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.

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).

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.

HIV and syphilis infections and associated factors among patients in treatment at a Specialist Alcohol, Tobacco, and Drugs Center in São Paulo's "Cracolândia".

INTRODUCTION: This study describes the epidemiological scenario of human immunodeficiency virus (HIV) and syphilis at the biggest specialist drug addiction center in Brazil. The great challenge is to find strategies to reduce the impact of inequality and discrimination and develop policies to protect individuals living with - or at risk of - infections. METHODS: During the period from January 1 to May 31, 2016, a cross-sectional study was conducted on which all patients (N = 806) seeking inpatient treatment were enrolled. A structured diagnostic interview and rapid tests were conducted initially, and diagnoses were confirmed by tests conducted at a venereal disease research laboratory (VDRL). RESULTS: HIV and syphilis rates were 5.86% and 21.9%, respectively. Women were nearly 2.5 times more likely to have syphilis. HIV infection was associated with unprotected sex (odds ratio [OR]: 3.27, p = 0.003, 95% confidence interval [95%CI]: 1.51-7.11), and suicidal ideation (OR: 6.63, p = 0.001, 95%CI: 3.37-14.0). Although only 1.86% reported injecting drugs at any point during their lifetimes, this variable was associated with both HIV and syphilis. Elevated rates of HIV and syphilis were observed in the context of this severe social vulnerability scenario. CONCLUSION: The risk factors identified as associated with HIV and syphilis should be taken into consideration for implementation of specific prevention strategies including early diagnosis and treatment of sexually transmitted infections (STI) to tackle the rapid spread of STIs in this population.

HIV and syphilis infections and associated factors among patients in treatment at a Specialist Alcohol, Tobacco, and Drugs Center in São Paulo's "Cracolândia"

Abstract Introduction This study describes the epidemiological scenario of human immunodeficiency virus (HIV) and syphilis at the biggest specialist drug addiction center in Brazil. The great challenge is to find strategies to reduce the impact of inequality and discrimination and develop policies to protect individuals living with - or at risk of - infections. Methods During the period from January 1 to May 31, 2016, a cross-sectional study was conducted on which all patients (N = 806) seeking inpatient treatment were enrolled. A structured diagnostic interview and rapid tests were conducted initially, and diagnoses were confirmed by tests conducted at a venereal disease research laboratory (VDRL). Results HIV and syphilis rates were 5.86% and 21.9%, respectively. Women were nearly 2.5 times more likely to have syphilis. HIV infection was associated with unprotected sex (odds ratio [OR]: 3.27, p = 0.003, 95% confidence interval [95%CI]: 1.51-7.11), and suicidal ideation (OR: 6.63, p = 0.001, 95%CI: 3.37-14.0). Although only 1.86% reported injecting drugs at any point during their lifetimes, this variable was associated with both HIV and syphilis. Elevated rates of HIV and syphilis were observed in the context of this severe social vulnerability scenario. Conclusion The risk factors identified as associated with HIV and syphilis should be taken into consideration for implementation of specific prevention strategies including early diagnosis and treatment of sexually transmitted infections (STI) to tackle the rapid spread of STIs in this population.

Suicidal behavior among substance users: data from the Second Brazilian National Alcohol and Drug Survey (II BNADS)

Objective: To investigate the prevalence rates of suicidal ideation (SI) and suicide attempts (SA) and their association with substance use in a nationally representative sample of Brazilians. Methods: The Second Brazilian National Alcohol and Drug Survey (II BNADS) is a household cross-sectional survey that investigated the consumption of psychotropic drugs and associated risk factors. This national probability sample survey used a multistage cluster design to select 4,607 participants aged 14 or older and had a total response rate of 77%. Illegal drug use, SI and SA were obtained by confidential self-report assessment. Results: SI and SA were reported by 9.9 and 5.4% of the sample, respectively. This prevalence was 20.8 and 12.4% among individuals with alcohol use disorders (AUD), 31.5 and 16.5% among cannabis users and 40.0 and 20.8% among cocaine users. After adjusting for demographic characteristics, tobacco use, family history of suicide and depression, both SI and SA were positively associated with AUD, cannabis and cocaine use. Conclusion: AUD, cannabis and cocaine use were significantly associated with SI and SA, even after the adjustments. Public health initiatives targeting suicide prevention should consider including assessment and management of substance misuse, and therapeutic approaches to substance misuse should include assessment of suicidality.

