Can Contingency Management Solve the Problem of Adherence to Antiretroviral Therapy in Drug-Dependent Individuals?

Drug misuse among people living with HIV (human immunodeficiency virus) is associated with higher mortality. It is a frequently observed reason for treatment abandonment, with people who misuse drugs showing a 10 to 25 times higher risk of HIV than the general population. The authors conducted a systematic review and meta-analysis to assess the efficacy of contingency management (CM) to improve adherence to antiretroviral therapy in people living with HIV and substance use disorder (SUD). The inclusion criteria consisted of studies written in English, Italian, Spanish, German, and French; studies conducted with humans; and clinical trials that combined SUD treatment with CM for people living with HIV. Two hundred twenty-two articles were identified, five met all inclusion criteria, and three provided enough data to perform the meta-analysis. We considered treatment adherence by measuring the increase in the CD4 count as our primary outcome. We found a significant increase in treatment adherence in the patient group compared with the control groups during the intervention phase. Positive findings did not persist after the cessation of the incentives. The meta-analysis showed that the intervention improved patient adherence by 2.69 (95% confidence interval: [0.08, 0.51]; p = .007) compared with the control group during the intervention period. All short-term CM studies converged on a positive result for adherence to antiretroviral therapy.

Immigrants, refugees and cannabis use.

Immigration typically occurs from low- to high-income countries and regions. Unfortunately, these wealthier areas also have higher rates of cannabis use (e.g. European Union and the US). This systematic review aimed to summarize available studies on cannabis use among immigrants, refugees, and asylum seekers. In addition, evidence on the association between immigration and cannabis use was reviewed. The rates of cannabis use were lower among immigrants than natives. The risk and protective factors to cannabis use were quite similar to those of the native populations. The population at greatest risk for cannabis use were refugees, males, singles, non-religious, those with lower educational level, living in urban areas, with friends that use cannabis and/or other drugs. Cannabis use tend to increase over generations, and acculturation seems to play a pivotal role. First generation migrants report equal or lower consumption of cannabis when compared with the majority population with a subsequent increase in following generations, with a clear association with acculturation factors. A higher cannabis use was found among migrants with lower cultural congruity as well as a higher level of culture assimilation. This use seems to be unrelated to alcohol or illicit drugs consumption, but possibly associated with tobacco smoking.

GLP-1a: Going beyond Traditional Use.

Glucagon-like peptide-1 (GLP-1) is a human incretin hormone derived from the proglucagon molecule. GLP-1 receptor agonists are frequently used to treat type 2 diabetes mellitus and obesity. However, the hormone affects the liver, pancreas, brain, fat cells, heart, and gastrointestinal tract. The objective of this study was to perform a systematic review on the use of GLP-1 other than in treating diabetes. PubMed, Cochrane, and Embase were searched, and the PRISMA guidelines were followed. Nineteen clinical studies were selected. The results showed that GLP-1 agonists can benefit defined off-medication motor scores in Parkinson's Disease and improve emotional well-being. In Alzheimer's disease, GLP-1 analogs can improve the brain's glucose metabolism by improving glucose transport across the blood-brain barrier. In depression, the analogs can improve quality of life and depression scales. GLP-1 analogs can also have a role in treating chemical dependency, inhibiting dopaminergic release in the brain's reward centers, decreasing withdrawal effects and relapses. These medications can also improve lipotoxicity by reducing visceral adiposity and decreasing liver fat deposition, reducing insulin resistance and the development of non-alcoholic fatty liver diseases. The adverse effects are primarily gastrointestinal. Therefore, GLP-1 analogs can benefit other conditions besides traditional diabetes and obesity uses.

Mental health and quality of life in a population of recreative cannabis users in Brazil.

