quality of life in studies with patients under treatment ... · quality of life in studies with...

ReviewArticle

Rev.Eletr.Enf.[Internet].2015oct/dec;17(4).Availablefrom:http://dx.doi.org/10.5216/ree.v17i4.31515.

Qualityoflifeinstudieswithpatientsundertreatmentforsubstanceabuseandaddiction

Qualidadedevidaempesquisascomusuáriosemtratamentoparaabusoedependênciadesubstâncias

SelvaRiosCampêlo1,MariaAlvesBarbosa2,CelmoCelenoPorto31Psychologist.MasterstudentattheLifeSciencesGraduateProgramattheFederalUniversityofGoiás(UFG)Goiânia,Goiás,Brazil.E-mail:[email protected],Master'sdegree.AssociateprofessoroftheSchoolofNursingofUFG.Goiânia,Goiás,Brazil.E-mail:[email protected],Ph.D.inMedicine.VisitingprofessorattheLifeSciencesGraduateProgramofUFG.Goiânia,Goiás,Brazil.E-mail:[email protected].

ABSTRACT

ThepurposeofthisstudywastofindQualityofLife(QoL)instrumentsandtheirpurposeinstudieswithpatientsunder

treatmentforsubstanceabuseandaddiction.Thisisanintegrativereview,whosearticleswereavailableontheVirtual

Health Library (VHL) and published between 2010 and 2015 with the associated descriptors "Substance-Related

Disorders"and"QualityofLife".Twenty-ninetextswereanalyzedandtheinstrumentsweregroupedintofourpossible

usesofmeasurementofQualityofLife.ThemajorityusedgenericinstrumentssuchasWHOQOL-BrefforgeneralQuality

ofLifeandtheSF-36ofHealth-RelatedQualityofLife(HRQoL).Itisrecommendedthatfurtherstudiesbecarriedout

ontheuseofQualityofLifeinstrumentsinrelationtoaddiction,especiallywithspecificinstrumentsthatarebeginning

toappearinsomestudiesandwhichhavenotbeenconsolidatedinthefield.

Descriptors:QualityofLife;Substance-RelatedDisorders;Questionnaires.

RESUMO

Oestudoobjetivou identificar instrumentos deQualidadedeVida e sua finalidade empesquisas comusuários em

tratamentoparaabusoedependênciadesubstâncias.Trata-sederevisãointegrativa,cujosartigosestavamdisponíveis

naBibliotecaVirtualdeSaúde(BVS),epublicadosentre2010e2015comosdescritoresTranstornosRelacionadosao

UsodeSubstânciaseQualidadedeVidaassociados.Vinteenovetextosforamanalisadoseosinstrumentosagrupados

emquatrodiferentespossibilidadesdeutilizaçãodemedidasdeQualidadedeVida.Amaioriautilizouinstrumentos

genéricos, taiscomoWHOQOL-BrefdeQualidadedeVidageral,eSF-36deQualidadedeVidaRelacionadaàSaúde

(QVRS).Recomenda-sea realizaçãodemaisestudos relacionadosaousode instrumentosdeQualidadedeVidano

âmbitodadependência,principalmenteemrelaçãoaosinstrumentosespecíficosquecomeçamasurgirnaspesquisas

eaindanãosãoconsolidadosnaárea.

Descritores:QualidadedeVida;TranstornosRelacionadosaoUsodeSubstâncias;Questionários.

CampêloSR,BarbosaMA,PortoCC..


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INTRODUCTION

Consumption and addiction to alcohol and other

drugs are a worldwide concern which result in several

clinicalandsocialcomplications(1),andthushavebecome

achallengeforpublichealth.Therearedifferentlevelsof

severity in individual consumption patterns. Substance

Use Disorder (SUD), for instance, concerns abuse or

addiction to a substance(2) related to increased risk of

harmfulconsequencestotheindividual.

