Intervención grupal para reducir la violencia de género entre consumidoras de drogas. Resultados de un estudio piloto en un centro comunitario de tratamiento de adicciones A group intervention to reduce intimate partner violence among female drug users. Results from a randomized controlled pilot trial in a community substance-abuse center

Autores/as

  • Judit Tirado-Muñoz Addiction Research Group, IMIM-Institut Hospital del Mar d’Investigacions Mèdiques; Universitat Autónoma de Barcelona, Barcelona
  • Gail Gilchrist Addiction Research Group, IMIM-Institut Hospital del Mar d’Investigacions Mèdiques; Universitat Autónoma de Barcelona, Barcelona. España. National Addiction Centre, Institute of Psychiatry, King’s College, London
  • Eva Lligoña Institute of Neuropsychiatry and Addictions, Parc de Salut Mar, Barcelona
  • Louisa Gilbert Social Intervention Group, Columbia University, New York, NY
  • Marta Torrens Social Intervention Group, Columbia University, New York

DOI:

https://doi.org/10.20882/adicciones.703

Palabras clave:

violencia de género, abuso de substancias, mujeres, terapia cognitivo-conductual, intervención grupal, ensayo aleatorizado controlado. intimate partner violence, substance abuse, females, cognitive behavioral therapy, group intervention, randomized controlled trial.

Resumen

Antecedentes: Las mujeres usuarias de drogas son víctimas de violencia de género en mayor proporción que las mujeres en población general; sin embargo, pocas intervenciones se han desarrollado para reducir la violencia de género entre mujeres usuarias de drogas. Métodos: Una versión adaptada de la intervención “Women’s Wellness Treatment” para reducir violencia de género y  síntomas depresivos, ha sido evaluada mediante un ensayo clínico piloto en un centro de tratamiento ambulatorio en Barcelona, España. Catorce mujeres que recibían tratamiento ambulatorio para un trastorno por consumo de sustancias  y que declararon ser víctimas de violencia en el mes anterior fueron incluidas en el ensayo clínico. Las participantes fueron asignados al azar para recibir 10 sesiones grupales de terapia cognitivo-conductual (IPaViT-CBT) o tratamiento habitual. La frecuencia de violencia, síntomas depresivos, consumo de sustancias, calidad de vida y estado de salud fueron evaluados al inicio del estudio y 1, 3 y 12 meses después de la intervención. Se realizó análisis por intención de tratar. Resultados: Se encontraron efectos moderados de la intervención en la reducción de maltrato psicológico, aumento de la asertividad y la reducción de la agresividad en la relación de pareja, y reducción en la frecuencia de consumo de alcohol hasta 3 meses después de la intervención. La intervención no redujo significativamente la probabilidad de ser víctima de cualquier tipo de violencia de género, los síntomas depresivos, calidad de vida o el estado de salud auto-referido, hasta 12 meses después de la intervención. Conclusiones: Los resultados de este estudio piloto indican que es factible realizar una intervención de 10 sesiones grupales  de TCC entre las víctimas de violencia de género que reciben tratamiento por uso de sustancias en un centro comunitario de tratamiento de adicciones. Se requiere un ensayo clínico más robusto para replicar estos resultados.
Background: A greater proportion of drug dependent women are victims of intimate partner violence (IPV) than women in the general population; however, few interventions have been developed to reduce IPV among drug dependent women. Methods: An adapted version of the Women’s Wellness Treatment, to address IPV and depressive symptoms, was piloted in a randomized controlled trial conducted in outpatient treatment program in Barcelona, Spain among 14 women receiving outpatient treatment for a drug use disorder who screened positive for IPV in the previous month. Participants were randomly assigned to receive the 10 session cognitive behavioral therapy (IPaViT-CBT) group intervention or treatment as usual. The frequency of IPV, depressive symptoms, substance use, quality of life and health status were assessed at baseline and 1, 3 and 12 months post intervention. Intention to treat analysis was performed. Results: Moderate effects for the intervention were found in reducing psychological maltreatment, increasing assertiveness of IPV and reducing aggressiveness in the partner relationship, and in reducing the frequency of drinking up to 3 months post intervention. The intervention did not significantly reduce the likelihood of any IPV, depressive symptoms, quality of life or self-reported health status, up to 12-months post intervention. Conclusion: This pilot trial suggests some initial support for the 10-session CBT group intervention among IPV victims who received treatment for drug use. Study findings indicate that it is feasible to deliver the intervention in a community substance abuse center.  An adequately powered trial is required to replicate these results.

