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.

Substance-using adolescents admitted to inpatient treatment: Characteristics and factors associated with length of time in treatment. / Adolescentes usuarios de sustancias ingresados en tratamiento: Características y factores asociados a la duración del tratamiento.

Studies of adolescents receiving inpatient substance use treatment remain limited. We explored the characteristics of adolescents who received substance use treatment as inpatients in a psychiatric hospital in Brazil and factors associated with length of time in this treatment. METHODS: A retrospective observational study was performed. Electronic treatment records of 172 young people (aged 17 and below) receiving substance use treatment at Hospital Lacan in Brazil were analysed. RESULTS: The mean age of participants was 15.18 years (SD = 1.39). The sample was characterised as predominately male (68.60%), who entered treatment involuntarily (80.81%), were out of school (89.82%), were involved with the criminal justice system (59.88%) and came from a family with substance use problems (74.67%). Re-admission to inpatient treatment for substance use problems was common. On average, adolescents received inpatient treatment for 3 months. Length of time in treatment was associated with: involuntary admission to treatment, re-admission to inpatient treatment, requests of discharge from treatment by a relative/caretaker, education level, leaving school due to aggressive behaviours and cocaine use. CONCLUSION: Findings highlight the complex profiles of adolescents receiving substance use treatment in Brazil. Cross-system collaboration between mental health, educational and justice services are needed to treat adolescents' substance use.

Los estudios sobre adolescentes ingresados para tratamiento de uso de sustancias son limitados. Analizamos las características de adolescentes ingresados para tratamiento en un hospital psiquiátrico en Brasil y los factores asociados con la duración de su tratamiento. Métodos: estudio observacional retrospectivo. Analizamos los registros electrónicos de tratamiento de 172 jóvenes (hasta los 17 años de edad) ingresados para tratamiento por uso de sustancias en el Hospital Lacan en Brasil. Resultados: La edad media de los participantes era 15,18 años (SD = 1,39). La muestra era mayoritariamente masculina (68,60%), cuyo ingreso fue involuntario (80,81%), sin escolarizar (89,82%), involucrada en el sistema de justicia penal (59,88%) y proveniente de una familia con problemas relacionados con el uso de sustancias (74,67%). La readmisión como paciente a tratamiento por problemas de uso de sustancias era frecuente. Como media, los adolescentes estuvieron ingresados para tratamiento durante 3 meses. La duración del tratamiento estaba asociada con: admisión involuntaria al tratamiento, reingreso hospitalario para tratamiento, solicitudes de alta del tratamiento por parte de familiares/cuidadores, nivel de estudios, abandono escolar debido a conducta agresiva, y uso de cocaína. Conclusión: Los hallazgos destacan los perfiles complejos de los adolescentes ingresados para tratamiento por el uso de sustancias en Brasil. Es necesaria una colaboración entre los sistemas de salud mental, educación y servicios de justicia para tratar el uso de sustancias entre adolescentes.

Adolescentes usuarios de sustancias ingresados en tratamiento: Características y factores asociados a la duración del tratamiento / Substance-using adolescents admitted to inpatient treatment: Characteristics and factors associated with length of time in treatment

Los estudios sobre adolescentes ingresados para tratamiento de uso de sustancias son limitados. Analizamos las características de adolescentes ingresados para tratamiento en un hospital psiquiátrico en Brasil y los factores asociados con la duración de su tratamiento. Métodos: estudio observacional retrospectivo. Analizamos los registros electrónicos de tratamiento de 172 jóvenes (hasta los 17 años de edad) ingresados para tratamiento por uso de sustancias en el Hospital Lacan en Brasil. Resultados: La edad media de los participantes era 15,18 años (SD = 1,39). La muestra era mayoritariamente masculina (68,60%), cuyo ingreso fue involuntario (80,81%), sin escolarizar (89,82%), involucrada en el sistema de justicia penal (59,88%) y proveniente de una familia con problemas relacionados con el uso de sustancias (74,67%). La readmisión como paciente a tratamiento por problemas de uso de sustancias era frecuente. Como media, los adolescentes estuvieron ingresados para tratamiento durante 3 meses. La duración del tratamiento estaba asociada con: admisión involuntaria al tratamiento, reingreso hospitalario para tratamiento, solicitudes de alta del tratamiento por parte de familiares/cuidadores, nivel de estudios, abandono escolar debido a conducta agresiva, y uso de cocaína. Conclusión: Los hallazgos destacan los perfiles complejos de los adolescentes ingresados para tratamiento por el uso de sustancias en Brasil. Es necesaria una colaboración entre los sistemas de salud mental, educación y servicios de justicia para tratar el uso de sustancias entre adolescentes. (AU)

