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Problema de Salud AUGE N°53

Consumo perjudicial y Dependencia de Alcohol y otras Drogas en personas menores de 20 años

r1-2018

En personas menores de 20 años con consumo perjudicial o dependencia de alcohol o drogas, el Ministerio de Salud SUGIERE realizar intervención motivacional de “enganche” previo al inicio de tratamiento.
Comentarios del panel:
►La intervención motivacional esta descrita en la Guía de intervención motivacional (ver documento)

El Panel de Expertos analizó y debatió cada uno de las preguntas de la “Tabla de la evidencia a la decisión”, considerando tanto la evidencia de investigación, experiencia clínica, conocimiento de gestión o experiencia de los pacientes. Una vez consensuada la postura del panel respecto a las preguntas, emitieron un juicio seleccionando la opción de respuesta que mejor representaba la opinión del conjunto (destacada con color). Finalmente cuando el panel emitió su juicio sobre todas las preguntas, se emitió la recomendación.

A continuación se presenta la “Tabla de la evidencia a la decisión” con el resumen de los juicios, la evidencia de investigación evaluada, consideraciones adicionales y comentarios planteados por el panel.

 1.- ¿El problema es una prioridad?
No Probablemente no Probablemente sí Varía No lo sé

El problema ha sido definido como prioritario en el marco de las Garantías Explícitas en Salud (GES), régimen integral de salud que prioriza un grupo de patologías o problemas de salud, garantizando el acceso a tratamiento oportuno y de calidad.

 2.- ¿Qué tan significativos son los efectos deseables anticipados?
Trivial Pequeño Moderado Grande Varía No lo sé

Moderados: El panel de expertos consideró que los efectos deseables de realizar intervención motivacional son moderados, en función de la evidencia de investigación, experiencia clínica, conocimiento de gestión o experiencia de los pacientes.

Consideraciones adicionales

El panel considera que la entrevista motivacional genera vínculos para adherir al tratamiento, siendo este el outcome que consideran más importante.

Evidencia de investigación

Tabla de Resumen de Resultados (Summary of Findings)

Intervención motivacional en personas menores de 20 años con trastornos por uso de alcohol y drogas

Pacientes

En personas menores de 20 años con trastornos por uso de alcohol y otras drogas.

Intervención

Realizar intervención motivacional.

Comparación

No realizar intervención motivacional.

Desenlaces

Efecto relativo

(IC 95%)

Estudios/

pacientes

Efecto

Certeza de la evidencia

(GRADE)

Mensajes clave en términos sencillos

Adherencia al tratamiento**

4 ensayos en una revisión sistemática/ 1354 pacientes

[140] 

DME*: 0,11 menos 

(0,41 a 0,19 más)

◯◯◯1,2,3

Muy baja

Realizar intervención motivacional podría tener poca diferencia en la adherencia al tratamiento en comparación a no realizar. Sin embargo, existe considerable incertidumbre dado que la certeza de la evidencia es muy baja.

Libre de uso de sustancias***

(Seguimiento de 6 a 12 meses)

5 ensayos en una revisión sistemática/ 890 pacientes

[140] 

 

DME*: 0,08 más 

(0,05 a 0,21 más)

⊕⊕◯◯1,2

Baja

Realizar intervención motivacional podría tener poca diferencia en el uso de sustancias a mediano plazo en comparación a no realizar, pero la certeza de la evidencia es baja.

DME: Diferencia de medias estandarizada.
GRADE: Grados de evidencia Grading of Recommendations Assessment, Development and Evaluation.
* La diferencia de medias estandarizada se utiliza cuando el desenlace ha sido medido en diferentes escalas y es difícil de interpretar clínicamente. Una regla general es que valores menores a 0,2 son de poca relevancia clínica, valores de 0,5 de relevancia moderada y 0,8 relevancia clínica importante.
** La adherencia o retención del tratamiento fue medido en días de asistencia a las sesiones en relación al número total de sesiones de tratamiento.
*** La proporción de abuso de sustancias fue medido en días de abstinencia de alcohol y drogas en relación al tiempo total de seguimiento.
1 Se disminuyó un nivel de certeza de evidencia por riesgo de sesgo ya que varios ensayos no fueron ciegos y no está claro o no es adecuada la generación de secuencia de aleatorización y ocultamiento de ésta.
2 Se disminuyó un nivel de certeza de evidencia por ser indirecta, ya que la estimación proviene de pacientes adultos.
3 Se disminuyó un nivel de certeza por inconsistencia, ya que existen diferencias entre los resultados de los distintos estudios incluidos y presenta un i2 alto.
Fecha de elaboración de la tabla: Diciembre, 2018.