Cannabis is the third most used recreational drug worldwide. Despite the popularity of cannabis use among Brazilians, information about frequent cannabis users outside clinical contexts remains scarce. This is a cross-sectional study of a non-probabilistic sample of 7405 Brazilian adults (6620 [89.4%] cannabis users and 785 [10.6%] non-users) who answered an online survey that collected demographic data, cannabis and other substance use information (initial substance use, lifetime and past-month use), and standardized scales to assess quality of life, subjective well-being, anxiety, and depression scores. Among cannabis users, 17.1% of the participants self-classified themselves as occasional users, 64.6% as habitual users, and 7.7% as dysfunctional users. Participants were mostly young male adults, with at least high-school education, employed, without children. The highest scores for quality of life were observed among habitual cannabis users, followed by occasional users, while both non-users and dysfunctional users presented less favorable scores. Subjective measures of well-being were higher among habitual and occasional users than among non-users, whereas dysfunctional users were the most affected. Poor quality of life, depression or anxiety were more prevalent among dysfunctional users, but non-users of cannabis reported more depression or anxiety symptoms and less quality of life than both occasional and habitual users. The results obtained in this study are particularly relevant because they refer to a sample predominantly composed of habitual cannabis users from the general population, a rarely represented group in other surveys. The fact that cannabis use is generally associated with increased risk of adverse health outcomes was not observed in this study.

Matriciamento: uma experiência ambulatorial / Matrix practice: an outpatient experience / Apoyo matriz: una experiencia ambulatoria

OBJETIVO: compreender a construção do matriciamento em um serviço de atenção a dependentes. MÉTODO: trata-se de uma pesquisa-ação realizada nos últimos sete anos, considerando as experiências de uma terapeuta ocupacional durante suas atividades no serviço, abrangendo reuniões clínicas, supervisões, grupos de estudos e capacitações. Os materiais utilizados foram prontuários, registros de supervisão e reunião e anotações pessoais. RESULTADOS: as demandas de cada sujeito são abordadas para além das especificidades de cada área. Os saberes são transmitidos nos encontros de equipe, permitindo, a quem está lidando diretamente com o caso, uma ampliação em sua compreensão e a experimentação de instrumentos clínicos construídos junto dos colegas. O processo de construção de trabalho com cada sujeito, matriciado constantemente entre os profissionais, permite, àquele que oferece a atenção, maior apropriação da construção clínica. Tal fenômeno também ocorre durante capacitações oferecidas pelo serviço a outras equipes de saúde. CONCLUSÃO: os espaços coletivos consideram a compreensão do sujeito por diversas perspectivas, mesmo sem contato direto com o indivíduo, a partir das narrativas de um dos profissionais e de hipóteses dos demais membros da equipe, ampliando as possibilidades de cuidado. O trabalho em projetos terapêuticos propaga-se pela instituição e em capacitações de outras equipes, permitindo a circulação e integração do saber.

OBJECTIVE: to understand the construction of the dependent care service matrixing. METHOD: this is an action-research conducted over the past seven years, considering the experiences of an occupational therapist during her service activities, covering clinical meetings, supervision, study groups and training. The materials used were medical records, supervision and meeting records and personal notes. RESULTS: the demands of each subject are addressed beyond the specificities of each area. The knowledge is transmitted in the team meetings, allowing, to those who are dealing directly with the case, an expansion in their understanding and the experimentation of clinical instruments built with colleagues. The process of building work with each subject, constantly matrixed among the professionals, allows, to the one who offers the attention, greater appropriation of the clinical construction. This phenomenon also occurs during training offered by the service to other health care teams. CONCLUSION: the collective spaces consider the subject's understanding from different perspectives, even without direct contact with the individual, from the narratives of one of the professionals and from the hypotheses of the other team members, expanding the possibilities of care. The work in therapeutic projects is spread throughout the institution and in training of other teams, allowing the circulation and integration of knowledge.