TheNational InstituteonDrugAbuse (NIDA)of the

UnitedStatesconcludedin2009thateffectivetreatments

for SUD should address the consequences and

characteristics of abuse or addiction, as well as the

quantityandfrequencyofdruguse.Inthisway,according

tothisstudy,QualityofLife(QoL)maybeconsideredasa

primaryoutcomeoftreatment,whichbringsaboutthree

importantconsiderations.First,asubjectiveassessment

bytheindividualincreasesthepossibilityofassessingthe

patient'sevolution,whichisnotwellcapturedbyreports

that come from secondary sources, such as caregivers,

relatives, friends and medical records. Second, the

assessmentofQoLreferstoboththeimpactofabuseor

addiction and its treatment, which enables to evaluate

theeffectsoftreatmentthatreduceQoLevenwhenthey

reduce the use of drugs. And third, by the fact that

potentially harmful consequences of substance abuse

maybeseriousandaffectvariousfieldsofhumanlife,an

assessment of quality of life that distinguishes these

differentfieldswillbringaboutrelevantcontributions(3).

TheintroductionoftheconceptofQoLasanoutcome

measure appeared in the 1970s. The attempt to assess

chronic diseases in a situation of progress of medicine

revealed that the traditional methods based on

laboratoryexamsandclinicalevaluationwereinsufficient

toassessthewaypeoplelivedformoreyearswhenthey

underwenttreatmentsthatdidnothealbutallowedfor

controllingsymptomsoradelayinitsnaturalcourse(4-5).

Substanceusedisorderisachronicconditionformost

affectedindividuals.Inthiscase,theimprovementofQoL

becomes a rather important objective. From that

perspective,treatmentforsubstanceabuseoraddiction

must be a broad objective for recovery, defined as

abstinence plus quality of life(6). Therefore, the

importanceofQoLrates inservicesandstudies isclear,

withthepurposeofimprovingtreatmentoutcomes.

Despite the acknowledgment of the importance of

assessingQoL, the lackofconsensuson its concepthas

leadtotheformulationofdifferentdefinitionsandtothe

development of different instruments(4). The World

Health Organization (WHO) defined QoL as the

"individuals' perception of their position in life in the

contextofthecultureandvaluesystemsinwhichtheylive

andinrelationtotheirgoals,expectations,standardsand

concerns"(7:3). This definition is based on the broad

overviewofhealthasastateofcompletephysical,mental

andsocialwell-being,notonlytheabsenceofillness.

ThetheoreticalmodelsofQoLmaybegroupedinthe

satisfactionmodelandthefunctionalistmodel.Whereas

the theoreticalmodelof satisfaction ismoreassociated

with general QoL by assessing broad objectives of

individual satisfaction with life, the functionalist model

considers mainly the individual's functional and health

statuses. Instruments based on the functionalistmodel

were grouped according to the term Health-Related

QualityofLife(HRQoL)(4).

General or overall QoL is related to patients'

satisfactionwithlifeasawholeandnotonlytolimitations

resultingfromadisease.Themostusedinstrumentsare

theWHOQOL-100anditsabbreviatedversion,WHOQOL-

Bref(6).HRQoLisrelatedtotheindividuals'perceptionof

theeffectsofanillnessonthephysical,mentalandsocial

aspectsofwell-being.Themostusedinstrumentsarethe

Medical Outcome Study SF-36 and its abbreviated

version, SF-12(6). There are also HRQoL instruments

intended to a specific disease, which search for more

sensitivityintheassessmentofclinicalchanges(8).

As regards addiction, the QoL construct has been

used for different objectives, such as describing and

comparingsubpopulationsofdrugusers;understanding

how QoL is associated with other variables related to



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abuseoraddiction;usingQoLasavariableoftherapeutic

outcome; and finally, analyzing the metric properties

usedtomeasurethisconstructindrugusers(9).

Despite the potential of using aQoL assessment in

health, it is still recent and little explored in the

monitoringoftreatmentsandinstudieswithalcoholand

drug abusers and addicts, when compared to other

fields(6,10-12).

Theliteratureshowscertaingapsintheinvestigation

ontheuseofQoLinstrumentsformonitoringtreatments

and for studies with the population of abusers and

addicts,whichjustifiesthisstudy.Thisreviewenablesto

synthesize knowledge produced on the topic and to

supportprofessionalsand researcherswhowork in this

field,contributingtoaredirectionofactionsinhealthand

tothedevelopmentoffuturestudies.

Thus, the purpose of this study was to find

instruments for measuring QoL and their purpose in

studies with patients under treatment for substance

abuseandaddiction.