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112. Stein LA, Clair M, Lebeau R, Colby SM, Barnett NP, Golembeske C, Monti PM. Motivational interviewing to reduce substance-related consequences: effects for incarcerated adolescents with depressed mood. Drug and alcohol dependence. 2011;118(2-3):475-8. www.epistemonikos.org/en/documents/ed8a31b1f667055dfb415d29c510396193faae39
113. Stein LA, Monti PM, Colby SM, Barnett NP, Golembeske C, Lebeau-Craven R, Miranda R. Enhancing Substance Abuse Treatment Engagement in Incarcerated Adolescents. Psychological services. 2006;3(1):25-34. www.epistemonikos.org/en/documents/004044ca45560ef8708038ae9849856c1f4906f8
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115. Suffoletto B, Kristan J, Chung T, Jeong K, Fabio A, Monti P, Clark DB. An Interactive Text Message Intervention to Reduce Binge Drinking in Young Adults: A Randomized Controlled Trial with 9-Month Outcomes. PloS one. 2015;10(11):e0142877. www.epistemonikos.org/en/documents/60625f4d956b4f75f36bb0d6b7caf530e0acab57
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120. Thrush C, Wiers RW, Moerbeek M, Ames SL, Grenard JL, Sussman S, Stacy AW.. Influence of motivational interviewing on explicit and implicit alcohol‐related cognition and alcohol use in at‐risk adolescents. Psychology of Addictive Behaviors. 2009;23(1):146-51. www.epistemonikos.org/en/documents/c1bde28059a05433eafdb45c2a471f28ab866101
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Búsqueda y Síntesis de Evidencia

 3.- ¿Qué tan significativos son los efectos indeseables anticipados?
Grande Moderado Pequeño Trivial Varía No lo sé

Pequeños: El panel de expertos consideró que los efectos indeseables de realizar intervención motivacional son pequeños, en función de la evidencia de investigación, experiencia clínica, conocimiento de gestión o experiencia de los pacientes.

Consideraciones Adicionales

No se reportaron eventos adversos asociado al uso de bastón con un punto de apoyo en la evidencia seleccionada.

Evidencia de investigación

Tabla de Resumen de Resultados (Summary of Findings)

Intervención motivacional en personas menores de 20 años con trastornos por uso de alcohol y drogas

Pacientes

En personas menores de 20 años con trastornos por uso de alcohol y otras drogas.

Intervención

Realizar intervención motivacional.

Comparación

No realizar intervención motivacional.

Desenlaces

Efecto relativo

(IC 95%)

Estudios/

pacientes

Efecto

Certeza de la evidencia

(GRADE)

Mensajes clave en términos sencillos

Adherencia al tratamiento**

4 ensayos en una revisión sistemática/ 1354 pacientes

[140] 

DME*: 0,11 menos 

(0,41 a 0,19 más)

◯◯◯1,2,3

Muy baja

Realizar intervención motivacional podría tener poca diferencia en la adherencia al tratamiento en comparación a no realizar. Sin embargo, existe considerable incertidumbre dado que la certeza de la evidencia es muy baja.

Libre de uso de sustancias***

(Seguimiento de 6 a 12 meses)

5 ensayos en una revisión sistemática/ 890 pacientes

[140] 

 

DME*: 0,08 más 

(0,05 a 0,21 más)

⊕⊕◯◯1,2

Baja

Realizar intervención motivacional podría tener poca diferencia en el uso de sustancias a mediano plazo en comparación a no realizar, pero la certeza de la evidencia es baja.

DME: Diferencia de medias estandarizada.
GRADE: Grados de evidencia Grading of Recommendations Assessment, Development and Evaluation.
* La diferencia de medias estandarizada se utiliza cuando el desenlace ha sido medido en diferentes escalas y es difícil de interpretar clínicamente. Una regla general es que valores menores a 0,2 son de poca relevancia clínica, valores de 0,5 de relevancia moderada y 0,8 relevancia clínica importante.
** La adherencia o retención del tratamiento fue medido en días de asistencia a las sesiones en relación al número total de sesiones de tratamiento.
*** La proporción de abuso de sustancias fue medido en días de abstinencia de alcohol y drogas en relación al tiempo total de seguimiento.
1 Se disminuyó un nivel de certeza de evidencia por riesgo de sesgo ya que varios ensayos no fueron ciegos y no está claro o no es adecuada la generación de secuencia de aleatorización y ocultamiento de ésta.
2 Se disminuyó un nivel de certeza de evidencia por ser indirecta, ya que la estimación proviene de pacientes adultos.
3 Se disminuyó un nivel de certeza por inconsistencia, ya que existen diferencias entre los resultados de los distintos estudios incluidos y presenta un i2 alto.
Fecha de elaboración de la tabla: Diciembre, 2018.

