Trastornos por abuso y dependencia de sustancias en población colombiana: su prevalencia y comorbilidad con otros trastornos mentales seleccionados

Article information

Resumen

Introducción

Poco se conoce sobre la prevalencia de los trastornos por abuso y dependencia de sustancias y su comorbilidad con otros trastornos psiquiátricos en Colombia.

Objetivos

Calcular la prevalencia anual y de vida para uso y trastornos por abuso o dependencia de sustancias y su comorbilidad con trastornos del ánimo, ansiedad e impulsividad.

Método

Analítico, a partir de la información de la Encuesta Nacional de Hogares, que para el diagnóstico de los trastornos psiquiátricos aplicó el CIDI-WHO a 3.896 adultos de 18 a 54 años de edad no institucionalizados y residentes en el área urbana.

Resultados

La prevalencia anual para trastorno por uso de sustancias en los 12 meses anteriores fue de 0,7% y para alguna vez en la vida de 2,4%. En el grupo de trastornos de ansiedad, el estrés postraumático presentó la mayor fuerza de asociación. Entre los trastornos del estado del ánimo, el trastorno afectivo bipolar (TAB) I presentó la asociación más alta. Entre los trastornos del impulso, la asociación más fuerte se encontró con el trastorno de la conducta.

Conclusión

Este estudio sugiere que existe una fuerte asociación entre los trastornos por uso de sustancias y otros trastornos psiquiátricos, como el síndrome de estrés postraumático, el TAB I y trastornos de la conducta. Estos resultados tienen gran importancia clínica y de salud pública.

Palabras clave:

comorbilidad

estudios transversales

oportunidad relativa

trastornos relacionados con sustancias

Abstract

Introduction

Little is known about the prevalence of drug use, abuse and dependence and its comorbility with DSM-IV mental disorders in the general population in Colombia.

Objective

To estimate the lifetime and 12-month prevalence of comorbidities such as anxiety, mood, impulse control, and substance disorders in the Colombia National Comorbidity Survey.

Method

Nationally representative face-to-face household survey conducted using a fully structured diagnostic interview, the World Health Organization World Mental Health Survey Initiative version of the Composite International Diagnostic Interview with 3,896 respondents 18 to 54 years old.

Results

the lifetime and 12-month prevalence of substance use disorders were 0.7% and 2.4%, respectively. An important contribution of this study is the assessment of the associations between substance use disorders and other psychiatric disorders studied. In the anxiety disorders group, post-traumatic stress had the strongest association with substance use disorders. Among mood disorders, bipolar I disorder had the highest association. Among the disorders of impulse, the strongest association found was with conduct disorder.

Conclusion

There is a strong association between substance use disorders and other psychiatric disorders such as post-traumatic stress disorder, bipolar I disorder, and conduct disorder. These results have great clinical and public health relevance.

Key words:

Comorbility

cross-sectional studies

odds ratio

substance-related disorders

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Referencias

[1]

World Drug Report 2009. [Internet] 2009 [citado: 20 mayo 2010].

Disponible en: http://www.cdc.gov/Features/SubstanceAbuse/

[2]

J Posada-Villa, L Gómez, L Gómez.

Estudio Nacional de Salud Mental-Colombia, 2003, Ministerio de la Protección Social, (2005),

[3]

DW Brook, JS Brook, C Zhang, P Cohen, M Whiteman.

Drug use and the risk of major depressive disorder, alcohol dependence, and substance use disorders.

Arch Gen Psychiatry, 59 (2002), pp. 1039-1044

Medline

[4]

European Monitoring Centre for Drugs and Drug Addiction.

Comorbidity-drug use and mental disorders. [Internet] 2010 [citado: 20 mayo 2010].

Disponible en: http://www.emcdda.europa.eu/html.cfm/index36329EN.html

[5]

M Farrell, S Howes, P Bebbington, T Brugha, R Jenkins, G Lewis, et al.

Nicotine, alcohol and drug dependence and psychiatric comorbidity. Results of a national household survey.

Br J Psychiatry, 179 (2001), pp. 432-437

Medline

[6]

Y Torres de Galvis.

Consumo de sustancias psicoactivas: Prevalencia y factores asociados. Resultados de la investigación en jóvenes escolarizados del Departamento de Antioquia 2003. Hallazgos para la prevención, L. Marín Vieco, (2003),

[7]

ID Montoya.

