OBJECTIVE: Synthesize and assess the available scientific evidence from the period 2008-2012 on interventions of demonstrated efficacy in the treatment and rehabilitation of adolescents and adults engaged in the problematic use of alcohol and other substances. METHODS: A systematic review was undertaken with search and analysis of national and international literature on the subject in Spanish and English in the main international databases: PubMed/MEDLINE, LILACS, Embase, PsycINFO, SciELO, the databases of the York University Centre for Reviews and Dissemination (DARE, ETS Database), the Cochrane Library, and other sources of gray literature. The search criteria included randomized clinical trials and systematic reviews but excluded observational studies, qualitative studies, and articles of poor methodological quality. RESULTS: The final sample consisted of 69 studies. The psychosocial interventions shown to be effective were cognitive behavioral therapy, family interventions, self-help interventions using the Internet, couples behavioral therapy, community strengthening and family training, telephone monitoring and support, and integrated therapy for substance abuse disorder with anxiety and depression comorbidity. Pharmacological interventions of demonstrated effectiveness were acamprosate, lysergic acid diethylamide (LSD), and benzodiazepines in problematic alcohol use, as well as maintenance therapy with high-dose opioids. CONCLUSIONS: The demonstrated effectiveness of psychosocial and pharmacological interventions is slight but significant. However, strongly multidisciplinary interventions that use a cognitive behavioral approach and the involvement of people close to the consumer, as well as some of the specific pharmacological interventions, have been shown to yield the best results in terms of indicators of abstinence and prevention of relapses.

OBJETIVO: Sintetizar y valorar la evidencia científica disponible durante el período 2008-2012, respecto de las intervenciones con eficacia demostrada en el tratamiento y rehabilitación de personas adolescentes y adultas con consumo problemático de alcohol y otras sustancias. MÉTODOS: Se realizó una revisión sistemática con búsqueda y análisis de la literatura nacional e internacional, en español e inglés, consultando las principales bases de datos internacionales, incluyendo PubMed/MEDLINE, LILACS, EMBASE, PsycINFO, SciELO, bases de datos del Centro para Revisión y Diseminación de la Universidad de York (DARE, HTA Database), Cochrane Library y otras fuentes de literatura gris. Se incluyeron ensayos clínicos aleatorizados, revisiones sistemáticas, y se excluyeron estudios observacionales, estudios cualitativos y artículos de baja calidad metodológica. RESULTADOS: La muestra final consistió en 69 estudios. Las intervenciones psicosociales con eficacia demostrada fueron terapia cognitivo conductual; intervenciones de tipo familiar; intervenciones de autoayuda vía Internet; terapia conductual de pareja; refuerzo comunitario y entrenamiento familiar; seguimiento y apoyo telefónico, y terapia integrada del trastorno por abuso de sustancia con comorbilidad ansiosa y depresiva. Las intervenciones farmacológicas con eficacia demostrada fueron acamprosato, dietilamida de ácido lisérgico (LSD) y benzodiacepinas en el consumo problemático de alcohol, y la terapia de mantención con opioides en altas dosis. CONCLUSIONES: La eficacia demostrada de las intervenciones psicosociales y farmacológicas es pequeña, pero significativa. Son las intervenciones marcadamente multidisciplinarias, con enfoque cognitivo conductual e involucramiento de personas significativas allegadas al consumidor, las que han demostrado tener mejores resultados en indicadores de abstinencia y prevención de recaídas, así como también algunas intervenciones farmacológicas específicas.

Background: Amphotericin B is efficacious for the treatment of systemic candidiasis, however it has potentially serious toxic effects. Administration as lipid emulsions has been advocated to decrease its toxicity. Aim: To compare the safety and tolerance of amphotericin B administered as lipid emulsion or dissolved in dextrose in water. Patients and methods: Forty five patients with confirmed or highly suspected systemic candidiasis were studied. Between January 1996 and June 1997 amphotericin B was administered in dextrose in water to 17 patients (group 1). Between July 1997 and December 1998, the drug was delivered in lipid emulsions (Intralipid, group 2). Clinical and laboratory parameters (serum creatinine, urea nitrogen and potassium), were assessed daily. Results: Both treatment groups were clinically comparable and had the same survival. Accumulative amphotericin B dose administered was 343.2 ± 197 and 414.6 ± 518 mg respectively. Hypokalemia was more frequent in group 2 (52 and 25 % respectively, p < 0.05). There were no differences in the outcome of renal function or other adverse reactions. Conclusions: Administration of amphotericin B as lipid emulsions did not reduce its toxicity in critical patients (Rev Méd Chile 2000; 128: 1101-07)