Alcohol misuse among women in Brazil: recent trends and associations with unprotected sex, early pregnancy, and abortion

Objective: This study compared the rates of binge drinking (BD) and alcohol use disorder (AUD) reported for 2006 with those reported for 2012, exploring their associations with unprotected sex, early pregnancy, and abortion in a representative sample of women in Brazilian households. Methods: This was a descriptive analysis of data from a cross-sectional study involving randomized multistage cluster sampling of the population ≥ 14 years of age. Weighted prevalence rates and odds ratios were estimated, and serial mediation analysis was performed. Results: A total of 4,256 women were analyzed. The BD prevalence was 35.1% and 47.1% in 2006 and 2012, respectively, a significant increase, especially among women 40-59 years of age. There was no significant difference in AUD prevalence. BD (without AUD) was found to increase the odds of unprotected sex and abortion. The path analysis showed that early pregnancy was a mediator of the relationship between alcohol consumption and abortion. Conclusion: Among women in Brazil, the harmful use of alcohol is increasing, which has an impact on female reproductive health and exposure to risks. There is a need for specific prevention initiatives focusing on alcohol-related behaviors in women.

Rape in Brazil and relationships with alcohol consumption: estimates based on confidential self-reports. / Estupros no Brasil e relações com o consumo de álcool: estimativas baseadas em autorrelato sigiloso.

This study presents the rape prevalence and its relationship with alcohol consumption based on the analysis of cross-sectional data from the 2012 Second National Alcohol and Drugs Survey, which used a cluster-stratified probabilistic sample of the Brazilian population. We included 1,918 men and 2,365 women, for a total sample of 4,283 individuals. Our results estimate the over-lifetime rape prevalence at 2.6% for the entire population, 1.7% for men and 3.5% for women. For both sexes, the highest prevalences were concentrated among those aged between 26 and 59 years (3.3%), those with low educational levels (3.8%), and those who were single, divorced or widowed (3.1%). Among individuals who were diagnosed with alcohol use disorder, according to the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders), 6% reported having been raped, as did 3.3% of those who reported binge drinking. Logistical and multivariate regression analyses showed that, for both women and men, age (those between 26 and 59 years), marital status (single), alcohol use disorder and binge drinking are factors associated with an increased probability of being raped, whereas a higher educational level (more than 9 years of schooling) was shown to be capable of reducing the odds of being raped. Awareness of prevalences and of victims' sociodemographic profiles is necessary in order to identify the scope of this public health problem as well as to evaluate the urgency of implementing preventative and supportive measures.

Com base na análise dos dados de corte transversal provenientes do Segundo Levantamento Nacional de Álcool e Drogas realizado em 2012, utilizando-se uma amostra probabilística estratificada por conglomerado representativa da população brasileira, este estudo apresenta as prevalências de estupro e analisa a relação deste evento com o consumo de álcool. Foram considerados 1.918 homens e 2.365 mulheres, totalizando uma amostra de 4.283 indivíduos. Nossos resultados estimam a prevalência de estupro na vida em 2,6% da população geral, sendo 1,7% entre os homens e 3,5% entre as mulheres. Para ambos os sexos, as maiores prevalências se concentraram entre indivíduos com idades entre 26 e 59 anos (3,3%), com baixa escolaridade (3,8%), solteiros, divorciados ou viúvos (3,1%). Entre os indivíduos com diagnóstico para transtorno por uso de álcool de acordo com o DSM-5 (Manual Diagnóstico e Estatístico de Transtornos Mentais), 6% relataram ser vítimas de estupro, bem como, 3,3% daqueles que disseram beber pesado episódico (binge). Análises de regressão logística e multifatorial indicaram que tanto para mulheres quanto para homens a idade (aqueles entre 26 e 59 anos), o estado civil (solteiro), o diagnóstico de transtorno por uso de álcool e o beber pesado episódico são fatores associados ao aumento da probabilidade de vitimização por estupro, enquanto maior nível de educação (mais do que 9 anos de estudos) revelou-se um fator capaz de diminuir as chances de ocorrência. A identificação da amplitude desse problema de saúde pública, bem como a avaliação da urgência na implantação de medidas preventivas e assistenciais, partem do conhecimento das prevalências e do perfil sociodemográfico das vítimas.

