Psychometric properties of the Brazilian version of the Big Five Inventory.

INTRODUCTION: There is growing interest in the fields of psychiatry and psychology in investigating the relationship between personality and psychopathology. The Big-5 is a model developed to investigate five personality dimensions: Extroversion, Agreeableness, Conscientiousness, Neuroticism, and Openness. In the present study, we describe the process of translation into Brazilian Portuguese and adaptation of a free tool to evaluate the Big-5 model: The Big-5 Inventory (BFI). The instrument has 44 items with a Likert response scale ranging from 1 to 5. OBJECTIVES: To translate and adapt the BFI into Brazilian Portuguese. METHODS: The adaptation was conducted in the following steps: 1) Translation, 2) Evaluation Committee, 3) Back-translation, 4) Pilot study, 5) Evaluation Committee, and 6) Application. The sample comprised 490 participants from various regions of Brazil. The participants' ages ranged from 18 to 71 years, most of them had completed high school (62.9%), and the majority were women (75%). RESULTS: A model with the following fit indexes was found: χ2/df: 1.954; goodness fit index (GFI): 0.924; comparative fit index (CFI): 0.920; and root mean square error of approximation (RMSEA): 0.044. CONCLUSION: The results are suggestive that the Brazilian version of this instrument has good psychometric properties and represent a cost-free option for investigating associations with the Big-5 in psychiatry.

Psychometric properties of the Brazilian version of the Big Five Inventory

Abstract Introduction There is growing interest in the fields of psychiatry and psychology in investigating the relationship between personality and psychopathology. The Big-5 is a model developed to investigate five personality dimensions: Extroversion, Agreeableness, Conscientiousness, Neuroticism, and Openness. In the present study, we describe the process of translation into Brazilian Portuguese and adaptation of a free tool to evaluate the Big-5 model: The Big-5 Inventory (BFI). The instrument has 44 items with a Likert response scale ranging from 1 to 5. Objectives To translate and adapt the BFI into Brazilian Portuguese. Methods The adaptation was conducted in the following steps: 1) Translation, 2) Evaluation Committee, 3) Back-translation, 4) Pilot study, 5) Evaluation Committee, and 6) Application. The sample comprised 490 participants from various regions of Brazil. The participants' ages ranged from 18 to 71 years, most of them had completed high school (62.9%), and the majority were women (75%). Results A model with the following fit indexes was found: χ2/df: 1.954; goodness fit index (GFI): 0.924; comparative fit index (CFI): 0.920; and root mean square error of approximation (RMSEA): 0.044. Conclusion The results are suggestive that the Brazilian version of this instrument has good psychometric properties and represent a cost-free option for investigating associations with the Big-5 in psychiatry.

Sexual risky behavior, cocaine and alcohol use among substance users in an outpatient facility: a cross section study.

BACKGROUND: Substance dependence is considered an international health issue and studies that access the characteristic of this population are required to develop public health programs for harm reduction. To this aim, we purpose to to identify, in a population undergo addiction treatment, if the use of substances leads to sexual risky behavior and also check if another variables influences in this behavior. METHOD: Observational study of clinical sample collected of adult patients seeking treatment to dependence of alcohol and cocaine. The data collected were: socio-demographic, substance use, sexual behavior and childhood abuse. Risky sexual behaviors were considered: inconsistent use of condoms and presence of multiple sexual partners in the past six months. An exploratory analysis of the association between the variable "risky sexual behavior" and the other variables was performed using Pearson's chi-square, followed by a multivariate logistic regression analysis. RESULTS: After analyzing the variables with the presence or absence of risky sexual behavior, were included in the logistic regression the data that presented association with sexual risk behavior, and age appears as an independent factor for risky sexual behaviors. Other factors, such as schooling and unemployment, influence as much as the use of substances in risky sexual behaviors. CONCLUSION: Attributing just to the substance use this risky sexual behavior seems too simplistic. Other structural factors such as schooling, work, age and sexual abuse in childhood can influence decision making for safe sex.

N-acetylcysteine for treating cocaine addiction - A systematic review.