Perspectivas sobre la comorbilidad entre trastornos por uso de sustancias y trastornos psiquiátricos.

Rev Colomb Psiquiatr, 36 (2007), pp. 388-2007

[8]

A Montoya, SC Corrales, ÁM Segura Cardona.

Prevalencia y factores asociados al consumo de sustancias psicoactivas en estudiantes de secundaria municipio de Guatapé, Antioquia.

Investigaciones Andina, 16 (2008), pp. 44-56

[9]

American Psychiatric Association.

Manual diagnóstico y estadístico de los trastornos mentales, Masson, (1995),

[10]

CA Saavedra.

Comorbilidad en dependencia a sustancias.

Psicoactiva 2001, 19 (2004), pp. 63-103

[11]

National Institute on Drug Abuse. Comorbidity: addition and other mental Illnesses. Research report series 2009.

[12]

WM Compton, YF Thomas, FS Stinson, BF Grant.

Prevalence, correlates, disability, and comorbidity of DSM-IV drug abuse and dependence in the United States: results from the national epidemiologic survey on alcohol and related conditions.

Arch Gen Psychiatry, 64 (2007), pp. 566-576

http://dx.doi.org/10.1001/archpsyc.64.5.566 | Medline

[13]

SB Quello, KT Brady, SC Sonne.

Mood disorders and substance use disorder: a complex comorbidity.

Sci Pract Perspect, 3 (2005), pp. 13-21

Medline

[14]

L Weich, W Pienaar.

Occurrence of comorbid substance use disorders among acute psychiatric inpatients at Stikland Hospital in the Western Cape, South Africa.

Afr J Psychiatry, 12 (2009), pp. 213-217

[15]

E Sihvola, RJ Rose, DM Dick, L Pulkkinen, M Marttunen, J Kaprio.

Early-onset depressive disorders predict the use of addictive substances in adolescence: a prospective study of adolescent Finnish twins.

Addiction, 103 (2008), pp. 2045-2053

http://dx.doi.org/10.1111/j.1360-0443.2008.02363.x | Medline

[16]

D Deas.

Adolescent sustance abuse and psychiatric comorbitidies.

J Clin Psychiatry, 67 (2006), pp. 18-23

Medline

[17]

Bipolarweb.

Patología dual: Abuso de sustancias y enfermedad mental. [Internet] 2009 [citado: 20 mayo 2010].

Disponible en: http://www.bipolarweb.com/Articulos/Patologiadual.htm

[18]

MB First.

Mutually exclusive versus co-occurring diagnostic categories: the challenge of diagnostic comorbidity.

Psychopathology, 38 (2005), pp. 206-210

http://dx.doi.org/10.1159/000086093 | Medline

[19]

AJ Arias, J Gelernter, G Chan, RD Weiss, KT Brady, L Farrer, et al.

Correlates of co-occurring ADHD in drug-dependent subjects: prevalence and features of substance dependence and psychiatric disorders.

Addict Behav, 33 (2008), pp. 1199-1207

http://dx.doi.org/10.1016/j.addbeh.2008.05.003 | Medline

[20]

CM Corcoran, D Kimhy, A Stanford, S Khan, J Walsh, J Thompson, et al.

Temporal association of cannabis use with symptoms in individuals at clinical high risk for psychosis.

Schizophr Res, 106 (2008), pp. 286-293

http://dx.doi.org/10.1016/j.schres.2008.08.008 | Medline

[21]

MD Glantz, JC Anthony, PA Berglund, L Degenhardt, L Dierker, A Kalaydjian, et al.

Mental disorders as risk factors for later substance dependence: estimates of optimal prevention and treatment benefits.

Psychol Med, 39 (2009), pp. 1365-1377

http://dx.doi.org/10.1017/S0033291708004510 | Medline

[22]

Guisado JA, Vaz FJ, Fernández-Gil MÁ, Peral PD, López-Ibor JJ. Comorbilidad psiquiátrica en drogodependencias. Psiquiatria.com 2000;4(4). [Internet] 2009 [citado: 20 mayo 2010]; Disponible en: http://www.psiquiatria.com/articulos/adicciones/drogas/2939/

[23]

NR Marmorstein, WG Iacono, M McGue.

Alcohol and illicit drug dependence among parents: associations with offspring externalizing disorders.

Psychol Med, 39 (2009), pp. 149-155

http://dx.doi.org/10.1017/S0033291708003085 | Medline

[24]

J Swendsen, KP Conway, L Degenhardt, L Dierker, M Glantz, R Jin, et al.

