Abstract Introduction Factors associated with drug use are defined in terms of their proximity to the phenomenon and can be classified as individual, microsocial, and macrosocial. Macrosocial factors include variables of a geographic, economic, demographic, and social nature, which can be compiled from population censuses and surveys. Objective To determine the levels of risk for drug use in municipalities in Mexico based on macro-social indicators. Method Retrospective cross-sectional study, based on the analysis of population data, weighted by the Delphi method. Results Sixty-four municipalities with a high or very high risk of drug use were identified. Factors such as the volume of drug seizures, prevalence of student use, alcohol supply, and inequality among the population were weighted as the factors with greatest risk for drug use. Discussion and conclusion These data serve as a benchmark for guiding the efficient, rational administration of resources assigned for dealing with the problem of addictions, since they make it possible to identify localities with a greater need for care services.

Resumen Introducción Los factores asociados al consumo de drogas se definen en función de su proximidad con el fenómeno y pueden clasificarse en individuales, microsociales y macrosociales. Entre los factores macrosociales se incluyen variables de tipo geográfico, económico, demográfico y social, que es posible integrar a partir de censos y encuestas poblacionales. Objetivo Determinar niveles de riesgo del consumo de drogas en municipios de la República Mexicana con base en indicadores macrosociales. Método Estudio transversal retrospectivo, basado en el análisis de datos poblacionales, ponderados mediante el método Delphi. Resultados Se identificaron 64 municipios con alto o muy alto riesgo de consumo de drogas. Factores como el volumen de decomisos de drogas, prevalencia de consumo en estudiantes, oferta de alcohol y desigualdad entre la población fueron ponderadas como los factores de mayor riesgo para el consumo de drogas. Discusión y conclusión Estos datos representan un referente para orientar la administración eficiente y racional de los recursos destinados a atender el problema de las adicciones en tanto permiten identificar localidades que requieren servicios de atención con mayor prioridad.

Abstract With the objective to identify, among 317 municipalities and delegations of the country, those requiring with higher priority drug abuse prevention and treatment services, it was made a cross-sectional study, based on the Delphi method, which is a structured methodology to systematically collect expert opinions on an issue, so that the individual assessments are transformed to produce a collective judgment on the subject that was carried out, and apply a weight to the variables under study. In this case we had a panel of 55 experts, whose assessed the risk level of 33 updated demographic, health, economic, education, housing, geographic, touristic, socio-familiar, drug trafficking and use of illegal drugs. The studied variables were: Proportion of urban concentration, average growth rate, average age, proportion of male population, international migration rate, Proportion of health services, Homes with water and electricity, Drawnig housing service, Internet housing service, Overcrowding level, Income level, Food poverty, Capability poverty, Patrimony poverty, Persons of 3 years and older who do not attend school, Persons aged 12 and over who do not attend school, school level, location on the northern border, are part of large metropolis, inflow of national and international tourism, proportion of early pregnancy, people who practice some religion, be located on routes of trafficking marijuana, cocaine, methamphetamine and / or heroin, prevalence of drug use among young people, prevalence of cocaine and marijuana use, the perception of increased drug use, and the proportion of the population that has been offered drugs for free. The results showed that of the 371 municipalities and delegations with 50,000 inhabitants or more considered for this study, 85 of them were part of large metropolis with more than a million people; 73 were tourist spots and 73.5% of the localities made urban concentrations. Were identified 59 municipalities and delegations with a high or very high macro-social risk level and 105 municipalities and delegations with a medium-high macro-social risk level, requiring with highest priority services of prevention, treatment and rehabilitation of drug abuse problems.

