Performance measures for alcohol and other drugs services: a commentary.

Alcohol and other drugs treatment includes a wide range of service and personal characteristics, along with expected and unexpected barriers to treatment. To capture the benefits and the gaps of a designed treatment, one needs to consider process-of-care and outcome measurements. Process-of-care measures are mainly developments of the rationale proposed by The Washington Circle and capture all variants in the process-of-care as proportions. Outcome measures are strongly related to different concepts of recovery and described as simple yes/no answers type to wide levels of response, such as in Likert-type scales. According to the studies collected here, more realistic periods of data-collection for process-of-care measures and a more reliable format to capture outcome particularities should be designed.

Alcohol Use and COVID-19: Can we Predict the Impact of the Pandemic on Alcohol Use Based on the Previous Crises in the 21st Century? A Brief Review.

The enormous health and economic challenges precipitated by the 2019 coronavirus disease (COVID-19) pandemic are comparable or even greater than those associated with previous historical world crises. Alcohol use, especially drinking to cope with stress, is a concern, as an increase in its sales has been reported in some countries during the quarantine. This study aims to provide a better understanding of what to expect in terms of alcohol consumption, risk factors for excessive use, and its potential consequences during this pandemic based on previous experiences. We investigated how traumatic events related to alcohol consumption. Studies on mass traumatic events (i.e., terrorism as 9/11), epidemic outbreaks (i.e., severe acute respiratory syndrome [SARS] in 2003), economic crises (such as 2008's Great Recession), and COVID-19 were selected. The main keywords used to select the studies were alcohol use, drinking patterns, alcohol use disorders, and alcohol-related consequences. Previous studies reported increases in alcohol use associated with those events mediated, at least partially, by anxiety and depressive symptoms, and posttraumatic stress disorder (PTSD). Being male, young, and single also seems to be associated with a higher vulnerability to develop risky drinking behavior after those tragic events. The discussion of previous risk and protective factors can contribute to elaborate more specific public health policies to mitigate the impact of the current pandemic on people's mental health, especially alcohol-related problems.

The role of neurocognitive functioning, substance use variables and the DSM-5 severity scale in cocaine relapse: A prospective study.

BACKGROUND: The severity of substance use disorder (SUD) is currently defined by the sum of DSM-5 criteria. However, little is known about the validity of this framework or the role of additional severity indicators in relapse prediction. This study aimed to investigate the relationship between DSM-5 criteria, neurocognitive functioning, substance use variables and cocaine relapse among inpatients with cocaine use disorder (CUD). METHODS: 128 adults aged between 18 and 45 years were evaluated; 68 (59 males, 9 females) had CUD and 60 (52 males, 8 females) were healthy controls. For the group with CUD, the use of other substances was not an exclusion criterion. Participants were tested using a battery of neurocognitive tests. Cocaine relapse was evaluated 3 months after discharge. RESULTS: Scores for attention span and working memory were worse in patients compared to controls. Earlier onset and duration of cocaine use were related to poorer inhibitory control and global executive functioning, respectively; recent use was related to worse performance in inhibitory control, attention span and working memory. More DSM-5 criteria at baseline were significantly associated with relapse. CONCLUSIONS: Recent cocaine use was the most predictive variable for neurocognitive impairments, while DSM-5 criteria predicted cocaine relapse at three months post treatment. The integration of neurocognitive measures, DSM-5 criteria and cocaine use variables in CUD diagnosis could improve severity differentiation. Longitudinal studies using additional biomarkers are needed to disentangle the different roles of severity indicators in relapse prediction and to achieve more individualized and effective treatment strategies for these patients.

Intention to Drive After Drinking Among Medical Students: Contributions of the Protection Motivation Theory.

