Intervention diversity predicts social rehabilitation indicators at discharge in Therapeutic Communities.

INTRODUCTION: The Therapeutic Community Model narrows the gap in substance use disorder's network of assistance in Brazil by offering residential treatment to socially vulnerable populations. Due to a historical lack of evidence-based approaches, the government has established treatment guidelines and has been trying to implement training and monitoring methods. METHOD: This study analysed real-world data from the monitoring system implemented in the largest network of institutions receiving public funds in the State of Sao Paulo. Data came from 8109 records of individuals admitted between 2014 and 2016 in 48 institutions. RESULTS: Results showed that less than half of the sample was exposed to at least one therapeutic activity from each of the recreational, spiritual, educational and selfcare intervention domains, as proposed by the national guidelines. Social rehabilitation outcome (SRO) defined by housing and self-support at discharge was reported by 21 % of the sample, who stayed in residential treatment for 82.6 days in average. More than half completed the therapeutic programme while 27.3 % dropout. Treatment duration and the diversity of the interventions offered were significantly associated with SRO when mutually adjusted. Chances of SRO increased nearly 5 times when residents were offered the full range of intervention domains, even when controlling for treatment duration. Treatment duration increased chances of SRO in a dose-response manner with a threefold increase for stays up to 90 days and over 9 times for stays longer than 90 days. CONCLUSION: Our findings offer evidence to promote treatment guidelines compliance and to pave the way for the implementation of monitoring systems for this modality of treatment in Brazil and abroad.

Contingency management is effective in promoting abstinence and retention in treatment among crack cocaine users with a previous history of poor treatment response: a crossover trial.

BACKGROUND: Crack use has become a severe health problem in Brazil. Contingency management has shown robust evidence of efficacy in the treatment of cocaine use disorder (CUD) in high-income countries; however, it is still unclear how this intervention can impact treatment in low-income countries. OBJECTIVE: To evaluate the efficacy of contingency management in the treatment of CUD among individuals with a previous history of poor treatment response in Brazil. METHODS: Six months after the end of treatment, 32 participants previously allocated to the usual care condition (UCC) were invited to receive an additional 12 weeks of treatment in a contingency management condition (CMC), and 16 accepted the invitation. We compared data obtained from only the 16 participants (14 male) exposed to both treatment conditions. RESULTS: Participants attended more treatment sessions and were retained in treatment for a longer period during the CMC than during the UCC (p < .01 for both). The proportion of negative cocaine samples submitted, the mean longest duration of cocaine abstinence, and the odds of being abstinent from cocaine during the 12 weeks of treatment were significantly higher during treatment in the CMC when compared to the UCC (p < .05). CONCLUSIONS: This study provides further evidence that contingency management is effective in promoting abstinence and retention in treatment among individuals with CUD with a history of poor treatment response. Our findings argue for the incorporation of CM among public treatment services for CUD in Brazil. TRIAL REGISTRATION: This study was registered at ClinicalTrials.gov as NCT01815645 on March 21, 2013.

Violência na infância, exposição a violência parental e abuso e/ou dependência de álcool na idade adulta* / Childhood violence, exposure to parental violence and alcohol dependence/abuse in adulthood / La violencia infantil, exposición a la violencia de los padres y el abuso y/o dependencia del alcohol en la edad adulta

Este artigo examina a associação entre o histórico de violência na infância e a dependência e uso nocivo de álcool na idade adulta. Uma amostra probabilística multiestagio foi usada para selecionar 3.007 indivíduos de 14 anos de idade ou mais, dos lares brasileiros, entre novembro de 2005 e abril de 2006. As análises mostraram a existência de associação entre o histórico de abuso físico e exposição à violência parental (p<0,001). O modelo de regressão multinomial mostrou uma associação entre o histórico de violência na infância e a dependência de álcool na idade adulta. As variáveis de maior impacto na chance para dependência do álcool foram sexo masculino, exposição à violência parental e histórico de abuso físico. Desta forma, observou-se que quanto maior o grau de exposição, maior a porcentagem de violência severa sofrida na infância. Os resultados corroboram com prévios achados que sugerem que um histórico positivo de violência na infância é um componente importante na etiologia dos transtornos decorrentes do consumo de álcool.