OBJETIVO: comprender la construcción del apoyo matriz en un servicio de atención a dependientes. MÉTODO: se trata de una investigación de acción realizada en los últimos siete años, considerando las experiencias de una terapeuta ocupacional durante sus actividades en el servicio, abarcando reuniones clínicas, supervisiones, grupos de estudios y capacitaciones. Los materiales utilizados fueron prontuarios, registros de supervisión y reunión y anotaciones personales. RESULTADOS: las demandas de cada sujeto se abordan más allá de las especificidades de cada área. Los saberes se transmiten en los encuentros de equipo, permitiendo a quien está lidiando directamente con el caso, una ampliación en su comprensión, experimentación de instrumentos clínicos construidos junto a los colegas. El proceso de construcción de trabajo con cada sujeto, con apoyo matriz constantemente entre los profesionales, permite al que ofrece la atención, mayor apropiación de la construcción clínica. Tal fenómeno, también ocurre durante capacitaciones ofrecidas por el servicio a otros equipos de salud. CONCLUSIÓN: los espacios colectivos consideran la comprensión del sujeto por diversas perspectivas, incluso sin contacto directo con el individuo, a partir de las narrativas de uno de los profesionales y de hipótesis de los demás miembros del equipo, amplían posibilidades de cuidado. El trabajo en proyectos terapéuticos, se propaga por la institución y en capacitaciones de otros equipos, permitiendo la circulación e integración del saber.

Effect of chronic cocaine use on fine motor coordination tested during ophthalmic vitreoretinal simulated performance.

We conducted a case-control study using the Eyesi simulator to assess the surgical performance of 24 chronic cocaine users (CCUs) and 24 sex-/age-matched controls to numerically quantify ophthalmic microsurgical simulator performance and fine motor deficiencies. The inclusion criteria were no exposure to illicit drugs other than cocaine, marijuana, or alcohol within the previous month and no health conditions that could impact manual task performance. The outcomes included surgical scores (0-100, worst-best) and task completion time (minutes). Fisher's exact test, analysis of variance, Mann-Whitney U test, and Kruskal-Wallis test followed by Dunn-Bonferroni post-hoc were conducted for statistical analysis. The Eyesi scores were lower among CCUs compared to controls for bimanual tasks (4.50 ± 14.30 vs. 18.46 ± 26.64, p = 0.012), for exercises demanding upper and lower limb coordination (both hands and two foot pedals, respectively) (74.13 ± 35.01 vs. 85.21 ± 24.1, p = 0.045), and in the overall score for all three tasks (27.38 ± 15.06 vs. 39.5 ± 18.66, p = 0.021). CCUs took longer to complete tasks when performing exercises demanding upper and lower limb coordination compared to controls (1.26 ± 0.38 vs. 1.02 ± 0.44 min, p = 0.006). Individuals who used cocaine during the previous month had an independent lower bimanual score compared to controls (1.42 ± 4.91 vs. 18.46 ± 26.64, p = 0.018). No differences in performance among the CCUs were attributable to sporadic cannabis or alcohol use. Chronic use of cocaine negatively impacted fine dexterity as measured by bimanual tasks or maneuvers that required simultaneous coordination of the upper and lower limbs. This was most notable among individuals who used cocaine during the 1-month period before the simulation.

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.

Medical use, non-medical use and use disorders of benzodiazepines and prescription opioids in adults: Differences by insurance status.

