Trastornos por consumo de sustancias: entre las inequidades y el estigma
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Publicado:
feb. 15, 2019
Palabras clave:
Trastornos relacionados con sustancias, condiciones sociales, inequidad social, estigma social, revisión
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Resumen
Las personas que reúnen criterios para trastornos por consumo de sustancias (TCS) con frecuencia son víctimas del complejo estigma-discriminación (CED), no sólo por parte de la sociedad general, sino también por profesionales de la salud y la presencia de autoestigma. No obstante, la relación de los TCS con factores biológicos predisponentes y condiciones sociales adversas se considera que estos son ‘autoinducidos’. Asimismo, se conoce que en los TCS se presentan cambios biológicos, psicológicos o del desarrollo que menoscaban la decisión de abandono y la persistencia en el consumo, a pesar de las consecuencias negativas físicas, emocionales y sociales. El CED relacionado con el TCS es un estresor que deteriora aún más la calidad de vida de las personas consumidoras y, al mismo tiempo, se configura como una barrera de acceso a servicios de salud. Es necesario diseñar e investigar la efectividad de estrategias para reducir el CED relacionado con TCS en diferentes poblaciones y contextos.
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Cassiani-Miranda, C. A., Campo-Arias, A., & Herazo, E. (2019). Trastornos por consumo de sustancias: entre las inequidades y el estigma. Duazary, 16(2), 271–280. https://doi.org/10.21676/2389783X.2751
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Artículo de revisión
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Citas
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2. Arboleda-Florez J. Stigma and discrimination: an overview. World Psychiatry. 2005; 4(1):8-10.
3. Phelan JC, Link BG, Dovidio JF. Stigma and prejudice: one animal or two? Soc Sci Med. 2008; 67(3):358-67.
4. Mukolo A, Heflinger CA, Wallston KA. The stigma of childhood mental disorders: A conceptual framework. J Am Acad Child Adolesc Psychiatry. 2010; 49(2):92-103.
5. Pescosolido BA, Martin JK. The stigma complex. Ann Rev Soc. 2015; 41:87-116.
6. Campo-Arias A, Herazo E. El complejo estigma-discriminación asociado a trastorno mental como factor de riesgo de suicidio. Rev Colomb Psiquiatr. 2015; 44(3):243-50.
7. Goffman E. Estigma. La identidad deteriorada. Buenos Aires: Amorrortu Editores; 1963.
8. Scheff TJ. Being mentally ill: A sociological theory. Chicago: Aldine Publications; 1966.
9. Weiner B. Judgments of responsibility: A foundation for a theory of social conduct. New York: Guilford Press; 1995.
10. Corrigan P, Markowitz FE, Watson A, Rowan D, Kubiak MA. An attribution model of public discrimination towards persons with mental illness. J Health Soc Behav. 2003; 44(2):162-79.
11. Rosen G. De la policía médica a la medicina social. México DF: Siglo XXI Editores; 1985.
12. García OS. La inequidad en salud. Su desarrollo histórico. Rev Peru Med Exp Salud Pública. 2014; 30(4):709-13.
13. Ortiz-Hernández L, López-Moreno S, Borges G. Desigualdad socioeconómica y salud mental: revisión de la literatura latinoamericana. Cad Saúde Sública. 2007; 23(6):1255-172.
14. Krieger N. Glosario de epidemiología social. Rev Panam Salud Pública 2002; 11(5/6):480-90.
15. Álvarez LS. Los determinantes sociales de la salud: más allá de los factores de riesgo. Rev Gerenc Polit Salud. 2009; 8(1):69-79.
16. Benach J, Muntaner C. Empleo, trabajo y desigualdades en salud una visión global. Madrid: Icaria Editorial; 2010.
17. Rodríguez S. La desigualdad de ingreso y salud en Colombia. Perf Latinoam. 2016; 24(48):265-96.
18. Cuba MS, Albrecht C. A 30 años de la Carta de Ottawa. Acta Med Peru. 2017; 34(1):66-7.
19. Arias-Valencia SA. Epidemiología, equidad en salud y justicia social. Rev Fac Nac Salud Pública. 2017; 35(2):186-96.
20. Manrique-Villanueva L, Eslava-Schmalbach J. Auscultando la corrupción en la salud en la salud: definición y causas: ¿Qué está en juego? Rev Colomb Obstet Ginecol. 2011; 62(4):308-14.
21. Agost MR, Martín L. Acercamiento al papel de los procesos de exclusión social y su relación con la salud. Rev Cuba Salud Pública. 2012; 38(1):126-40.
22. Palomina PA, Grande ML, Linares M. La salud y sus determinantes sociales. Desigualdades y exclusión en la sociedad del siglo XXI. Rev Int Sociol. 2014; 72(Extra 1):45-70.