METHOD

Thisisanintegrativereviewcarriedoutfollowingthe

steps recommended by the literature(13). The first is

relatedtotheidentificationofthetopicandtheguiding

question,thesecondistheestablishmentofinclusionand

exclusion criteria in studies and how the search in the

literature is performed to obtain the sample. The third

refers to the definition of information that will be

extractedfromtheselectedstudies.Thefourthstepisan

assessmentthatissimilartothedataanalysisofstudies

included in the review. The fifth consists of the

interpretationanddiscussionofresults found instudies

andthesixthsteppresentstheknowledgesynthesis.

Theguidingquestiondefinedforourstudywas:what

are the QoL instruments used in studies with patients

underSUDtreatmentandwhatistheaimoftheirusein

thesestudies?

Thesearchforscientificoutputwascarriedoutinthe

Virtual Health Library (VHL), by selecting the following

databases:theSpanishBibliographicIndexoftheHealth

Sciences(IBECS),theLatin-AmericanLiteratureinHealth

Sciences(LILACS)andtheMedicalLiteratureAnalysisand

RetrievalSystemOnline(MEDLINE).Toconductthestudy,

anadvancedsearchwasperformedontheVHLportalby

means of the Boolean operator "AND", which found

documents with the descriptors "Quality of life" and

"Substance-RelatedDisorders"appearingsimultaneously.

The inclusion criteria for selecting the research

material considered: articles from studies which used

instruments of QoL in treatments for alcohol and drug

abuse and addictionof people agedover 18, published

between January 2010 and July 2015, in English,

PortugueseandSpanish.Theexclusioncriterionwasthe

unavailability of full texts on theVHLplatform, if these

could not be retrieved on the CAPES portal. Figure 1

shows the flowchart of the selection process of the

scientificoutputofthereview.

For data collection, completed in August 2015, the

following items were investigated: level of evidence,

populationandplaceoftreatment,QoLinstrumentsused

andpurposesoftheQoLinstrumentforthisstudy.These

itemswerecreatedwiththeaimofleadingtothestudy

question.

Theintegrativereviewoftheliteratureisoneofthe

possibilities of evidence-based practice, which is an

approach that enables decision making by healthcare

professionals for solving problems related to clinical

practice. The classification of evidence found in

publications becomes necessary for this decision to be

made carefully. Considering the amount of scientific

output on evidence-based practice in health care, we

chosetoadoptforthisreviewaclassificationofevidence

levels already used by Brazilian authors, especially

nurses(13-14), proposed by Stetler et al.(15). Supported by

thisapproach,theclassificationofevidencelevelsofthe

analyzed articleswas performed by the researchers, as

showninthechartbelow.



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Figure1:Flowchartoftheselectionprocessofthescientificoutputanalyzed.

Chart1:ClassificationofevidencelevelsastothenatureofstudiesLevelI Meta-analysisofmultiplecontrolledstudiesLevelII Individualexperimentalstudies(randomizedclinicaltrial).

LevelIIIQuasi-experimentalstudies-Non-randomizedclinicalstudies,singlepre-andpost-testgroup,time

seriesandcase-controlstudies.

LevelIVNon-experimentalstudies-descriptive,correlatedandcomparativestudies,qualitativestudiesand

casestudies.LevelIV Datafromassessmentofprogramsobtainedsystematically.LevelVI Specialists'opinion,experiencereports,consensus,regulationsandlegislation.

Source:Stetleretal.(1998).

RESULTS

Twenty-ninearticlesmettheinclusionandexclusion

criteriaandwereselectedforanalysis.Theresultswere

summarizedinChart2,whichshowsthedetailsregarding

thetitle,author,country,year,journal,levelofevidence

ofthestudy,populationundertreatment,instrumentof

QoLusedand itspurpose in that study.Although these

studiesusedotherrelatedinstruments,thepresentstudy

tookintoconsiderationonlyQoLinstruments.



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Chart2:Synthesisofarticlesincludedintheintegrativereview

Title/Author/Country/YearJournalandlevelofevidenceofthe

article

Populationundertreatment(Samples)

QoLinstrumentanditspurposeinthestudy

Lacalidaddevidaenpacientescontrastornopordependenciaalalcoholcontrastornosdelapersonalidade:relacióncomelajustepsicológicoycraving.MartínezGonzálezJM,etal.,Spain,2010(16)

Psicothema(Oviedo)III

65alcoholaddictedpatientsundertreatmentattheprovincialcenterofdrugaddicts,Granada,Spain.