OBJECTIVES: To report and analyze prevalence's of Benzodiazepines (BZDs) and Prescription Opioids (POs) use by insurance status and to investigate associations between insurance status and BZDs, POs and concurrent medical/non-medical use and use disorders. METHODS: This study included 81,133 adults ages 18 and older from 2015 and 2016 National Survey on Drug Use and Health. Participants' self-reported past- year medical use, non-medical use and use disorders of BZDs and POs were assessed, along with their insurance status (Private/Military, Medicare, Medicaid, and Uninsured) and demographic characteristics. RESULTS: In 2015-2016, 12.6% of adults reported using BZDs and 36.9% reported using POs in the past year. Among adults, 8.3% reported past-year use of both BZDs and POs; also, 1.9% and 3.8% reported non-medical use of BZDs and POs, respectively, and 0.9% reported non-medical use of both BZDs and POs. Medicaid-covered respondents had higher risk of BZDs (aRRR = 1.59, 95%CI = [1.45, 1.74]), POs (aRRR = 1.66, 95%CI = [1.54, 1.79]) and concurrent past-year medical use (aRRR = 2.11, 95%CI = [1.87, 2.38]), higher risk of BZDs non-medical use (aRRR = 1.40, 95%CI = [1.17, 1.68]) and BZD Use Disorders (aRRR = 2.60, 95%CI = [1.82, 3.72]), POs non-medical use (aRRR = 1.67, 95%CI = [1.45, 1.92]), PO use Disorders (aRRR = 4.12, 95%CI = [3.33, 5.11]) and concurrent non-medical use (aRRR = 1.52, 95%CI = [1.20, 1.92]) and Use Disorders (aRRR = 3.68, 95%CI = [1.93, 6.78]), compared to those with private insurance. CONCLUSIONS: Future health policies should focus on reducing individual and co-prescription of BZDs and POs and providing different strategies of pain management.

Contingency Management with pharmacologic treatment for Stimulant Use Disorders: A review.

OBJECTIVES: Stimulant Use Disorders (SUDs) are an emergent public health concern in the United States and worldwide. However, there is still a lack of consensus for best-approaches regarding treatment of SUD. Recent trials have evaluated combinations of medications and psychosocial treatments to enhance efficacy. Contingency Management (CM) is a behavioral intervention that has shown effectiveness in treating SUDs. Our aim was to review studies using a combined methods approach such as CM and medications for the treatment of SUD. DESIGN: We performed a qualitative literature review of clinical trials that combined CM with any pharmacological treatment for SUDs. RESULTS: Among twenty-one publications included, ten reviewed a combination of CM and medications was superior to each intervention alone. In three of studies patients receiving CM showed better outcomes than those with no CM, regardless of their medication status. In one, groups receiving medication with or without CM had better outcomes than groups that received no medication. Finally, seven of the studies found no difference in the outcomes of interest for either CM, medication, or the combination of CM and medication. CONCLUSIONS: CM and medication as treatment for SUD could act synergistically and enhance each other's effect. Combining CM and medications may be a key strategy for effective SUD treatment. Future studies should further investigate the efficacy of the combined approach of medications and CM.

Translation and validation of the Brown attention-deficit disorder scale for use in Brazil: identifying cases of attention-deficit/hyperactivity disorder among samples of substance users and non-users. Cross-cultural validation study.

BACKGROUND: The Brown Attention-Deficit Disorder Scale (BADDS) was developed as a self-report assessment that was designed to screen for presence of symptoms of attention deficit hyperactivity disorder (ADHD). The objective here was to translate and validate the adult self-report BADDS for use in Brazil. DESIGN AND SETTING: Cross-cultural validation study conducted in an addiction unit at a public university hospital. METHODS: This study included a control group (n = 100) and a drug-user group (n = 100). Both groups included subjects aged 18 to 60 years old. The control group had no prior diagnosis of drug addiction and the drug-user group included participants with a diagnosis of addiction. Each participant answered Brazilian Portuguese translations of both the BADDS and the Adult Attention Deficit Hyperactivity Disorder Self-Report Scale (ASRS) questionnaires, in paper-and-pencil format. RESULTS: The drug-user group scored higher than the control group on both scales. The mean scores on ASRS were 27.26 (standard deviation, SD: 11.99) and 25.85 (SD: 8.65) respectively (P > 0.05). The mean scores on BADDS were 79.56 (SD: 29.61) and 79.31 (SD: 18.09), respectively (P > 0.05). Cronbach's alpha for BADDS was 0.95. BADDS presented fair sensitivity (72% accuracy) and fair specificity (88% accuracy). CONCLUSION: This study provides discriminative validity evidence for use of BADDS among Brazilian adults with substance-use disorders.