This article analyses the association between the history of violence in childhood and alcohol abuse and dependence in adulthood. A multistage probabilistic sample was used to select 3,007 individuals aged 14 years or older, living in Brazil, between November 2005 and April 2006. Analyses showed an association between history of physical abuse and exposure to parental violence (p<0.001). A multinomial regression model showed a significant association between history of physical abuse in childhood and alcohol dependence in adulthood. The following variables have greater impact on the probability of alcohol dependence: male sex, exposure to parental violence and history of physical abuse. Thus, the higher the level of exposure, the greater the percentage of severe violence suffered in childhood. Results corroborate previous findings, which suggest the importance of a childhood history of violence in the etiology of disorders resulting from alcohol consumption.

En este artículo se estudia la relación entre la historia de la violencia en la infancia y la dependencia y el uso nocivo de alcohol en la edad adulta. Una muestra de probabilidad de varias etapas fue utilizada para seleccionar 3.007 individuos de 14 años de edad o más de los hogares brasileños entre noviembre de 2005 y abril de 2006. El análisis mostró que hay una asociación entre la historia de abuso físico y la exposición a la violencia de los padres (p<0,001). El modelo de regresión multinomial mostró una asociación entre la historia de violencia en la infancia y la dependencia del alcohol en la edad adulta. Las variables con mayor impacto en la probabilidad de dependencia del alcohol fueran el sexo masculino, la exposición a la violencia de los padres y la historia de abuso físico. Cuanto mayor sea el grado de exposición, mayor es el porcentaje de violencia grave sufrido en la infancia. Los resultados corroboran hallazgos previos que sugieren que una historia positiva de violencia en la infancia es un componente importante en la etiología de los trastornos derivados del consumo de alcohol.

Contingency management is effective in promoting abstinence and retention in treatment among crack cocaine users with a previous history of poor treatment response: a crossover trial

Background: Crack use has become a severe health problem in Brazil. Contingency management has shown robust evidence of efficacy in the treatment of cocaine use disorder (CUD) in high-income countries; however, it is still unclear how this intervention can impact treatment in low-income countries. Objective: To evaluate the efficacy of contingency management in the treatment of CUD among individuals with a previous history of poor treatment response in Brazil. Methods: Six months after the end of treatment, 32 participants previously allocated to the usual care condition (UCC) were invited to receive an additional 12 weeks of treatment in a contingency management condition (CMC), and 16 accepted the invitation. We compared data obtained from only the 16 participants (14 male) exposed to both treatment conditions. Results: Participants attended more treatment sessions and were retained in treatment for a longer period during the CMC than during the UCC (p < .01 for both). The proportion of negative cocaine samples submitted, the mean longest duration of cocaine abstinence, and the odds of being abstinent from cocaine during the 12 weeks of treatment were significantly higher during treatment in the CMC when compared to the UCC (p < .05). Conclusions: This study provides further evidence that contingency management is effective in promoting abstinence and retention in treatment among individuals with CUD with a history of poor treatment response. Our findings argue for the incorporation of CM among public treatment services for CUD in Brazil. Trial registration: This study was registered at ClinicalTrials.gov as NCT01815645 on March 21, 2013.

Factors associated with attrition rate in a supportive care service for substance using pregnant women in Brazil.

BACKGROUND AND OBJECTIVES: Retaining substance using women in antenatal care remains a major challenge. This study explored factors associated with attrition rate among women with substance use problems attending a supportive care service during pregnancy and soon after the birth of the infant. METHODS: Records of 166 women's antenatal consultations were analyzed. RESULTS: Attrition rate was high (75/166, 45.2%), and was associated with women having no schooling/primary schooling only, no family contact, having child(ren), crack-cocaine use, poly drug use, and substance use problems by the expected child's father. DISCUSSION AND CONCLUSIONS: Attrition may be the outcome of socio-demographic, family, individual, and substance use issues not fully addressed in prenatal interventions. SCIENTIFIC SIGNIFICANCE: Identification of who are at risk for dropping out affords services with an opportunity to prevent its occurrence. (Am J Addict 2017;26:676-679).