En base a un análisis de datos de corte transversal, procedente del Segundo Estudio Nacional sobre Alcohol y Drogas, realizado en 2012, utilizando un muestreo probabilístico estratificado por conglomerados -representativo de la población brasileña-, este estudio presenta las prevalencias de violación y analiza su relación con el consumo de alcohol. Se consideraron a 1.918 hombres y 2.365 mujeres, totalizando una muestra de 4.283 individuos. Nuestros resultados estiman la prevalencia de violación durante la vida en un 2,6% de la población general, siendo 1,7% en el caso de los hombres y 3,5% en las mujeres. Para ambos sexos, las mayores prevalencias se concentraron entre individuos con edades entre 26 y 59 años (3,3%), con baja escolaridad (3,8%), solteros, divorciados o viudos (3,1%). Entre los individuos diagnosticados con trastorno, debido al consumo de alcohol, de acuerdo con el DSM- 5 (Manual Diagnsotico y Estadístico de los Trastornos Mentales), un 6% informaron ser víctimas de violación, asimismo, un 3,3% de ellos dijeron beber en grandes cantidades episódicamente (binge). Los análisis de regresión logística y multifactorial indicaron que tanto para mujeres, como para hombres, la edad (quienes tenían entre 26 y 59 años), estado civil (soltero), diagnóstico de trastorno por consumo de alcohol, y beber en grandes cantidades episódicamente, son factores asociados al aumento de la probabilidad de victimización por violación, sin embargo, cuanto mayor era el nivel de educación (más de 9 años de estudios), mayor era la capacidad de disminuir las oportunidades de ocurrencia. La identificación de la dimensión de este problema de salud pública, así como la evaluación de la urgencia en la implantación de medidas preventivas y asistenciales, parten del conocimiento de las prevalencias y del perfil sociodemográfico de las víctimas.

Prevalence of and pathways to benzodiazepine use in Brazil: the role of depression, sleep, and sedentary lifestyle

Objective: This study aimed to determine the prevalence of benzodiazepine (BZD) use in Brazil and to investigate the direct and indirect effects of alcohol consumption, sedentary lifestyle (SL), depressive symptoms (DS), and sleep dissatisfaction (SD) on BZD use. Methods: The Second Brazilian Alcohol and Drugs Survey (II BNADS) used stratified cluster probabilistic sampling to select 4,607 individuals aged 14 years and older from the Brazilian household population. Results: The lifetime and 12-month prevalence of BZD use was 9.8 and 6.1%, respectively. Older participants (age 40 and older) and women had higher rates. Alcohol use disorder, DS, and SD were significantly more prevalent in BZD users. The parallel multiple mediator model showed a positive direct effect of alcohol consumption on BZD use, with significant positive indirect effects of SL, SD, and DS as simultaneous mediators leading to higher BZD intake. Other statistically significant indirect pathways were DS alone, SD alone, and all of the above except SL. Conclusion: The prevalence of BZD use in Brazil is high compared to that of other countries. Knowledge of the main risk factors and pathways to consumption can guide prevention initiatives and underlie the development of better tailored and effective treatment strategies.

Suicidal behavior among substance users: data from the Second Brazilian National Alcohol and Drug Survey (II BNADS).

OBJECTIVE: To investigate the prevalence rates of suicidal ideation (SI) and suicide attempts (SA) and their association with substance use in a nationally representative sample of Brazilians. METHODS: The Second Brazilian National Alcohol and Drug Survey (II BNADS) is a household cross-sectional survey that investigated the consumption of psychotropic drugs and associated risk factors. This national probability sample survey used a multistage cluster design to select 4,607 participants aged 14 or older and had a total response rate of 77%. Illegal drug use, SI and SA were obtained by confidential self-report assessment. RESULTS: SI and SA were reported by 9.9 and 5.4% of the sample, respectively. This prevalence was 20.8 and 12.4% among individuals with alcohol use disorders (AUD), 31.5 and 16.5% among cannabis users and 40.0 and 20.8% among cocaine users. After adjusting for demographic characteristics, tobacco use, family history of suicide and depression, both SI and SA were positively associated with AUD, cannabis and cocaine use. CONCLUSION: AUD, cannabis and cocaine use were significantly associated with SI and SA, even after the adjustments. Public health initiatives targeting suicide prevention should consider including assessment and management of substance misuse, and therapeutic approaches to substance misuse should include assessment of suicidality.

Alcohol misuse among women in Brazil: recent trends and associations with unprotected sex, early pregnancy, and abortion.

OBJECTIVE: This study compared the rates of binge drinking (BD) and alcohol use disorder (AUD) reported for 2006 with those reported for 2012, exploring their associations with unprotected sex, early pregnancy, and abortion in a representative sample of women in Brazilian households. METHODS: This was a descriptive analysis of data from a cross-sectional study involving randomized multistage cluster sampling of the population ≥ 14 years of age. Weighted prevalence rates and odds ratios were estimated, and serial mediation analysis was performed. RESULTS: A total of 4,256 women were analyzed. The BD prevalence was 35.1% and 47.1% in 2006 and 2012, respectively, a significant increase, especially among women 40-59 years of age. There was no significant difference in AUD prevalence. BD (without AUD) was found to increase the odds of unprotected sex and abortion. The path analysis showed that early pregnancy was a mediator of the relationship between alcohol consumption and abortion. CONCLUSION: Among women in Brazil, the harmful use of alcohol is increasing, which has an impact on female reproductive health and exposure to risks. There is a need for specific prevention initiatives focusing on alcohol-related behaviors in women.

