ABSTRACT
The purpose of this paper is to supply a narrative review of the concepts, history, functions, methods, development and theoretical bases for the use of halfway houses for patients with mental disorders, and their correlations, for the net construction of chemical dependence model. This theme, in spite of its relevance, is still infrequently explored in the national literature. The authors report international and national uses of this model and discuss its applicability for the continuity of services for alcohol dependents. The results suggest that this area is in need of more attention and interest for future research.
Subject(s)
Alcoholism/rehabilitation , Halfway Houses/organization & administration , Brazil , Cost-Benefit Analysis , Halfway Houses/economics , Health Care Reform , Humans , Models, OrganizationalABSTRACT
OBJECTIVE: To evaluate anticraving action and tolerability of topiramate in cocaine user treatment. METHOD: Male users of inhaled cocaine which met criteria for cocaine dependence (Diagnostic and Statistical Manual of Mental Disorders, fourth edition) were selected for outpatient 12-week, open label trial with topiramate; individual dosage ranged between 25-300 mg/day. Main clinical variables were abstinence rate, craving intensity, frequency and duration, adherence, dropouts, side effects and impulsivity measure through Barratt Impulsivity Scale. Patients received assertive strategic counseling for abstinence assistance and medication monitoring evaluation every two weeks. Comparative analysis was made with intention to treat, missing values were replaced (last observation carried forward), and significance level was 5 percent. RESULTS: Adherence to treatment was 57 percent (at least three evaluations), 32 percent dropped out (one evaluation). There were no severe side effects. Negative test average was 25.4 percent (31.2). Significant reduction in craving intensity and duration was observed in 25 percent of the sample. No statistical significant reduction in craving frequency was observed in 7.1 percent. Increase in frequency was observed in 10.7 percent and 82.1 percent did not present any variation. No significant statistical variations in Barratt Impulsivity Scale or in the total score were found in the final evaluation when compared to baseline. CONCLUSION: More randomized placebo-controlled trials with topiramate for cocaine dependants should be performed to evaluate preliminary evidence.
OBJETIVO: Avaliar a ação anticraving e tolerabilidade do topiramato em usuários de cocaína. MÉTODO: Homens usuários de cocaína inalada que preenchiam critérios para dependência de cocaína (Manual Diagnóstico e Estatístico de Desordens Mentais, quarta edição) foram selecionados para 12 semanas de tratamento ambulatorial, em ensaio clínico aberto com topiramato; dosagens escalonadas entre 25-300 mg/dia. As principais variáveis clínicas foram taxa de abstinência, intensidade, freqüência e duração do craving, aderência, perdas, efeitos colaterais e impulsividade medida por meio da Escala de Impulsividade Barratt. Os pacientes receberam estratégias assertivas de aconselhamento para manutenção da abstinência e monitoramento da medicação avaliada a cada duas semanas. Análises comparativas foram feitas com intenção de tratar, valores perdidos foram substituídos (última observação carregada ao final) e o nível de significância de 5 por cento. RESULTADOS: A aderência ao tratamento foi de 57 por cento (pelo menos três avaliações), 32 por cento de perdas (uma avaliação). Não houve efeitos colaterais graves. A média de testes negativos foi 25,4 por cento (31,2). Significante redução na intensidade e duração do craving foi observada em 25 por cento da amostra. Nenhuma redução significativa na freqüência do craving foi observada em 7,1 por cento. Aumento na freqüência foi observado em 10,7 por cento e 82,1 por cento não apresentaram nenhuma variação. Nenhuma variação estatisticamente significativa na Escala de Impulsividade Barratt ou na pontuação total foi encontrada no final da avaliação quando comparado à inicial. CONCLUSÃO: Mais ensaios clínicos placebo-controlados com o topiramato para dependentes de cocaína deveriam ser conduzidos a fim de avaliar a evidência preliminar.
