Tratamiento integrado vs. tratamiento paralelo en adolescentes con consumo de sustancias y trastornos comórbidos: Un ensayo aleatorizado

• Díaz Hurtado, Rosa ^[2] ; Goti, Javier ^[3] ; Magallón-Neri, Ernesto ^[1] ; Mateus-Gómez, Sandra ^[1] ; Ilzarbe, Daniel ^[4] ; Castro-Fornieles, Josefina ^[5]
  1. [1] Universitat de Barcelona

     Universitat de Barcelona

     Barcelona, España

     
  2. [2] Departamento de Psiquiatría y Psicología infanto juvenil. 2017SGR881. Instituto de Neurociencias. Hospital Clínic Universitari de Barcelona, Barcelona Departamento de Psicología Clínica y Psicobiología. 2017SGR1681 (GEIMAC). Facultad de Psicología. Universidad de Barcelona, Barcelona
  3. [3] Servicio de Psiquiatría y Psicología, IMQ-AMSA, Bilbao
  4. [4] Departamento de Psiquiatría y Psicología infanto juvenil. 2017SGR881. Instituto de Neurociencias. Hospital Clínic Universitari de Barcelona, Barcelona Institut d’Investigació August Pi I Sunyer (IDIBAPS), Barcelona Centro de Investigación Biomédica en Red de Salut Mental (CIBERSAM), Madrid
  5. [5] Departamento de Psiquiatría y Psicología infanto juvenil. 2017SGR881. Instituto de Neurociencias. Hospital Clínic Universitari de Barcelona, Barcelona Institut d’Investigació August Pi I Sunyer (IDIBAPS), Barcelona Centro de Investigación Biomédica en Red de Salut Mental (CIBERSAM), Madrid Departamento de Medicina. Instituto de Neurociencias. Universidad de Barcelona, Barcelona

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• Localización: Adicciones: Revista de socidrogalcohol, ISSN 0214-4840, Vol. 36, Nº. 4, 2024, págs. 399-414
• Idioma: español
• DOI: 10.20882/adicciones.1912
• Títulos paralelos:
  • Integrated vs. parallel treatment in adolescents with substance use and comorbid disorders: A randomized trial
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• Resumen
  • español

    Los tratamientos integrados suelen recomendarse para adolescentes con trastornos por uso de sustancias (TUS) y patologías comórbidas. Este estudio compara la eficacia de dos programas de intervención (integrado y paralelo) e investiga factores predictores de resultados del tratamiento. Setenta y cinco adolescentes (13-17 años) con TUS y trastorno comórbido, remitidos a un programa ambulatorio, fueron asignados aleatoriamente a un tratamiento integrado (n = 33) o paralelo (n = 32). Se evaluaron variables sociodemográficas, psicopatología, consumo de sustancias y funcionamiento global al inicio del tratamiento y 12 meses después. Ambos tratamientos se asociaron con cambios positivos pre-post en diferentes variables (problemas escolares, familiares, psiquiátricos, funcionamiento global y estadio de cambio). El tratamiento integrado mostró mejores resultados en adherencia (χ2 = 14,328; p > ,001) y en una medida global compuesta basada en la gravedad de problemas relacionados con drogas (χ2 = 8,833; p = ,003). Siguiendo una estrategia de tratamiento adaptativa, ofrecimos a los pacientes que abandonaron el tratamiento paralelo (n = 12) la posibilidad de entrar en el integrado. Once aceptaron, constituyendo un tercer grupo de comparación («paralelo a integrado»). El análisis de regresión logística multivariante mostró que la probabilidad de resultado global positivo aumentaba en los pacientes de los grupos integrado y «paralelo a integrado», con trastornos comórbidos internalizantes o mixtos, mayor edad y menores problemas legales. El tratamiento integrado mostró mejor adherencia y resultados globales que el paralelo en adolescentes con patología dual. Una mayor edad y menos problemas legales también se relacionaron con un resultado global positivo.

