E. (1999). A study of minimal interventions for problem drinkers in acute care setting. International Journal of Nursing Studies, 36 (5): 425-434.
Williams, S., Brown, A., Patton, R., Crawford, M.J. & Touquet, R. (2005). The half-life of the “teachable moment” for alcohol misusing patients in the emergency department. Drug & Alcohol Dependence
, 205-208.
Wright, S., Moran, L., Meyrick, M., O’Connor, R. & Touquet, R. (1998). Intervention by an alcohol health worker in an accident and emergency department. Alcohol & Alcoholism 1998; 33: 651-6.