Q-LES-QTorelateQoLwithdualdiagnosis,

psychologicaladjustmentandcraving

Predictorsofmotivationforabstinenceattheendofoutpatientsubstanceabusetreatment.LaudetAB,StanickV.,E.U.A,2010(17)

JournalSubstanceTreatment

IV

250usersofmultiplesubstancesoftwooutpatienttreatmentprogramscarriedoutwithpublicfunding,New

York,USA

WHOQOL-100–itemofgeneralsatisfactionwithlife

TorelateQoLwithcommitmentofabstinencebytheendoftreatment

Qualityoflifeamongtreatmentseekingmethamphetamine-dependentindividuals.GonzalesRetal.,USA,2011(18)

TheAmericanJournalonAddictions

IV

838methamphetamine-dependentindividualsofaprojectcarriedoutbetween1999and2001,fromeightoutpatienttreatmentprograms,California,Montanaand

Hawaii,USA.

SF-36TorelateQoLwithsociodemographicandpsychosocialdata,severityofuse,

doctorsandpsychiatrists.

Qualityoflifeprofilesandchangesinthecourseofmaintenancetreatmentamong1,015patientswithsevereopioiddependence.

KarowA,etal.,Germany,2011(19)

SubstUseMisuseIII

1,015opioid-dependentpatientsunderoutpatienttreatmentwithheroininjectionsundersupervisionormethadonemaintenanceinsevenGermancities.

MSQoLTocompareQoLbetweendifferent

groups(drugusers,depressedpatients,schizophrenicpatients,healthy

individuals)

Clinicalcorrelatesofhealth-relatedqualityoflifeamongopioid-dependentpatients.HeslinKC,etal.,USA,2011(20)

QualityofLifeResearch

IV

344opioid-dependentindividuals,ofwhich113werehospitalizedand231wereunderoutpatienttreatment,treatedattheCTN(NationalInstituteonDrugAbuseClinicalTrialsNetwork)indifferentstatesoftheUSA

SF-36TorelateQoLwithphysiologicalfactors,withdrawalsymptoms,

addictionseverity

Developmentandvalidationofaqualityoflifeinstrumentforpatientswithdrugdependence:comparisonswithSF-36and

WHOQOL-100.WanCetal.China,2011(12)

InternationalJournalofNursingStudies

LevelIV

212drugaddicts,54heroin-dependents,caredforatacompulsoryrehabilitationanddetoxificationcenterin

Kunming,China

SF-36WHOQOL-100

TovalidateanotherQoLinstrument,calledQOL-DA

Useofitemresponsetheoryandlatentclassanalysistolinkpoly-substanceusedisorderswithaddictionseverity,HIVrisk,and

qualityoflifeamongopioid-dependentpatientsintheClinicalTrialsNetwork.WuLT,etal.,USA,2011(21)

DrugAlcoholDependIV

113hospitalizedand230outpatientopioid-dependentpatientsof12treatmentprogramsintheUSA

SF-36TorelateQoLwiththeuseofdifferent

substances.

Problemareasreportedbysubstanceabusingindividualsandtheirconcernedsignificantothers.HussaatsPetal.,Netherlands,

2012(22)

TheAmericanJournalonAddictions

IV

32usersunderoutpatienttreatment,(and32concernedsignificantothers),inamentalhealthcenterin

SpijkenisseandRotterdam,Netherlands.

EQ-5DTocompareQoLamongdifferentgroups(drugusers,relativesor

significantothers)



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article



Qualityoflifeanddepressivesymptomsamongcaregiversanddrugdependentpeople.