Studies of adolescents receiving inpatient substance use treatment remain limited. We explored the characteristics of adolescents who received substance use treatment as inpatients in a psychiatric hospital in Brazil and factors associated with length of time in this treatment. Methods: A retrospective observational study was performed. Electronic treatment records of 172 young people (aged 17 and below) receiving substance use treatment at Hospital Lacan in Brazil were analysed. Results: The mean age of participants was 15.18 years (SD = 1.39). The sample was characterised as predominately male (68.60%), who entered treatment involuntarily (80.81%), were out of school (89.82%), were involved with the criminal justice system (59.88%) and came from a family with substance use problems (74.67%). Re-admission to inpatient treatment for substance use problems was common. On average, adolescents received inpatient treatment for 3 months. Length of time in treatment was associated with: involuntary admission to treatment, re-admission to inpatient treatment, requests of discharge from treatment by a relative/caretaker, education level, leaving school due to aggressive behaviours and cocaine use. Conclusion: Findings highlight the complex profiles of adolescents receiving substance use treatment in Brazil. Cross-system collaboration between mental health, educational and justice services are needed to treat adolescents’ substanceuse. (AU)

Religiosity as a potential mediator for violence in childhood and adulthood: results from a Brazilian nationally representative survey.

OBJECTIVES: Although previous studies have investigated the role of religiosity in violence outcomes, there is a lack of studies including this aspect as a mediator for violence in childhood and adulthood. This study aimed to investigate the relationship between religiosity and violence in childhood, as well as the possible mediating role of religiosity between suffering violence in childhood and suffering and/or perpetrating violence in adulthood. DESIGN: Cross-sectional population-based study carried out from November 2011 to March 2012. SETTING: Face-to-face surveys (at participants' homes) were performed in a Brazilian nationally representative sample. PARTICIPANTS: A total of 3378 adults (aged 19 years and above) were included. PRIMARY AND SECONDARY OUTCOMES MEASURES: The association between suffering violence in childhood and religiosity, and the mediating role of religiosity between childhood and adulthood violence were analysed using logistic regression models. RESULTS: Religiosity was associated with childhood violence, showing that those who suffered less violence in childhood were more religious in adulthood and considered religion more important in their lives. However, while there was a significant association between suffering violence during childhood and suffering and/or perpetrating violence in adulthood, religiosity did not mediate this relationship. CONCLUSIONS: Although religious individuals self-reported less violence suffered in childhood, religiosity did not show evidence of being a potential mediator for childhood and adulthood violence (experienced and/or perpetrated). These results could help researchers explore this phenomenon, and aid health professionals and managers when proposing future interventions.

Real world evidence in involuntary psychiatric hospitalizations: 64,685 cases

Objective: We explored hospitalization patterns and the clinical and individual characteristics of a large cohort of patients who underwent involuntary psychiatric hospitalization in Brazil (n=64,685). Methods: Data were collected from the District Attorney's Office of the State of São Paulo (Ministério Público do Estado de São Paulo) on all involuntary psychiatric hospitalizations in the city of São Paulo between January 2003 and February 2020. The annual involuntary psychiatric hospitalization rate was calculated and descriptive statistics of the characteristics were produced. Results: Involuntary psychiatric hospitalizations increased from 5.8 to 25.5 per 100,000 population, with an eight-folder increase in the first 10-year period (2003-2013). The majority of admissions were to public institutions (86.6%), involved a psychotic disorder in the primary diagnosis (26.1%), involved more than one diagnosis (83.7%), and lasted less than 7 days (52.4%). The majority of the patients were aged 18 to 39 years and were single, and readmission was relatively common (13%). Although the reason for admission was missing in many reports (44%), the risk of harm to self or others was the most common (68.5%). Conclusion: This is one of the largest cohorts of involuntary psychiatric hospitalization records ever explored. These findings build upon existing international evidence about involuntary psychiatric hospitalizations and show recent trends in admission rates in the largest city in Brazil.