Guidelines of the Brazilian Association of Studies on Alcohol and Other Drugs (ABEAD) for diagnosis and treatment of psychiatric comorbidity with alcohol and other substance and dependence.

In recent years, several studies have been focused on the comorbidity of psychiatric disorders with alcohol and other substance dependence. In this context, the Brazilian Association of Studies on Alcohol and Other Drugs initiated a project to establish Brazilian Guidelines. The aim of this study was to review diagnostic and therapeutic criteria for the most prevalent psychiatric comorbidities. Randomized clinical trials, epidemiological studies, animal testing and other forms of research are reviewed herein. The main psychiatric comorbidities are investigated and data published in the literature are reviewed, based on guidelines adopted by other countries. Epidemiological aspects, diagnostic criteria, integrated treatment and the organization of specialized service, as well as details regarding psychotherapy and pharmacological treatment are discussed. The guidelines of the Brazilian Association of Studies on Alcohol and Other Drugs reinforce the importance of adequate diagnosis and treatment regarding alcoholic and drug dependent patients suffering of comorbid psychiatric disorders.

Binge drinking among Brazilians: Higher drinking frequency increases related problems.

Abstract Aims: To correlate binge drinking (BD) with alcohol-related problems (ARP) in the Brazilian population. Methods: A representative cross-sectional survey was conducted in 143 Brazilian cities. Associations between the frequencies of BD and ARP were gathered using an ordered logit regression model. Results: Higher BD frequencies significantly increased the chance of injury in accidents, job loss, and involvement in intense arguments and assaults over the year. High frequency in BD increases the odds of all ARP. Conclusion: There is a dose-response association between the frequency BD and ARP and is therefore a possible target for public prevention policies.

Depression during gestation in adolescent mothers interferes with neonatal neurobehavior

Objective: To compare the neurobehavior of neonates born to adolescent mothers with and without depression during gestation. Methods: This prospective cross-sectional study included healthy term neonates born to adolescent mothers with untreated depression during gestation, without exposure to legal or illicit drugs, and compared them with infants born to adolescent mothers without psychiatric disorders. Maternal psychiatric diagnoses were assessed by the Composite International Diagnostic Interview (CIDI 2.1) and neonatal neurobehavior by the Neonatal Intensive Care Unit Network Neurobehavioral Scale (NNNS) at 24 to 72 hours of life. Neurobehavioral outcomes were analyzed by ANOVA adjusted for confounders. Results: 37 infants born to mothers with depression during gestation were compared to 332 infants born to mothers without psychiatric disorders. Infants of mothers with depression had smaller head circumferences. Significant interactions of maternal depression and male gender, gestational age > 40 weeks, regional anesthesia during delivery, vaginal delivery, and infant head circumference ≥ 34 cm were found. Worse performance was noted in the following neonatal neurobehavioral parameters: arousal, excitability, lethargy, hypotonicity, and signs of stress and abstinence. Conclusion: Infants born to adolescent mothers with depression exhibit some behavioral changes in the first days of life. These changes are associated with infant sex, gestational age, type of anesthesia, mode of delivery, and head circumference. .

Depression during gestation in adolescent mothers interferes with neonatal neurobehavior.