Subject(s)
Adult , Humans , Male , Behavior, Addictive/drug therapy , Cocaine-Related Disorders/drug therapy , Fructose/analogs & derivatives , Neuroprotective Agents/therapeutic use , Substance Withdrawal Syndrome/psychology , Ambulatory Care , Behavior, Addictive/psychology , Cocaine-Related Disorders/psychology , Fructose/adverse effects , Fructose/therapeutic use , Medication Adherence/psychology , Neuroprotective Agents/adverse effects , Patient Dropouts/psychology , Self-AssessmentABSTRACT
OBJECTIVE: To evaluate anticraving action and tolerability of topiramate in cocaine user treatment. METHOD: Male users of inhaled cocaine which met criteria for cocaine dependence (Diagnostic and Statistical Manual of Mental Disorders, fourth edition) were selected for outpatient 12-week, open label trial with topiramate; individual dosage ranged between 25-300 mg/day. Main clinical variables were abstinence rate, craving intensity, frequency and duration, adherence, dropouts, side effects and impulsivity measure through Barratt Impulsivity Scale. Patients received assertive strategic counseling for abstinence assistance and medication monitoring evaluation every two weeks. Comparative analysis was made with intention to treat, missing values were replaced (last observation carried forward), and significance level was 5%. RESULTS: Adherence to treatment was 57% (at least three evaluations), 32% dropped out (one evaluation). There were no severe side effects. Negative test average was 25.4% (31.2). Significant reduction in craving intensity and duration was observed in 25% of the sample. No statistical significant reduction in craving frequency was observed in 7.1%. Increase in frequency was observed in 10.7% and 82.1% did not present any variation. No significant statistical variations in Barratt Impulsivity Scale or in the total score were found in the final evaluation when compared to baseline. CONCLUSION: More randomized placebo-controlled trials with topiramate for cocaine dependants should be performed to evaluate preliminary evidence.
Subject(s)
Behavior, Addictive/drug therapy , Cocaine-Related Disorders/drug therapy , Fructose/analogs & derivatives , Neuroprotective Agents/therapeutic use , Substance Withdrawal Syndrome/psychology , Adult , Ambulatory Care , Behavior, Addictive/psychology , Cocaine-Related Disorders/psychology , Fructose/adverse effects , Fructose/therapeutic use , Humans , Male , Medication Adherence/psychology , Neuroprotective Agents/adverse effects , Patient Dropouts/psychology , Self-Assessment , TopiramateABSTRACT
The purpose of this paper is to supply a narrative review of the concepts, history, functions, methods, development and theoretical bases for the use of halfway houses for patients with mental disorders, and their correlations, for the net construction of chemical dependence model. This theme, in spite of its relevance, is still infrequently explored in the national literature. The authors report international and national uses of this model and discuss its applicability for the continuity of services for alcohol dependents. The results suggest that this area is in need of more attention and interest for future research.
Subject(s)
Humans , Alcoholism/rehabilitation , Halfway Houses/organization & administration , Brazil , Cost-Benefit Analysis , Health Care Reform , Halfway Houses/economics , Models, OrganizationalABSTRACT
OBJECTIVE: Although there is a considerable amount of data in the literature regarding the association between alcohol consumption and injuries treated in emergency rooms, little is known about the relationship between such injury and the use of other substances. The objective of this study was to estimate the prevalence of substance use in patients admitted to the emergency room for non-fatal injuries. METHOD: A prospective cross-sectional study assessing all patients admitted to the emergency room within 6 hours after a non-fatal injury was conducted over a three-month period. The following were used as measures of alcohol and drug use: a standardized World Health Organization questionnaire; a self-administered questionnaire related to drug consumption within the 24 hours preceding contact; the Drug Abuse Screening Test; urine screens for cannabis, cocaine and benzodiazepines; and determination of blood alcohol concentration. Descriptive analyses were performed and the confidence interval used was 95%. RESULTS: A total of 353 patients were included. Cannabis and cocaine screens were conducted for 242 patients and benzodiazepine screens were conducted for 166. Blood alcohol concentrations reached the level of positivity in 11% (n = 39), and 10% (n = 33) presented some degree of intoxication. Among the 242 patients screened, 13.6% (n = 33) tested positive for cannabis, and 3.3% (n = 8) tested positive for cocaine, whereas 4.2% (n = 7) of the 166 patients screened tested positive for benzodiazepines. CONCLUSIONS: Substance use was highly prevalent among these individuals. In this sample, the frequency for the use of cannabis (an illicit drug) was comparable to that of alcohol. More studies are needed in order to characterize such use among Brazilians and to develop proper approaches to such cases, with the aim of reducing substance use and its consequences.