The Perceptions of Domestic Violence by a Family Member Who Uses Crack or Cocaine: A Secondary Retrospective Cross-Sectional Study.

OBJECTIVE: To evaluate the relationship between crack/cocaine use and domestic violence perpetration from the perspective of substance users' families. A secondary retrospective cross-sectional study, with 3162 family members of crack/cocaine users seeking treatment in the Recomeço Família Programme in São Paulo/Brazil was undertaken. Family members of crack/cocaine users reported that their relatives were more involved in domestic violence such as stealing (money and objects) at home [Odds Ratio Adjusted ORA = 2.17 (CI 95% 1.87; 2.53)], the family gave money to the user to buy drugs [ORA = 1.27 (1.08; 1.48)], and having problems with the judiciary [ORA = 1.48 (CI 95% 1.28; 1.71)]. Relatives of snorted cocaine users reported that there was physical and interpersonal violence, such as fathers being assaulted [ORA = 2.50 (CI 95% 1.08; 5.82)], assaulted someone else [ORA = 1.86 (CI 95% 1.32; 2.60)], threats of violence fights, arguments when the family talk about problematic drug use [ORA = 1.50 (CI 95% 1.13; 1.96)] and threatened some family members [ORA = 1.52 (CI 95% 1.14; 2.04)]. In this sample, there was a connection between crack/cocaine use and the perpetuation of domestic violence, corroborating with important implications for public policies, substance use treatment and prevention of domestic violence interventions.

Real world evidence in involuntary psychiatric hospitalizations: 64,685 cases.

OBJECTIVE: We explored hospitalization patterns and the clinical and individual characteristics of a large cohort of patients who underwent involuntary psychiatric hospitalization in Brazil (n=64,685). METHODS: Data were collected from the District Attorney's Office of the State of São Paulo (Ministério Público do Estado de São Paulo) on all involuntary psychiatric hospitalizations in the city of São Paulo between January 2003 and February 2020. The annual involuntary psychiatric hospitalization rate was calculated and descriptive statistics of the characteristics were produced. RESULTS: Involuntary psychiatric hospitalizations increased from 5.8 to 25.5 per 100,000 population, with an eight-folder increase in the first 10-year period (2003-2013). The majority of admissions were to public institutions (86.6%), involved a psychotic disorder in the primary diagnosis (26.1%), involved more than one diagnosis (83.7%), and lasted less than 7 days (52.4%). The majority of the patients were aged 18 to 39 years and were single, and readmission was relatively common (13%). Although the reason for admission was missing in many reports (44%), the risk of harm to self or others was the most common (68.5%). CONCLUSION: This is one of the largest cohorts of involuntary psychiatric hospitalization records ever explored. These findings build upon existing international evidence about involuntary psychiatric hospitalizations and show recent trends in admission rates in the largest city in Brazil.

Sociodemographic and clinical profile of crack cocaine treatment-seeking individuals living in "Crackland", Brazil / Perfil sociodemográfico e clínico de indivíduos em busca de tratamento para o uso de crack que vivem na "Cracolândia"

OBJECTIVE: São Paulo's Crackland is the biggest and oldest open drug use scene in Brazil, yet little is known about the profile of crack cocaine treatment-seeking individuals living in this region. The aim of this crossectional study was to describe the demographics and clinical characteristics of treatment-seeking crack users living in the Crackland region. METHODS: A sample of nighty eight individuals were screened for DSM-V substance use disorders, including substance use, impulsiveness, and psychiatric symptoms. Recent crack cocaine use was also tested using biologic specimens. RESULTS: Results indicated severe social vulnerability, as participants experienced high rates of homelessness (46.9%), unstable housing (50%), unemployment (60.4%) and early school drop-out (27.5%). The average age of crack use onset was 20 years (SD = 6.9) and the mean duration of continuous crack use was 15 years (SD = 9.7). Most participants presented with concomitant mental health disorders, particularly alcohol use disorder (87.8%), as well high rates of psychiatric symptomatology and impulsiveness. More than half of the sample reported at least one previous inpatient (73.5%) and outpatient (65.3%) addiction treatment attempt. CONCLUSION: This population profile should inform mental healthcare services, promoting the provision of tailored assistance by targeting specific demands at all levels of treatment.