OBJECTIVE: To compare the neurobehavior of neonates born to adolescent mothers with and without depression during gestation. METHODS: This prospective cross-sectional study included healthy term neonates born to adolescent mothers with untreated depression during gestation, without exposure to legal or illicit drugs, and compared them with infants born to adolescent mothers without psychiatric disorders. Maternal psychiatric diagnoses were assessed by the Composite International Diagnostic Interview (CIDI 2.1) and neonatal neurobehavior by the Neonatal Intensive Care Unit Network Neurobehavioral Scale (NNNS) at 24 to 72 hours of life. Neurobehavioral outcomes were analyzed by ANOVA adjusted for confounders. RESULTS: 37 infants born to mothers with depression during gestation were compared to 332 infants born to mothers without psychiatric disorders. Infants of mothers with depression had smaller head circumferences. Significant interactions of maternal depression and male gender, gestational age > 40 weeks, regional anesthesia during delivery, vaginal delivery, and infant head circumference ≥ 34 cm were found. Worse performance was noted in the following neonatal neurobehavioral parameters: arousal, excitability, lethargy, hypotonicity, and signs of stress and abstinence. CONCLUSION: Infants born to adolescent mothers with depression exhibit some behavioral changes in the first days of life. These changes are associated with infant sex, gestational age, type of anesthesia, mode of delivery, and head circumference.

Clinical and demographic profile of anesthesiologists using alcohol and other drugs under treatment in a pioneering program in Brazil.

BACKGROUND AND OBJECTIVES: Anesthesiologists are the majority in impaired-physician programs that assist physicians who abuse psychoactive substances. The aim of this paper is to show a descriptive study about the clinical and sociodemographic profile of a sample of chemically dependent anesthesiologists treated in a reference program. In addition, the objective is to cite the psychiatric comorbities, the most frequently used drugs and the psychosocial and professional repercussions of substance abuse. METHOD: A cross-sectional and prospective study was conducted, and a socio-occupational questionnaire and a structured interview were carried out to diagnose mental and psychoactive substance use disorders, according to the International Classification of Diseases (the ICD-10). The questionnaire and the structured interview were carried out by two skilled researchers. RESULTS: Fifty-seven anesthesiologists were interviewed. Most of them were male (77.2%), and the mean age was 36.1 years (SD=8.5%). A high prevalence of abuse of opioid (59.6%), benzodiazepine (3.1%) and alcohol (35.1%) was observed. Opioid users sought treatment earlier than other substance users and usually they were under pressure from their colleagues and the Regional Council of Medicine. The incidence of drug abuse for self-medication was high in this subgroup. CONCLUSIONS: Anesthesiologists may present a different profile concerning the risks of opioid use. Opioid abuse usually begins during medical residency or during the first years of clinical practice, which supports the hypothesis that addiction to opioids is an occupational issue among anesthesiologists.

Sociodemographic characteristics associated with binge drinking among Brazilians.

BACKGROUND: Binge drinking (BD) is a harmful pattern of alcohol use. This study describes this pattern of drinking and the sociodemographic variables associated with it in a representative sample of Brazilians. METHODS: A cross-sectional survey of 3007 individuals using a multistage probabilistic sample was conducted in 143 Brazilian municipalities. The frequency of BD in the year preceding the study was assessed. BD was defined as the consumption of four drinks of alcohol within a two-hour period for women and five drinks in two hours for men. Weighted-ordered logit regression was used to assess the relationship between sociodemographic factors and BD. RESULTS: Most respondents had not engaged in binge drinking (69.7%; 95% confidence interval (CI) 67.0-72.2%). Binge drinking was more common among participants who were male (odds ratio (OR) 2.9; 95% CI 2.3-3.6) or single (OR 1.5; 95% CI 1.1-2.1) or had higher family income (OR 2.3; 95% CI 1.3-3.8). Individuals between 18 and 44 years of age were four times more likely to engage in binge drinking than adolescents (OR 4.7; 95% CI 3.3-6.8). Evangelicals/Protestants were less likely to engage in binge drinking (OR 0.7; 95% CI 0.2-0.5). CONCLUSIONS: Our study, which is the first representative survey of BD in Brazil, showed that the age range of adults who engaged in BD is wider than the age range observed in other countries. These individuals are at increased risk for the adverse consequences of binge drinking, including addiction, car accidents, involvement in crime, absenteeism, and family violence.

