Calidad asistencial y cronicidad en los programas de mantenimiento con agonistas opiaceos

ENGLISH :
In mental health, 'chronicity' has moved from the need for long periods of care to matching patients' needs to community social and health resources. Opiate maintenance treatments have tended to harm reduction, with great effectiveness, but have been dogged by being labelled as provoking chronicity. Although crowding may involve longer treatment duration, lengthy maintenance merely means prolonged support to break the chronicity of drug use problems. Greater effectiveness implies less chronicity, this being understood to mean dependence on treatment, which would not foster personal autonomy for a life free of drugs. The quality of treatment should give patients what they need or ask for, reducing their disabilities and chronicity. The advantage of a quality system in addiction treatments is that it implies a continuous improvement. And this improvement means the complete incorporation of MMTs in the general health system, thereby achieving an overall and integrated attention. Subprogrammes must be defined, ranging from abstinence to palliative care, with their procedures, and also matching them with different assistance levels. It is also necessary to adapt to new needs by 'old' users and to the new ones, updating goals and outcome indicators, and trying to identify variables related to effectiveness and chronicity, The success of MMTs in containing AIDS should not allow us to forget that they are true biopsychosocial treatments, of proven efficacy and, consequently, should be perfectly suitable for this objective. (Author' s abstract)