OBJETIVO: Localizada em São Paulo, a Cracolândia é o maior e mais antigo cenário aberto de uso de drogas do Brasil. Ainda assim, pouco se sabe sobre o perfil dos indivíduos que vivem nessa região e buscam tratamento para crack. O objetivo deste estudo transversal foi descrever características demográficas e clínicas de usuários de crack vivendo na região da Cracolândia que estão em busca de tratamento. MÉTODOS: Noventa e oito indivíduos foram avaliados para transtornos por uso de substâncias do DSM-V, padrão de uso de substâncias, impulsividade e sintomatologia psiquiátrica. O uso recente de crack também foi determinado por meio de coleta de amostras toxicológicas. RESULTADOS: Os resultados indicaram grave vulnerabilidade social, com significativas prevalências de falta de moradia (46,9%), moradia instável (50%), desemprego (60,4%) e abandono escolar precoce (27,5%). A idade média de início do uso de crack foi de 20 anos (DP = 6,9) e a duração média do uso contínuo do crack foi de 15 anos (DP = 9,7). A maioria dos participantes apresentou alguma comorbidade psiquiátrica, particularmente transtorno por uso de álcool (87,8%), bem como altas taxas de sintomatologia psiquiátrica e impulsividade. Mais da metade da amostra relatou pelo menos uma tentativa anterior de tratamento por internação (73,5%) e ambulatorial (65,3%). CONCLUSÃO: Os achados desse estudo permitem um maior entendimento do perfil e das necessidades de usuários de crack vivendo na região da Cracolândia e podem ajudar serviços de saúde especializados em dependência química a promoverem uma assistência mais direcionada às demandas específicas dessa população.

Rape, Child Sexual Abuse, and Mental Health in a Brazilian National Sample.

The objective of this study is to evaluate the prevalence of self-reported rape and its associations with other forms of violence and mental health outcomes. The Brazilian National Alcohol and Drugs Survey is a probabilistic household survey that collected data from 4,283 Brazilians aged 14 years and older in 2012. The prevalence of rape was 2.3% (n = 107) and the majority (n = 81) of rapes were reported by women. Female gender increased the chances of rape (adjusted odds ratio [AOR] = 2.7, 95% confidence interval [CI] = [1.7, 4.3]). Adults aged 35 to 46 years (AOR = 2.0, 95% CI = [1.2, 4.4]) and being without religion (AOR = 2.2, 95% CI = [1.3, 3.8]) were also associated with increased chances of rape. Participants with a history of childhood sexual abuse (CSA) were 16.5 times (95% CI = [10.1, 26.7]) more likely to report having been raped. Other outcomes related to been raped were history of child prostitution (AOR = 5.1, 95% CI = [2.1, 13.4]) and witnesses of violence during childhood (AOR = 2.4, 95% CI = [1.5, 3.8]). People without social support (AOR≅3, 95% CI = [1.8, 4.3]), victims of multiple recent negative events (AOR = 3.7, 95% CI = [2.4, 5.8]), people with depression (AOR = 2.6, 95% CI = [1.7, 3.9]), history of suicidal ideation (AOR = 3.8, 95% CI = [2.0, 7.1]), and history of suicide attempts (AOR = 2.2, 95% CI = [1.1, 4.3]) are other outcomes related to having been raped. In this sample, rape was related to gender and to other forms of violence and victimization. Self-reports of rape appear to underestimate the true prevalence as the figures obtained from the survey were low. Other methods should be used to investigate this issue.

Acceptability and feasibility of incorporating contingency management into a public treatment program for homeless crack cocaine users in Brazil: A pilot study.