Referencias

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86. Larimer ME, Turner AP, Anderson BK, Fader JS, Kilmer JR, Palmer RS, Cronce JM. Evaluating a brief alcohol intervention with fraternities. Journal of studies on alcohol. 2001;62(3):370-80. www.epistemonikos.org/en/documents/ce5250581ede9883985aae2ffe2f9b8ee1df1f74
87. Lipkus IM, McBride CM, Pollak KI, Schwartz-Bloom RD, Tilson E, Bloom PN. A randomized trial comparing the effects of self-help materials and proactive telephone counseling on teen smoking cessation. Health psychology : official journal of the Division of Health Psychology, American Psychological Association. 2004;23(4):397-406. www.epistemonikos.org/en/documents/ce678e69a0ea2a31e3ab9a7caeca233cd1d788bd
88. Marsden J, Stillwell G, Barlow H, Boys A, Taylor C, Hunt N, Farrell M. An evaluation of a brief motivational intervention among young ecstasy and cocaine users: no effect on substance and alcohol use outcomes. Addiction (Abingdon, England). 2006;101(7):1014-26. www.epistemonikos.org/en/documents/32a2d3d946295c19935c1aac07320f423441fc84
89. Martens MP, Smith AE, Murphy JG. The efficacy of single-component brief motivational interventions among at-risk college drinkers. Journal of consulting and clinical psychology. 2013;81(4):691-701. www.epistemonikos.org/en/documents/df931b2940dfc011ea87a801c3d7e71b079dbb2f
90. Martin G, Copeland J. The adolescent cannabis check-up: randomized trial of a brief intervention for young cannabis users. Journal of substance abuse treatment. 2008;34(4):407-14. www.epistemonikos.org/en/documents/e5bea7a4c73bafa62ed22b53c71d6b04d185dcba
91. Mason M, Pate P, Drapkin M, Sozinho K. Motivational interviewing integrated with social network counseling for female adolescents: a randomized pilot study in urban primary care. Journal of substance abuse treatment. 2011;41(2):148-55. www.epistemonikos.org/en/documents/de8113a43fb27f6a1f764ad3798491c53fdf65d4
92. McCambridge J, Hunt C, Jenkins RJ, Strang J. Cluster randomised trial of the effectiveness of motivational interviewing for universal prevention. Drug and alcohol dependence. 2011;114(2-3):177-84. www.epistemonikos.org/en/documents/3a65fe3c4ad720995284d038f407d156910f0d4e
93. McCambridge J, Slym RL, Strang J. Randomized controlled trial of motivational interviewing compared with drug information and advice for early intervention among young cannabis users. Addiction (Abingdon, England). 2008;103(11):1809-18. www.epistemonikos.org/en/documents/8ac3523ac7e7df051cfbd706e8519a17ff2fbccb
94. McNally AM, Palfai TP, Kahler CW. Motivational interventions for heavy drinking college students: examining the role of discrepancy-related psychological processes. Psychology of addictive behaviors : journal of the Society of Psychologists in Addictive Behaviors. 2005;19(1):79-87. www.epistemonikos.org/en/documents/ad6f7a835ce7c5fa40676f3c1ab5506830db1e1e
95. Michael, Kurt D., Curtin, Lisa, Kirkley, Dale E., Jones, Dan L., Harris Jr., Rafael. Group-based motivational interviewing for alcohol use among college students: An exploratory study. Professional Psychology: Research and Practice. 2006;37(6):629-634. www.epistemonikos.org/en/documents/1328528fea84144988c47abd8ae128934802dea9
96. Monti PM, Colby SM, Barnett NP, Spirito A, Rohsenow DJ, Myers M, Woolard R, Lewander W. Brief intervention for harm reduction with alcohol-positive older adolescents in a hospital emergency department. Journal of consulting and clinical psychology. 1999;67(6):989-94. www.epistemonikos.org/en/documents/f9ccbf18bd9ae9ab6e490badd9b728b042c3c6b7
97. Mullins SM, Suarez M, Ondersma SJ, Page MC. The impact of motivational interviewing on substance abuse treatment retention: a randomized control trial of women involved with child welfare. Journal of substance abuse treatment. 2004;27(1):51-8. www.epistemonikos.org/en/documents/e794adbaea826fcb561137e8df57c285a6663a46
98. Murphy DA, Chen X, Naar-King S, Parsons JT, Adolescent Trials Network. Alcohol and marijuana use outcomes in the Healthy Choices motivational interviewing intervention for HIV-positive youth. AIDS patient care and STDs. 2012;26(2):95-100. www.epistemonikos.org/en/documents/2d1fa34a7bf5ab2b245e445ee48f15a6870b7076