Perfil clínico e demográfico de anestesiologistas usuários de álcool e outras drogas atendidos em um serviço pioneiro no Brasil / Clinical and demographic profile of anesthesiologists using alcohol and other drugs under treatment in a pioneering program in Brazil / Perfil clínico y demográfico de los anestesiólogos usuarios de alcohol y otras drogas atendidos en un servicio pionero en Brasil

JUSTIFICATIVA E OBJETIVOS: Anestesiologistas são os mais representados em serviços de atendimento a médicos com transtornos por uso de substâncias psicoativas. O objetivo deste trabalho é apresentar um estudo descritivo sobre o perfil clínico e sociodemográfico de uma amostra de anestesiologistas dependentes químicos atendidos em um serviço de referência, bem como elencar comorbidades psiquiátricas, drogas frequentemente utilizadas e repercussões psicossociais e profissionais do consumo. MÉTODO: Realizou-se estudo transversal, prospectivo, tendo sido aplicadas entrevistas estruturadas para diagnóstico de transtornos mentais e transtornos por uso de substâncias psicoativas, com base na Classificação Internacional de Doenças - Versão 10 - e questionário sócio-ocupacional, aplicados por dois pesquisadores treinados. RESULTADOS: Cinquenta e sete anestesiologistas foram entrevistados, em sua maioria do sexo masculino (77,2%), idade média de 36,1 anos (DP = 8,5). Observou-se uma alta prevalência de uso de opioides (59,6%), benzodiazepínicos (35,1%) e álcool (35,1%). Usuários de opioides procuraram tratamento mais precocemente comparado aos não usuários desta substância e, geralmente, sob influência da pressão de colegas ou do conselho regional de medicina. O uso de drogas como automedicação foi elevado dentro deste subgrupo. CONCLUSÕES: Anestesiologistas podem apresentar um perfil distinto de risco de uso de opioides. O padrão de início de consumo, associado aos anos de residência médica ou aos primeiros anos da prática médica, reforça a hipótese de dependência de opioides como problema ocupacional entre anestesiologistas.

BACKGROUND AND OBJECTIVES: Anesthesiologists are the majority in impaired-physician programs that assist physicians who abuse psychoactive substances. The aim of this paper is to show a descriptive study about the clinical and sociodemographic profile of a sample of chemically dependent anesthesiologists treated in a reference program. In addition, the objective is to cite the psychiatric comorbities, the most frequently used drugs and the psychosocial and professional repercussions of substance abuse. METHOD: A cross-sectional and prospective study was conducted, and a socio-occupational questionnaire and a structured interview were carried out to diagnose mental and psychoactive substance use disorders, according to the International Classification of Diseases (the ICD-10). The questionnaire and the structured interview were carried out by two skilled researchers. RESULTS: Fifty-seven anesthesiologists were interviewed. Most of them were male (77.2%), and the mean age was 36.1 years (SD = 8.5%). A high prevalence of abuse of opioid (59.6%), benzodiazepine (3.1%) and alcohol (35.1%) was observed. Opioid users sought treatment earlier than other substance users and usually they were under pressure from their colleagues and the Regional Council of Medicine. The incidence of drug abuse for self-medication was high in this subgroup. CONCLUSIONS: Anesthesiologists may present a different profile concerning the risks of opioid use. Opioid abuse usually begins during medical residency or during the first years of clinical practice, which supports the hypothesis that addiction to opioids is an occupational issue among anesthesiologists.