Subject(s)
Alcohol-Related Disorders/epidemiology , Marijuana Abuse/epidemiology , Wounds and Injuries/epidemiology , Adult , Alcohol-Related Disorders/blood , Alcohol-Related Disorders/complications , Anti-Anxiety Agents/analysis , Benzodiazepines/analysis , Brazil/epidemiology , Cocaine/blood , Cross-Sectional Studies , Emergency Service, Hospital/statistics & numerical data , Female , Humans , Male , Marijuana Abuse/complications , Marijuana Abuse/urine , Prevalence , Prospective Studies , Substance Abuse Detection , Wounds and Injuries/etiologyABSTRACT
OBJECTIVE: Although there is a considerable amount of data in the literature regarding the association between alcohol consumption and injuries treated in emergency rooms, little is known about the relationship between such injury and the use of other substances. The objective of this study was to estimate the prevalence of substance use in patients admitted to the emergency room for non-fatal injuries. METHOD: A prospective cross-sectional study assessing all patients admitted to the emergency room within 6 hours after a non-fatal injury was conducted over a three-month period. The following were used as measures of alcohol and drug use: a standardized World Health Organization questionnaire; a self-administered questionnaire related to drug consumption within the 24 hours preceding contact; the Drug Abuse Screening Test; urine screens for cannabis, cocaine and benzodiazepines; and determination of blood alcohol concentration. Descriptive analyses were performed and the confidence interval used was 95 percent. RESULTS: A total of 353 patients were included. Cannabis and cocaine screens were conducted for 242 patients and benzodiazepine screens were conducted for 166. Blood alcohol concentrations reached the level of positivity in 11 percent (n = 39), and 10 percent (n = 33) presented some degree of intoxication. Among the 242 patients screened, 13.6 percent (n = 33) tested positive for cannabis, and 3.3 percent (n = 8) tested positive for cocaine, whereas 4.2 percent (n = 7) of the 166 patients screened tested positive for benzodiazepines. CONCLUSIONS: Substance use was highly prevalent among these individuals. In this sample, the frequency for the use of cannabis (an illicit drug) was comparable to that of alcohol. More studies are needed in order to characterize such use among Brazilians and to develop proper approaches to such cases, with the aim of reducing substance use and its consequences.
OBJETIVO: Ainda que haja significativa literatura sobre a associação entre álcool e trauma, pouco se sabe sobre o uso de outras substâncias e trauma em pronto socorro. O objetivo do estudo foi estimar a prevalência do uso de substâncias em pacientes admitidos em um pronto socorro por trauma não fatal. MÉTODO: Um estudo prospectivo de corte transversal avaliando todos os pacientes admitidos dentro de 6 horas antes de trauma não fatal em pronto socorro durante um período de três meses. Um questionário padronizado pela Organização Mundial de Saúde, o auto-relato do consumo de drogas nas últimas 24 horas antes do contato; Drug Abuse Screening Test); screening de urina para maconha, cocaína e benzodiazepínicos e Concentração de Alcool no Sangue foram utilizados como medidas de avaliação do uso de álcool e drogas. Foram realizadas análises descritivas e o intervalo de confiança foi de 95 por cento. RESULTADOS: Foram incluídos 353 pacientes, tendo sido coletados screenings de maconha e cocaína de 242 pacientes e de 166 pacientes para benzodiazepínicos. A Concentração de Alcool no Sangue foi positiva em 11 por cento (n = 39) e 10 por cento (n = 33) apresentaram algum grau de intoxicação alcoólica. O teste de maconha foi positivo em 13,6 por cento (n = 33); respectivamente de cocaína em 3,3 por cento (n = 8) e de benzodiazepínicos em 4,2 por cento (n = 7). CONCLUSÕES: O uso de substâncias nesses indivíduos que sofreram trauma é altamente prevalente. Nesta amostra, a freqüência para maconha (uma droga ilícita) esteve próxima ao de álcool. Mais estudos são necessários a fim de identificar a realidade brasileira e elaborar identificações adequadas para estes casos, visando à redução do uso de substâncias e suas conseqüências.