99. Murphy JG, Dennhardt AA, Skidmore JR, Martens MP, McDevitt-Murphy ME. Computerized versus motivational interviewing alcohol interventions: impact on discrepancy, motivation, and drinking. Psychology of addictive behaviors : journal of the Society of Psychologists in Addictive Behaviors. 2010;24(4):628-39. www.epistemonikos.org/en/documents/101e76f02c6b6144a3c853e381a00afa8071d5f0
100. Murphy JG, Benson TA, Vuchinich RE, Deskins MM, Eakin D, Flood AM, McDevitt-Murphy ME, Torrealday O. A comparison of personalized feedback for college student drinkers delivered with and without a motivational interview. Journal of studies on alcohol. 2004;65(2):200-3. www.epistemonikos.org/en/documents/9c1190fd065df697c76bcf1ab31df1216bb191ce
101. Murphy JG, Dennhardt AA, Skidmore JR, Borsari B, Barnett NP, Colby SM, Martens MP. A randomized controlled trial of a behavioral economic supplement to brief motivational interventions for college drinking. Journal of consulting and clinical psychology. 2012;80(5):876-86. www.epistemonikos.org/en/documents/3c52c9a6cee2ad56f42ce96b755fe6c819c19fef
102. Murphy JG, Duchnick JJ, Vuchinich RE, Davison JW, Karg RS, Olson AM, Smith AF, Coffey TT. Relative efficacy of a brief motivational intervention for college student drinkers. Psychology of addictive behaviors : journal of the Society of Psychologists in Addictive Behaviors. 2001;15(4):373-9. www.epistemonikos.org/en/documents/1a85e55e5b69216fcc2bd4da6f90d843fa0e6722
103. Nirenberg T, Longabaugh R, Baird J, Mello MJ. Treatment may influence self-report and jeopardize our understanding of outcome. Journal of studies on alcohol and drugs. 2013;74(5):770-6. www.epistemonikos.org/en/documents/d40656960158ac109cbf30423bbf5575412e589c
104. Pbert L, Osganian SK, Gorak D, Druker S, Reed G, O’Neill KM, Sheetz A. A school nurse-delivered adolescent smoking cessation intervention: a randomized controlled trial. Preventive medicine. 2006;43(4):312-20. www.epistemonikos.org/en/documents/0cb2fc64c31e6d4e1fb004288f6bb5da4972bccd
105. Peterson PL, Baer JS, Wells EA, Ginzler JA, Garrett SB. Short-term effects of a brief motivational intervention to reduce alcohol and drug risk among homeless adolescents. Psychology of addictive behaviors : journal of the Society of Psychologists in Addictive Behaviors. 2006;20(3):254-64. www.epistemonikos.org/en/documents/b448acb0e18f181ff8d465e124da502f5b1a07ff
106. Rongkavilit C, Naar-King S, Wang B, Panthong A, Bunupuradah T, Parsons JT, Phonphithak S, Koken JA, Saengcharnchai P, Phanuphak P. Motivational interviewing targeting risk behaviors for youth living with HIV in Thailand. AIDS and behavior. 2013;17(6):2063-74. www.epistemonikos.org/en/documents/4fe13c32db9ed90b011373393ae49c8595f3d180
107. Schaus JF, Sole ML, McCoy TP, Mullett N, O’Brien MC. Alcohol screening and brief intervention in a college student health center: a randomized controlled trial. Journal of studies on alcohol and drugs. Supplement. 2009;(16):131-41. www.epistemonikos.org/en/documents/d7fdc82b000cb3de483ddedd291db5c26102c9f4
108. Segatto ML, Andreoni S, Souza e Silva R, Diehl A, Pinsky I.. Intervenção motivacional breve e brochura educacional em pronto‐socorro para adolescentes e adultos jovens com problemas relacionados ao álcool: um ensaio clínico simples cego randomizado. [Brief motivational interview and educational brochure in emergency room settings for adolescents and young adults with alcohol related problems: a randomized single blind clinical trial]. Revista Brasileira de Psiquiatria. 2010;33(3):225-33. www.epistemonikos.org/en/documents/f9de5e653ae62e34e014288f412f9342ef731e89
109. Spirito A, Monti PM, Barnett NP, Colby SM, Sindelar H, Rohsenow DJ, Lewander W, Myers M. A randomized clinical trial of a brief motivational intervention for alcohol-positive adolescents treated in an emergency department. The Journal of pediatrics. 2004;145(3):396-402. www.epistemonikos.org/en/documents/af439216d2b34eddc080d62748d3bbca017f89be
110. Spirito A, Sindelar-Manning H, Colby SM, Barnett NP, Lewander W, Rohsenow DJ, Monti PM. Individual and family motivational interventions for alcohol-positive adolescents treated in an emergency department: results of a randomized clinical trial. Archives of pediatrics & adolescent medicine. 2011;165(3):269-74. www.epistemonikos.org/en/documents/ea8a25d3e622b1d7c57f23b8743e95637fae5045