JUSTIFICATIVA Y OBJETIVOS: Los anestesiólogos son los más representados en los servicios de atención a médicos con trastornos por el uso de sustancias psicoactivas. El objetivo de este trabajo, es presentar un estudio descriptivo sobre el perfil clínico y socio-demográfico de una muestra de anestesiólogos dependientes químicos, atendidos en un servicio de referencia, como también discriminar las comorbilidades psiquiátricas, las drogas a menudo utilizadas y las repercusiones psicosociales y profesionales del consumo. MÉTODO: Se hizo un estudio transversal, prospectivo, y se aplicaron entrevistas estructuradas para el diagnóstico de los trastornos mentales y de los trastornos por el uso de sustancias psicoactivas, con base en la Clasificación Internacional de Enfermedades (Versión 10) y cuestionario socio-ocupacional, aplicados por dos investigadores entrenados para tal función. RESULTADOS: Cincuenta y siete anestesiólogos fueron entrevistados, en su mayoría del sexo masculino (77,2%), edad promedio de 36,1 años (DE = 8,5). Se observó una alta prevalencia del uso de opioides (59,6%), benzodiazepínicos (35,1%) y alcohol (35,1%). Los usuarios de opioides buscaron tratamiento más rápidamente si los comparamos con los no usuarios de esa sustancia y generalmente, bajo la influencia de la presión de colegas o del Órgano Regional de Medicina. El uso de drogas como automedicación fue elevado dentro de este subgrupo. CONCLUSIONES: Los anestesiólogos pueden presentar un perfil distinto de riesgo de uso de opioides. El estándar de inicio de consumo, asociado a los años de residencia o a los primeros años de la práctica médica, refuerza la hipótesis de dependencia de opioides como el problema ocupacional entre los anestesiólogos.

[The Impact of Prohibition on drinking and driving in Belo Horizonte in the State of Minas Gerais]. / O impacto da "Lei Seca" sobre o beber e dirigir em Belo Horizonte/MG.

The scope of this paper is to present comparative data on drinking and driving behavior among drivers in Belo Horizonte in the State of Minas Gerais, in the period from 2005 to 2009, evaluating the impact of Law No. 11.705 (Prohibition), dated June 6, 2008. Data regarding prevalence of this behavior, collected at Sobriety Checkpoints (internationally used methodology) were analyzed using representative samples obtained from drivers on different public roads with intensive traffic in Belo Horizonte (2005-2009), thus permitting analysis of the impact of the new law. In 2008, the data showed a reduction of approximately 50% in the prevalence of individuals driving with any level of alcohol in the blood, when compared to 2007, after the change in legislation. This study showed that the impact caused by Law No.11.705 was marked in the sense of modifying the behavior under scrutiny. However, other control measures need to be added to the current legislation, in order to obtain a continuous reduction of drinking and driving behavior, thereby fostering a culture of sobriety on the road.

O impacto da "Lei Seca" sobre o beber e dirigir em Belo Horizonte/MG / The Impact of Prohibition on drinking and driving in Belo Horizonte in the State of Minas Gerais

O objetivo do presente trabalho é apresentar dados, de estudo comparativo, sobre a conduta de beber e dirigir na cidade de Belo Horizonte, no período de 2005 a 2009, avaliando o impacto da Lei 11.705, a "Lei Seca", de 20 de junho de 2008. Para tanto, dados de prevalência desta conduta, coletados em postos de fiscalização da sobriedade (Sobriety Checkpoints) - metodologia internacionalmente utilizada -, foram analisados a partir de amostras representativas de motoristas abordados em vias públicas de tráfego intenso dessa capital, permitindo a avaliação do impacto da nova Lei. Os resultados da análise destes dados apontaram para uma redução de cerca de 50% na prevalência de condutores dirigindo com algum nível de álcool no sangue, em 2008, quando comparados a 2007, o que coincide com a mudança na legislação. O estudo permitiu determinar que o impacto da Lei 11.705/2008 foi bastante expressivo, no sentido de modificar a conduta estudada. Entretanto, outras medidas de controle devem somar-se à mudança na legislação, para que seja buscada uma contínua redução na incidência do "beber e dirigir", favorecendo, assim, uma cultura de sobriedade no trânsito.