Citas

Beck, A. T., Steer, R. A., y Garbin, M.G. (1988). Psychometric properties of the Beck Depression Inventory: Twenty-five years of evaluation. Clinical Psychology Review, 8, 77-100.

Boer, A. G., Lanschot, J. J., Stalmeier, P. F., Sandick, J. W., Hulscher, J. B., Haes, J. C., y Sprangers, M. A. (2004). Is a single-item visual analogue scale as valid, reliable and responsive as multi-item scales in measuring quality of life? Quality of Life Research, 13, 311-320.

Bonicatto, S., Dew, A. M., y Soria, J. J. (1998). Analysis of the psychometric properties of the Spanish version of the Beck Depression Inventory in Argentina. Psychiatry Research, 79, 277-285.

Bourgois, P., Prince, B., y Moss, A. (2004). The everyday violence of hepatitis C among young women who inject drugs in San Francisco. Human Organization, 63, 253-264.

Campbell, J. C. (2002). Health consequences of intimate partner violence. Lancet, 359, 1331-1336. doi: 10.1016/s0140-6736(02)08336-8

Campbell, J. C., Baty, M. L., Ghandour, R. M., Stockman, J. K., Francisco, L., y Wagman, J. (2008). The intersection of intimate partner violence against women and HIV/AIDS: A review. International Journal of Injury Control and Safety Promotion, 15, 221-231. doi: 10.1080/17457300802423224

Carpenter, K. M., Aharonovich, E., Smith, J. L., Iguchi, M. Y., y Nunes, E. V. (2006). Behavior therapy for depression in drug dependence (BTDD): Results of a stage Ia therapy development pilot. The American Journal of Drug and Alcohol Abuse, 32, 541-548. doi: 10.1080/00952990600919450

Castillo-Camiglia, A., Pizarro, E., Luengo, D., y Soto-Brandt, G. (2014). Consumo de alcohol y autoinforme de eventos violentos en Chile. Adicciones, 26, 46-53.

Cohen, L. R., Field, C., Campbell, A. N., y Hien, D. A. (2013). Intimate partner violence outcomes in women with PTSD and substance use: A secondary analysis of NIDA Clinical Trials Network “Women and Trauma” Multi-site Study. Addictive Behaviors, 38, 2325-2332. doi: 10.1016/j.addbeh.2013.03.006

Cohen, L. R., y Hien, D. A. (2006). Treatment outcomes for women with substance abuse and PTSD who have experienced complex trauma. Psychiatric Services, 57, 100-106. doi: 10.1176/appi.ps.57.1.100

Connelly, C. D., Hazen, A. L., Baker-Ericzen, M. J., Landsverk, J., y Horwitz, S. M. (2013). Is screening for depression in the perinatal period enough? The co-occurrence of depression, substance abuse, and intimate partner violence in culturally diverse pregnant women. Journal of Women’s Health (Larchmt), 22, 844-852. doi: 10.1089/jwh.2012.4121

El-Bassel, N., Gilbert, L., Witte, S., Wu, E., y Chang, M. (2011). Intimate partner violence and HIV among drug-involved women: contexts linking these two epidemics--challenges and implications for prevention and treatment. Substance Use & Misuse, 46, 295-306. doi: 10.3109/10826084.2011.523296

El-Bassel, N., Gilbert, L., Wu, E., Go, H., y Hill, J. (2005). Relationship between drug abuse and intimate partner violence: a longitudinal study among women receiving methadone. American Journal of Public Health, 95, 465-470. doi: 10.2105/ajph.2003.023200

Fearday, F., Clark, C., y Edington, M. (Eds.) (2001). Triad Women’s Project Group Facilitator Manual and Workbook. Tampa, FL: Louis de la Porte Florida Mental Health Institute, University of South Florida.