111. Stein LA, Colby SM, Barnett NP, Monti PM, Golembeske C, Lebeau-Craven R. Effects of motivational interviewing for incarcerated adolescents on driving under the influence after release. The American journal on addictions / American Academy of Psychiatrists in Alcoholism and Addictions. 2006;15 Suppl 1:50-7. www.epistemonikos.org/en/documents/6054e90102759d335fc7ca8342252cae4c967f21
112. Stein LA, Clair M, Lebeau R, Colby SM, Barnett NP, Golembeske C, Monti PM. Motivational interviewing to reduce substance-related consequences: effects for incarcerated adolescents with depressed mood. Drug and alcohol dependence. 2011;118(2-3):475-8. www.epistemonikos.org/en/documents/ed8a31b1f667055dfb415d29c510396193faae39
113. Stein LA, Monti PM, Colby SM, Barnett NP, Golembeske C, Lebeau-Craven R, Miranda R. Enhancing Substance Abuse Treatment Engagement in Incarcerated Adolescents. Psychological services. 2006;3(1):25-34. www.epistemonikos.org/en/documents/004044ca45560ef8708038ae9849856c1f4906f8
114. Stein LA, Lebeau R, Colby SM, Barnett NP, Golembeske C, Monti PM. Motivational interviewing for incarcerated adolescents: effects of depressive symptoms on reducing alcohol and marijuana use after release. Journal of studies on alcohol and drugs. 2011;72(3):497-506. www.epistemonikos.org/en/documents/48aad71ee5663ab919192d430286256449586840
115. Suffoletto B, Kristan J, Chung T, Jeong K, Fabio A, Monti P, Clark DB. An Interactive Text Message Intervention to Reduce Binge Drinking in Young Adults: A Randomized Controlled Trial with 9-Month Outcomes. PloS one. 2015;10(11):e0142877. www.epistemonikos.org/en/documents/60625f4d956b4f75f36bb0d6b7caf530e0acab57
116. Suffoletto B, Kristan J, Callaway C, Kim KH, Chung T, Monti PM, Clark DB. A text message alcohol intervention for young adult emergency department patients: a randomized clinical trial. Annals of emergency medicine. 2014;64(6):664-72.e4. www.epistemonikos.org/en/documents/6ebabb1221fcd2e432c17ccb713fbae894b2a030
117. Sussman S, Sun P, Rohrbach LA, Spruijt-Metz D. One-year outcomes of a drug abuse prevention program for older teens and emerging adults: evaluating a motivational interviewing booster component. Health psychology : official journal of the Division of Health Psychology, American Psychological Association. 2012;31(4):476-85. www.epistemonikos.org/en/documents/88e24cf965d9ec194f8c3229de59860153961f50
118. Terlecki M.. The Long‐term Effect of a Brief Motivational Alcohol Intervention for Heavy Drinking Mandated College Students [PhD thesis]. Louisiana State University and Agricultural and Mechanical College. 2010; www.epistemonikos.org/en/documents/ca0eeeafb06d36eec76ebba9e380d3ac4ea60ae0
119. Tevyaw TO, Borsari B, Colby SM, Monti PM. Peer enhancement of a brief motivational intervention with mandated college students. Psychology of addictive behaviors : journal of the Society of Psychologists in Addictive Behaviors. 2007;21(1):114-9. www.epistemonikos.org/en/documents/e93d773348b98a677e9cd8596763c3c3bd105c3a
120. Thrush C, Wiers RW, Moerbeek M, Ames SL, Grenard JL, Sussman S, Stacy AW.. Influence of motivational interviewing on explicit and implicit alcohol‐related cognition and alcohol use in at‐risk adolescents. Psychology of Addictive Behaviors. 2009;23(1):146-51. www.epistemonikos.org/en/documents/c1bde28059a05433eafdb45c2a471f28ab866101
121. Thush C, Wiers RW, Moerbeek M, Ames SL, Grenard JL, Sussman S, Stacy AW. Influence of motivational interviewing on explicit and implicit alcohol-related cognition and alcohol use in at-risk adolescents. Psychology of addictive behaviors : journal of the Society of Psychologists in Addictive Behaviors. 2009;23(1):146-51. www.epistemonikos.org/en/documents/1cce7962c6eb67faf5046aa072f79b1b7cd3c18c
122. Turrisi R, Larimer ME, Mallett KA, Kilmer JR, Ray AE, Mastroleo NR, Geisner IM, Grossbard J, Tollison S, Lostutter TW, Montoya H. A randomized clinical trial evaluating a combined alcohol intervention for high-risk college students. Journal of studies on alcohol and drugs. 2009;70(4):555-67. www.epistemonikos.org/en/documents/70c89ea4c0f1003e8c55cbbce05031b104472345
