Trends in Psychiatry and Psychotherapy
https://trends.org.br/article/doi/10.1590/2237-6089-2014-0040
Trends in Psychiatry and Psychotherapy
Original Article

Who seeks public treatment for substance abuse in Brazil? Results of a multicenter study involving four Brazilian state capitals

Quem procura tratamento para abuso de substância na rede pública no Brasil? Resultados de um estudo multicêntrico envolvendo quatro capitais brasileiras

Sibele Faller; Ana Carolina Peuker; Anne Sordi; Anderson Stolf; Maria Lucia Souza-Formigoni; Marcelo Santos Cruz; Sílvia Brasiliano; Flavio Pechansky; Felix Kessler

http://dx.doi.org/10.1590/2237-6089-2014-0040 Trends Psychiatry Psychother, vol.36, n4, p.193-202, 2014
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Abstract

OBJECTIVE: To assess the characteristics of alcohol and drug users who seek treatment at the Brazilian Unified Health System in Brazil.METHOD:A multicenter cross-sectional study involving five clinical and research centers located in four Brazilian state capitals was conducted with 740 in- and outpatients. The only exclusion criterion was the presence of neurological or severe psychiatric symptoms at the moment of the interview. The Addiction Severity Index (ASI-6) and the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) were used to assess the severity of substance use and the problems related.RESULTS: There were significantly more men than women in the sample; mean age was 36 years. The drug most frequently used at all sites was alcohol (78%), followed by cocaine/crack (51%). Alcohol was the drug that most commonly motivated treatment seeking, at all centers. ASI-6 Summary Scores for Recent Functioning (SS-Rs) were quite similar among centers. SS-Rs were compared between users who had never received treatment for psychoactive substance abuse (n = 265, 36.1%) and those who had already been treated at one or more occasions (n = 470, 63.9%). This analysis revealed significant differences between the groups in the drug, psychiatric symptoms, legal, and family/social problems areas (p < 0.05).CONCLUSION: Our findings confirm previous evidence suggesting that the management of patients seeking drug abuse treatment should take several different aspects into consideration, e.g., education, employment, and family relationships, which often appear as areas of concern for these individuals.

Keywords

Substance abuse, treatment, multicenter, alcohol, drugs, public health

Resumo

OBJETIVO: Avaliar as características dos usuários de álcool e drogas que procuram tratamento no Sistema Único de Saúde.MÉTODO:Estudo transversal multicêntrico envolvendo cinco centros clínicos/de pesquisa localizados em quatro capitais brasileiras foi realizado com 740 pacientes hospitalizados e ambulatoriais. O único critério de exclusão foi a presença de sintomas neurológicos ou psiquiátricos graves no momento da entrevista. A Escala de Gravidade de Dependência (Addiction Severity Index, ASI-6) e o teste ASSIST (Alcohol, Smoking and Substance Involvement Screening Test) foram utilizados para avaliar a severidade do uso de substância e problemas relacionados.RESULTADOS:Houve significativamente mais homens do que mulheres na amostra; a idade média foi de 36 anos. A droga mais usada em todos os centros foi o álcool (78%), seguido de cocaína/crack (51%). O álcool foi a droga que mais motivou procura por tratamento, em todos os centros. Os Escores Resumidos da ASI-6 para Funcionamento Recente (SS-Rs) foram bastante similares nos centros. SS-Rs foram comparados entre usuários que nunca haviam recebido tratamento para abuso de substâncias (n = 265, 36,1%) e aqueles que já haviam sido tratados uma ou mais vezes (n = 470, 63,9%). Foram observadas diferenças significativas entre os grupos nas áreas de droga, sintomas psiquiátricos e problemas legais e familiares/sociais (p < 0,05).CONCLUSÕES: Nossos dados confirmam evidências prévias de que o manejo de pacientes que procuram tratamento para abuso de substância deve levar em conta vários aspectos, como educação, emprego e relações familiares, que normalmente geram preocupação nesses indivíduos.

Palavras-chave

Abuso de substâncias, tratamento, multicêntrico, álcool, drogas, saúde pública

References

Carlini EA, Galduróz JC, Noto AR, Carlini CM, Oliveira LG, Nappo SA. II levantamento domiciliar sobre o uso de drogas psicotrópicas no Brasil: estudo envolvendo as 108 maiores cidades do país: 2005. 2007.

Bastos F, Bertoni N, Hacker M. Grupo de Estudos em População, Sexualidade e Aids. [Drug and alcohol use: main findings of a national survey, Brazil 2005]. Rev Saude Publica. 2008;42:109-17.

Rehm J, Taylor B, Room R. Global burden of disease from alcohol, illicit drugs and tobacco. Drug Alcohol Rev.. 2006;25:503-13.

Ciraulo DA, Piechniczek-Buczek J, Iscan EN. Outcome predictors in substance use disorders. Psychiatr Clin North Am.. 2003;26:381-409.