  • English

    Integrated treatments are often recommended for adolescents with substance use disorders (SUD) and comorbid pathologies. This study aims to compare the effectiveness of two different intervention programs (integrated and parallel) and to investigate treatment outcome predictors. Seventy-five adolescents (13-17 years old) with substance use and comorbid disorders referred to our outpatient program were randomized to integrated (n = 33) or parallel (n = 32) treatment groups. Their sociodemographic variables, psychopathology, substance use problems, and global functioning were assessed at baseline and 12 months after treatment initiation. Both treatments were associated with positive pre-post changes in several outcome variables (severity of school, family, and psychiatric problems; global functioning; and stage of change). Integrated treatment showed better outcome on adherence (χ2 = 14.328; p > .001) and a composite global measure based on the severity of drug-related problems (χ2 = 8.833, p = .003). Following an adaptive treatment strategy, we offered patients who dropped out of parallel treatment (n = 12) the possibility of entering integrated treatment. Eleven of them accepted and constituted a third comparison group (parallel-to-integrated). Multivariate logistic regression analysis showed that the likelihood of a positive global treatment outcome increased with integrated or parallel-to-integrated treatment, internalizing or mixed comorbid disorders, older age, and fewer legal issues. Integrated treatment showed better adherence and global treatment outcomes than parallel treatment in adolescent patients with dual disorders. Older age and fewer legal issues were also related to a positive global treatment outcome.