The scope of this paper is to present comparative data on drinking and driving behavior among drivers in Belo Horizonte in the State of Minas Gerais, in the period from 2005 to 2009, evaluating the impact of Law No. 11.705 (Prohibition), dated June 6, 2008. Data regarding prevalence of this behavior, collected at Sobriety Checkpoints (internationally used methodology) were analyzed using representative samples obtained from drivers on different public roads with intensive traffic in Belo Horizonte (2005-2009), thus permitting analysis of the impact of the new law. In 2008, the data showed a reduction of approximately 50% in the prevalence of individuals driving with any level of alcohol in the blood, when compared to 2007, after the change in legislation. This study showed that the impact caused by Law No.11.705 was marked in the sense of modifying the behavior under scrutiny. However, other control measures need to be added to the current legislation, in order to obtain a continuous reduction of drinking and driving behavior, thereby fostering a culture of sobriety on the road.

Cannabis use before age 15 and subsequent executive functioning.

BACKGROUND: Many studies have suggested that adolescence is a period of particular vulnerability to neurocognitive effects associated with substance misuse. However, few large studies have measured differences in cognitive performance between chronic cannabis users who started in early adolescence (before age 15) with those who started later. AIMS: To examine the executive functioning of individuals who started chronic cannabis use before age 15 compared with those who started chronic cannabis use after 15 and controls. METHOD: We evaluated the performance of 104 chronic cannabis users (49 early-onset users and 55 late-onset users) and 44 controls who undertook neuropsychological tasks, with a focus on executive functioning. Comparisons involving neuropsychological measures were performed using generalised linear model analysis of variance (ANOVA). RESULTS: The early-onset group showed significantly poorer performance compared with the controls and the late-onset group on tasks assessing sustained attention, impulse control and executive functioning. CONCLUSIONS: Early-onset chronic cannabis users exhibited poorer cognitive performance than controls and late-onset users in executive functioning. Chronic cannabis use, when started before age 15, may have more deleterious effects on neurocognitive functioning.

Frontal Assessment Battery (FAB) is a simple tool for detecting executive deficits in chronic cannabis users.

BACKGROUND: Cannabis is the most used illicit drug in the world, and its use has been associated with prefrontal cortex (PFC) dysfunction, including deficits in executive functions (EF). Considering that EF may influence treatment outcome, it would be interesting to have a brief neuropsychological battery to assess EF in chronic cannabis users (CCU). In the present study, the Frontal Assessment Battery (FAB), a brief, easy to use neuropsychological instrument aimed to evaluate EF, was used to evaluate cognitive functioning of CCU. METHODS: We evaluated 107 abstinent CCU with the FAB and compared with 44 controls matched for age, estimated IQ, and years of education. RESULTS: CCU performed poorly as compared to controls (FAB total score = 16.53 vs. 17.09, p < .05). CCU had also a poor performance in the Motor Programming subtest (2.47 vs. 2.73, p < .05). CONCLUSION: This study examined effects of cannabis in executive functioning and showed evidence that the FAB is sensitive to detect EF deficits in early abstinent chronic cannabis users. Clinical significance of these findings remains to be investigated in further longitudinal studies. FAB may be useful as a screening instrument to evaluate the necessity for a complete neuropsychological assessment in this population.

Prevalence and correlates of gambling problems among a nationally representative sample of Brazilian adolescents.

The objectives of the study are: (a) to provide the first prevalence estimates of pathological gambling among Brazilian adolescents using an age-specific instrument in a nationally representative sample; (b) to investigate the extent to which adolescents participate in gambling activities in a developing country; and (c) to correlate different levels of gambling behavior with demographic variables. Multistage cluster sampling selected 3,007 individuals over 14 years of age from Brazilian household population. A total of 661 participants were between 14 and 17 years old. The Lie/Bet Questionnaire and the DSM-IV-MR-J were used for assessing problem and pathological gambling. 2.8% scored positive on the screening questionnaire, while 1.6% were classified as problem and pathological gamblers. Factors associated with problem and pathological gambling were male sex, not currently studying and considering religion as not important. Less than 4 months elapsed between the age of regular gambling involvement and the first gambling problem. Prevalence rates were quite similar from recent studies which used nationally representative samples. The association of problem and pathological gambling with male sex, school drop-out and low religiosity supports the Problem Behavior Theory. The fast progression to problem gambling adds evidence that adolescents may be more vulnerable to the effects of gambling.

