Martínez-Lanz P, Medina-Mora ME, Rivera E

Language: Spanish
References: 18
Page: 17-27
PDF size: 132.74 Kb.

ABSTRACT

Toxic substance abuse is a currently occuring phenomenon in most countries, which severely affects all aspects of health and society. Numerous studies exist on the prevalence of alcohol consumption and drugs focusing on countries and determined population groups. Nevertheless, only a few of them analyze the consumption of these substances within the scope of health professionals.
One of the factors that affect and is affected by alcohol and drug consumption is the performance of individuals regarding their work. Positions related to producing or dealing with alcohol or drugs, thus granting access to the product, as well as the ones which involve high levels of tension or stress involve a greater risk of alcohol and drug consumption by their employees. The problem of alcoholism at work has existed for over 50 years, as reported by Fillmore, K. and Caetano, R., in a study on alcoholism and occupations. However, these reports focus solely on the labor field as an important location to identify alcoholism problems. Considering that medical doctors and health institutions personnel are among those professionals whose field of work favors a greater risk regarding drug and alcohol consumption, the present study analyzes possible risk factors related to this consumption by health professionals.
Alcohol
0Even though several studies have shown since 1960 the high economic costs resulting from alcohol abuse, few have further considered the work environment as a factor associated to alcoholism, when compared to several investigations and studies that account for the psychological, physical and subcultural aspects of alcoholism.
There are three factors that influence the risk levels of alcohol consumption at work:

1. Work conditions in which alcohol is readily available for consumption during labor hours.
2. Considerable peer pressure related to alcohol consumption (sailors, retailers, travellers, etc.).
3. Separation of normal sexual or social relations, that is, when work isolates the individual from his or her interpersonal relations. Drugs
The problem of drug use at work and its consequences is a complex field of study. Several investigations have proved the existence and increase in drug users at work, stating that illegal drug users show a greater tendency than non-users towards constantly shifting between jobs and towards unemployment. However, whether substance abuse is the reason that leads to the separation from a job or if it is the job that leads to the use of drugs is a question that has not been established yet.
Since toxic substance consumption in relation to occupation is related directly to some high risk factors, it is considered that health professionals and employees have a greater risk regarding consumption of these substances and alcohol, since they are subject to three factors of high risk: substance availability, changes in work shifts, and a stressful work environment.
Several studies and investigations carried out in different countries have considered the relation between stress, dependency on alcohol and/or drugs with a deterioration in work performance. Numerous studies also exist on the prevalence of alcohol consumption and drugs focusing on countries and selected population groups. Nevertheless, few of these analyze the consumption of these substances within health-related work environments.
Methodology
The present work is an ex post facto design study, carried out at a general hospital belonging to the Health Ministry, which included 198 resident medical school students of both sexes, between 24 and 37 years old, enrolled at the General Hospital of Mexico City the time of the study who took part in the investigation. The factors related to alcohol and drugs consumption were analyzed in order to:

• Identify levels of alcohol and drug consumption in a sample of resident medical doctors of a general hospital.
• Acknowledge possible sociodemographic factors related to the consumption of these substances, within the study sample.
• Determine possible characteristics pertaining to the field of work or the employees, related to the consumption of alcohol and drugs.
• Establish stress levels in the study population. Instruments
In order to establish alcohol and/or drug consumption levels, as well as some factors related to these within the study population composed by resident doctors, a structured and autoaplicable questionnaire was elaborated. The instrument consisted of 114 questions, including 43 items pertaining to depression and stress scates.
Results
Consumption patterns indicate that 41.2% of alcohol consumers are frequent drinkers, 37.6% are moderate drinkers and 12.9% are slight drinkers. When analyzing the patterns of consumption in relation to sociodemographic variables such as sex and age, the following is reported: From the whole sample of alcohol consumers (n=149), 74.5% are male subjects and 25.5% are female. Most male subjects report high consumption in the moderate-low and frequent-low groups, whereas for females the highest percentage is detected in the patterns of low-frequent consumption and least-frecuent, although the moderate classification also reports a relevant percentage.
When analyzing the total consumption of medical drugs and non-medical drugs, the first group revealed that from the total of medical drug users, 7.3% of the subjects had consumed analgesic narcotics at least once, 10.6% used tranquilizers, 2.2% sedatives and 3.4% anphetamines/stimulants. Regarding the non-medical drugs group, consumption at least once revealed: inhalable hallucinogenics 1.1%, 4.5% marijuana, 5% and 2.8% cocaine. From the total of non-medical drug only 4% of the population use these drugs, and as to the medical drug group the same percentage corresponds to 2.8%. There is a strong tendency regarding medical drugs towards the use of analgesic, narcotics and tranquilizers in users as an experimental consumption and regarding non-medical drugs towards marijuana.
In relation to substance abuse by gender there is a greater drug consumption by males but within the groups the percentage of users is less than that of experimental users, whereas for females the phenomenon proves to be different, because the percentage of drug users is proportionally higher than that of experimental consumers. In relation to the prevalence of consumption, subjects reported that with the exception of analgesic narcotics, consumption has taken place during the last year.
In the scales of depression and stress, a total of 38 participants in the study did not respond to all the reactives of the scales. In order to lessen error probabilities and to obtain the results, when cross-referencing variables to patterns of alcohol consumption and drug consumption against depression scales and stress scales, these subjects were eliminated. Thus, for this analysis the sample was reduced to 152 resident doctors.
Depression and Stress Scales
For both scales the statistical treatment used in previous studies for the depression scale was applied (CES-D). In relation to the statistical analysis between the scale of stress and the scale of depression, the indexes of subjects with high level of stress are as much as 14% of the studied subjects. Another finding was that the pattern of high alcohol consumption during the last year of the group with high level of stress was of 42,1% and the subjects with moderate and low consumption was of 57.9%. The age reports a greater tendency towards stress as age decreases, both in the group of high alcohol consumption as in the low one. The results on the analysis of the scale of depression by gender indicate that greater depression indexes prevail in female subjects whereas the stress scale reports greater signs of this condition in male subjects.

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