23. Martínez MF. Inequidad en los sistemas de salud de América Latina: Análisis para Colombia, Argentina y México. Rev Inv. 2017; 2(1):71-81.
24. García M. Crisis económicas y salud en controversia: el “debate Brenner”, 1970-2012. Rev Cienc Salud. 2017; 15(1):87-104.
25. López-Dicastillo O, Canga-Armayor N, Mujika A, Pardavila-Belio MI, Belintxon M, Serrano-Monzó I, et al. Cinco paradojas de la promoción de la salud. Gac Sanit. 2017; 31(3):269-72.
26. American Psychiatric Association. Guía de consulta de los criterios diagnósticos del DSM-5. Washington, DC: American Psychiatric Publishing; 2014.
27. Cía AH. Las adicciones no relacionadas a sustancias (DSM-5, APA, 2013): un primer paso hacia la inclusión de las Adicciones Conductuales en las clasificaciones categoriales vigentes. Rev Neuro-Psiquiatr. 2013; 76(4):210-7.
28. Jorm AF, Wright AM. Influences on young people's stigmatising attitudes towards peers with mental disorders: National survey of young Australians and their parents. Br J Psychiatry. 2008; 192(2):144-9.
29. Campo-Arias A, Herazo E. Estigma, prejuicio y discriminación en salud mental. Rev Cienc Biomed. 2013; 4(1):9-10.
30. Boyce N. David Nutt: making the medical case for addiction. Lancet. 2013; 381(9871):987.
31. Shaw VN. Substance use and abuse: Sociological perspectives. Westport: Praeger Publishing Group; 2002.
32. Mcquown SC, Wood MA. Epigenetic regulation in substance use disorders. Cur Psychiatry Report. 2010; 12(2):145-53.
33. Benyamina A, Kebir O, Blecha L, Reynaud M, Krebs MO. CNR1 gene polymorphisms in addictive disorders: a systematic review and a meta‐analysis. Addict Biol. 2011; 16(1):1-6.
34. Myers B, Carney T, Wechsberg WM. “Not on the agenda”: A qualitative study of influences on health services use among poor young women who use drugs in Cape Town, South Africa. Int J Drug Policy. 2016; 30(1):52-8.
35. Schomerus G, Lucht M, Holzinger A, Matschinger H, Carta MG, Angermeyer MC. The stigma of alcohol dependence compared with other mental disorders: a review of population studies. Alcohol Alcohol. 2011; 46(2):105-112.
36. Opris I, Gerhardt GA, Hampson RE, Deadwyler SA. Disruption of columnar and laminar cognitive processing in primate prefrontal cortex following cocaine exposure. Front Syst Neurosci. 2015; 29; 9:79. doi: 10.3389/fnsys.2015.00079
37. Goldstein RZ, Volkow ND. Dysfunction of the prefrontal cortex in addiction: neuroimaging findings and clinical implications. Nat Rev Neurosci 2011; 12(11):652-69.
38. Volkow ND, Koob GF, McLellan AT. Neurobiologic advances from the brain disease model of addiction. N Engl J Med. 2016; 374(4):363-71.
39. Cassiani CA. Trastornos adictivos como enfermedades del cerebro: Análisis de la evidencia e implicaciones prácticas. Salud Uninorte. 2018; 34(1): en prensa.
40. Evans-Lacko S, Thornicroft G. Stigma among people with dual diagnosis and implications for health services. Adv Dual Diagn. 2010; 3(1):4-7.
41. Kulesza M, Ramsey SE, Brown RA, Larimer ME. Stigma among individuals with substance use disorders: Does it predict substance use, and does it diminish with treatment? J Addict Behav Ther Rehabil. 2014; 3(1):1000115. doi:10.4172/2324-9005.1000115
42. Ahern J, Stuber J, Galea S. Stigma, discrimination and the health of illicit drug users. Drug Alcohol Depend. 2007; 88(2):188-96.
43. Van Boekel LC, Brouwers EP, Van Weeghel, J, Garretsen HF. Stigma among health professionals towards patients with substance use disorders and its consequences for healthcare delivery: systematic review. Drug Alcohol Depend. 2013; 131(1):23-35.
44. Mota T, Higgins-Biddle J, Furtado EF. Stigmatization of alcohol and other drug users by primary care providers in Southeast Brazil. Soc Sci Med. 2009; 69(7):1080-4.
45. Isaacson JH, Fleming M, Kraus M, Kahn R, Mundt M. A national survey of training in substance use disorders in residency programs. J Stud Alcohol. 2000; 61(6):912-5.
46. McDonagh JE, Minnaar G, Kelly K, O'connor D, Shaw KL. Unmet education and training needs in adolescent health of health professionals in a UK children's hospital. Acta Paediatr. 2006; 95(6):715-9.