The aim of this paper is to extensively review the current literature available on N-acetylcysteine (NAC) treatment for cocaine dependence (clinical and experimental studies). We screened all articles published before February 2016 reporting on the use of NAC as a pharmacological intervention for cocaine dependence or discussed its potential as a therapeutic approach for cocaine dependence. We described our results qualitatively. 21 studies matched our search criteria: 6 clinical trials and 15 animal studies. Four clinical studies showed NAC's capacity to reduce craving, desire to use cocaine, cocaine-cue viewing-time and cocaine-related spending. Studies in animal models also support this reinstatement prevention application of NAC. NAC reverses the disruption of glutamate homeostasis caused by long-term cocaine use restoring function of the cystine-glutamate exchanger in glial cells and reversing the downregulated GLT-1 receptor. Current data suggest promising potential for NAC as an anti-relapse agent, as a double-blind placebo trial was mainly negative, except in the subgroup of patients who were already abstinent. An optimal dose for relapse prevention may be one that restores extrasynaptic glutamate to physiological levels and predominantly activates mGluR2 and 3, but not mGluR5 receptors, which are linked to relapse. NAC may be better suited for avoiding relapse in already abstinent subjects.

Psychological and neuropsychological assessment of regular hoasca users.

BACKGROUND: Hoasca (also called ayahuasca) is a N,N-dimethyltryptamine (DMT) - containing psychedelic brew originally used for magico-religious purposes by Amerindian populations of the Amazon Basin. Recently, Brazilian syncretic churches have helped spread the ritual use of hoasca to Western societies. The aim of this study was to evaluate substance use, and neuropsychological and psychological functioning of regular hoasca users within a religious setting. METHODS: Assessment of socio-economic status, mood, personality traits, impulsiveness, drug use, quality of life, extrinsic and intrinsic religiosity, and neuropsychological function was performed on 30 volunteers from a U.S. branch of União do Vegetal (UDV), a Brazilian religion which uses hoasca ritually. We also assessed 27 non-hoasca-using control subjects matched by socio-demographic profile and church attendance. Mann-Whitney U, chi-squared and Fisher tests were used to analyze differences between groups. Spearman's association and simple logistic regression tests were used to analyze the impact of frequency of hoasca use on dependent variables. RESULTS: Relative to the control group, the UDV group demonstrated lower scores for depression (p=0.043, r=.27) and confusion (p=0.032, r=.29) as assessed by the Profile of Mood States (POMS); higher scores on the instrument Big Five Inventory (BFI) for the personality traits agreeableness (p=0.028, r=.29) and openness (p=0.037, r=.28); higher scores on the quality life domain role limitations due to physical health as determined by the instrument Medical Outcomes Study Short Form-36 - SF-36 (p=0.035, r=.28); less recent use of alcohol (p<0.001, φc=.57), greater past use of alcohol to intoxication (p=0.007, φc=.36) and past use of cannabis (p=0.001, φc=.45) as measured by the Addiction Severity Index (ASI), 5th edition; better score on a measure of memory vulnerability to proactive interference as measured by the California Verbal Learning Test - CVLT (p=0.040, r=.27). Lifetime use of hoasca was positively correlated with role limitations due to physical health (p=0.032, rs=.39) and negatively associated with lifetime heavy alcohol use (p=0.034, OR=0.979). CONCLUSIONS: The findings indicate that religious use of hoasca does not adversely affect neuropsychological functioning and may have positive effects on substance abuse and mood.

Acute Biphasic Effects of Ayahuasca.

Ritual use of ayahuasca, an amazonian Amerindian medicine turned sacrament in syncretic religions in Brazil, is rapidly growing around the world. Because of this internationalization, a comprehensive understanding of the pharmacological mechanisms of action of the brew and the neural correlates of the modified states of consciousness it induces is important. Employing a combination of electroencephalogram (EEG) recordings and quantification of ayahuasca's compounds and their metabolites in the systemic circulation we found ayahuasca to induce a biphasic effect in the brain. This effect was composed of reduced power in the alpha band (8-13 Hz) after 50 minutes from ingestion of the brew and increased slow- and fast-gamma power (30-50 and 50-100 Hz, respectively) between 75 and 125 minutes. Alpha power reductions were mostly located at left parieto-occipital cortex, slow-gamma power increase was observed at left centro-parieto-occipital, left fronto-temporal and right frontal cortices while fast-gamma increases were significant at left centro-parieto-occipital, left fronto-temporal, right frontal and right parieto-occipital cortices. These effects were significantly associated with circulating levels of ayahuasca's chemical compounds, mostly N,N-dimethyltryptamine (DMT), harmine, harmaline and tetrahydroharmine and some of their metabolites. An interpretation based on a cognitive and emotional framework relevant to the ritual use of ayahuasca, as well as it's potential therapeutic effects is offered.

Treating drug dependence with the aid of ibogaine: a retrospective study.