Otiashvili D, Djordjevic A, Morales D, Parsons A, Platt E, Stempliuk V. Factors related to the process of seeking and completing treatment for drug abuse (qualitative methods in drug abuse research). Georgian Med News. 2005;122:29-32.

Locastro JS, Potter JS, Donovan DM, Couper D, Pope KW. Characteristics of first-time alcohol treatment seekers: the COMBINE Study. J Stud Alcohol Drugs. 2008;69:885-95.

Rapp R, Xu J, Carr CA, Lane DT, Wang J, Carlson R. Treatment barriers identified by substance abusers assessed at a centralized intake unit. J Subst Abuse Treat.. 2006;30:227-35.

McLellan AT, Alterman AI, Metzger DS, Grissom GR, Woody GE, Luborsky L. Similarity of outcome predictors across opiate, cocaine, and alcohol treatments: role of treatment services. J Consult Clin Psychol.. 1994;62:1141-58.

Silva O, Yonamine M. Drug abuse among workers in Brazilian regions. Rev Saude Publica. 2004;38:552-6.

Laranjeira R, Marques AC, Ramos Sde P, Campana A, Luz E Jr, França J. Who runs alcohol policy in Brazil?. Addiction. 2007;102:1502-3.

Marsden J, Gossop M, Stewart D, Rolfe A, Farrell M. Psychiatric symptoms among clients seeking treatment for drug dependence. Intake data from the National Treatment Outcome Research Study. Br J Psychiatry. 2000;176:285-9.

Borges CF, Baptista TW. The mental health care model in Brazil: a history of policy development from 1990 to 2004. Cad Saude Publica. 2008;24:456-68.

Moraes M. Integral healthcare model for treating problems caused by alcohol and other drugs: perceptions of users, their companions and practitioners. Cien Saude Colet.. 2008;13:121-33.

Kessler F, Cacciola J, Faller S, Souza-Formigoni ML, Cruz M, Brasiliano S. Adaptação transcultural multicêntrica da sexta versão da Escala de Gravidade de Dependência (ASI6) para o Brasil. Rev Psiquiatr Rio Gd Sul.. 2007;29:335-6.

Henrique IF, De Micheli D, Lacerda RB, Lacerda LA, Formigoni ML. Validation of the Brazilian version of Alcohol, Smoking and Substance Involvement Screening Test (ASSIST). Rev Assoc Med Bras.. 2004;50:199-206.

Green CA, Polen MR, Dickinson DM, Lynch FL, Bennett MD. Gender differences in predictors of initiation, retention, and completion in an HMO-based substance abuse treatment program. J Subst Abuse Treat. 2002;23:285-95.

Wechsberg WM, Luseno W, Ellerson RM. Reaching women substance abusers in diverse settings: stigma and access to treatment 30 years later. Subst Use Misuse. 2008;43:1277-9.

Stein MD, Mulvey KP, Plough A, Samet JH. The functioning and well being of persons who seek treatment for drug and alcohol use. J Subst Abuse. 1998;10:75-84.

Elbreder MF, Laranjeira R, Siqueira MM, Barbosa DA. Perfil de mulheres usuárias de álcool em ambulatório especializado em dependência química. J Bras Psiquiatr.. 2008;57:9-15.

Hingson RW, Heeren T, Winter MR. Age at drinking onset and alcohol dependence: age at onset, duration, and severity. Arch Pediatr Adolesc Med.. 2006;160:739-46.

Chen CY, Storr CL, Anthony JC. Early-onset drug use and risk for drug dependence problems. Addict Behav.. 2009;34:319-22.

Zilberman ML, Hochgraf PB, Brasiliano S, Milharcic SI. Drug-dependent women: demographic and clinical characteristics in a Brazilian sample. Subst Use Misuse.. 2001;36:1111-27.

Bernardy CC, de Oliveira ML. The role of family relationships in the initiation of street drug abuse by institutionalized youths. Rev Esc Enferm USP. 2010;44:11-7.

Censo Demográfico 2000 [Internet]. 2002.

Lincoln A, Paasche-Orlow MK, Cheng DM, Lloyd-Travaglini C, Caruso C, Saitz R. Impact of health literacy on depressive symptoms and mental health-related: quality of life among adults with addiction. J Gen Intern Med.. 2006;21:818-22.

Santos GPG. Unemployment, informality and precariousness: the labor market situation in Brazil after 1990. Pro-Prosições. 2008;19:151-61.

McLellan AT, Cacciola JC, Alterman AI, Rikoon SH, Carise D. The Addiction Severity Index at 25: origins, contributions and transitions. Am J Addict. 2006;15:113-24.

Caetano R, Laranjeira R. A 'perfect storm' in developing countries: economic growth and the alcohol industry. Addiction. 2006;101:149-52.