47. Priester MA, Browne T, Iachini A, Clone S, DeHart D, Seay KD. Treatment access barriers and disparities among individuals with co-occurring mental health and substance use disorders: An integrative literature review. J Subst Abuse Treat. 2016; 61(1):47-59.
48. van Boekel LC, Brouwers EP, van Weeghel J, Garretsen HF. Healthcare professionals’ regard towards working with patients with substance use disorders: comparison of primary care, general psychiatry and specialist addiction services. Drug Alcohol Depend. 2014; 134:92-8.
49. Raistrick DS, Tober GW, Unsworth SL. Attitudes of healthcare professionals in a general hospital to patients with substance misuse disorders. J Subst Use. 2015; 20(1):56-60.
50. van Boekel LC, Brouwers EP, van Weeghel J, Garretsen HF. Comparing stigmatising attitudes towards people with substance use disorders between the general public, GPs, mental health and addiction specialists and clients. Int J Soc Psychiatry. 2015; 61(6):539-49.
51. Luoma JB, Twohig MP, Waltz T, Hayes SC, Roget N, Padilla M, et al. An investigation of stigma in individuals receiving treatment for substance abuse. Addict Behav. 2007; 32(7):1331-46.
52. Kulesza M, Watkins KE, Ober AJ, Osilla KC, Ewing B. Internalized stigma as an independent risk factor for substance use problems among primary care patients: Rationale and preliminary support. Drug Alcohol Depend. 2017; 180(1):52-5.
53. Brown SA, Kramer K, Lewno B, Dumas L, Sacchetti G, Powell E. Correlates of self-stigma among individuals with substance use problems. Int J Ment Health Addiction. 2015; 13(6):687-98.
54. Boekel LC, Brouwers EP, Weeghel J, Garretsen HF. Experienced and anticipated discrimination reported by individuals in treatment for substance use disorders within the Netherlands. Health Soc Care Community. 2015; 24(5):e23-33. doi:10.1111/hsc.122
55. Meyer IH. Prejudice as stress: conceptual and measurement problems. Am J Public Health. 2003; 93(2):262-5.
56. Skosireva A, O’Campo P, Zerger S, Chambers C, Gapka S, Stergiopoulos V. Different faces of discrimination: perceived discrimination among homeless adults with mental illness in healthcare settings. BMC Health Serv Res. 2014; 14(1):376.
57. Fanale CM, Maarhuis P, Wright BR, Caffrey K. The effect of attitudinal barriers to mental health treatment on cannabis use and mediation through coping motives. Addict Behav. 2017; 69(1):35-41.
58. Semple SJ, Grant I, Patterson TL. Utilization of drug treatment programs by methamphetamine users: the role of social stigma. Am J Addiction. 2005; 14(4):367-80.
59. Livingston JD, Boyd JE. Correlates and consequences of internalized stigma for people living with mental illness: A systematic review and meta-analysis. Soc Sci Med. 2010; 71(12):2150-61.
60. Kendler KS, Ohlsson H, Edwards AC, Sundquist J, Sundquist K. A developmental etiological model for drug abuse in men. Drug Alcohol Depend. 2017; 179(1):220-8.
61. Room R. Stigma, social inequality and alcohol and drug use. Drug Alcohol Rev. 2005; 24(2):143-55.
62. Pinto-Meza A, Moneta MV, Alonso J, Angermeyer MC, Bruffaerts R, De Almeida JMC, et al. Social inequalities in mental health: results from the EU contribution to the World Mental Health Surveys Initiative. Soc Psychiatry Psychiatr Epidemiol. 2013; 48(2):173-81.
63. Kendler KS, Sundquist K, Ohlsson H, Palmér K, Maes H, Winkleby MA, et al. Genetic and familial environmental influences on the risk for drug abuse: A National Swedish Adoption Study. Arch Gen Psychiatry. 2012; 69(7):690-7.
64. Abeldaño RA, Fernández AR, Ventura CA. Estario JC. Consumo de sustancias psicoactivas en dos regiones argentinas y su relación con indicadores de pobreza. Cad Saúde Pública. 2013; 29(5):899-908.
65. Delker E, Brown Q, Hasin D. Epidemiological studies of substance dependence and abuse in adults. Curr Behav Neurosci Report. 2015; 2(1):15-22.
66. Becoña E. La adicción “no” es una enfermedad cerebral. Papel Psicol. 2016; 37(2):118-25.
67. Kendler KS, Ohlsson H, Sundquist K, Sundquist J. The rearing environment and risk for drug abuse: a Swedish national high-risk adopted and not adopted co-sibling control study. Psychol Med. 2016; 46(7):1359-66.
68. Hall W, Carter A, Forlini C. The brain disease model of addiction: is it supported by the evidence and has it delivered on its promises? Lancet Psychiatry. 2015; 2(1):105-10.
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