OBJECTIVE: The aim of this study was to investigate whether cognitive variables proposed by the protection motivation theory (PMT) were predictive of occasional and frequent intention to drive after drinking in medical students. METHODS: One hundred fifty-five students attending preclinical years at a Medical School in São Paulo, Brazil, participated in the study. They were asked about their last month substance use, history of drinking and driving, including driving after binge drinking, and risk perceptions based on a self-report questionnaire with statements about protection motivation, threat, and coping appraisals from the PMT model. RESULTS: Fifty-two students (33%) had previous experience of driving after drinking during the last year, and 54 students (35%) reported intention to drive after drinking within the next year. Regression analysis showed that higher scores in perception of personal vulnerability to risks were associated with occasional and frequent intention to continue pursuing this particular behavior. Poorer evaluations about short-term consequences of alcohol consumption and cognitions regarding external rewards were significantly associated with reported intention to continue driving after drinking. CONCLUSIONS: Considering the social and health impact of alcohol-impaired behaviors, our findings suggest the need of interventional efforts focused in increasing students' awareness about the negative consequences of drinking and driving aiming to enhance their motivation towards more adaptive behaviors.

Fatores associados à Depressão Pós-Parto em mulheres em situação de vulnerabilidade social / Factors associated with postpartum depression in social vulnerability women / Factores asociados con la depresión posparto en las mujeres en situación de vulnerabilidad social

O presente trabalho teve por objetivo avaliar possíveis fatores associados com a depressão pós-parto (DPP), como o uso de substâncias e o suporte psicossocial em uma amostra de 102 mulheres em situação de vulnerabilidade social. O estudo foi realizado com puérperas que residiam provisoriamente no alojamento de um Hospital Maternidade público. Aproximadamente 20% das puérperas apresentaram critérios para a DPP além de um padrão de uso de álcool e maconha superior àquelas que não tinham o transtorno. Observou-se também associação entre violência, falta de suporte psicológico e apoio familiar com a DPP. Observou-se uma associação entre a DPP com outras comorbidades de modo que algumas variáveis estudadas possam estar envolvidas na etiologia e manutenção deste transtorno.

This study aimed to evaluate possible factors associated with postpartum depression syndrome (PDD), as the substance abuse and psychosocial support in a sample of 102 women in a social vulnerability condition. The study was conducted with mothers who were residents in specific hospital's lodging. Almost 20% of mothers showed symptoms to PDD as well as abusive alcohol and marijuana consumption compared with those who did not have PDD. Besides, it was observed an association between lack of psychological and familiar support with PDD. PDD it seems to be associated with other comorbidities so that some of these variables can be linked on the etiology and maintenance of PDD.

Este estudo tuvo como objectivo evaluar possibles factores associados con la Depresión Posparto (DPP) como el uso de substancias y apoio psicossocial em 102 mujeres em situación de vulnerabilidad social. El estúdio se realizó com las madres residentes transitórias em la vivienda de un Hospital Maternidad. Aproximadamente 20% de las madres presentaron criterios para el DPP, así como un de consumo de alcohol y marihuana superior a aquellas que no tienen el trastorno. También fue observada uma asociación entre la violencia, falta de apoyo psicológico y de la familia con el DPP. El DPP parece estar asociada con otras enfermedades concomitantes por lo que algunas variables pueden estar implicados en la etiología y el mantenimiento de este trastorno.

The influence of depressive symptoms and substance use on adherence to antiretroviral therapy. A cross-sectional prevalence study / A influência dos sintomas depressivos e do uso de substâncias na adesão à terapia antirretroviral. Um estudo transversal de prevalência

CONTEXT AND OBJECTIVE: Adherence to antiretroviral treatment (ART) is not a stable condition, but is dynamic, like mental conditions. The aim of this study was to examine whether non-adherence to ART is related to demographic and immunological variables, substance use and presence of depressive symptoms. DESIGN AND SETTING: This was a cross-sectional prevalence study carried out at a public AIDS treatment center in the city of São Paulo, Brazil, between July 2006 and January 2007. METHODS: 438 patients on regular ART schedules with recent laboratory tests answered a demographic questionnaire, questions about substance use, the Hamilton Depression Rating Scale (HDRS) and the Simplified Medication Adherence Questionnaire (SMAQ). RESULTS: The prevalence of non-adherence over the past three months (a pattern of treatment interruption) was 46.3%, and 27.2% also reported this in the past week (a pattern of missed doses). ART interruption was significantly related to older age, lower CD4+ cell count and homosexual/bisexual transmission. The pattern of missed doses was significantly related to younger age, higher HDRS scores and higher viral load of RNA HIV. CONCLUSION: ART interruption may reflect recall errors and changes to the Brazilian demographic characteristics of HIV infection. The missed doses may reflect lifestyle characteristics of younger individuals. Attendance for HIV-positive individuals, particularly younger patients, should involve interventions and counseling in relation to the presence of depressive symptoms. .

