Efectividad de las técnicas de consejo breve
DOI:
https://doi.org/10.20882/adicciones.532Palabras clave:
intervención breve, eficacia, efectividad, eficiencia, validezResumen
En los últimos 20 años se ha investigado extensamente la eficacia de las intervenciones breves, denominación que designa una serie de intervenciones marginales con respecto a los programas terapéuticos tradicionales y que se caracterizan por su brevedad y concisión. Más de 40 estudios y diversos metaanálisis avalan la eficacia de estas intervenciones, cuya rentabilidad superaría a cualquier otra intervención en el medio inespecífico. Aunque su efectividad (resultados en condiciones naturales) y generalización no son tan evidentes como su eficacia en condiciones experimentales, su potencial repercusión sobre la Salud Pública hace que profesionales y autoridades sanitarias se esfuercen en su difusión y promoción. Pero, ¿nos hallamos ante una panacea? La diversidad de intervenciones agrupadas bajo el común denominador de intervenciones breves y la disparidad de estudios, a menudo difícilmente comparables, obligan a una revisión crítica que cuestione también su validez. Se concluye que la intervención breve es en conjunto eficaz, efectiva y eficiente, sobre todo en Atención Primaria de Salud, aunque no todas las intervenciones son igualmente eficaces. La ampliación del espectro terapéutico, aplicando intervenciones más sencillas a los bebedores de riesgo, no debería hacerse en detrimento de recursos específicos más complejos para los alcohol-dependientes. Por lo que respecta a la intervención breve propiamente dicha, debe seguirse investigando su aplicación óptima: qué ingredientes, duración y extensión, en qué medio, a cargo de qué profesional, para qué paciente.Citas
(1) * Miller WR, Brown J, Simpson TL, Handmaker NS, Bien TH, Luckie LF, Montgomery HA, Hester RK, Tonigan JS: What works? A methodological analysis of the alcohol treatment outcome literature. En Hester RK & Miller WR (eds.): Handbook of Alcoholism Treatment Approaches: Effective Alternatives. Massachusetts: Allyn & Bacon, 1995 (pp.: 12-44)
(2)** Bien, Th.; Miller, W.R.; Tonigan, J.S.: Brief interventions for alcohol problems: a review. Addiction 1993; 88: 315-336.
(3)* Wilk AI; Jensen NM; Havighurst TC: Metaanalysis of randomized control trials assessing brief interventions in heavy alcohol drinkers. J Gen Int Med 1997; 12: 274-283.
(4)** Kahan M, Wilson L, Becker L: Effectiveness of physician-based interventions with problem drinkers: a review. Can Med Assoc J 1995; 152:851-859.
(5)* Poikolainen K. Effectiveness of brief interventions to reduce alcohol intake in primary health care populations: A meta-analysis. Preventive Medicine 1999; 28: 503-509.
(6) Orford J, Edwards G: Alcoholism: A comparison of treatment and advice, with a study of the influence of marriage. Maudsley Monographs nº 26. Oxford: Oxford Univss, 1977.
(7)** Heather N: Brief Intervention Strategies. En Hester RK & Miller WR (eds.): Handbook of Alcoholism Treatment Approaches. Effective Alternatives. Boston, London Allyn & Bacon, 1995 (pp.: 105 –122).
(8)** Wallace P, Cutler S, Haines A.: Randomised controlled trial of general practitioner intervention in patients with excessive alcohol consumption. Br Med J 1988; 297:663-668.
(9) Scott, E.; Anderson, P.: Randomized controlled trial of general practitioner intervention in women with excessive alcohol consumption. Drug and Alcohol Review 1991; 10: 313-321.
(10) Anderson, P.; Scott, E.: The effect of general practitioner’s advice to heavy drinking men. Br. J. Add 1992; 87: 891-900.
(11) Fleming MF, Barry KL,Manwill LB, et al: Brief physician advice for problem drinkers: A randomized controlled trail in community based primary care practices. JAMA 1997;25:52-71
(12) Kristensson H, Ohlin H, Hulten-Nosslin MB, Trell E, Hood B. Identification and intervention in heavy drinking in middle-aged men: results and follow-up of 24-60 month of long-term
study with randomized controls. Alcoholism: Clin and Exp Res; 1983, 7: 203-209.
(13) Romesljö A, Andersson L, Barrner H, Borg S, Granstrand C, et al.: Randomized study of secondary prevention of early stage problem drinkers in primary health care. Br J Add 1989;
: 1319-1327.