• Referencias bibliográficas
  • Achenbach, T. M. y Rescorla, L. A. (2001). Manual for the ASEBA School-Age Forms & Profiles: An integrated system of multi-informant assessment....
  • Adams, Z. W., McCauley, J. L., Back, S. E., Flanagan, J. C., Hanson, R. F., Killeen, T. K. y Danielson, C. K. (2016). Clinician perspectives...
  • Anton, R. F., Malley, S. S. O., Ciraulo, D. A., Cisler, R. A., Couper, D., Donovan, D. M., Gastfriend, D. R., Hosking, J. D., Locastro, J....
  • APA. (2002). Diagnostic and Statistical Manual of Mental Disorders-Text Revision. MASSON.
  • Black, J. J. y Chung, T. (2014). Mechanisms of change in adolescent substance use treatment: How does treatment work? Substance Abuse, 35(4),...
  • Brannigan, R., Schackman, B. R., Falco, M. y Millman, R. B. (2004). The quality of highly regarded adolescent substance abuse treatment programs:...
  • Cornelius, T., Earnshaw, V. A., Menino, D., Bogart, L. M. y Levy, S. (2017). Treatment motivation among caregivers and adolescents with substance...
  • Dahlberg, M., Boson, K., Anderberg, M. y Wennberg, P. (2022). Long-term outcomes for young people with substance use problems in outpatient...
  • del Palacio-Gonzalez, A., Hesse, M., Thylstrup, B., Pedersen, M. U. y Pedersen, M. M. (2022). Effects of contingency management and use of...
  • Dennis, M., Godley, S. H., Diamond, G., Tims, F. M., Babor, T., Donaldson, J., Liddle, H., Titus, J. C., Kaminer, Y., Webb, C., Hamilton,...
  • Díaz, R., Castro-Fornieles, J., Serrano, L., González, L., Calvo, R., Goti, J., Kaminer, Y. y Gual, A. (2008). Clinical and research utility...
  • Díaz, R., Goti, J., García, M., Gual, A., Serrano, L., González, L., Calvo, R. y Castro-Fornieles, J. (2011). Patterns of substance use in...
  • Drake, R. E., O’Neal, E. L. y Wallach, M. A. (2008). A systematic review of psychosocial research on psychosocial interventions for people...
  • Edalati, H. y Conrod, P. J. (2019). A review of personality-targeted interventions for prevention of substance misuse and related harm in...
  • Erskine, H. E., Moffitt, T. E., Copeland, W. E., Costello, E. J., Ferrari, A. J., Patton, G., Degenhardt, L., Vos, T., Whiteford, H. A. y...
  • Esposito-Smythers, C., Spirito, A., Kahler, C. W., Hunt, J. y Monti, P. (2011). Treatment of co-occurring substance abuse and suicidality...
  • Fernández-Artamendi, S., Fernández-Hermida, J. R., García-Cueto, E., Secades-Villa, R., García-Fernández, G. y Barrial-Barbén, S. (2012)....
  • Garner, B. R., Godley, S. H. y Funk, R. R. (2008). Predictors of early therapeutic alliance among adolescents in substance abuse reatment....
  • Glowacki, K., Whyte, M., Weinstein, J., Marchand, K., Barbic, D., Scheuermeyer, F., Mathias, S. y Barbic, S. (2022). Exploring how to enhance...
  • Goti, J., Diaz, R., Serrano, L., Gonzalez, L., Calvo, R., Gual, A. y Castro, J. (2009). Brief intervention in substance-use among adolescent...
  • Grant, S., Agniel, D., Almirall, D., Burkhart, Q., Hunter, S. B., McCaffrey, D. F., Pedersen, E. R., Ramchand, R. y Griffin, B. A. (2017)....
  • Grella, C. E., Hser, Y. I., Joshi, V. y Rounds-Bryant, J. (2001). Drug treatment outcomes for adolescents with comorbid mental and substance...
  • Hawkins, E. H. (2009). A tale of two systems: Co-occurring mental health and substance abuse disorders treatment for adolescents. Annual Review...
  • Hersh, J., Curry, J. F. y Becker, S. J. (2013). The influence of comorbid depression and conduct disorder on MET/CBT treatment outcome for...
  • Hesse, M., Jones, S., Pedersen, M. M., Skov, K. B. E., Thylstrup, B. y Pedersen, M. U. (2023). The predictive value of brief measures of externalizing...
  • Hesse, M., Thylstrup, B., Karsberg, S., Mulbjerg Pedersen, M. y Pedersen, M. U. (2021). Voucher reinforcement decreases psychiatric symptoms...
  • Hides, L., Carroll, S., Catania, L., Cotton, S. M., Baker, A., Scaffidi, A. y Lubman, D. I. (2010). Outcomes of an integrated cognitive behaviour...
  • Hogue, A., Becker, S. J., Wenzel, K., Henderson, C. E., Bobek, M., Levy, S. y Fishman, M. (2021). Family involvement in treatment and recovery...
  • Hogue, A., Bobek, M. y MacLean, A. (2020). Core elements of CBT for adolescent conduct and substance use problems: Comorbidity, clinical techniques,...
  • Hogue, A., Henderson, C. E., Becker, S. J. y Knight, D. K. (2018). Evidence base on outpatient behavioral treatments for adolescent substance...
  • Hogue, A., Henderson, C. E., Ozechowski, T. J. y Robbins, M. S. (2014). Evidence base on outpatient behavioral treatments for adolescent substance...
  • Hulvershorn, L. A., Quinn, P. D. y Scott, E. L. (2015). Treatment of adolescent substance use disorders and co- occurring internalizing disorders:...
  • Kaminer, Y., Ohannessian, C. M. C. y Burke, R. H. (2017). Adolescents with cannabis use disorders: Adaptive treatment for poor responders....
  • Kaminer, Y., Ohannessian, C. M., McKay, J. R., Burke, R. H. y Flannery, K. (2018). Goal commitment predicts treatment outcome for adolescents...
  • Kaufman, J., Birmaher, B., Brent, D., Rao, U. y Ryan, N. (1996). Kiddie-Schedule for Affective Disorders and Schizophrenia, Present and Lifetime...