Neurobehavioral profile of healthy full-term newborn infants of adolescent mothers.

BACKGROUND: The Neonatal Intensive Care Unit Network Neurobehavioral Scale (NNNS) is used to assess neurological integrity, behavioral function and the existence of stress and abstinence signs in newborn infants. AIM: To determine the neurobehavioral profile of healthy term neonates of adolescent mothers. DESIGN: Cross-sectional study with prospective collection of data. SUBJECTS: 419 healthy newborns without analgesic/sedative use at labor, intra-uterine drug exposure, multiple gestation, congenital malformations or infections. The NNNS was applied with 33+/-7 hours of life in a quiet and dark room, between feedings. OUTCOME MEASURES: Mean, SD, and 5th, 10th, 25th, 50th, 75th, 90th and 95th percentiles for each of 13 NNNS variables were determined and compared according to maternal age (12-14 years vs. 15-17 years vs. 18-19 years) by ANOVA. RESULTS: Mothers had 17+/-1.5 years, 50% white, 7.1+/-2.2 years of education, prenatal care in 96%, vaginal delivery in 73%, and local/regional anesthesia in 75%. Neonates had birth weight 3205+/-299 g, gestational age 39.4+/-1.1 weeks, 55% male, 1 min Apgar 8.2+/-1.3, and 5 min Apgar 9.6+/-0.6. NNNS scores (mean+/-SD): habituation: 6.86+/-1.49; attention: 5.73+/-1.32; arousal: 3.70+/-0.70; regulation: 6.06+/-0.74; orientation handling procedures: 0.36+/-0.26; quality of movements: 5.11+/-0.49; excitability: 2.48+/-1.68; lethargy: 4.04+/-1.82; non-optimal reflexes: 3.67+/-1.35; asymmetry: 0.71+/-0.94; hypertonicity: 0.18+/-0.39; hypotonicity: 0.13+/-037; and stress/abstinence signs: 0.07+/-0.05. Infants of younger adolescent mothers were less lethargic than infants of older ones. CONCLUSION: The description of the neurobehavioral profile of healthy term newborns of adolescent mothers is important to establish normal standards for this population.

Exposure to marijuana during pregnancy alters neurobehavior in the early neonatal period.

OBJECTIVE: To assess the neurobehavior of full-term neonates of adolescent mothers exposed to marijuana during pregnancy. STUDY DESIGN: This prospective cross-sectional study included full-term infants within 24 to 72 hours of life born to adolescent mothers at a single center in Brazil. Data on sociodemographic and obstetrical and neonatal characteristics were collected. The mothers underwent the Composite International Diagnostic Interview, and the infants were assessed with the Neonatal Intensive Care Unit Network Neurobehavioral Scale (NNNS). Maternal hair and neonatal meconium were analyzed. Neonates exposed in utero to tobacco, alcohol, cocaine, and/or any other drugs except marijuana were excluded. RESULTS: Of 3685 infants born in the study hospital, 928 (25%) were born to adolescent mothers. Of these, 561 infants met the inclusion criteria and were studied. Marijuana exposure was detected in 26 infants (4.6%). Infants exposed (E) or not exposed (NE) to marijuana differed in the following NNNS variables: arousal (E, 4.05 +/- 1.19 vs NE, 3.68 +/- 0.70), regulation (E, 5.75 +/- 0.62 vs NE, 6.04 +/- 0.72), and excitability (E, 3.27 +/- 1.40 vs NE, 2.40 +/- 1.57). After controlling for confounding variables, the effect of marijuana exposure on these scores remained significant. CONCLUSIONS: Marijuana exposure during pregnancy alters the neurobehavioral performance of term newborn infants of adolescent mothers.