Translation and validation of the Brown attention-deficit disorder scale for use in Brazil: identifying cases of attention-deficit/hyperactivity disorder among samples of substance users and non-users. Cross-cultural validation study

ABSTRACT BACKGROUND: The Brown Attention-Deficit Disorder Scale (BADDS) was developed as a self-report assessment that was designed to screen for presence of symptoms of attention deficit hyperactivity disorder (ADHD). The objective here was to translate and validate the adult self-report BADDS for use in Brazil. DESIGN AND SETTING: Cross-cultural validation study conducted in an addiction unit at a public university hospital. METHODS: This study included a control group (n = 100) and a drug-user group (n = 100). Both groups included subjects aged 18 to 60 years old. The control group had no prior diagnosis of drug addiction and the drug-user group included participants with a diagnosis of addiction. Each participant answered Brazilian Portuguese translations of both the BADDS and the Adult Attention Deficit Hyperactivity Disorder Self-Report Scale (ASRS) questionnaires, in paper-and-pencil format. RESULTS: The drug-user group scored higher than the control group on both scales. The mean scores on ASRS were 27.26 (standard deviation, SD: 11.99) and 25.85 (SD: 8.65) respectively (P > 0.05). The mean scores on BADDS were 79.56 (SD: 29.61) and 79.31 (SD: 18.09), respectively (P > 0.05). Cronbach's alpha for BADDS was 0.95. BADDS presented fair sensitivity (72% accuracy) and fair specificity (88% accuracy). CONCLUSION: This study provides discriminative validity evidence for use of BADDS among Brazilian adults with substance-use disorders.

Women Crack Users, Pregnancy and Motherhood: Potential Periods for Health Care / Mulheres Usuárias de Crack, Gravidez e Maternidade: Períodos Potenciais para Cuidados em Saúde

Abstract This study aimed to understand how women report their behaviors concerning drug use during pregnancy and breastfeeding. This is a qualitative study, conducted in the metropolitan area of Santos. Twelve women who have used crack were interviewed through a semistructured interview. The interviews were analyzed from the perspective of content analysis. Our data indicate that pregnancy is a critical time to sensitize these women and try to lessen the damage and the risks associated with the use of crack among them.

Resumo Este estudo objetivou compreender como as mulheres reportam seus comportamentos em relação ao uso de drogas durante a gravidez e a amamentação. Trata-se de um estudo qualitativo, realizado na região metropolitana de Santos. Doze mulheres usuárias de crack foram entrevistadas por meio de entrevista semiestruturada. As entrevistas foram analisadas a partir da análise de conteúdo. Os dados indicam que a gravidez é um momento crítico para sensibilizar essas mulheres e tentar diminuir danos e riscos associados ao consumo de crack entre elas.

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.

Vitamin D and alcohol: A review of the current literature.

Vitamin D is associated with bone mineral density, and its deficiency is a global health problem. In psychiatry, low vitamin D levels have been associated with schizophrenia, depression, psychotic symptoms, and, more recently, alcohol use disorders. Alcohol use disorders are among the most prevalent mental disorders worldwide. Therefore, our aim was to evaluate the association between alcohol use and vitamin D serum levels. The PubMed, SCIELO, and Lilacs databases were searched for this systematic review. We assessed all articles published from 1976 to December 2015, and we examined the associated reference lists to retrieve articles that appeared to fulfill our criteria. Of 932 articles, 49 met our inclusion criteria. The majority of the papers (71.4%) were cross-sectional studies. Alcohol intake was found to be positively associated with vitamin D status in 15 articles and negatively associated with vitamin D in 18 articles; no association was found in 16 articles. Heterogeneous results were found in our review, with a similar number of papers indicating a positive association, a negative association or the absence of any association between alcohol use and vitamin D levels. Nevertheless, it is important to note that the studies in which a positive association was found were more recent papers that involved considerably larger sample sizes than those in other studies. The older studies compared vitamin D levels in alcoholic and non-alcoholic patients, in contrast to more recent studies, which focused on more specific populations. In addition, most of the selected papers were from high latitude countries, where exposure to sunlight tends to be lower than in tropical countries. The data concerning vitamin D levels in patients with alcohol use disorders remain controversial. Additional research using a standardized methodology is necessary to demonstrate the real impact of alcohol consumption on vitamin D serum levels as well as on the health status of alcohol users.