MarconSRetal.Brazil,2012(23)

LatinAmericanNursingMagazine

IV

109individualsunderoutpatienttreatment(and109caregivers),selectedfrom4PsychosocialCareCenters-Drugsandalcohol(CAPS),inthestateofMatoGrosso,

Brazil

SF-361.TorelateQoLwithdepressive

symptoms2.TocompareQoLamongdifferent

groups(drugusers,relatives/caregivers)

Theapplicationofthedruguserqualityoflifescale(DUQOL)inAustralia.ZubaranCetal.,Australia,2012(24)

HealthQualityofLifeOutcomes

IV

120drugusersunderhospitaloroutpatienttreatmentinthewesterndistrictofSydney,Australia

WHOQOL-BrefTovalidateanotherQoLinstrument,

calledDUQOL

Improvementofqualityoflifefollowing6monthsofmethadonemaintenancetherapyinMalaysia.BaharomNetal.,Malaysia,2012(25)

SubstAbuseTreatPrevPolicy

IV

122drugusersoftwogovernmentprogramsofmethadonemaintenanceinthedistrictofTampin,

Negeri,Sembilan,Malaysia

WHOQOL-Bref1.TouseQoLasavariableof

therapeuticoutcome.2.TorelateQoLwithsociodemographicvariables,HIV,hepatitisC,beginning

anddurationofdruguseComparisonofthecourseofsubstanceusedisordersamongindividualswithandwithoutgeneralizedanxietydisorderina

nationallyrepresentativesample.MagidsonJFetal.,USA,2012(26)

JPsychiatrResIII

6016drugusers.SUD:5730andSUDandgeneralizedanxietydisorder(GAD):286accessedintheNational

EpidemiologicalSurveyonAlcoholandRelatedConditions(NESARC)intheUSA

SF-12TocompareQoLamongdifferent

groups(druguserswithoutSUD,druguserswithSUD)

Prospectivepatternsandcorrelatesofqualityoflifeamongwomeninsubstanceabusetreatment.TracyAMetal.,USA,2012(27)

DrugAlcoholDependIV

240womeninsubstanceabusetreatmentinCleveland,Ohio,USA.

WHOQOL-BrefTorelateQoLwithsociodemographic,clinicalandsocialsupportvariables

Health-relatedqualityoflifeinpatientswithdualdiagnosis:clinicalcorrelates.

BenaigesIetal.,Spain,2012(28)

HealthQualLifeOutcomes

IV

125users:35withSUDandseverementaldisorders(SMD);35withSMDonlyand35withSUDonly(3rdgroupintreatmentinthetherapeuticcommunityof

Gressol,Barcelona,Catalonia,Spain

SF-36TocompareQoLamongdifferent

groups(druguserswithoutSMD,druguserswithSMD,patientswithSMD

withoutSUD)TDAHenpacientesconadicciónasustancias:análisisdela

prevalenciaydelosproblemasrelacionadosconelconsumoenunamuestraatendidaenunserviciodetratamientoambulatorio.

TorricoLinaresJ,E,etal.,Spain,2012(29)

TrastoradictIV

162substanceusersundertreatmentattheprovincialcenterofdrugaddictsofHuelva,Spain.

TECVASPTorelateQoLwithattentiondeficit

hyperactivitydisorder(ADHD)



7


article



Improvingphysicalhealthandreducingsubstanceuseinpsychosis-randomizedcontroltrial(IMPACTRCT):studyprotocolforaclusterrandomizedcontrolledtrial.GaughranFetal.,UnitedKingdom,

2013(30)

BMCPsychiatryII

392druguserswithSMD,assistedbytheCommunityMentalHealthTeamofSouthLondon,UnitedKingdom

SF-36TouseQoLasavariableoftherapeutic

result

Doesbuprenorphinemaintenanceimprovethequalityoflifeofopioidusers?

DhawanA;ChopraA,India,2013(31)

IndianJMedResIII

231opioidusersselectedfromfivetreatmentunits,twoinDelhiandthreeineasternIndia

WHOQOL-BrefTouseQoLasavariableoftherapeutic

result

Drogodependientesvs.Usuáriosdesaludmentalcomtranstornosdepersonalidade:surelacióncomlacalidadedevida,la

psicopatologiaemEjeI,elajustepsicológicoydinâmicafamiliar.Martínez-GonzálezJMetal.,Spain,2013(32)

An.psicol.IV

68patientswithpersonalitydisorder(PD),ofwhich42.6%wereuserswithoutSUD,57.4%weredrugaddictsunderoutpatienttreatmentattheprovincialcenterof

drugaddictsinGranada,Spain

Q-LES-QTocompareQoLindifferentgroups

(individualswithPDandSUD,individualswithPDwithnoSUD)

Qualityoflife,self-esteemandself-identityofdrugaddictsSilveiraCDetal.,Brazil,2013(33)

