Quasi-randomized trial of solution-focused brief therapy intervention for readiness to change and alcohol and other drug use in a Brazilian community-based treatment center.

OBJECTIVE: Strategies to increase readiness to change may enhance community-based substance use treatment outcomes. This study evaluated the effect of solution-focused brief therapy (SFBT) on readiness to change and substance use compared to treatment as usual (TAU) in a Brazilian community-based substance use treatment center. METHODS: One hundred two adults (M = 36.79, SD = 10.29) were quasi-randomized into SFBT or TAU groups. Assessments were completed at baseline, post-test, and 1-month follow-up. The primary outcome was the changes in readiness to change at post-test and 1-month follow-up. The secondary outcome was the change in substance use at 1-month follow-up. RESULTS: Through Quade non-parametric analysis of covariance (ANCOVA), both groups decreased tobacco, alcohol, and cocaine/crack use at 1-month follow-up, but SFBT had greater reductions in alcohol use (p = .05). ANCOVA analysis demonstrated no differences between groups on readiness to change at any time point. However, among participants who used multiple substances (n = 59), SFBT showed higher readiness to change at post-test (p = .05). CONCLUSIONS: These findings strengthen the evidence that SFBT holds promise for positive community-based substance use treatment outcomes.

Drug Use among the Elderly Assisted by the Psychosocial Assistance Center in District Federal-Brasilia.

The inadequate and abusive usage of psychoactive substances is something real that affects Brazil's elderly population, and it is a huge challenge for the public health system and its professionals. Aware of the social impact involving the use of illegal drugs, in 2002, the Ministry of Health instituted a network of psychosocial assistance as a strategy to deal with the problem. This study carried out an analysis of the profile of use of legal and illegal drugs by the elderly who are assisted by the network of psychosocial assistance in the Federal District. A quantitative and analytical study with secondary data collection, using patient records held in the CAPS-AD in the Federal District. The inclusion criteria were people of 60 and over who were users of alcohol and other drugs and who sought assistance at CAPS-AD between 2000 and 2017. A total of 408 medical records were analyzed concerning social demographic variations, types of rehabilitation services sought, types of substances consumed, associations between drugs consumed, time of consumption, and adherence to the treatment. Most of the elderly users were male (85.3%), on average 64 ± 4.42 years old. Regarding the drugs consumed, the highest quantity was for illegal substances (76%), compared to the legal ones (23%). No significant difference was found between males (OR = 1.1) and females (OR = 0.74) regarding the use or abuse of multiple drugs. The elderly used both legal and illegal drugs for a long period of time, with low adherence to the treatment, and alcohol consumption among the elderly prevailed above the other psychoactive substances.

The impact of integrated care in community-based substance use treatment in Brazil: A longitudinal study.

Integrated care (outpatient-inpatient) plays a vital function in community care for people with drug use problems. Its recent and innovative treatment model is representing a challenge for the deinstitutionalisation process. The purpose of this study was to assess the impact of integrated care using biopsychosocial indicators. We conducted a prospective longitudinal study with 122 clients from the baseline undergoing integrated care of two Psychosocial Care Centers for Alcohol and Other Drugs in São Paulo, Brazil, with three months follow-up (February 2019-January 2020). To assess the biopsychosocial indicators of the impact, we used the Substance Addiction Consequences (SAC), WHOQOL-BREF quality of life scales and the psychosocial rehabilitation axes (housing, work/income, and support network). We conducted a longitudinal analysis with linear mixed-effects models. The integrated care impacted the reduction in the days of substance use and increase of abstinence with a significant difference for cannabis (p < 0.001) and crack (p = 0.021). It reduced the substance use harms in all SAC scale dimensions (p < 0.001). Quality of life increased and remained mainly associated with the psychological size (p < 0.001). All psychosocial rehabilitation axes improved with a difference for income (p = 0.025). The increase in people's participation in treatment was relevant. The integrated care of Brazilian services has a positive impact on reducing substance use days and harms associated, improves the quality of life and contributes to the psychosocial rehabilitation of clients. Should be taken efforts to maintain long-term results.

Characteristics of clients using a community-based drug treatment service ('CAPS-AD') in Brazil: An exploratory study.

BACKGROUND: Substance use is common in Brazil. In order to improve availability of substance misuse care services, over 400 Psycho-Social Care Centres for Alcohol and Drugs (CAPS-AD) - providing community-based care - have been established following mental health care reform (2001). Information on CAPS-AD clients and outcomes is limited. The present study examined select characteristics of local CAPS-AD clients. METHODS: N=143 adult CAPS-AD clients in Ceilândia (suburb of Brasília, Federal District) participated in a 1-week 'snapshot' assessment of service users (February 2015). Following consent, descriptive data were collected by a brief, anonymous interviewer-administered questionnaire that included socio-demographic, drug use, treatment history and needs/barriers information. RESULTS: Participants were predominantly male; middle-aged; unemployed; married; with middle-school education; primary problem drugs indicated were alcohol and cocaine/crack; half had prior treatment histories and indicated that treatment was externally motivated; 60% reported ways to improve treatment and possible reasons for treatment discontinuation; in multi-variate analyses, the latter was associated with employment and education status (both p<.05). CONCLUSION: CAPS-AD services appear to have increased low-barrier substance misuse treatment availability in Brazil, as well as attract individuals new to the treatment system. Various potential barriers to continuing in treatment should be addressed and more research on CAPS-AD clients and outcomes is needed.