Homeless substance users are particularly hard to treat. In this pilot study, we evaluated the acceptability and feasibility of incorporating Contingency Management (CM) into a public Abstinent-Contingent Housing (ACH) treatment program developed to treat currently homeless crack cocaine users. A total of 21 homeless crack cocaine users were randomized to receive 12 weeks of ACH alone (n = 9) or ACH plus CM (ACH + CM) (n = 12). Twelve treatment providers in the ACH treatment program were trained to deliver the CM intervention. CM was rated as relatively (41.7%) or very (58.3%) easy to understand and relatively (50%) or very (50%) easy to conduct by the ACH treatment providers. On a 10-point Likert scale, providers rated the importance of incorporating CM into public treatment programs for crack cocaine at M = 8.3 (SD = 2). Participants exposed to CM rated as relatively (33.3%) or very (66.7%) easy to understand. One hundred percent liked receiving the intervention "a lot," and 78.9% believed it helped them achieve and maintain crack cocaine abstinence. Finally, compared to the ACH condition, the ACH + CM condition was consistently associated with better treatment retention and cocaine use outcome measures, yelling small to large effect sizes. However, possibly due to the small sample size, most of these differences did not achieve statistical significance. CM was well integrated into the ACH treatment program and was well accepted by both the providers and participants, suggesting the feasibility of incorporating CM into a public treatment program for homeless crack cocaine users from low- and middle-income countries. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Cannabis Consumption Onset and Addiction: Data from the Second Brazilian Drugs and Alcohol Survey (BNADS).

The objective of this study was to provide rates of cannabis use and dependence and risk factors, proposing a conditional path model for cannabis addiction. A subsample of adult participants from a Brazilian household survey was analyzed to estimate cannabis dependence. Estimation of prevalence rates and association between dependence and age of cannabis use initiation were performed. The conditional model was applied to investigate the mediation of depressive symptoms and alcohol consumption in the association of early cannabis use and dependence. Lifetime and last year cannabis use were 6.47% and 2.81%, respectively. Moderate and severe cannabis dependence were 0.74% and 0.18% in the population, and 26.47% and 6.38% among last year's cannabis users. A Parallel Multiple Mediator Model revealed strong association between cannabis use initiation age and dependence, when depressive symptoms or alcohol consumption mediate this association. The proportion of cannabis users displaying dependence symptoms is elevated and it is associated with the age of cannabis use initiation. The results show the importance of primary prevention interventions, prioritizing the delay of cannabis and alcohol experimentation. Our findings can enrich the debate on drugs policies and legislation, reinforcing the need for stronger restrictions of adolescent drug access and ensuring its enforcement.

Effectiveness of incorporating contingency management into a public treatment program for people who use crack cocaine in Brazil. A single-blind randomized controlled trial.

BACKGROUND: Smoked cocaine (i.e., crack use) is a severe health problem in Brazil, with the country being reported as having the largest crack market in the world. The objective of this study was to evaluate the effectiveness of incorporating Contingency Management targeting cocaine abstinence into a public treatment program in Brazil. METHODS: Single-blind randomized controlled trial conducted at Unidade Recomeço Helvétia (URH), a public ambulatory treatment program for persons who use crack and live in the "Crackland" region in downtown São Paulo, Brazil. In total, 98 treatment-seeking individuals who use crack were randomized to one of two treatment conditions. Participants allocated to the control condition (n = 48) received 12 weeks of the standard treatment provided at URH. Participants allocated to the experimental condition (n = 50) received the same treatment in combination with Contingency Management (URH+CM). In URH+CM, participants were provided with vouchers with monetary value for submission of negative cocaine urinalysis twice weekly. RESULTS: Compared to the URH group, the URH+CM group was significantly more likely to submit a negative cocaine urinalysis during treatment, with odds ratios ranging from 4.17 to 6.78, depending on how missing data was accounted for (p<0.01). Participants receiving Contingency Management also had higher odds of achieving three or more weeks of continuous abstinence (OR= 8.07; 95% CI [2.48, 26.24]), achieved longer durations of abstinence (B = 2.14; 95% CI [0.67, 3.61]), submitted a higher percentage of negative urinalysis (B = 19.85; 95% CI [6.89, 32.82]), and were retained in treatment for a longer period (B = 3.00; 95% CI [1.04, 4.97]), compared to those receiving URH alone (p<0.01 for all). CONCLUSIONS: The incorporation of Contingency Management was effective in promoting cocaine abstinence and treatment retention. The large-scale dissemination of Contingency Management may be an effective strategy to treat Brazilians with cocaine use disorders.