Socio-demographic risk factors for alcohol and drug dependence: the 10-year follow-up of the national comorbidity survey.

Addiction, 104 (2009), pp. 1346-1355

http://dx.doi.org/10.1111/j.1360-0443.2009.02622.x | Medline

[25]

T Pereira.

Neurobiología de la adicción.

Rev Psiquiatr Urug, 73 (2008), pp. 9-24

[26]

RC Kessler, TB Ustun.

The World Mental Health (WMH). Survey Initiative Version of the World Health Organization (WHO). Composite International Diagnostic Interview (CIDI).

Int J Methods Psychiat Res, 13 (2004), pp. 93-121

[27]

KP Conway, W Compton, FS Stinson, BF Grant.

Lifetime comorbidity of DSM-IV mood and anxiety disorders and specific drug use disorders: results from the National Epidemiologic Survey on Alcohol and Related Conditions.

J Clin Psychiatry, 67 (2006), pp. 247-257

Medline

[28]

DS Hasin, FS Stinson, E Ogburn, BF Grant.

Prevalence, correlates, disability, and comorbidity of DSM-IV alcohol abuse and dependence in the United States: results from the National Epidemiologic Survey on Alcohol and Related Conditions.

Arch Gen Psychiatry, 64 (2007), pp. 830-842

http://dx.doi.org/10.1001/archpsyc.64.7.830 | Medline

[29]

RC Kessler, WT Chiu, O Demler, KR Merikangas, EE Walters.

Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication.

Arch Gen Psychiatry, 62 (2005), pp. 617-627

http://dx.doi.org/10.1001/archpsyc.62.6.617 | Medline

[30]

O Bukstein.

Substance abuse in patients with attention-deficit/hyperactivity disorder.

Medscape J Med, 10 (2008), pp. 24

Medline

[31]

MD Ohlmeier, K Peters, BT Te Wildt, M Zedler, M Ziegenbein, B Wiese, et al.

Comorbidity of alcohol and substance dependence with attention-deficit/hyperactivity disorder (ADHD).

Alcohol Alcohol, 43 (2008), pp. 300-304

http://dx.doi.org/10.1093/alcalc/agn014 | Medline

[32]

K Shantna, S Chaudhury, AN Verma, AR Singh.

Comorbid psychiatric disorders in substance dependence patients: A control study. Ind.

Psych Journal, 18 (2009), pp. 84-87

[33]

N Breslau, GC Davis, LR Schultz.

Posttraumatic stress disorder and the incidence of nicotine, alcohol, and other drug disorders in persons who have experienced trauma.

Arch Gen Psychiatry, 60 (2003), pp. 289-294

Medline

[34]

M Ferigolo, AT Stein, FD Fuchs, HM Barros.

Influence of depression and early adverse experiences on illicit drug dependence: a case-control study.

Rev Bras Psiquiatr, 31 (2009), pp. 106-113

Medline

[35]

LK Jacobsen, SM Southwick, TR Kosten.

Substance use disorders in patients with posttraumatic stress disorder: a review of the literature.

Am J Psychiatry, 158 (2001), pp. 1184-1190

http://dx.doi.org/10.1176/appi.ajp.158.8.1184 | Medline

[36]

ND Volkow.

Drug abuse and mental illness: progress in understanding comorbidity.

Am J Psychiatry, 158 (2001), pp. 1181-1183

http://dx.doi.org/10.1176/appi.ajp.158.8.1181 | Medline

[37]

R de Graaf, RV Bijl, F Smit, WA Vollebergh, J Spijker.

Risk factors for 12-month comorbidity of mood, anxiety, and substance use disorders: findings from the Netherlands Mental Health Survey and Incidence Study.

Am J Psychiatry, 159 (2002), pp. 620-629

http://dx.doi.org/10.1176/appi.ajp.159.4.620 | Medline

[38]

S Currie, SB Patten, J Williams, J Wang, C Beck, N El-Guebaly, et al.

Comorbidity of major depression with substance use disorders.

Can J Psychiatry, 50 (2005), pp. 660-667

Medline

[39]

L Davis, A Uezato, JM Newell, E Frazier.

Major depression and comorbid substance use disorders.

Curr Opin Psychiatry, 21 (2008), pp. 14-18

http://dx.doi.org/10.1097/YCO.0b013e3282f32408 | Medline