123. Vader AM, Walters ST, Prabhu GC, Houck JM, Field CA. The language of motivational interviewing and feedback: counselor language, client language, and client drinking outcomes. Psychology of addictive behaviors : journal of the Society of Psychologists in Addictive Behaviors. 2010;24(2):190-7. www.epistemonikos.org/en/documents/7c4de7c1ee7d553812236fb969b78151b05f625a
124. Wagener TL, Leffingwell TR, Mignogna J, Mignogna MR, Weaver CC, Cooney NJ, Claborn KR. Randomized trial comparing computer-delivered and face-to-face personalized feedback interventions for high-risk drinking among college students. Journal of substance abuse treatment. 2012;43(2):260-7. www.epistemonikos.org/en/documents/383e999fc147f80406f156a3dd02ac32587e629c
125. Waldron HB, Slesnick N, Brody JL, Turner CW, Peterson TR. Treatment outcomes for adolescent substance abuse at 4- and 7-month assessments. Journal of consulting and clinical psychology. 2001;69(5):802-13. www.epistemonikos.org/en/documents/96b8f69b8de8c5a179ef145f9cc9f87f2257c507
126. Walker DD, Roffman RA, Picciano JF, Stephens RS. The check-up: in-person, computerized, and telephone adaptations of motivational enhancement treatment to elicit voluntary participation by the contemplator. Substance abuse treatment, prevention, and policy. 2007;2:2. www.epistemonikos.org/en/documents/955ab05aadee0ad7109e0283384d841f45ae3668
127. Walker DD, Roffman RA, Stephens RS, Wakana K, Berghuis J, Kim W. Motivational enhancement therapy for adolescent marijuana users: a preliminary randomized controlled trial. Journal of consulting and clinical psychology. 2006;74(3):628-32. www.epistemonikos.org/en/documents/aa240272ae9b03c8e2152b0d5f1b5f001694afa4
128. Walker DD, Stephens R, Roffman R, Demarce J, Lozano B, Towe S, Berg B. Randomized controlled trial of motivational enhancement therapy with nontreatment-seeking adolescent cannabis users: a further test of the teen marijuana check-up. Psychology of addictive behaviors : journal of the Society of Psychologists in Addictive Behaviors. 2011;25(3):474-84. www.epistemonikos.org/en/documents/31c1605eb8473805d03dba29df4b9d377ebb7509
129. Walters ST, Bennett ME, Miller JH. Reducing alcohol use in college students: a controlled trial of two brief interventions. Journal of drug education. 2000;30(3):361-72. www.epistemonikos.org/en/documents/d21db5bb543c87720a66e29bb5948bdf81c60e3e
130. Wilke, D J, Mennicke, A, Howell, R L, Magnuson, A B. A Peer-Facilitated Intervention to Reduce Risky Drinking Among Fraternity and Sorority Members. Journal of Social Work Practice in the Addictions. 2014;14(1):42-63. www.epistemonikos.org/en/documents/ecd93a581693cd62efa9c2041376e3a8fc01cd8e
131. Winters KC, Leitten W. Brief intervention for drug-abusing adolescents in a school setting. Psychology of addictive behaviors : journal of the Society of Psychologists in Addictive Behaviors. 2007;21(2):249-54. www.epistemonikos.org/en/documents/a5ff93372125d0ba4d9073405051758a920a20e9
132. Wood MD, Fairlie AM, Fernandez AC, Borsari B, Capone C, Laforge R, Carmona-Barros R. Brief motivational and parent interventions for college students: a randomized factorial study. Journal of consulting and clinical psychology. 2010;78(3):349-61. www.epistemonikos.org/en/documents/47299c1e4b2385abdbd153dac77b14609eb4aa4f
133. Gray E, McCambridge J, Strang J. The effectiveness of motivational interviewing delivered by youth workers in reducing drinking, cigarette and cannabis smoking among young people: quasi-experimental pilot study. Alcohol and alcoholism (Oxford, Oxfordshire). 2005;40(6):535-9.
134. LaBrie JW, Thompson AD, Huchting K, Lac A, Buckley K. A group Motivational Interviewing intervention reduces drinking and alcohol-related negative consequences in adjudicated college women. Addictive behaviors. 2007;32(11):2549-62.
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139. Hungerford DW, Williams JM, Furbee PM, Manley WG, Helmkamp JC, Horn K, Pollock DA. Feasibility of screening and intervention for alcohol problems among young adults in the ED. The American journal of emergency medicine. 2003;21(1):14-22.
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Búsqueda y Síntesis de Evidencia