Psychometric properties of the Brazilian version of the Personal Experience Screening Questionnaire.

INTRODUCTION:: The Personal Experience Screening Questionnaire (PESQ) is an instrument devised for assessing the magnitude of drug misuse among adolescents. However, its psychometric properties have not been evaluated in adolescent samples outside the United States. OBJECTIVE:: To assess the internal reliability and validity of the Brazilian version of the PESQ. METHOD:: A cross-sectional study was carried out with 84 adolescents from a clinical sample and a community-based sample. All of them answered the PESQ. RESULTS:: Among adolescents from the community, the PESQ problem severity index, which can vary from 18 to 72, was 26.48±9.28, whereas the clinical sample scored 42.89±10.02 (p<0.001). Cronbach's alpha was 0.91. Factor analysis resulted in a four-factor solution. Furthermore, both samples also had different mean scores for the other distinct content areas measured by the instrument. CONCLUSION:: Evidence to support the reliability and validity of the Brazilian version of the Personal Experience Questionnaire was found.

Psychometric properties of the Brazilian version of the Personal Experience Screening Questionnaire / Propriedades psicométricas da versão brasileira do Personal Experience Screening Questionnaire

Summary Introduction: The Personal Experience Screening Questionnaire (PESQ) is an instrument devised for assessing the magnitude of drug misuse among adolescents. However, its psychometric properties have not been evaluated in adolescent samples outside the United States. Objective: To assess the internal reliability and validity of the Brazilian version of the PESQ. Method: A cross-sectional study was carried out with 84 adolescents from a clinical sample and a community-based sample. All of them answered the PESQ. Results: Among adolescents from the community, the PESQ problem severity index, which can vary from 18 to 72, was 26.48±9.28, whereas the clinical sample scored 42.89±10.02 (p<0.001). Cronbach's alpha was 0.91. Factor analysis resulted in a four-factor solution. Furthermore, both samples also had different mean scores for the other distinct content areas measured by the instrument. Conclusion: Evidence to support the reliability and validity of the Brazilian version of the Personal Experience Questionnaire was found.

Resumo Introdução: o Personal Experience Screening Questionnaire (PESQ) é um instrumento destinado ao rastreamento de problemas relacionados ao uso de drogas entre adolescentes. Entretanto, suas propriedades psicométricas não foram avaliadas em populações de adolescentes de outros países além dos Estados Unidos. Objetivo: avaliar a confiabilidade e a validade da versão brasileira do PESQ. Método: foi feito um estudo transversal envolvendo 84 adolescentes de uma amostra clínica e de uma amostra não clínica. Todos responderam ao PESQ. Resultados: entre os adolescentes da população geral, o índice de severidade de problema da PESQ, que pode variar de 18 a 72, foi de 26,48±9,28. Por outro lado, a população clínica teve pontuação de 42,89±10,02 (p<0,001). O alfa de Cronbach foi de 0,91. A análise fatorial resultou em uma solução de quatro fatores. Além disso, ambas as populações apresentaram pontuações significativamente diferentes em outras subescalas do PESQ. Conclusão: as evidências sustentam a validade e a confiabilidade da versão brasileira do PESQ.

Factors associated with illicit drugs' lifetime and frequent/heavy use among students results from a population survey.