Fowler, D. N., y Faulkner, M. (2011). Interventions targeting substance abuse among women survivors of intimate partner abuse: a meta-analysis. Journal of Substance Abuse Treatment, 41, 386-98. doi: 10.1016/j.jsat.2011.06.001.

Gilbert, L., El-Bassel, N., Manuel, J., Wu, E., Go, H., Golder, S., . . . Sanders, G. (2006). An integrated relapse prevention and relationship safety intervention for women on methadone: testing short-term effects on intimate partner violence and substance use. Violence and Victims, 21, 657-672.

Gilchrist, G., Blazquez, A., y Torrens, M. (2011). Psychiatric, behavioural and social risk factors for HIV infection among female drug users. AIDS and Behavior, 15, 1834-1843. doi: 10.1007/s10461-011-9991-1

Gilchrist, G., Blazquez, A., y Torrens, M. (2012). Exploring the relationship between intimate partner violence, childhood abuse and psychiatric disorders among female drug users. Advances in Dual Diagnosis, 5, 46-58.

Harris, M., y Community Connections Trauma Work Group (Eds.) (1998). Trauma Recovery and Empowerment: A Clinician’s guide for working with women in groups. New York: Community Connections, Inc.

Hearn, K. D., O’Sullivan, L. F., El-Bassel, N., y Gilbert, L. (2005). Intimate partner violence and monogamy among women in methadone treatment. AIDS and Behavior, 9, 177-186. doi: 10.1007/s10461-005-3899-6

Hegarty, K., Bush, R., y Sheehan, M. (2005). The composite abuse scale: further development and assessment of reliability and validity of a multidimensional partner abuse measure in clinical settings. Violence and Victims, 20, 529-547.

Hegarty, K., O’Doherty, L., Taft, A., Chondros, P., Brown, S., Valpied, J., . . . Gunn, J. (2013). Screening and counselling in the primary care setting for women who have experienced intimate partner violence (WEAVE): a cluster randomised controlled trial. Lancet, 382, 249-258. doi: 10.1016/s0140-6736(13)60052-5

Hegarty, K., Sheehan, M., y Schonfeld, C. (1999). A Multidimensional Definition of Partner Abuse: Development and Preliminary Validation of the Composite Abuse Scale. Journal of Family Violence, 14, 399-415.

Higgins, S. T., Alessi, S. M., y Dantona, R. L. (2002). Voucher-based incentives. A substance abuse treatment innovation. Addictive Behaviors, 27, 887-910.

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

Howard, L. M., Trevillion, K., Khalifeh, H., Woodall, A., Agnew-Davies, R., y Feder, G. (2010). Domestic violence and severe psychiatric disorders: prevalence and interventions. Psychological Medicine, 40, 881-893. doi: 10.1017/s0033291709991589

Illangasekare, S. L., Burke, J. G., McDonnell, K. A., y Gielen, A. C. (2013). The impact of intimate partner violence, substance use, and HIV on depressive symptoms among abused low-income urban women. Journal of Interpersonal Violence, 28, 2831-2848. doi: 10.1177/0886260513488682

Kaysen, D., Dillworth, T. M., Simpson, T., Waldrop, A., Larimer, M. E., y Resick, P. A. (2007). Domestic violence and alcohol use: trauma-related symptoms and motives for drinking. Addictive Behaviors, 32, 1272-1283. doi: 10.1016/j.addbeh.2006.09.007

Liebschutz, J. M., Mulvey, K. P., y Samet, J. H. (1997). Victimization among substance-abusing women. Worse health outcomes. Archives of Internal Medicine, 157, 1093-1097. McKinney, C. M., Caetano, R., Rodriguez, L. A., y Okoro, N. (2010). Does alcohol involvement increase the severity of intimate partner violence? Alcoholism, Clinical and Experimental Research, 34, 655-658. doi: 10.1111/j.1530-0277.2009.01134.x

Miller, D., y Guidry, L. (Eds.) (2001). Addictions and Trauma Recovery: Healing the Body, Mind, and Spirit. New York: W.W. Norton and Co.

Miller, B. A., Downs, W. R., y Testa, M. (1993). Interrelationships between victimization experiences and women’s alcohol use. Journal of Studies on Alcohol. Supplement, 11, 109-117.