Resumen Con el objetivo de identificar, entre 317 municipios y delegaciones del país, aquellos que requieren con mayor prioridad servicios de tratamiento y prevención del consumo de drogas, se llevó a cabo un estudio transversal con base en el método Delphi, el cual constituye una metodología estructurada para recolectar sistemáticamente juicios de expertos sobre un problema, de manera que las apreciaciones individuales se transforman para elaborar un juicio colectivo sobre el tema, lo que sirve para aplicar un peso ponderado a las variables en estudio. En este caso se contó con un panel de 55 expertos que valoró el nivel de riesgo de 33 indicadores demográficos, de salud, económicos, de educación, vivienda, geográficos, turísticos, sociofamiliares, del tráfico de estupefacientes y del consumo de drogas ilegales que se encontraban vigentes. Las variables estudiadas fueron: proporción de concentración urbana, tasa media de crecimiento, edad promedio, proporción de población masculina, tasa de migración internacional, proporción de servicios de salud, viviendas con agua y energía eléctrica, viviendas con servicio de drenaje, viviendas con Internet, nivel de hacinamiento, nivel de ingreso, pobreza alimentaria, pobreza de capacidades, pobreza de patrimonio, personas de 3 años y más que no asisten a la escuela, personas de 12 años y más que no asisten a la escuela, nivel de escolaridad, ubicación en la frontera norte, formar parte de grandes metrópolis, afluencia de turismo nacional e internacional, proporción de embarazos tempranos, proporción de personas que profesan alguna religión, encontrarse ubicado en rutas de tráfico de marihuana, cocaína, metanfetaminas y/o heroína, la prevalencia del consumo de drogas en los jóvenes, las prevalencias del consumo de cocaína y de marihuana, la percepción de incremento del consumo de drogas y la proporción de la población a la que le han ofrecido drogas regaladas. Los resultados mostraron que de los 371 municipios y delegaciones con 50,000 habitantes o más considerados para este estudio, 85 de ellos formaron parte de grandes metrópolis, con más de un millón de personas; 73 fueron puntos turísticos y 73.5% de las localidades conformaron concentraciones urbanas. Se identificaron 59 municipios y delegaciones con nivel de riesgo macrosocial alto o muy alto y 105 municipios y delegaciones con un nivel de riesgo macrosocial mediano-alto, que requieren con mayor prioridad de servicios de prevención, tratamiento y rehabilitación del consumo de drogas.

As a part of a innovative research line on mental health and addictions focused to operationalize the clinical approach of Maslow's motivational theory, this study is focused to prove a theoretical multi-factorial model that presuppose a relationship between a set of psycho-social protective factors and affective disorders, attraction to drugs, and severity of legal and illegal drug use, all them mediated by the satisfaction degree of deficit needs and its pleasurable associated sensations. The study was implemented with a cross-sectional, ex-post-facto design, with a 241 sample made out by urban young adults that were actual illicit drug users, which used more than five times one of the next drugs: marijuana, cocaine, crack, inhalants, heroin or metamphetamine. These subjects had a 24,5 mean age (SD= 5,1), with a ratio of almost eight men at of each woman. More than half of them were single, a third part was married or lived together and the fifth part was separated or divorced. Half of participants had high school studies, a fourth part had college and 8% had superior level. Half of the subjects were employed, 10% were students, 4% were housemakers, 5% studied and worked simultaneously, and a third part did not work. A fourth part were referred to previous treatment(s) for drug abuse. Based on the diagnosis, marijuana was identified as a drug of greater impact (29,9%), followed by cocaine (27,4%), inhalants (16,2%), heroin (12.0%), crack (10%) and crystal (4,6%). It was applied a battery of instruments that included: a) A scale to test the Severity of drug abuse (alpha = .953), that included items to evaluate issues such as: the incapacity to control drug use; intense desire to use; increase in the consumption; inability to reject drugs; changes in mood; transgression of the rules; residual symptoms; fights, and self injures. b) The Beck Depression Inventory (alpha = .918), conformed by two factors, Affective-cognitive depression (alpha = .867), with items related to feeling punished, failed and guilty, and Physiological-behavioral depression (alpha = .853) with items associated to insomnia, feeling tired, irritable, unsatisfied and hesitated. c) A multifactorial scale of Degree of Satisfaction of Deficit Needs of Health and security (alpha = .876), with items such as: tranquility, confidence, order and education; authenticity (alpha = .878), with items like honesty, sincerity, respect and freedom; affective (alpha = .780), with items like affection, friendship and love; self esteem (alpha = .825), with items like recognition, work, success and money; and enjoyment (alpha = .910), with items like joy, amusement, happiness, play, laugh, sing and dance. d) A multi-factorial risk and protection scale of drug use and related syndromes (alpha = .794), with the following factors: satisfactory family relations (alpha = .850), satisfactory relation with friends (alpha =927) and individual ability for satisfaction (alpha = .841). e) A multi-factorial scale related with the attraction for legal and illegal drugs (alpha = .949), with a factor for alcohol attraction (alpha = .933), other factor for tobacco attraction (alpha = .890) and a factor for alcohol attraction (alpha = .926). Furthermore, two models were developed with three antecedent manifest variables: individual ability for satisfaction, satisfactory family relations and satisfactory relation with friends. Both models showed that individual ability for satisfaction predicts 17% of variance of the satisfactory family relations and 10% of the satisfactory relation with friends. The mediating latent variable Satisfaction degree of deficit needs showed different forms in each model because the first one included a) satisfaction degree of health and security needs, b) satisfaction degree of self esteem needs and c) satisfaction degree of enjoyment needs, whereas the second model, more parsimonious, kept the first two factors. Both models incorporate, as consequent latent variables, depression (explained in 53% of its variance in model 2) as well as the manifest variable of: severity of drug abuse (explained in 45%) and the mediating latent variable attraction for legal and illegal drugs with an explained variance of 32% (for example: <<I like them, they help you to feel relax, they are tasty, they produce pleasure, they help you to have friends, to have fun, to make you laugh and to have joy>>). The models provide conceptual validity to the clinical approach of Maslow's theory, because it verifies that the unsatisfaction of deficit needs is related to: the presence of affective disturbance like depression; the attraction by legal and illegal drugs; and the severity of alcohol consumption and drugs. Model one includes among others the mediating variable satisfaction of the needs of self esteem, showing the influence of Jonah's complex usually related to the fear of recognition, success, etc. Model 2 is more parsimonious and reaffirms the importance of satisfying physiological and security needs, and its associated enjoinment. In adittion, it stands out that the individual capacity of satisfaction is related to the satisfaction of deficit needs causing the appearance of moments of joy, amusement and happiness, possibly associated with the Reward Circuit Activation. On the other hand, the individual capacity of satisfaction also maintains a direct relation with satisfactory relations with family and friends. Both variables have as well a positive influence in the satisfaction of deficit needs. Moreover, the individual capacity of satisfaction is related to the satisfaction of the deficit necessities, causing the appearance of moments of joy, amusement and happiness possibly associated with the reward circuit activation. On the other hand, the individual capacity of satisfaction also maintains a direct relationship with satisfactory relations with family and friends, which have also a positive influence to the satisfaction of the deficit needs and their associated enjoyment sensations, such as laugh, singing and dancing, that usually take place in social interactions. Also, it was shown how the individual aptitudes as well as relationships with others were substantial sources for satisfaction of deficit needs. Additionally, it was observed that a deficient degree of needs satisfaction was related to an increment in affection disturbances and in the severity of drug use, supporting the Maslow's psycho-pathogenesis construct. Finally, it was observed how a deficient degree of satisfaction also shows a direct relationship with the attraction to legal and illegal drugs, and is stand out how the presence of affection disturbances increases the attraction to drugs, which at the same time increases the severity of drug use.