Substance use among teenage students and factors associated were investigated through a survey using a questionnaire adapted from the WHO's Program on Research and Reporting on the Epidemiology of Drug Dependence, additional questions on family factors and personal risks, and the Coopersmith Self-Esteem Inventory, adapted to Brazil. The target population consisted of 3891 10-22-year-old students from the city of Embu das Artes, São Paulo, Brazil. The prevalence of lifetime substance use was 26.7%. Most commonly used substances were energy drinks combined with alcohol (19%), solvents (11.2%) and marijuana (4.8%). Almost 60% of the students had already tried alcohol and 18.2% had tried tobacco. Factors associated to lifetime substance use were: lower self-esteem, going to nightclubs at least twice a week, use of alcohol, trying tobacco, bad relationship with the mother, permissive mothers, practicing sports as an obligation, working, and higher socioeconomic level. Concerning frequent/heavy substance use, chances were found to be higher among students who had use tobacco and alcohol, going to nightclubs at least twice a week, and those with lower self-esteem. Preventive actions concerning drug use should focus on avoiding the first experimentation, approaching family relationships, and improving students' self-esteem.

O ensino de Terapia Ocupacional na clínica das dependências: Uma experiência na liga acadêmica de farmacodependências (PROAD–UNIFESP) / Teaching Occupational Therapy on the Addiction Field - An experience in a multidisciplinary context with undergraduate students

Objetiva-se discutir o ensino de Terapia Ocupacional (TO) no contexto da dependência química com alunos de graduação. Visando debater sobre a experiência da prática multidisciplinar supervisionada durante o trajeto de formação acadêmica, apresenta-se a Liga Acadêmica de Farmacodependências (LFD) como espaço para compreensão do fenômeno da dependência e da construção da clínica. Foi realizado um estudo qualitativo, de caráter observacional, no qual foi realizada a análise de conteúdo das discussões realizadas entre os preceptores e os 25 alunos de diferentes cursos (TO, Psicologia, Enfermagem e Medicina) que compõem a LFD, vinculada ao PROAD (Programa de Orientação e Atendimento a Dependentes) da Universidade Federal de São Paulo. Foram observadas articulações acerca da construção do raciocínio clínico em TO, assim como sobre a constituição do olhar do aluno enquanto profissional membro de uma equipe multidisciplinar. A experiência da construção da especificidade da TO, somada à articulação de diferentes olhares na supervisão coletiva, favoreceu a construção de uma compreensão ampliada sobre os sujeitos atendidos na LFD. As discussões de caso coletivas permitem um diálogo multidisciplinar que vai constituindo a identidade dos alunos enquanto profissionais da sa�de que se posicionam em uma equipe de raciocínio coeso. Percebeu-se que o ensino de TO, no contexto de uma liga multiprofissional, inserida em um programa de atenção a pessoas com problemas relacionadas ao uso, abuso e/ou dependência de substâncias, tem sido uma experiência de construção contínua de um espaço que visa sustentar e dialogar sobre questões da especificidade da profissão e da sua inserïção em equipe.(AU)

This article intends to discuss the teaching of Occupational Therapy (OT) in the context of substance abuse to undergraduate students. Aiming to debate the experience of multidisciplinary supervised practice during the course of academic studies, it presents the Academic League on Drug Dependence - LFD as a space for understanding the phenomenon of addiction and the construction of practice in this area. A qualitative observational study was carried out on the analysis of discussion between tutors and 25 undergraduate students from different courses (OT, psychology, nursing, and medicine) that comprise the LFD, which is associated with the Program of Treatment and Guidance to Drug Addicts - PROAD of the Federal University of São Paulo - UNIFESP. We observed articulations about the construction of clinical reasoning in the OT area and the constitution of the students’ perceptions while professionals participating in a multidisciplinary team. It was possible to observe that the experience of the specificity of OT and collective supervision, which, in turn, enables the articulation, favored the construction of an expended comprehension of the subjects treated in the LFD. In this sense, the collective discussion of cases allowed multidisciplinary dialogue that will constitute the identity of students as health professionals who position themselves in a coherent team. It was perceived that the teaching of OT, in the context of a multiprofessional league, inserted in a program of care for people with probles related to substance use, abuse and/or dependence, has been an experience of a continuous construction of a space that supports and dialogues on issues of the specificity of profession, and its inclusion in this team.(AU)