 4.- ¿Cuál es la certeza general de la evidencia sobre efectos?
Muy baja Baja Moderada Alta Ningún estudio incluido

Muy Baja: Existe considerable incertidumbre respecto del efecto de realizar intervención motivacional.

Evidencia de investigación

Desenlaces

Importancia

Certeza de la evidencia

 (GRADO)

Adherencia al tratamiento

CRÍTICO

    

MUY BAJA a, b, c

Libre de uso de sustancias

IMPORTANTE

    

BAJA a, c

a. Se redujo el nivel de certeza de evidencia de riesgo de sesgo y de que varios ensayos no fueron ciegos y no está claro o no es adecuado para la generación de la secuencia de aleatorización y ocultamiento de esta.
b. Se ha reducido el nivel de certeza por la inconsistencia, y se tiene que ver con los resultados de los distintos estudios incluidos.
c. Se ha reducido el nivel de certeza de la evidencia por ser indirecta, y se ha llegado a la conclusión.

 5.- ¿Hay incertidumbre importante o variabilidad sobre qué tanto valora la gente los desenlaces principales?
Incertidumbre o variabilidad importantes Posiblemente hay incertidumbre o variabilidad importantes Probablemente no hay incertidumbre ni variabilidad importantes No hay variabilidad o incertidumbre importante

Probablemente no hay incertidumbre ni variabilidad importantes: El panel de expertos consideró que probablemente no hay incertidumbre ni variabilidad importantes respecto a lo que la mayoría de los pacientes podrían llegar a elegir, en función de la evidencia de investigación, experiencia clínica, conocimiento de gestión o experiencia de los pacientes.

Consideraciones Adicionales

EI panel concuerda en que una intervención corta puede ser beneficiosa, y que los pacientes aceptarían una intervención breve.

Evidencia de investigación

Se identificó un estudio (1 ) que describe una intervención breve de entrevistas motivacionales en atención primaria para reducir el consumo de alcohol y marihuana en adolescentes de 12 a 18 años de edad en situación de riesgo.
Se llevó a cabo un ensayo controlado aleatorio en 4 clínicas de atención primaria desde abril de 2013 hasta noviembre de 2015 para determinar el efecto de una intervención (entrevista motivacional de 15 minutos) relacionada con alcohol y marihuana.
Aquellos identificados como en riesgo fueron asignados al azar a la intervención o a atención habitual. Los adolescentes completaron 4 encuestas: de línea de base y a los 3, 6 y 12 meses.
La muestra (n=294) fue 58% femenina, con edad promedio de 16 años.
En comparación con los adolescentes de la atención usual, los adolescentes de la intervención motivacional informaron un consumo significativamente menor de alcohol y marihuana entre los tres meses siguientes (alcohol: p <.0001; marihuana p = .01) y 6 meses (alcohol: p = .04; marihuana p = .04). Estos adolescentes también informaron menos consecuencias negativas asociadas a alcohol experimentadas a los 6 meses (p = .08). A los 12 meses, en comparación con la atención habitual, los adolescentes de la intervención motivacional informaron menor consumo de alcohol (p = .04) y marihuana (p <.01) entre pares y que el consumo de alcohol (p = .03) y marihuana (p = .04) tuvieron menos consecuencias negativas. Una breve intervención motivacional entregada en atención primaria redujo las consecuencias negativas del consumo de alcohol y marihuana un año después. Los hallazgos enfatizan que los adolescentes pueden beneficiarse de las intervenciones en atención primaria que abordan de manera breve y efectiva el consumo de alcohol y marihuana.