  • Kavanagh, D. J. y Connolly, J. M. (2009). Interventions for co-occurring addictive and other mental disorders (AMDs). Addictive Behaviors,...
  • Kim, H. S. y Hodgins, D. C. (2018). Component model of addiction treatment: A pragmatic transdiagnostic treatment model of behavioral and...
  • Köck, P., Meyer, M., Elsner, J., Dürsteler, K. M., Vogel, M. y Walter, M. (2022). Co-occurring mental disorders in transitional aged youth...
  • Krebs, P., Norcross, J. C., Nicholson, J. M. y Prochaska, J. O. (2018). Stages of change and psychotherapy outcomes: A review and meta-analysis....
  • Latimer, W. W., Winters, K. C., D’Zurilla, T. y Nichols, M. (2003). Integrated family and cognitive-behavioral therapy for adolescent substance...
  • Libby, A. M. y Riggs, P. D. (2005). Integrated substance use and mental health treatment for adolescents: Aligning organizational and financial...
  • Magallón-Neri, E., Díaz, R., Forns, M., Goti, J., Canalda, G. y Castro-Fornieles, J. (2012). Subtipos de adolescentes con trastornos por uso...
  • Marchand, K., Beaumont, S., Westfall, J., MacDonald, S., Harrison, S., Marsh, D. C., Schechter, M. T. y Oviedo-Joekes, E. (2019). Conceptualizing...
  • Martínez-Miranda, J. y Espinosa-Curiel, I. E. (2022). Serious games supporting the prevention and treatment of alcohol and drug consumption...
  • Mason, W. A., Hitchings, J. E. y Spoth, R. L. (2008). The interaction of conduct problems and depressed mood in relation to adolescent substance...
  • Meisel, S. N., Pielech, M., Magill, M., Sawyer, K. y Miranda, R. (2022). Mechanisms of behavior change in adolescent substance use treatment:...
  • Moos, R. H. (1990). Conceptual and empirical approaches to developing family‐based assessment procedures: Resolving the case of the family...
  • Moos, R. H. y Moos, B. S. (1981). Family Environment Scale: Manual. Consulting Psychologists Press.
  • Morisano, D., Babor, T. F. y Robaina, K. A. (2014). Co-occurrence of substance use disorders with other psychiatric disorders: Implications...
  • Norberg, M. M., Battisti, R. A., Copeland, J., Hermens, D. F. y Hickie, I. B. (2012). Two sides of the same coin: Cannabis dependence and...
  • Passetti, L. L., Godley, M. D. y Kaminer, Y. (2016). Continuing care for adolescents in treatment for substance use disorders. Child and Adolescent...
  • Pedersen, M. U., Hesse, M., Thylstrup, B., Jones, S., Pedersen, M. M. y Frederiksen, K. S. (2021). Vouchers versus reminders to prevent dropout:...
  • Ramchand, R., Griffin, B. A., Suttorp, M., Harris, K. M. y Morral, A. (2011). Using a cross-study design to assess the efficacy of motivational...
  • Rohde, P., Waldron, H. B., Turner, C. W., Brody, J. y Jorgensen, J. (2014). Sequenced versus coordinated treatment for adolescents with comorbid...
  • Sampl, S. y Kadden, R. (2001). Motivational enhancement therapy and cognitive behavioral therapy for adolesent cannabis users: 5 sessions....
  • Santisteban, D. A., Mena, M. P., Muir, J., McCabe, B. E., Abalo, C. y Cummings, A. M. (2015). The efficacy of two adolescent substance abuse...
  • Schuler, M. S., Griffin, B. A., Ramchand, R., Almirall, D. y McCaffrey, D. F. (2014). Effectiveness of treatment for adolescent substance...
  • Shaffer, D., Gould, M. S., Brasic, J., Ambrosini, P., Fisher, P., Bird, H. y Aluwahlia, S. (1983). A children ’ s global assessment scale....
  • Silvers, J. A., Squeglia, L. M., Rømer Thomsen, K., Hudson, K. A. y Feldstein Ewing, S. W. (2019). Hunting for what works: Adolescents in...
  • Stanojlović, M. y Davidson, L. (2020). Targeting the barriers in the substance use disorder continuum of care with peer recovery support....
  • Sterling, S., Weisner, C., Hinman, A. y Parthasarathy, S. (2010). Access to treatment for adolescents with substance use and co-occurring...
  • Tamm, L., Trello-Rishel, K., Riggs, P., Nakonezny, P. A., Acosta, M., Bailey, G. y Winhusen, T. (2013). Predictors of treatment response in...
  • van Wamel, A., Lempens, A. y Neven, A. (2021). Integrated treatment of dual disorders in The Netherlands: A qualitative study of client experiences....
  • Waldron, H. B. y Turner, C. W. (2008). Evidence-based psychosocial treatments for adolescent substance abuse. Journal of Clinical Child and...
  • Wang, L. J., Lu, S. F., Chong, M. Y., Chou, W. J., Hsieh, Y. L., Tsai, T. N., Chen, C. y Lee, Y. H. (2016). A family-oriented therapy program...
  • Weiss, R. D., Griffin, M. L., Jaffee, W. B., Bender, R. E., Graff, F. S., Gallop, R. J. y Fitzmaurice, G. M. (2009). A “community-friendly”...
  • Winer, J. M., Yule, A. M., Hadland, S. E. y Bagley, S. M. (2022). Addressing adolescent substance use with a public health prevention framework:...
  • Winters, K. C., Stinchfield, R. D., Latimer, W. W. y Stone, A. (2008). Internalizing and externalizing behaviors and their association with...
  • Winters, K. C., Waldron, H., Hops, H., Ozechowski, T. y Montano, A. (2023). Brief interventions for cannabis using adolescents. Child and...
  • Wolff, J., Esposito-Smythers, C., Frazier, E., Stout, R., Gomez, J., Massing-Schaffer, M., Nestor, B., Cheek, S., Graves, H., Yen, S., Hunt,...