CienSaudeColetIV

100hospitalizedusersorunderoutpatienttreatmentattheSãoJoséinstituteinthestateofSantaCatarina,Brazil

WHOQOL-BrefTorelateQoLwithself-esteem,self-

identity

QualityoflifedeterminantsinpatientsofaPsychosocialCareCenterforalcoholandotherdrugusers.MariniM,etal.,Brazil,

2013(34)

IssuesMentHealthNursIV

77substance-dependentpatientsunderoutpatienttreatmentataPsychosocialCareCenterforalcoholand

drugs(CAPSad),inthesouthofBrazil

WHOQOL-BrefTorelateQoLwithaddictionseverity

anddepression

Auricularacupuncturefordrugdependence:anopen-labelrandomizedinvestigationonclinicaloutcomes,health-related

qualityoflife,andpatientacceptability.LuaPL;TalibNS,Malaysia,2013(35)

AlternTherHealthMedII

69opioid-dependentindividualsundertreatmentwithmethadonemaintenanceinagovernmenthospitaland2

communityclinicsinTerengganu,Malaysia


result

SeverityofpsychiatricandphysicalproblemsisassociatedwithlowerqualityoflifeinmethadonepatientsinIndonesia.IskandarS,

etal.,Indonesia,2013(36)

AmJHorthopsychiatr.

IV

112opioid-dependentindividualsundertreatmentwithmethadonemaintenanceinBanung,Indonesia

EQ-5DTorelateQoLwithotherclinical

aspects(QoLandseverityofphysicalandpsychiatricissues)

Theefficacyofatomoxetineasadjunctivetreatmentforco-morbidsubstanceusedisordersandexternalizingsymptoms.BenegalV,et

al.,India,2013(37)

AsianJPsychiatrIII

14usersofalcohol,tobaccoandotherdrugswithexternalizationofsymptoms,underoutpatienttreatmentinade-addictioncenterinIndia


result

AvalidationstudyoftheALQoL9tomeasurequalityoflife.ZubaranCetal.,Australia,2014(38)

AmJDrugAlcoholAbuseIV

138alcohol-dependentorabuserindividuals,underoutpatienttreatmentorhospitalizedinthewestern

districtofSydney,Australia

WHOQOL-BrefTovalidateanotherQoLinstrument,

calledALQoL9



8


article



Engaginginjob-relatedactivitiesisassociatedwithreductionsinemploymentproblemsandimprovementsinqualityoflifeinsubstanceabusingpatients.PetryNM,etal.,E.U.A.2014(39)

PsycholAddictBehavIII

185substance-dependentpatientsunderoutpatienttreatmentin3community-basedclinics,USA

QOLITouseQoLasavariableoftherapeutic

result

Correlationbetweendepressivesymptomsandqualityoflifeinusersofpsychoactivesubstances.MarconSRetal.,Brazil,2014(40)

VerEscEnfUSPIV

109substanceusersunderoutpatienttreatmentassistedin4CAPSadofthecenter-westregionofBrazil

SF-36TorelateQoLwithdepressive

symptoms

Qualityoflifeinacohortofhigh-dosebenzodiazepinedependentpatients.LugoboniF,etal.,Italy,2014(41)

DrugAlcoholDependIV

622benzodiazepinedependentpatientshospitalizedfordetoxificationattheuniversityhospitalofVerona,Italy

SF-36GHQ-12

TorelateQoLwithsociodemographicfactors,andexpectedQoL

Painandemotionaldistressamongsubstance-usepatientsbeginningtreatmentrelativetoarepresentativecomparisongroup.

WiestKL,etal.,USA,2014(42)

JAddictMedIV

406substance-dependentpatientsbeginningtreatment,170withmethadonemaintenanceand236underoutpatienttreatmentof3clinicslocatedinOregon,

PennsylvaniaandWashington,USA

PROMISTocompareQoLbetweendifferentgroups(patientsundermethadonetreatment,othertreatments,general

population)Combinationofclassicaltesttheory(CTT)anditemresponsetheory(IRT)analysistostudythepsychometricpropertiesoftheFrench

versionoftheQualityofLifeEnjoymentandSatisfactionQuestionnaire-ShortForm(Q-LES-Q-SF).Bourion-BédèsS,etal.,

France,2015(43)

QuallifeResIV

124alcohol-oropioid-dependentpatientsunderoutpatienttreatmentin4centersoftworegionsof

France

SF-12TovalidateanotherQoLinstrument,

calledQ-LES-Q-SF



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Most of the studies analyzed used generic

instrumentsofQoL,ofbothoverallQoL(12texts),which

usedmainlyWHOQOL-Bref,andHRQoL(18texts),which

usedmainlySF-36.Despitethefactthatonlyonearticle

usedaspecificinstrumentforSUD,threeanalyzedstudies

referred to the validation of specific scales for the

disorder.

