A SHORTAGE OF MEDICAL DOCTORS TO MEET THE CHALLENGES OF A GROWING ADDICTION PROBLEM IN LOW AND MIDDLE INCOME COUNTRIES: THE CASE IN MEXICO

Authors


The authors offer a challenging reflection on the possible reasons why medical specialties in addictions are failing to attract young physicians [1]. Unfortunately, this situation is not exclusive to the developed world; many developing countries have the same lack of psychiatrists and medical doctors for the treatment of all psychiatric disorders, including addictions [2]. In Mexico there are not enough specialists to work at new premises being opened up around the country to treat mental disorders and addictions in community settings.

Many of the issues addressed by the authors to explain why so few young doctors choose to specialize in this field are similar throughout the developing world. In Mexico, the curricula for residents in Psychiatry allows 16 hours to review the subject of addictions; the limited number of hours to review this complex subject might contribute to the perception of residents being insufficiently trained. Nonetheless they have the option to specialize in their fourth year of training in addictions, but this option has not succeeded in attracting more students.

Students probably share the stigma associated with addictions with the general population; people interviewed in household surveys consider addictions a disease but at the same time they regard addicts as criminals or weak individuals, and are less likely to agree that they require treatment [3]. Cross-cultural studies of families show that Mexican families share English families' guilt about having an alcoholic in the family but they also report shame; as a result, the presence of a member with a drinking problem is kept secret within the family for many years [4].

Another contributory factor is the lack of knowledge of new scientific advances in the medical treatment of the disorder; although it has been shown that treatment efficacy is similar to other chronic, relapsing diseases such as hypertension and diabetes [5], relapse after addiction treatment is regarded frequently as failure.

There is also a lack of service coverage and a long tradition of not using available health facilities, which contributes to the low level of job opportunities for a doctor specializing in this field. Half the Mexican population (53 million) is affiliated with the social security service but, within these institutions, although people with substance dependence receive treatment for complications of their addiction (such as liver cirrhosis or trauma), there are no programs available for treating the disease. Surveys show that affiliation to social security services makes no difference to the likelihood of receiving addiction treatment. Medical insurance does not cover mental disorders, including addictions. Despite the heroin problem in Mexico there is only one government organization providing methadone treatment; residential programs for severe dependence are handled by non-governmental organizations with limited resources. A new system of protection, known as the Popular Insurance Scheme, has been launched along with community clinics with more emphasis upon brief, early interventions than on treatment for chronic, severe patients.

Not surprisingly, few addicts receive treatment. A national survey of urban population aged 18 years and over showed that only 17% of respondents with substance use disorders reported having been treated during the 12 months prior to the study, usually by people in professions other than medicine and psychiatry [6].

The delay in treatment for people with substance use disorders is higher than for any other psychiatric diagnosis disorders, with less than 1% making contact the same year (0.9%), compared to 16% for any other mood disorder [7].

The possibility of modifying this situation depends upon our ability to modify popular perceptions, including the science of addiction in medical syllabi, and inform policy makers of the enormous cost-effectiveness of treatment in order to increase both the budget and facilities for addiction treatment. The high proportion of comorbidity of addictions with mental disorders highlights the need to integrate services, perhaps increasing the likelihood of attracting more psychiatrists to the field.

Both developed and developing counties must advance further in regarding addictions as a chronic disease and guarantee the right to treatment, as a result of which they might be able to attract more medical doctors to this field.

Declarations of interest

None.

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