Ibogaine is an alkaloid purported to be an effective drug dependence treatment. However, its efficacy has been hard to evaluate, partly because it is illegal in some countries. In such places, treatments are conducted in underground settings where fatalities have occurred. In Brazil ibogaine is unregulated and a combined approach of psychotherapy and ibogaine is being practiced to treat addiction. To evaluate the safety and efficacy of ibogaine, we conducted a retrospective analysis of data from 75 previous alcohol, cannabis, cocaine and crack users (72% poly-drug users). We observed no serious adverse reactions or fatalities, and found 61% of participants abstinent. Participants treated with ibogaine only once reported abstinence for a median of 5.5 months and those treated multiple times for a median of 8.4 months. This increase was statistically significant (p < 0.001), and both single or multiple treatments led to longer abstinence periods than before the first ibogaine session (p < 0.001). These results suggest that the use of ibogaine supervised by a physician and accompanied by psychotherapy can facilitate prolonged periods of abstinence, without the occurrence of fatalities or complications. These results suggest that ibogaine can be a safe and effective treatment for dependence on stimulant and other non-opiate drugs.

Chronic light deprivation inhibits appetitive associative learning induced by ethanol and its respective c-Fos and pCREB expression.

To address the role of mixed anxiety/mood disorder on appetitive associative learning, we verify whether previous chronic light deprivation changes ethanol-induced conditioned place preference and its respective expression of c-Fos and pCREB, markers of neuronal activity and plasticity. The experimental group was maintained in light deprivation for 24 h for a period of 4 wk. Subsequently, it was adapted to a standard light-dark cycle for 1 wk. As a control, some mice were maintained in standard cycle for a period of 4 wk (Naïve group). Then, all animals were submitted to behavioral tests to assess emotionality: elevated plus maze; open field; and forced swim. After that, they were submitted to ethanol-induced conditioned place preference. Ninety minutes after the place preference test, they were perfused, and their brains processed for c-Fos and pCREB immunohistochemistry. Light deprivation induced anxiety-like trait (elevated plus maze), despair (forced swim), and hyperlocomotion (open field), common features seen in other animal models of depression. Ethanol-induced conditioned place preference was accompanied by increases on c-Fos and pCREB in the hippocampus, prefrontal cortex and striatum. Interestingly, mice previously submitted to light deprivation did not develop either acquisition and/or expression of ethanol-induced conditioned place preference or increases in c-Fos and pCREB. Therefore, chronic light deprivation mimics several behavioral aspects of other animal models of depression. Furthermore, it could be useful to study the neurochemical mechanisms involved in the dual diagnosis. However, given its likely deleterious effects on appetitive associative memory, it should be used with caution to investigate the cognitive aspects related to the dual diagnosis.

Is drug use related to the choice of potentially more harmful methods in suicide attempts?

OBJECTIVE: To identify whether drug abuse is a risk factor for potentially more harmful methods of suicide attempts that could predict suicide completion in the future. METHODS: The study involved the assessment of 86 patients who attempted suicide and who were admitted to the emergency ward of a Southwestern Brazilian general hospital. RESULTS: Most patients were women (84.9%), young adults (30.53 ± 10.4 years), and single (61.6%). Recent drug use was reported by 53.5%, and 25.6% reported the use of drugs during the 24-hour period immediately before the suicide attempt. Most patients (75.6%) ingested pills when attempting suicide-a method considered potentially less harmful. Hanging, jumping, gas inhaling, and wrist cutting accounted for 22.2% of the attempts. Considering dual diagnoses, 54.7% presented with a depressive disorder, 8.1% with a disorder on the impulse control spectrum, and 26.7% reported an associated clinical condition. Recent drug use was predictive of the severity of the suicide attempt, as it was reported by 81% of those who engaged in more harmful attempts and by 46.2% of those who used less harmful methods (P < 0.01; odds ratio = 4.96; confidence interval: 1.5-16.4). CONCLUSION: The identified variables associated with the use of potentially more harmful methods in suicide attempts were gender (male), presence of an impulsive control disorder, and recent use of psychoactive drugs.

Systematic review of the literature on clinical and experimental trials on the antitumor effects of cannabinoids in gliomas.