Najavits, L. M. (Ed.) (2009). Psychotherapies for trauma and substance abuse in women: review and policy implications. Trauma, Violence & Abuse, 10, 290-8. doi: 10.1177/1524838009334455.

Najavits, L. M. (2002). Seeking Safety: A Treatment Manual for PTSD and Substance Abuse. Nueva York: Guildford Press.

Najavits, L. M., Sonn, J., Walsh, M., y Weiss, R. D. (2004). Domestic violence in women with PTSD and substance abuse. Addictive Behaviors, 29, 707-715. doi: 10.1016/j.addbeh.2004.01.003

O’Leary, K. D., y Curley, A.D. (1986). Assertion and family violence: Correlates of Spouse Abuse. Journal of Marital and Family Therapy, 12, 281- 289.

Okuda, M., Olfson, M., Hasin, D., Grant, B. F., Lin, K. H., y Blanco, C. (2011). Mental health of victims of intimate partner violence: results from a national epidemiologic survey. Psychiatric Services, 62, 959-962. doi: 10.1176/appi.ps.62.8.959

Peters, E. N., Khondkaryan, E., y Sullivan, T. P. (2012). Associations between expectancies of alcohol and drug use, severity of partner violence, and posttraumatic stress among women. Journal of Interpersonal Violence, 27, 2108-2127. doi: 10.1177/0886260511432151

Singer, M. (1996). A dose of drugs, a touch of violence, a case of AIDS: Conceptualizing the SAVA syndemic. Free Inquiry in Creative Sociology, 24, 99–110.

Sobell, L. S., y Sobell, M. B. (1992). Timeline follow-back: A technique for assessing self-reported ethanol consumption. Measuring Alcohol Consumption: Psychological and Biological Methods, 41–72.

Sobell, L. C., Maisto, S. A., Sobell, M. B., y Cooper, A. M. (1979). Reliability of alcohol abusers’ self-reports of drinking behavior. Behaviour Research and Therapy, 17, 157-160.

Testa, M., Livingston, J. A., y Hoffman, J. H. (2007). Does sexual victimization predict subsequent alcohol consumption? A prospective study among a community sample of women. Addictive Behaviors, 32, 2926-2939. doi: 10.1016/j.addbeh.2007.05.017

Tirado-Muñoz, J., Gilchrist, G., Farré, M., Hegarty, K., y Torrens, M. (2014). The efficacy of cognitive behavioural therapy and advocacy interventions for women who have experienced intimate partner violence: A systematic review and meta-analysis. Annals of Medicine, 11, 1-20. doi:10.3109/07853890.2014.941918

Tolman, R.M. (1989). The development of a measure of psychological maltreatment of women by their male partners. Violence and Victims, 4, 159-177.

Tolman, R. M. (1999). The validation of the Psychological Maltreatment of Women Inventory. Violence and Victims, 14, 25-37.

Torrens, M., Gilchrist, G., y Domingo-Salvany, A. (2011). Psychiatric comorbidity in illicit drug users: substance-induced versus independent disorders. Drug and Alcohol Dependence, 113, 147-156. doi: 10.1016/j.drugalcdep.2010.07.013

Trevillion, K., Oram, S., Feder, G., y Howard, L. M. (2012). Experiences of domestic violence and mental disorders: a systematic review and meta-analysis. PLoS One, 7, e51740. doi: 10.1371/journal.pone.0051740

Wagner, K. D., Hudson, S. M., Latka, M. H., Strathdee, S. A., Thiede, H., Mackesy-Amiti, M. E., y Garfein, R. S. (2009). The effect of intimate partner violence on receptive syringe sharing among young female injection drug users: an analysis of mediation effects. AIDS and Behavior, 13, 217-224. doi: 10.1007/s10461-007-9309-5

World Health Organization. (2013). Responding to intimate partner violence and sexual violence against women: WHO clinical and policy guidelines. Recuperado de http://apps.who.int/iris/bitstream/10665/85240/1/9789241548595_eng.pdf?ua=1

Descargas

Publicado

2015-09-15

Número

Vol. 27 Núm. 3 (2015)

Sección

Originales