Cannabidiol for the treatment of crack-cocaine craving: an exploratory double-blind study

Objective: To assess the efficacy of cannabidiol (CBD) in the management of crack-cocaine craving and the treatment of frequent withdrawal symptoms. Methods: Thirty-one men with a diagnosis of crack-cocaine dependence were enrolled in a randomized, double-blind, placebo-controlled trial. We applied neuropsychological tests and assessed craving intensity, anxiety and depression symptoms, and substance use patterns at baseline and at the end of the trial. The participants were treated with CBD 300 mg/day or placebo for 10 days. During this period, we used a technique to induce craving and assessed the intensity of symptoms before and after the induction procedure. Results: Craving levels reduced significantly over the 10 days of the trial, although no differences were found between the CBD and placebo groups. Craving induction was successful in both groups, with no significant differences between them. Indicators of anxiety, depression, and sleep alterations before and after treatment also did not differ across groups. Conclusion: Under the conditions of this trial, CBD was unable to interfere with symptoms of crack-cocaine withdrawal. Further studies with larger outpatient samples involving different doses and treatment periods would be desirable and timely to elucidate the potential of CBD to induce reductions in crack-cocaine self-administration.

Factors associated with crack-cocaine early initiation: a Brazilian multicenter study.

BACKGROUND: Crack-cocaine dependence is a serious public health issue, related to several psychiatric and psychosocial problems. Crack-cocaine users are usually embedded in a context of great social vulnerability, often associated with violence, poverty, family conflict and easy and early access to alcohol, tobacco and other drugs. METHODS: This cross-sectional study enrolled a consecutive sample of 577 patients admitted to 20 therapeutic communities located in Southern Brazil, between September 2012 and September 2013. A structured interview assessed life-time exposure to risk and protective factors for drug use, such as parental monitoring in childhood, deviant behaviors and peer pressure. RESULTS: Presence of family conflict (p = 0.002), maltreatment (p = 0.016), and deviant behavior prior to age 15 in a bivariate analysis predicted an earlier age of crack-cocaine initiation, whereas adolescents experiencing parental monitoring during adolescence started use later (p < 0.001). In the multivariate model, perceptions related to ease of access of illicit drugs (marijuana: p = 0.028, 95% CI = - 3.81, - 0.22; crack-cocaine: p < 0.001, 95% CI = - 7.40, - 4.90), and deviant behavior (threatening someone with a gun: p = 0.028, 95% CI = - 2.57, - 0.14) remained independent predictors of early age of crack-cocaine initiation. CONCLUSIONS: Early onset of crack-cocaine use seems to be associated with exposure to family conflict, easy access to drugs and deviant behavior. Treatment and preventive programs should take these factors into account when designing and implementing community interventions.

Cannabidiol for the treatment of crack-cocaine craving: an exploratory double-blind study.

OBJECTIVE: To assess the efficacy of cannabidiol (CBD) in the management of crack-cocaine craving and the treatment of frequent withdrawal symptoms. METHODS: Thirty-one men with a diagnosis of crack-cocaine dependence were enrolled in a randomized, double-blind, placebo-controlled trial. We applied neuropsychological tests and assessed craving intensity, anxiety and depression symptoms, and substance use patterns at baseline and at the end of the trial. The participants were treated with CBD 300 mg/day or placebo for 10 days. During this period, we used a technique to induce craving and assessed the intensity of symptoms before and after the induction procedure. RESULTS: Craving levels reduced significantly over the 10 days of the trial, although no differences were found between the CBD and placebo groups. Craving induction was successful in both groups, with no significant differences between them. Indicators of anxiety, depression, and sleep alterations before and after treatment also did not differ across groups. CONCLUSION: Under the conditions of this trial, CBD was unable to interfere with symptoms of crack-cocaine withdrawal. Further studies with larger outpatient samples involving different doses and treatment periods would be desirable and timely to elucidate the potential of CBD to induce reductions in crack-cocaine self-administration.

Relapse in involuntary substance treatment: a transversal study.