CONTEXTO E OBJETIVO: Adesão ao tratamento antirretroviral (TARV) não é uma condição estável, mas dinâmica, como os transtornos mentais. O objetivo deste estudo foi verificar se a não adesão ao TARV relaciona-se às variáveis demográficas e imunológicas, ao uso de substâncias e à presença de sintomas depressivos. DESENHO E LOCAL: Este estudo transversal de prevalência foi realizado em um serviço público para tratamento de pessoas HIV-positivas na cidade de São Paulo, Brasil, entre julho 2006 e janeiro 2007. MÉTODOS: 438 pacientes em regime regular de TARV, que tinham exames laboratoriais recentes, responderam a questionário demográfico, questões sobre uso de substâncias, Escala de Hamilton para Depressão (HAM-D) e Questionário Simplificado de Adesão à Medicação (QSAM). RESULTADOS: A prevalência de não adesão nos últimos três meses (um padrão de interrupção de tratamento) foi de 46,3% e de 27,2% na última semana (um padrão de perda de doses). A interrupção do TARV relacionou-se significativamente a maior idade, menor contagem de células CD4+ e contágio homo/bissexual, enquanto o padrão de perda de doses relacionou-se significativamente com idade mais jovem, pontuação mais alta na HAM-D e maior carga viral de RNA HIV. CONCLUSÃO: A interrupção do TARV pode refletir erros de memória e mudanças nas características demográficas brasileiras da infecção por HIV. A perda de doses pode refletir aspectos de estilo de vida de indivíduos mais jovens. O atendimento de indivíduos HIV-positivos, particularmente os mais jovens, deve envolver intervenções e aconselhamento em relação à presença de sintomas depressivos. .

Alcohol dependence and CD4 cell count: is there a relationship?

Alcohol and other drugs use seem to be common among people infected with HIV on antiretroviral treatment (ART). Their effects on HIV progression is still in debate. This study aimed to assess the association between alcohol and drug use and an HIV disease progression biomarker (CD4 cell count) among patients on ART. A cross-sectional study was carried out at an HIV treatment center affiliated with Medical School of the University of São Paulo, Brazil. Four hundred and thirty-eight HIV-positive patients on ART were interviewed by trained psychiatrists and psychologists using the following instruments: Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I), Alcohol Use Disorders Identification Test (AUDIT), 17-item Hamilton Rating Scale for Depression, and the Simplified Medication Adherence Questionnaire (SMAQ). In the previous month, 219 (50%) and 41 (9.3%) patients reported use of alcohol and illicit drugs, respectively. Fifty patients (12.6%) were classified as having harmful alcohol use by AUDIT. According to SCID-I, 80 patients (18.3%) were alcohol abusers, 24 (5.5%) alcohol dependents, and 21 (4.2%) had a current depressive disorder. Almost 73% (n = 319-72.8%) of the patients were adherent to ART. Alcohol dependents were nine times (p < 0.01) more likely to have CD4 cell count ≤200/mm(3), and this association was independent of ART adherence. In conclusion, alcohol dependence seems to be associated with low CD4 cell count in HIV-positive patients. Based on these data, HIV health care workers should always assess alcohol consumption in the treatment setting, and patients should be advised that alcohol dependence may be linked to low CD4.

The influence of depressive symptoms and substance use on adherence to antiretroviral therapy. A cross-sectional prevalence study.

CONTEXT AND OBJECTIVE: Adherence to antiretroviral treatment (ART) is not a stable condition, but is dynamic, like mental conditions. The aim of this study was to examine whether non-adherence to ART is related to demographic and immunological variables, substance use and presence of depressive symptoms. DESIGN AND SETTING: This was a cross-sectional prevalence study carried out at a public AIDS treatment center in the city of São Paulo, Brazil, between July 2006 and January 2007. METHODS: 438 patients on regular ART schedules with recent laboratory tests answered a demographic questionnaire, questions about substance use, the Hamilton Depression Rating Scale (HDRS) and the Simplified Medication Adherence Questionnaire (SMAQ). RESULTS: The prevalence of non-adherence over the past three months (a pattern of treatment interruption) was 46.3%, and 27.2% also reported this in the past week (a pattern of missed doses). ART interruption was significantly related to older age, lower CD4+ cell count and homosexual/bisexual transmission. The pattern of missed doses was significantly related to younger age, higher HDRS scores and higher viral load of RNA HIV. CONCLUSION: ART interruption may reflect recall errors and changes to the Brazilian demographic characteristics of HIV infection. The missed doses may reflect lifestyle characteristics of younger individuals. Attendance for HIV-positive individuals, particularly younger patients, should involve interventions and counseling in relation to the presence of depressive symptoms.