To evaluate, through a systematic review of the literature, the antitumoral effects of cannabinoids on gliomas. Research included the following electronic databases: PUBMED, EMBASE, LILACS and The Cochrane Collaboration Controlled Trials Register. All published studies involving the antitumoral effects (cellular and molecular mechanisms) of cannabinoids were considered for this review. The bibliography search strategy included all publications of each of these databases until December 31, 2012. From 2,260 initially identified articles, 35 fulfilled the inclusion criteria for this review. All the studies included in this systematic review were experimental (in vivo and/or in vitro), except for one pilot clinical trial phase I/II involving humans. In all experimental studies included, cannabinoids exerted antitumoral activity in vitro and/or antitumoral evidence in vivo in several models of tumor cells and tumors. The antitumor activity included: antiproliferative effects (cell cycle arrest), decreased viability and cell death by toxicity, apoptosis, necrosis, autophagy, as well as antiangiogenic and antimigratory effects. Antitumoral evidence included: reduction in tumor size, antiangiogenic, and antimetastatic effects. Additionally, most of the studies described that the canabinnoids exercised selective antitumoral action in several distinct tumor models. Thereby, normal cells used as controls were not affected. The safety factor in the cannabinoids' administration has also been demonstrated in vivo. The various cannabinoids tested in multiple tumor models showed antitumoral effects both in vitro and in vivo. These findings indicate that cannabinoids are promising compounds for the treatment of gliomas.

Changes in aminoacidergic and monoaminergic neurotransmission in the hippocampus and amygdala of rats after ayahuasca ingestion.

AIM: To evaluate changes in neurotransmission induced by a psychoactive beverage ayahuasca in the hippocampus and amygdala of naive rats. METHODS: The level of monoamines, their main metabolites and amino acid neurotransmitters concentrations were quantified using high performance liquid chromatography (HPLC). Four groups of rats were employed: saline-treated and rats receiving 250, 500 and 800 mg/kg of ayahuasca infusion (gavage). Animals were killed 40 min after drug ingestion and the structures stored at -80 °C until HPLC assay. The data from all groups were compared using Analysis of variance and Scheffé as post test and P < 0.05 was accepted as significant. RESULTS: The results showed decreased concentrations of glycine (GLY) (0.13 ± 0.03 vs 0.29 ± 0.07, P < 0.001) and γ-aminobutyric acid (GABA) (1.07 ± 0.14 vs 1.73 ± 0.25, P < 0.001) in the amygdala of rats that received 500 of ayahuasca. Animals that ingested 800 mg/kg of ayahuasca also showed a reduction of GLY level (0.11 ± 0.01 vs 0.29 ± 0.07, P < 0.001) and GABA (0.98 ± 0.06 vs 1.73 ± 0.25, P < 0.001). In the hippocampus, increased GABA levels were found in rats that received all ayahuasca doses: 250 mg/kg (1.29 ± 0.19 vs 0.84 ± 0.21, P < 0.05); 500 mg/kg (2.23 ± 038 vs 084 ± 0.21, P < 0.05) and 800 mg/kg (1.98 ± 0.92 vs 0.84 ± 0.21, P < 0.05). In addition, an increased utilization rate of all monoamines was found in the amygdala after ayahuasca administration in doses: 250 mg/kg (noradrenaline: 0.16 ± 0.02 vs 0.36 ± 0.06, P < 0.01; dopamine: 0.39 ± 0.012 vs 2.39 ± 0.84, P < 0.001; serotonin: 1.02 ± 0.22 vs 4.04 ± 0.91, P < 0.001), 500 mg/kg (noradrenaline: 0.08 ± 0.02 vs 0.36 ± 0.06, P < 0.001; dopamine: 0.33 ± 0.19 vs 2.39 ± 0.84, P < 0.001; serotonin: 0.59 ± 0.08 vs 4.04 ± 0.91, P < 0.001) and 800 mg/kg (noradrenaline: 0.16 ± 0.04 vs 0.36 ± 0.06, P < 0.001; dopamine: 0.84 ± 0.65 vs 2.39 ± 0.84, P < 0.05; serotonin: 0.36 ± 0.02 vs 4.04 ± 0.91, P < 0.001). CONCLUSION: Our data suggest increased release of inhibitory amino acids by the hippocampus and an increased utilization rate of monoamines by the amygdala after different doses of ayahuasca ingestion.

Validation of a short version of the revised drug use screening inventory in a Brazilian sample of adolescents.