Con el fin de someter a prueba un modelo teórico multifactorial basado en la aproximación clínica de la teoría de la motivación de Maslow -modelo en el que se presupone una relación entre un conjunto de variables psicosociales protectoras y algunos trastornos afectivos, la atracción por las drogas y la severidad de su consumo, mediadas por el grado de satisfacción de ciertas necesidades deficitarias (salud, seguridad y autoestima) así como sensaciones de disfrute asociado- se llevó a cabo un estudio transversal, ex post facto, con una muestra de 241 adultos jóvenes urbanos, consumidores actuales de drogas ilícitas. Se desarrollaron dos modelos estadísticos con base en las variables antecedentes: capacidad individual de satisfacción, relaciones satisfactorias con la familia y relaciones satisfactorias con los amigos. En ambos modelos se encontró que la capacidad individual de satisfacción predice en cierta medida las relaciones satisfactorias con la familia y con los amigos. La variable mediadora satisfacción de necesidades deficitarias se manifestó en forma distinta en ambos modelos, pues el primero incluyó: a) grado de satisfacción de las necesidades de salud y seguridad, b) grado de satisfacción de necesidades de estima y c) grado de satisfacción de necesidades de disfrute, mientras que el segundo, más parsimonioso, conservó sólo las dos primeras variables manifiestas. Ambos modelos incorporan como variables consecuentes la depresión (explicada en 53% en el modelo 2), así como la severidad del consumo de drogas (explicada en 45% de su varianza en el modelo 2). Además, el modelo incorpora como una variable mediadora la atracción por las drogas con una varianza explicada de 32% en el segundo modelo. Los dos modelos aportan validez conceptual a la vertiente clínica de la teoría de Maslow, pues se verificó que la insatisfacción de las necesidades de deficiencia se relaciona con el surgimiento de trastornos afectivos como la depresión, con el gusto por las drogas legales e ilegales y con la severidad del consumo de alcohol y drogas. Además, se destaca que en el modelo 1 se incluye entre otras la variable mediadora: satisfacción de las necesidades de estima, verificándose con ello la influencia del <<Complejo de Jonás>>, relacionado con el temor al reconocimiento, éxito, etc. El modelo 2, es más parsimonioso y reafirma la importancia de resarcir las necesidades fisiológicas y de seguridad y de su disfrute asociado, antes que proponerse incrementar la satisfacción de necesidades deficitarias de niveles más elevados. Así pues, fue evidente cómo la Capacidad individual de satisfacción se relaciona con la Satisfacción de las necesidades deficitarias, y propicia la aparición de momentos de alegría, diversión y felicidad, posiblemente asociados con la Activación del Circuito de Recompensa (ACR). Del mismo modo, la Capacidad Individual de Satisfacción también mantiene una relación di recta con las relaciones satisfactorias con la familia y con los amigos. Ambas variables tienen, a su vez, una influencia positiva en la satisfacción de las necesidades deficitarias y sensaciones de disfrute asociadas como la risa, el canto y el baile, que se producen en la interacción social. Además, se aprecia cómo en las aptitudes individuales y en las relaciones con el medio se encuentran fuentes sustantivas para la satisfacción de las necesidades deficitarias. También se observa congruencia con respecto al constructo de psicopatogénesis, dado que un grado deficiente de satisfacción de las necesidades se relaciona con un incremento en los trastornos del afecto y en la severidad del consumo de drogas. Finalmente, se detectó cómo un grado deficiente de satisfacción en las necesidades también presenta una relación directa con la atracción por las drogas y se destaca cómo la presencia de trastornos del afecto incrementa el desarrollo de la atracción por las drogas, lo cual aumenta la severidad del consumo de sustancias.