(14) Nilssen O: The Tromso study: identification of a controlled intervention on a population of earlystage risk drinkers. Prev Med 1991; 20: 518-528.
(15) D’Onofrio G, Bernstein E, Bernstein J, Woolard R, Brewer Ph A, Craig SA et al.: Patients with alcohol problems in the emergency department, part 2: Intervention and referral. Academic Emerg Med 1998; 5: 1210-1217.
(16) DiClemente, CC. “Motivational interviewing and the stages of change”. En Miller WR, Rollnick S (eds) Motivational interviewing. New York, London, The Guiford Press, 1991 (pp. 191-202).
(17) Saunders JB, Lee NK: Hazardous alcohol use: its delineation as a subthreshold disorder, and approaches to its diagnosis and management. Comprehensive Psychiatry 2000, 41 (2), Suppl. 1: 95-103.
(18) Miller WR, Sánchez VC: Motivating young adults for treatment and lifestyle change. En: Howard G & Nathan (eds.): Alcohol use and misuse by young adults. Notre Dame IN, University of Notre Dame Press 1993 (pp: 55-81).
(19) World Health Organization Brief Intervention Study Group. A cross national trial of brief interventions with heavy drinkers. Am J Public Health 1996; 86: 948-955.
(20.) Israel Y, Hollander O, Sánchez-Craig M, Booker S, Miller V et al.: Screening for problem drinking and counseling by the primary care physician-nurse team. Alcoholism: Clinical & Experimental Research 1996; 20: 1443-1450.
(21) Richmond R; Anderson P. Research in general practice for smokers and drinkers in Australia and the UK.I. Interpretation of the results. Addiction 1994; 89: 35-40.
(22) Babor TF, Grant M (eds.) Programme on Substance Abuse. Project on identification and management of alcohol-related problems. Report on Phase II: a randomized clinical trial of
brief intervention in primary health care. Geneva, World Health Organization, 1992.
(23) Fleming MF, Manwell LB, Barry KL, Adams W, Stauffacher EA. Brief physician advice for alcohol problems in older adults: a randomized community-based trial. J Fam Pract 1999; 48
(5): 378-384.
(24) Gentinello, LM, Rivara FP, Donovan DM, Jurkovich GJ, Daranciang E et al.: Alcohol Interventions in a trauma center as a means of reducing the risk of injury recurrence. Ponencia al
th Meeting of the American Surgical Association, San Diego, 1999.
(25) Chick J, Ritson B, Connaughton J, Stewart A, Chick J: Advice versus extended treatment for alcoholism: a controlled study. Br J Add 1988; 83: 159-170.
(26) Antti-Poika I, Karaharju E, Roine R& Salaspuro M: Intervention of heavy drinking: a prospective and controlled study of 438 consecutive injured male patients. Alcohol &Alcoholism 1988; 23: 115-121.
(27) Richmond R, Heather N, Wodak A, Kehoe L, Webster I: Controlled evaluation of a general practice-based brief intervention for excessive drinking. Addiction 1995; 90: 119-132.
(28)* Altisent, R.; Córdoba, R.; Delgado, MT; Pico, MV.; et al.: Estudio multicéntrico sobre la eficacia del consejo para la prevención del alcoholismo en Atención Primaria EMPA. Med Clín, 1997; 109: 121-124.
(29)* Còrdoba R, Delgado MT, Pico V, Altisent R, Fores D, Monreal A, Frisas O, López del Val, A: Effectiveness of brief intervention on nondependent alcohol drinkers (EBIAL): a Spanish Multi-centre study. Family Practice 1998; 15 (6):
-568.
(30) Heather, N.; Campion, P.D.; Neville, R.G.; Mac Cabe, D.: Evaluation of a controlled drinking minimal intervention for problem drinkers in general practice (The DRAMS scheme). J. Roy. Coll. Gen. Pract.1987; 37:358-363.
(31) Heather, N.: The public health and brief interventions for excessive alcohol consumption: The British experience. Addictive Behaviors 1996; 21 (6): 857-868.
(32) Colom J, Gual A. Un modelo de intervención integral sobre los problemas derivados del alcohol desde la atención primaria de salud: el programa Beveu Menys. JANO 2000 LIX: 93-
(33) Fernández MI, Bermejo CJ, Alonso M, HerrerosB, Nieto M, Novoa A, Marcelo MT: Efectividad del consejo médico breve para reducir el consumo de alcohol en bebedores. Atención
Primaria 1997; 19 (3): 127-132.
