Trastorno por uso de sustanciastipologías diagnósticas, complicaciones y adherencia al tratamiento. Estudio prospectivo en una unidad de conductas adictivas

Resumen

Objectives: Recognize the rate of admissions to treatment in the Addictive Behavior Unit (UCA) of Orihuela. Describe and rate the adherence to treatment and therapeutic success rates, as well as the relationships between these variables. Describe and compare the diagnostic typologies, according to the types of Substance Use Disorder (TUS) diagnosis, dual pathology, number of substances consumed, adherence and therapeutic success. Recognize the relationship between the different studied variables and the long-term complications of TUS (development of neurological disorders and/or mental comorbidity). Recognize the predictive capacity of the independent variables: adherence to treatment, success rate in treatment, type of TUS diagnosis, number of substances and dual pathology, with respect to dependent variables: long-term success rate (relapse in long-term consumption), subsequent development of neurological disorders and/or mental comorbidity. Method: Sample composed of 3531 subject (men and women between 11-79 years old) with Substance Use Disorder (TUS) attended at the UCA between the years 1998 and 2014. The different variables were evaluated through careful study of the Clinical Stories of those subject. The level of significance used in all the analyzes was p<.05. Results: There exists a stable rate of admissions to treatment. Only 35% of patients maintained high adherence to treatment and only 18% finished it. Adherence was positively associated with therapeutic success in treatment and negatively with relapse in long-term use. 42% of the subjects were polyconsumed and 38% showed dual pathology. All substances are associated in a similar way with the adherence to treatment, the therapeutic success rate and the relapse in long-term consumption. Polydrug use and dual pathology were negatively associated with adherence to treatment and therapeutic success, and positively with relapse in long-term use. While adherence to treatment and therapeutic success were negatively associated with contact with neurology and/or with the development of mental comorbidity, polydrug and dual pathology did so positively and the type of substance did not prove to be significant. The high adherence to the treatment was the predictor with greater weight for the success rate in the treatment, while the success rate in the treatment was for the relapse in the long-term consumption and the low adherence for the contact with Neurology and/or development of mental comorbidity. Conclusions: There is a clear need to increase levels of adherence to treatment of TUS with the ultimate goal of achieving a better success rate in treatment, a lower probability of recurrence of TUS and a more favorable recovery that reduces risk of contact with Neurology and/or development of mental comorbidity. This could be achieved by designing therapeutic interventions aimed at minimizing polydrug use and dual pathology, also taking into account the main type of substance consumed. These interventions could help to reduce the high health, economic and social costs that this type of patients require, thus decreasing the rates of treatment abandonment and increasing the use of available resources.