OBJECTIVE: To evaluate the associations between relapse and admissions (voluntary and involuntary) in a sample of patients with substance dependence. METHODS: This is a cross-sectional study undertaken at a private medical therapeutic community specialised in treating addiction, located in a rural area of São Paulo, Brazil. Sociodemographic characteristics, the University of Rhode Island Change Assessment Scale (URICA), Stages Readiness and Treatment Eagerness Scale (SOCRATES), Beck Anxiety Inventory (BAI) and Beck Depression Inventory (BDI) and Structured Clinical Interview for DSM-IV-SCID were used. RESULTS: Relapse was associated with low family income (P=.006) and contemplation motivational stage (P<0.05). Nevertheless, no significant differences between individuals who were admitted involuntarily (64%) and voluntarily (54%) were observed (P=0.683) in terms of relapses. CONCLUSIONS: In this sample, the relapse outcome in involuntary admissions was no different from the voluntary ones.

Relapse in involuntary substance treatment: a transversal study

Objective: To evaluate the associations between relapse and admissions (voluntary and involuntary) in a sample of patients with substance dependence. Methods: This is a cross-sectional study undertaken at a private medical therapeutic community specialised in treating addiction, located in a rural area of São Paulo, Brazil. Sociodemographic characteristics, the University of Rhode Island Change Assessment Scale (URICA), Stages Readiness and Treatment Eagerness Scale (SOCRATES), Beck Anxiety Inventory (BAI) and Beck Depression Inventory (BDI) and Structured Clinical Interview for DSM-IV-SCID were used. Results: Relapse was associated with low family income (P = .006) and contemplation motivational stage (P<0.05). Nevertheless, no significant differences between individuals who were admitted involuntarily (64%) and voluntarily (54%) were observed (P = 0.683) in terms of relapses. Conclusions: In this sample, the relapse outcome in involuntary admissions was no different from the voluntary ones.

Objetivo: Evaluar las asociaciones entre recaída y admisiones (voluntarias e involuntarias) en una muestra de dependientes de sustancias. Métodos: Este es un estudio transversal realizado en una comunidad médica terapéutica privada, especializada en el tratamiento de la adicción, ubicada en una zona rural de São Paulo, Brasil. Se utilizaron las características sociodemográficas, la Escala de Evaluación de Cambios de la Universidad de Rhode Island (URICA), la Escala de Evaluación de la Etapa de Preparación y Tratamiento (SOCRATES), el Inventario de Ansiedad de Beck (BAI), el Inventario de Depresión de Beck (BDI) y la Entrevista Clínica Estructurada para DSM-IV-SCID. Resultados: La recaída se asoció con bajos ingresos familiares (p = 0,006) y contemplación de la etapa motivacional (p < 0,05). Sin embargo, no se observaron diferencias significativas entre los individuos que ingresaron involuntariamente (64%) y los voluntarios (54%) (p = 0,683) en términos de recaídas. Conclusiones: En esta muestra, el resultado de la recaída en admisiones involuntarias no fue diferente que en los voluntarios.

The effect of religiosity on violence: Results from a Brazilian population-based representative survey of 4,607 individuals.

Although there is a wide array of evidence showing the beneficial effect of religiosity on violence among adolescents, nationwide studies in the general population are scarce. This study aims to explore whether religiosity is associated or not with diminishing violence in a Brazilian population-based representative sample. This observational cross-sectional study was conducted in 2011-2012 using face-to-face interviews and included 4,608 individuals 14 years and older. The survey included measures of religiosity (religious affiliation and importance of religion), violence (involvement in fights, domestic violence and police detention), depression, social support and alcohol dependence. We used logistic regression models and mediation analyses. In the total sample analyses, after adjustments, having a religious affiliation was inversely associated with lower involvement in fights (OR = 0.60,CI95%:0.37-0.98) and less police detention (OR = 0.37,CI95%:0.20-0.70), whereas the importance of religion was only associated with less fights (OR = 0.60,CI95%:0.36-0.99). Subanalyses revealed different associations depending on the age group evaluated. Mediation tests showed that the association of religious affiliation on violence outcomes was mediated by alcohol use. In conclusion, religiosity seems to be an important factor associated with lower levels of violence in this nationwide representative survey and alcohol dependence seems to mediate this relationship. Health professionals should be aware of these findings in their clinical practice.