Referencia
1. D’Amico EJ, Parast L, Shadel WG, Meredith LS, Seelam R, Stein BD. Brief motivational interviewing intervention to reduce alcohol and marijuana use for at-risk adolescents in primary care. J Consult Clin Psychol. 2018 Sep;86(9):775-786.

Búsqueda y Síntesis de Evidencia

 6.- El balance entre efectos deseables e indeseables favorece la intervención o la comparación?
Favorece la comparación Probablemente favorece la comparación No favorece la intervención ni la comparación Probablemente favorece la intervención Favorece la intervención Varía No lo sé

Favorece la intervención: Considerando que la intervención es «realizar intervención motivacional» y la comparación es «no realizar», el panel de experto opinó que el balance entre efectos deseables e indeseables claramente favorece realizar intervención motivacional.

 7.- ¿Qué tan grandes son los recursos necesarios (costos)?
Costos extensos Costos moderados Costos y ahorros despreciables Ahorros moderados Ahorros extensos Varía No lo sé

Costos y ahorros despreciables: El panel de expertos consideró que para implementar la intervención realizar intervención motivacional no implica ni recursos ni ahorros significativos, en función de los antecedentes recolectados, experiencia clínica, conocimiento de gestión o experiencia de los pacientes.

Evidencia de investigación

Tabla. Precios referenciales*

Ítem

Realizar intervención motivacional

No realizar intervención motivacional

Consulta de psiquiatría

 

$ 7.8001

—–

Consulta o control por psicólogo clínico

 

$3.0601

—–

Consulta o control por enfermera, matrona o nutricionista 

1.2501

—–

 

Consulta de salud mental por otros profesionales 

$3.0601

—–

 

 

Rango: $ 1.250-$7.800

—–

*El porcentaje de cobertura del seguro de salud sobre el precio de la(s) prestación (es) sanitaria(s), dependerá del tipo de seguro de cada paciente.

Referencias:
1. Arancel MAI, 2018

Búsqueda y Síntesis de Evidencia

 8.- ¿La costo-efectividad de la intervención beneficia la intervención o la comparación?
Favorece la comparación Probablemente favorece la comparación No favorece la intervención ni la comparación Probablemente favorece la intervención Favorece la intervención Varía Ningún estudio incluido

Ningún estudio incluido: No se realizó búsqueda de estudios que abordaran costo-efectividad, debido a que esta búsqueda se realiza sólo cuando la intervención es considerada un tratamiento o diagnóstico de alto costo (1).

Ministerio de Salud. Decreto 80: Determinar umbral nacional de costo anual al que se refiere el artículo 6° de la Ley 20.850 [Internet]. Santiago; 2015 Nov.

 9.- ¿Cuál sería el impacto en equidad en salud?
Reducido Probablemente reducido Probablemente ningún impacto Probablemente aumentado Aumentado Varía No lo sé

Probablemente ningún impacto: El panel de expertos consideró que probablemente no tendría ningún impacto en la equidad en salud si se recomendase realizar intervención motivacional.

Consideraciones Adicionales

Existen grupos que no acuden a servicios de salud.
En algunos lugares no está disponible.
No siempre está disponible una persona entrenada que realice esta intervención.

 10.- ¿La intervención es aceptable para las partes interesadas?
No Probablemente no Probablemente sí Varía No lo sé

Sí: El panel de expertos consideró que realizar intervención motivacional SÍ es aceptable para las partes interesadas (profesionales de la salud, gestores de centros de salud, directivos servicios de salud, pacientes, cuidadores, seguros de salud, otros).

 11.- ¿Es factible implementar la intervención?
No Probablemente no Probablemente sí Varía No lo sé

Sí: El panel de expertos consideró que realizar intervención motivacional SÍ es factible implementar, contemplando la capacidad de la red asistencial, los recursos humanos disponibles a nivel país, recursos financieros, preferencias de los pacientes, etc.