The revised Drug Use Screening Inventory (DUSI-R) is a self-report questionnaire designed to quantify the severity of problems that are commonly associated with consumption of alcohol and other drugs. This study extends research conducted on the US population to determine whether the DUSI-R's substance abuse scale discriminates Brazilian youths in treatment (n = 41) from a general population sample (n = 43). A Portuguese translation of the substance abuse scale was administered in paper and pencil format at the time of intake into treatment and to randomly selected youths in school. The mean score on the 15-item substance abuse scale in the treatment group was 6.7 compared to 1.9 in the comparison group (t = 6.78; p < .001). The optimal cut-off score of two positive endorsements has 85% sensitivity and 70% specificity. This study demonstrates that the DUSI-R's substance abuse scale is valid for screening Brazilian youths who require treatment.

Reliability, validity and classification accuracy of the South Oaks Gambling Screen in a Brazilian sample.

The purpose of this study was to examine the reliability, validity and classification accuracy of the South Oaks Gambling Screen (SOGS) in a sample of the Brazilian population. Participants in this study were drawn from three sources: 71 men and women from the general population interviewed at a metropolitan train station; 116 men and women encountered at a bingo venue; and 54 men and women undergoing treatment for gambling. The SOGS and a DSM-IV-based instrument were applied by trained researchers. The internal consistency of the SOGS was 0.75 according to the Cronbach's alpha model, and construct validity was good. A significant difference among groups was demonstrated by ANOVA (F2.238 = 221.3, P < 0.001). The SOGS items and DSM-IV symptoms were highly correlated (r = 0.854, P < 0.01). The SOGS also presented satisfactory psychometric properties: sensitivity (100), specificity (74.7), positive predictive rate (60.7), negative predictive rate (100) and misclassification rate (0.18). However, a cut-off score of eight improved classification accuracy and reduced the rate of false positives: sensitivity (95.4), specificity (89.8), positive predictive rate (78.5), negative predictive rate (98) and misclassification rate (0.09). Thus, the SOGS was found to be reliable and valid in the Brazilian population.

Predictors of relapse in 300 Brazilian alcoholic patients: a 6-month follow-up study.

Three hundred alcoholic patients were interviewed at hospitalization and again 3 and 6 months thereafter in Porto Alegre, Brazil, from March 2002 to January 2004. Assessment included the SCID-I to check for the presence of Axis I mental disorders, a questionnaire focusing on patient relationship with AA groups, and specific questions about participation in psychotherapy. A logistic regression analysis was performed to determine predictive variables for relapse or abstinence 6 months after discharge. Previous treatment for alcohol dependence (OR = 3.65; CI: 1.77-7.05) and being single (OR = 2.39; CI: 1.06-5.42) proved to be associated with relapse, whereas adherence to AA (OR = 0.31; CI: 0.15-0.66), presence of a comorbid depressive disorder (OR = 0.46; CI: 0.23-0.92), and probably adherence to psychotherapy (OR = 0.52; CI: 0.26-1.04) could be associated with abstinence. These findings reinforce the importance of psychotherapy and AA groups for alcoholics to remain abstinent for longer. The greater adherence to treatment observed among depressive alcohol dependents can be explained by the fact that this is a comorbid condition that acts as a protective factor against relapse.

Do alcoholics anonymous groups really work? Factors of adherence in a Brazilian sample of hospitalized alcohol dependents.

This study was designed to determine factors affecting adherence to Alcoholics Anonymous (AA) groups. This cohort involved 300 alcoholics committed to three hospitals in Porto Alegre, Brazil. They were interviewed again in their homes after six months. The SCID-I and a questionnaire focusing on patient relationship with AA groups were used. The responses obtained through the questionnaire were independently evaluated by two researchers. AA adherence was below 20%. The main factors reported by patients as reasons for non-adherence to AA were relapse, lack of identification with the method, lack of need, and lack of credibility. The factors reported by patients as reasons for adherence were identification with the method and a way to avoid relapse. Although AA is considered an effective intervention for alcoholism, its adherence rate was excessively low. The identification of these nonadherence factors could help health professionals in referring certain alcoholic patients to therapeutic interventions other than AA.

Psychiatric comorbidity related to alcohol use among adolescents.

INTRODUCTION: Alcohol use is apparently related to high prevalences of psychiatric comorbidity, although scientific studies focusing the problem among adolescents are still lacking. OBJECTIVE: To evaluate the performance of adolescents with different patterns of alcohol use on screening instruments for psychiatric disorders. METHOD: Forty-one adolescents seeking assistance for alcohol-related problems were compared to a nonclinical sample of 43 adolescents. These 84 users were divided in three sub-groups according to pattern of recent alcohol intake. All subjects responded to validated versions of screening scales for mental disorders. Comparison of groups was held through Analysis of variance (ANOVA). RESULTS: Self Report Questionnaire (SRQ) aims to evaluate the presence of mental disorders. Heavy users presented significant higher scores than the other groups (p < .05) and half of them presented a psychiatry diagnosis. The same was observed for the CES-D. Using the cut-off, 76.9% of daily-users adolescents were considered depressive. In the Beck Anxiety Inventory the same was observed and 50.0% of those adolescents who drank daily could be considered at risk of presenting anxiety disorders. CONCLUSION: We detected higher prevalences of mental disorders among heavy alcohol users. This reinforces the importance of detailed diagnostic investigation of patients.