RegardingthepurposeoftheuseofQoLinstruments

inthestudiesanalyzed,14studiesusedQoLtorelateitto

other clinical characteristics, seven studies did it to

compareitbetweendifferentgroups,sixstudiesusedit

asavariableoftherapeuticoutcome,andfourstudiesdid

it to validate a new instrument of QoL. In Chart 3, the

instruments used or validated in the articles are

described.

Chart3:Descriptionofinstrumentsusedorvalidatedinthestudies

Instruments InstrumentdescriptionWorldHealthOrganization

QualityofLife1.WHOQOL-1002.WHOQOL-Bref

Generic.100itemsthatassesssixaspects:physical,psychological,degreeofdependence,socialrelationships,environmentandspirituality

WHOQOL-Brefisitsabbreviatedform,with26items

3.QualityofLifeInventory-QOLIGeneric.17aspects:work,lifeevents,home,love,friendship,leisure,self-esteem,life

philosophy,learning,creativity,socialservices,civicaction,community,neighborhood,health,relationshipwithchildrenandparents

MedicalOutcomesStudy4.MOSSF-36:5.MOSSF-12:

HRQoL(generic).36items.Physical(functionalcapacity,physicalaspects,pain,generalstateofhealth)andmentalaspects(vitality,socialaspects,emotionalaspects,mentalhealth)

MOSSF-12isitsabbreviatedform,with12items6.EuropeanQualityofLifeScale-

EQ-5DHRQoL(generic).Fiveitems:mobility,self-care,usualactivities,pain/discomfort,anxiety/depression.Thesecondpartinquiresaboutthecurrenthealthstate

7.QualityofLifeEnjoymentandSatisfactionQuestionnaire-Q-

LES-Q8.Q-LES-Q-SF

HRQoL(generic).Psychiatric/psychologicaldisorder.93items,whichreflectsatisfactionwithphysicalhealth,subjectivefeelings,work,domesticchores,school,leisure,socialrelationships

andgeneralactivities,andsatisfactionwithmedicationandlifeasawhole.Q-LES-Q-SFisitsabbreviatedform,with14items

9.ModularSystemforQualityofLife-MSQoL

HRQoL(generic).Mentaldisorders.39itemsmeasuringphysicalhealth,vitality,psychosocialQoL,emotionalQoL,materialsatisfaction,freetime,andoneitemmeasuringoverallQoL.

Optionalmodulesoffamily,childrenandoccupation

10.GeneralHealthQuestionnaireGHQ-12

HRQoL(generic).12itemsthatdescribemood:lostsleep,tension,lackofconcentration,unhappiness,depression,lackofconfidence,uselessness,andtheinabilitytoplayauseful

role,tofaceproblems,tomakedecisions,toovercomedifficulties,toenjoyeverydayactivities.

11.Patient-ReportedOutcomesMeasurementInformation

System-PROMIS

HRQoL(generic).Itemresponsetheory(IRT)model.4measures(impactofpain,anxiety,depression,fatigue).Italsoassessesresponsetopain,angerandtheabilitytoperform

everydayduties

12.DrugUsersQualityofLifeScale-DUQOL

SUDspecific.22aspects:tofeeluseful,drugs,drugtreatment,education,family,well-being,friends,harmreduction,health,medicalassistance,housing,freedomofchoice,leisure,

money,neighborhoodsecurity,partner(s),communityresources,sex,spirituality,transport,future,treatmentbyothers.