Fraga PCP. Plantios ilícitos no Brasil: notas sobre a violência e o cultivo de cannabis no polígono da maconha. Cad Ciencias Humanas - Especiaria. 2006;9:95-118.

Peuker AC, Fogaça J, Bizarro L. Expectativas e beber problemático entre universitários. Psic: Teor Pesq.. 2006;22:193-200.

Silveira CM, Wang YP, Andrade AG, Andrade LH. Heavy episodic drinking in the Sao Paulo epidemiologic catchment area study in Brazil: gender and sociodemographic correlates. J Stud Alcohol Drugs.. 2007;68:18-27.

Wechsler H, Nelson TF. Binge drinking and the American college student: what's five drinks?. Psychol Addict Behav.. 2001;15:287-91.

Laranjeira R, Pinsky I, Zaleski M, Caetano R. I Levantamento Nacional sobre os padrões de consumo de álcool na população brasileira. 2007.

Galduróz JC, Noto AR, Nappo SA, Carlini EA. Household survey on drug abuse in Brazil: study involving the 107 major cities of the country--2001. Addict Behav.. 2005;30:545-56.

Ferri CP, Laranjeira RR, da Silveira DA, Dunn J, FormigonI ML. Increase in the search for treatment by crack users in 2 outpatient clinics at the city of Sao Paulo from 1990 to 1993. Rev Assoc Med Bras.. 1997;43:25-8.

Inciardi JA, Surratt HL, Pechansky F, Kessler F, von Diemen L, da Silva EM. Changing patterns of cocaine use and hiv risks in the south of Brazil. J Psychoactive Drugs. 2006;38:305-10.

Kessler F, Pechansky F. A contemporary psychiatric view on the crack phenomenon. Rev Psiquiatr Rio Gd Sul.. 2008;30:1-3.

Kessler F, Woody G, De Boni R, Von Diemen L, Benzano D, Faller S. Evaluation of psychiatric symptoms in cocaine users in the Brazilian public health system: need for data and structure. Public Health. 2008;122:1349-55.

Cunningham JA, Breslin FC. Only one in three people with alcohol abuse or dependence ever seek treatment. Addict Behav.. 2004;29:221-3.

Evren C, Dalbudak E, Cakmak D. Personality dimensions in male patients with early-onset alcohol dependence who seek treatment. Isr J Psychiatry Relat Sci. 2009;46:204-6.

Ribeiro M, Dunn J, Sesso R, Dias AC, Laranjeira R. Causes of death among crack cocaine users. Rev Bras Psiquiatr.. 2006;28:196-202.

Duailibi LB, Ribeiro M, Laranjeira R. Profile of cocaine and crack users in Brazil. Cad Saude Publica. 2008;24:s545-57.

Carvalho HB, Seibel SD. Crack cocaine use and its relationship with violence and HIV. Clinics (Sao Paulo). 2009;64:857-66.

Guimarães CF, Santos DVV, Freitas RC, Araujo RB. Perfil do usuário de crack e fatores relacionados à criminalidade em unidade de internação para desintoxicação no Hospital Psiquiátrico São Pedro de Porto Alegre (RS). Rev Psiquiatr Rio Gd Sul.. 2008;30:101-8.

Schumacher JA, Coffey SF, Stasiewicz PR. Symptom severity, alcohol craving, and age of trauma onset in childhood and adolescent trauma survivors with comorbid alcohol dependence and posttraumatic stress disorder. Am J Addict. 2006;15:422-5.

Clark HW, Masson CL, Delucchi KL, Hall SM, Sees KL. Violent traumatic events and drug abuse severity. J Subst Abuse Treat. 2001;20:121-7.

Carey MP, Chandra PS, Carey KB, Neal DJ. Predictors of HIV risk among men seeking treatment for substance abuse in India. Arch Sex Behav.. 2003;32:339-49.

Wainberg ML, McKinnon K, Elkington KS, Mattos PE, Gruber Mann C, De Souza Pinto D. HIV risk behaviors among outpatients with severe mental illness in Rio de Janeiro, Brazil. World Psychiatry. 2008;7:166-72.

Carvalho HB, Seibel SD. Crack cocaine use and its relationship with violence and HIV. Clinics (Sao Paulo). 2009;64:857-66.

Elbreder MF, Laranjeira R, Siqueira MM, Barbosa DA. Perfil de mulheres usuárias de álcool em ambulatório especializado em dependência química. J Bras Psiquiatr.. 2008;57:9-15.

Campos EA, Reis JG. Representações sobre o uso de álcool por mulheres em tratamento em um centro de referência da cidade de São Paulo - Brasil. Interface (Botucatu) [online]. 2010;14:539-50.

Figlie NB, Laranjeira R. Gerenciamento de caso aplicado ao tratamento da dependência do álcool. Rev Bras Psiquiatr.. 2004;26:63-7.

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