Evolutional pattern of drug use by medical students.

Recent use of psychoactive substances among 456 medical students throughout the six grades was surveyed by way of a self-report questionnaire using World Health Organisation criteria. Among male medical students, the most frequently used substances were alcohol (80.5%), cannabis (25.3%), solvents (25.2%), and tobacco (25.2%), whereas among female students the most frequently used drugs were alcohol (72.6%), tobacco (14.6%), solvents (10.5%), and tranquillizers (7.5%). Switch from illegal to legal drugs were observed only among female medical students. Male students tend to alternate cannabis and solvents throughout college years. Interventions aiming to influence patterns of drug consumption among medical students must consider both gender differences and evolutional patterns of substance use throughout medical course.

Predictors of engagement in the Alcoholics Anonymous group or to psychotherapy among Brazilian alcoholics : a six-month follow-up study.

OBJECTIVE: To ascertain factors associated with engagement of patients with alcohol dependence in Alcoholics Anonymous (AA) groups and psychotherapy. METHODS: About 300 hospitalized alcoholics were interviewed at hospitalization and again 3 and 6 months thereafter. Assessment included the administration of standardized instruments. Determinants of engagement in both interventions were assessed through logistic regression analysis. RESULTS: Higher educational level was predictive of engagement in AA after 6 months (OR = 2.19; CI 1.08-4.41). Engagement in psychotherapy after 6 months was related to having a university degree (OR = 3.60; CI 1.6-7.9), to a co-morbid depressive disorder (OR = 3.47; CI 1.8-6.5), to the use of other drugs together with alcohol (OR = 3.08; CI 1.5-6.19), to previous treatment (OR = 2.87; CI 1.29-6.40), and to having a high school degree (OR = 2.44; CI 1.24-4.80). The presence of substance-induced anxiety disorder was associated with non-engagement in psychotherapy (OR = 0.27; CI 0.63-0.003). CONCLUSION: The identification of predictors of engagement is important to guide clinicians in the choice of the treatment strategies that are more likely to be successful.

Factors associated with the use of solvents and cannabis by medical students.

INTRODUCTION: The use of alcohol and other drugs among medical students has been a theme of growing interest and concern on the part of researchers, teaching institutions and medical associations since the decade of the 1960's. OBJECTIVE: Recent use of alcohol, tobacco, tranquillisers, amphetamines, cannabis, organic solvents, and cocaine among 456 medical students was surveyed. METHOD: Assessment was done by means of a self-report questionnaire according to World Health Organisation guidelines. RESULTS: Among medical students, after alcohol and tobacco, cannabis and solvents are the most frequently used psychoactive substances. As such, they were the most deeply analysed drugs in this study. Factors associated with the recent use of cannabis and solvents were established by logistic regression. Living with parents or a companion appeared as a protective factor for the use of cannabis. However, being male and regularly participating in the activities at the campus Sports Association showed as risk factors for the use of both cannabis and solvents. DISCUSSION: Concepts and misconceptions concerning protective and risk factors must be discussed in the light of cultural and circumstantial interferences. Harm reduction strategies should be seriously considered.

Does co-occurring social phobia interfere with alcoholism treatment adherence and relapse?

This study investigates the impact of social phobia on adherence to and outcomes 6 months following standard alcohol treatment and Alcoholics Anonymous (AA) group meetings among alcohol-dependent patients with and without social phobia. In a cohort study, 300 detoxified alcohol-dependent individuals in Porto Alegre, Brazil, were interviewed during, as well as 3 and 6 months after hospital detoxification. At both follow-up points, treatment adherence was low and relapse rates were high among patients with and without social phobia, and no significant differences were seen between the two groups of patients in relapse, adherence to AA, or adherence to psychotherapy. Findings from this sample suggest that although alcohol-dependent patients with social phobia showed a tendency for less adherence at AA and felt less integrated with their AA group, social phobia comorbidity was not a significant risk factor for alcohol use relapse or for nonadherence to AA or psychotherapy.