(34) Diéz Manrique JF, García Usieto E. Programa Cantabria Intervención Breve. Santander: Gobierno de Cantabria. Dirección Regional de Bienestar Social y Dirección General de Salud Mental, 1999.
(35) Miller WR, Sovereign RG, Krege B.: Motivational interviewing with problem drinkers: I. The Drinker’s Check-up as a preventive intervention. Behavioural Psychotherapy 1988; 16: 251-268.
(36) Heather N, Rollnick S, Bell A, Richmond R: Effects of brief counseling among male heavy drinkers identified on general hospital wards. Drug Alcohol Rev 1996; 15: 29-38.
(37) Chick J: Early intervention for hazardous drinking in the general hospital. Alcohol Suppl, 1991;1: 477-479.
(38) Chafetz ME, Blane HT, Abram HS, Golner J, Lacey E et al.: Establishing treatment relations with alcoholics. J Nerv Ment Dis 1962; 134:395-409.
(39) Bernstein E, Bernstein J, Levenson S: ProjectASSERT: an ED based intervention to increase access to primary care, preventive services, and the substance abuse treatment system.
Ann. Emerg Med 1997; 30: 181-189.
(40) Sommers MS, Dyehouse JM, Howe SR, Lemmink J.: Preventing alcohol-related motor vehicle injury with brief intervenction strategies: preliminary findings with 60 subjects. 42nd Annual Proceedings. Association for the Advancement
of Automotive Medicine. October 5-7, 1998. Charlottesville, Virginia.
(41) Sommers MS, Dyehouse JM, Howe SR, Weeks A, Russell AC: Using brief interventions following alcohol-related motor vehicle crashes to reduce drinking and further injury. Ponencia
presentada en ICADTS-2000, Estocolmo, 20-25 Mayo 2000.
(42) Longabaugh R, Minugh PA, Nirenberg TD, Clifford PR, Becker B, Woolard R. Injury as a motivator to reduce drinking. Acad Emerg Med 1995; 2: 817-825.
(43) Rodríguez-Martos A, Plasencia A, Escayola, M, Martí J, Ferrando J, Torralba Ll. Intervención breve sobre accidentados con alcoholemia positiva desde un centro de traumatologia. (Adicciones 2001; 13 (4), en prensa).
(44) Drummond DC, Thom B, Brown C, Edwards G, Mullan MJ. Specialist versus general practitioner treatment of problem drinkers. The Lancet 1990; 336: 915-918.
(45) Richmond R, Kehoe L, Hailstone S, Wodak A, Uebel-Yan m: Quantitative and qualitative evaluations of brief interventions to change excessive drinking, smoking and stress in the police
force. Addiction 1999; 94 (10): 1509-1521.
(46)* Drummond DC: Alcohol interventions: do the best things come in small packages? Addiction 1997; 92: 375-379.
(47) Richmond R; Anderson P. Research in general practice for smokers and drinkers in Australia and the UK.II. Representativeness of the results. Addiction 1994; 89: 41-48.
(48) Edwards AG, Rollnick S. Outcome studies of brief alcohol intervention in general practice: the problem of lost subjects. Addiction 1997; 92: 1699-1704.
(49) Higgins-Biddle JC, Mullahy J, Daniels J, Mc Ree B. Alcohol screening and brief intervention: where research meets practice. Conn Med. 1997; 61 (9): 565-575.
(50) Holder H, Longabaugh R, Miller WR & Rubonis AV: The cost-effectiveness of treatment for alcoholism: A first approximation. J Stud on Alc 1991; 52: 517-540.
(51)* Ballesteros J: ¿Es eficaz la intervención breve en bebedores a riesgo en el ámbito de la atención primaria? Una revisión sistemática de estudios españoles. Trastornos adictivos 2000; 2 (1): 32-40.
(52)* Nuffield Institute for Health: Brief interventions and alcohol use. Effective Health Care. Bulletin 1993;7.
(53) Delgado-Rodríguez M, Sillero-Arenas M. Sesgos en el metaanálisis. Med Clín (Barc) 1999; 112 (Supl 1): 43-50.
(54)** Heather N: Interpreting the evidence on brief interventions for excessive drinkers: the need for caution. Alcohol Alcohol 1995; 30:287-296.