Álcool e outras drogas: conceitos básicos

Texto que compõe a unidade 1 do módulo 3 "Álcool e outras drogas" do Curso de Capacitação em Dependência Química, produzido pela UNA-SUS/UFMA. Aborda os padrões individuais de uso de drogas, a classificação das substâncias psicoativas de acordo com os efeitos no sistema nervoso central, bem como alguns dados epidemiológicos referentes à prevalência de dependência de álcool e drogas na população brasileira.

Dependência química: álcool

Texto que compõe a unidade 2 ­ parte I do módulo 3 "Álcool e outras drogas" do Curso de Capacitação em Dependência Química, produzido pela UNA-SUS/UFMA. Aborda os aspectos neurobiológicos e farmacocinéticos da dependência química, os transtornos e comorbidades relacionados ao uso do álcool, bem como o apoio da família do dependente na superação de dificuldades no modo de vida sem o uso de álcool.

Dependência química: tabaco

Texto que compõe a unidade 2 ­ parte II do módulo 3 "Álcool e outras drogas" do Curso de Capacitação em Dependência Química, produzido pela UNA-SUS/UFMA. Aborda como o tabaco age no organismo e as diversas complicações clínicas e sociais envolvidas.

Dependência química: maconha

Texto que compõe a unidade 3 do módulo 3 "Álcool e outras drogas" do Curso de Capacitação em Dependência Química, produzido pela UNA-SUS/UFMA. Aborda a epidemiologia e as comorbidades relacionadas ao uso da maconha, como os transtornos psicóticos, de humor, ansiedade, bem como o Transtorno de Déficit de Atenção e Hiperatividade (TDAH).

Cocaína e crack: conceitos básicos

Texto que compõe a unidade 1 do módulo 4 "Cocaína e Crack" do Curso de Capacitação em Dependência Química, produzido pela UNA-SUS/UFMA. Aborda alguns conceitos básicos sobre a cocaína e o crack, as formas de uso, a farmacocinética e farmacodinâmica, os fatores de risco, a correlação da neurobiologia com a clínica do dependente de cocaína, bem como os déficits neurocognitivos associados ao uso de crack e da cocaína.

Tratamento para dependência química de álcool e outras drogas

Texto que compõe a unidade 4 do módulo 3 "Álcool e outras drogas" do Curso de Capacitação em Dependência Química, produzido pela UNA-SUS/UFMA. Aborda os tipos de tratamento: medicamentoso, psicológico e a atividade física e ocupacional destinado a usuários de álcool e drogas.

Cocaína e crack: tratamento

Texto que compõe a unidade 2 do módulo 4, "Cocaína e crack", do Curso de Capacitação em Dependência Química, produzido pela UNA-SUS/UFMA. Aborda os principais tipos de tratamento de dependentes de cocaína e crack, destacando as principais medidas a serem tomadas no processo de reconhecimento do problema e que propiciem a mudança no estilo de vida do dependente químico

Cocaína e crack: outras drogas

Texto que compõe a unidade 3 do módulo 4, "Cocaína e crack", do Curso de Capacitação em Dependência Química, produzido pela UNA-SUS/UFMA. Aborda os efeitos e tratamentos à algumas substâncias que são cada vez mais utilizadas por adolescentes e jovens, tais como a ecstasy, LSD, Rohypnol, anfetaminas e outras

Cocaína e crack: intervenção familiar

Texto que compõe a Unidade 4 do Módulo 4, "Cocaína e crack", do Curso de Capacitação em Dependência Química, produzido pela UNA-SUS/UFMA. Apresenta as intervenções psicossociais, destacando a intervenção familiar na abordagem ao dependente químico

The association between low alcohol use and traffic risk behaviors among Brazilian college students.