OBJECTIVES: To identify psychosocial risk factors for substance abuse among Mexican students and to offer elements for the design of prevention programs. METHODS: A cross-sectional, nonexperimental study of a sample of 516 high school students in six of Mexico's most important cities. From April-June 2005, a customized version of the Drug Use Screening Inventory (revised) (DUSI-R) was administered. The analysis comprised eight factors: alcohol and drug abuse, affective disorders, poor self-control, poor school adjustment, low social competence, dysfunctional family relationships, social isolation, and being part of a detrimental social network (whose members take drugs and have antisocial attitudes). Factors predictive for illicit drug use were found by logistical regression, and a structural equation model was designed to determine the relationships among the factors. RESULTS: The factors that predicted substance abuse were poor self-control with a tendency to act impulsively and aggressively; associating with troublemakers; and being frequently exposed to family conflicts, violence, and drug and/or alcohol use in the home. The structural equation model indicated that substance abuse is one of a group of disorders directly determined by associating with detrimental peers, and a higher rate of socioaffective disorders, and indirectly, by dysfunctional family relationships. CONCLUSIONS: Some of the suggestions made by theoretical models to explain substance abuse were confirmed. These empirically-supported elements can contribute to the design of prevention programs, especially those that are selective and recommended.

OBJETIVOS: Identificar factores psicosociales de riesgo de consumo de sustancias ilícitas en estudiantes mexicanos y ofrecer elementos para el diseño de programas de prevención. MÉTODOS: Estudio transversal no experimental con una muestra de 516 estudiantes de secundaria y bachillerato de seis de las principales ciudades de México. Entre abril y junio de 2005 se aplicó una adaptación de la versión abreviada del Inventario de Tamizaje sobre el Consumo de Drogas (DUSI-R). El análisis comprendió ocho factores: abuso en el consumo de bebidas alcohólicas o drogas, malestar afectivo, bajo control conductual, baja adherencia escolar, baja competencia social, relaciones familiares disfuncionales, aislamiento social y pertenencia a redes sociales desviantes (cuyos integrantes consumen drogas y adoptan actitudes antisocia-les). Se identificaron factores de predicción del consumo de drogas ilícitas mediante regresión logística y se elaboró un modelo de ecuaciones estructurales para determinar las relaciones entre los factores. RESULTADOS: Los factores de predicción del consumo de sustancias ilícitas fueron presentar un bajo control conductual con tendencia a actuar impulsivamente y con agresividad, estar vinculado con pares desviantes y estar expuesto con frecuencia a situaciones familiares de conflicto y violencia y al consumo de sustancias ilícitas y alcohol en el hogar. El modelo de ecuaciones estructurales indicó que el consumo de estas sustancias forma parte de un grupo de trastornos de ajuste conductual, determinado directamente por la vinculación con pares desviantes y por una mayor prevalencia de trastornos socioafectivos, e indirectamente por las relaciones familiares disfuncionales. CONCLUSIONES: Se confirmaron algunas implicaciones de los modelos teóricos propuestos para explicar el consumo de drogas. Estos elementos empíricamente sustentados pueden contribuir al diseño de programas preventivos, principalmente de tipos selectivo e indicado.