13.QualityofLifeforIndividualswithDrugAddiction/Dependence

-QOL-DA

SUDspecific.4aspects:physicalfunction,(bodymovement,sensoryperception,appetite,sexuality,sleepandenergy),psychologicalfunction(emotion,cognition,resistancetostressandself-esteem),socialfunction(socialsupportandfamilyadaptationandcareersupport)

andeliminationofsymptomsandsideeffects.14.TestparalaEvaluacióndelaCalidaddeVidaenAdictosaSustanciasPsicoactivas–

TECVASP

SUDspecific.22items.Physicalaspect(functionalactivity,pain,sleep,nausea,fatigue,physicaldependence).Psychosocialaspect(psychologicaldependence,depression,anxiety,aggressiveness,memory,hallucinations,concentration,orientation,perceptionofphysical

andpsychologicalhealth,socialfunctioning,expectations.

15.9-itemQoLscale-ALQoL9SUDspecific.9itemsthatassesshealthandtheconsequencesofalcoholismonindividuals

whicharenotrelatedtohealth.DesignedbyacondensationoftheSF-36andtheinclusionofaspectsrelatedtoalcoholism.



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DISCUSSION

Most articles studied used generic instruments of

QoL, overall QoL(17,24-25,27,31,33-35,37-39) or HRQoL(12,16,18-

23,26,28,30,32,36,40-43).Onlyone studyusedan instrumentof

HRQoLthatwasspecifictoSUD(29),althoughthreeofthe

selected studies referred to the validation of these

scales(12,24,38).Except for thepurposeof "comparingQoL

betweendifferentgroups",whichonlyusedinstruments

ofHRQoL,theothersusedinstrumentsofoverallQoLand

HRQoL.

These results confirm previous reviews on the

topic(6,9).Genericinstrumentsareusedmainlywhenthe

purposeofthestudyistocompareHRQoLofdrugabusers

with other groups of patients or with general

population(8,44) or alsowhen there are no valid specific

instruments(45), which justifies its wider use in cases of

dependence, for which there are few valid specific

instruments.

Thelimitationofassessmentsmadebygenericscales,

especially HRQoL, has been pointed out by some

authors(8-9,12), which indicates a current trend of

validationanduseofSUD-specificscales,adaptedtothe

population of drug abusers, enabling to select more

importantaspectsoflifeforthemandthustoassessmore

carefully the outcomes of treatment for SUD(8,12,24).

Examplesofspecificscalesinadditiontothosementioned

previously: Health-Related Quality of Life Test in Drug

Abuser (HRQOLDA), Injection Drug User Quality of Life

Scale(IDUQOL)(44).

Divergent positions are frequent among authors

regardingtheuseofinstrumentsofQoLintheassessment

of individuals undergoing treatment for abuse or

dependence of alcohol and drugs. Whereas some

authors(8,12,24,44)arguethatspecificinstrumentsallowfor

a more careful assessment of the outcomes of drug

dependence treatments, others(6,17,27) recommend the

use of generic instruments of overall QoL such as the

WHOQOL as they consider these instruments aremore

directly related to rehabilitation goals than HRQoL

measures.

Therefore,althoughitissaidthatgenericinstruments

shouldbemoreusedinsituationssuchasthecomparison

ofgroupsofdrugabuserswithotherpatientsorwiththe

general population, and that specific instruments may

assess a therapeutic intervention more precisely, the

findingsofthediscrepanciesmentionedaboveshowthe

needforfurtherstudies,especiallyonthedistinctionof

specific instruments that have been emerging and

WHOQOL generic instruments developed by theWHO,

whichseemtoalsomeasuresignificantaspectsrelatedto

therehabilitationofusersofalcoholanddrugs.

CONCLUSIONS

The articles analyzed in this review, most of them

with a level of evidence of IV, used instrumentswith a

generic approach of QoL, both the overall QoL

instruments, such as the WHOQOL-Bref, and HRQoL

instruments,suchastheSF-36.

Asforthepurposeoftheiruseinstudieswithusers

undergoing treatment for drug and alcohol abuse or

dependence, the instruments were randomly used

amongthedifferentpossibilitiesofuseofQoL,exceptfor

the purpose of "comparing QoL between different

groups",whichonlyusedinstrumentsofHRQoL.

Itisrecommendedthatfurtherstudiesbecarriedout

regardingtheuseofqualityoflifeinstrumentsinrelation

to addiction, especially in relation to recent specific

instrumentsthathavenotbeenconsolidatedinthefield.

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