Although there are a large number of studies focused on binge drinking and traffic risk behaviors (TRB), little is known regarding low levels of alcohol consumption and its association to TRB. The aim of this cross-sectional study is to examine the association of low to moderate alcohol intake pattern and TRB in college students in Brazil. 7037 students from a National representative sample were selected under rigorous inclusion criteria. All study participants voluntarily fulfilled a structured, anonymous, and self-questionnaire regarding alcohol and drug use, social-demographic data, and TRB. Alcohol was assessed according to the average number of alcoholic units consumed on standard occasions over the past 12 months. The associations between alcohol intake and TRB were summarized with odds ratio and their confidence interval obtained from logistic regression. Compared with abstainers students who consumed only one alcohol unit had the risk of being a passenger in a car driven by a drunk driver increased by almost four times, students who reported using five or more units were increased by almost five times the risk of being involved in a car crash. Compared with students who consumed one alcohol unit, the risk of driving under the influence of alcohol increased four times in students using three alcohol units. Age group, use of illicit drugs, employment status, gender, and marital status significantly influenced occurrence of TRB among college students. Our study highlights the potential detrimental effects of low and moderate pattern of alcohol consumption and its relation to riding with an intoxicated driver and other TRB. These data suggest that targeted interventions should be implemented in order to prevent negative consequences due to alcohol use in this population.

[Adolescent substance use and family problems]. / Uso de substâncias na adolescência e problemas familiares.

This study aimed to evaluate the association between substance use (alcohol, tobacco, and illicit drugs) and family problems among 965 adolescents from 50 public schools in two cities in São Paulo State, Brazil, in 2007. The Drug Use Screening Inventory (DUSI) was used for data collection. Use of alcohol, tobacco, and illicit drugs was associated with a negative assessment of the family relationship, lack of monitoring/support, and psychoactive substance use by family members (p < 0.05). Adolescents that reported having used alcohol, tobacco, and illicit drugs had more family problems than those who did not consume any substance (p < 0.001). Adolescents that used alcohol and tobacco (p = 0.028) and illicit drugs (p < 0.001) reported having more family problems than those who used only alcohol. The results highlight the importance of awareness of alcohol and tobacco use by adolescents, since such use was associated with significant family impairments, similar to illicit drug use.

Uso de substâncias na adolescência e problemas familiares / Adolescent substance use and family problems

Esta pesquisa visou a avaliar a associação entre o consumo de substâncias (álcool, tabaco e drogas ilícitas) e problemas familiares numa amostra de 965 adolescentes em 50 escolas públicas de dois municípios do Estado de São Paulo, Brasil, em 2007. Foi utilizado o Drug Use Screening Inventory (DUSI) para a coleta de dados. O uso de álcool, tabaco e drogas ilícitas foi associado à avaliação negativa da relação familiar, à falta de suporte/monitoramento e ao uso de substâncias por familiares (p < 0,05). Os estudantes que relataram ter feito uso de substâncias apresentaram mais problemas familiares do que aqueles que não consumiram nenhuma substância (p < 0,001). Os adolescentes que usaram álcool e tabaco (p = 0,028) e drogas ilícitas (p < 0,001) relataram ter mais problemas familiares do que aqueles que usaram apenas álcool. Os resultados apontam para a importância de se ficar atento ao consumo de álcool e tabaco entre os adolescentes, já que o relato do consumo das duas substâncias esteve associado a prejuízos familiares significativos, semelhantes ao uso de drogas ilícitas.

This study aimed to evaluate the association between substance use (alcohol, tobacco, and illicit drugs) and family problems among 965 adolescents from 50 public schools in two cities in São Paulo State, Brazil, in 2007. The Drug Use Screening Inventory (DUSI) was used for data collection. Use of alcohol, tobacco, and illicit drugs was associated with a negative assessment of the family relationship, lack of monitoring/support, and psychoactive substance use by family members (p < 0.05). Adolescents that reported having used alcohol, tobacco, and illicit drugs had more family problems than those who did not consume any substance (p < 0.001). Adolescents that used alcohol and tobacco (p = 0.028) and illicit drugs (p < 0.001) reported having more family problems than those who used only alcohol. The results highlight the importance of awareness of alcohol and tobacco use by adolescents, since such use was associated with significant family impairments, similar to illicit drug use.