Prevalence of and pathways to benzodiazepine use in Brazil: the role of depression, sleep, and sedentary lifestyle.

OBJECTIVE: This study aimed to determine the prevalence of benzodiazepine (BZD) use in Brazil and to investigate the direct and indirect effects of alcohol consumption, sedentary lifestyle (SL), depressive symptoms (DS), and sleep dissatisfaction (SD) on BZD use. METHODS: The Second Brazilian Alcohol and Drugs Survey (II BNADS) used stratified cluster probabilistic sampling to select 4,607 individuals aged 14 years and older from the Brazilian household population. RESULTS: The lifetime and 12-month prevalence of BZD use was 9.8 and 6.1%, respectively. Older participants (age 40 and older) and women had higher rates. Alcohol use disorder, DS, and SD were significantly more prevalent in BZD users. The parallel multiple mediator model showed a positive direct effect of alcohol consumption on BZD use, with significant positive indirect effects of SL, SD, and DS as simultaneous mediators leading to higher BZD intake. Other statistically significant indirect pathways were DS alone, SD alone, and all of the above except SL. CONCLUSION: The prevalence of BZD use in Brazil is high compared to that of other countries. Knowledge of the main risk factors and pathways to consumption can guide prevention initiatives and underlie the development of better tailored and effective treatment strategies.

Estupros no Brasil e relações com o consumo de álcool: estimativas baseadas em autorrelato sigiloso / Violaciones en Brasil y su vínculo con el consumo de alcohol: estimaciones basadas en autoinformes anónimos / Rape in Brazil and relationships with alcohol consumption: estimates based on confidential self-reports

Com base na análise dos dados de corte transversal provenientes do Segundo Levantamento Nacional de Álcool e Drogas realizado em 2012, utilizando-se uma amostra probabilística estratificada por conglomerado representativa da população brasileira, este estudo apresenta as prevalências de estupro e analisa a relação deste evento com o consumo de álcool. Foram considerados 1.918 homens e 2.365 mulheres, totalizando uma amostra de 4.283 indivíduos. Nossos resultados estimam a prevalência de estupro na vida em 2,6% da população geral, sendo 1,7% entre os homens e 3,5% entre as mulheres. Para ambos os sexos, as maiores prevalências se concentraram entre indivíduos com idades entre 26 e 59 anos (3,3%), com baixa escolaridade (3,8%), solteiros, divorciados ou viúvos (3,1%). Entre os indivíduos com diagnóstico para transtorno por uso de álcool de acordo com o DSM-5 (Manual Diagnóstico e Estatístico de Transtornos Mentais), 6% relataram ser vítimas de estupro, bem como, 3,3% daqueles que disseram beber pesado episódico (binge). Análises de regressão logística e multifatorial indicaram que tanto para mulheres quanto para homens a idade (aqueles entre 26 e 59 anos), o estado civil (solteiro), o diagnóstico de transtorno por uso de álcool e o beber pesado episódico são fatores associados ao aumento da probabilidade de vitimização por estupro, enquanto maior nível de educação (mais do que 9 anos de estudos) revelou-se um fator capaz de diminuir as chances de ocorrência. A identificação da amplitude desse problema de saúde pública, bem como a avaliação da urgência na implantação de medidas preventivas e assistenciais, partem do conhecimento das prevalências e do perfil sociodemográfico das vítimas.

En base a un análisis de datos de corte transversal, procedente del Segundo Estudio Nacional sobre Alcohol y Drogas, realizado en 2012, utilizando un muestreo probabilístico estratificado por conglomerados -representativo de la población brasileña-, este estudio presenta las prevalencias de violación y analiza su relación con el consumo de alcohol. Se consideraron a 1.918 hombres y 2.365 mujeres, totalizando una muestra de 4.283 individuos. Nuestros resultados estiman la prevalencia de violación durante la vida en un 2,6% de la población general, siendo 1,7% en el caso de los hombres y 3,5% en las mujeres. Para ambos sexos, las mayores prevalencias se concentraron entre individuos con edades entre 26 y 59 años (3,3%), con baja escolaridad (3,8%), solteros, divorciados o viudos (3,1%). Entre los individuos diagnosticados con trastorno, debido al consumo de alcohol, de acuerdo con el DSM- 5 (Manual Diagnśotico y Estadístico de los Trastornos Mentales), un 6% informaron ser víctimas de violación, asimismo, un 3,3% de ellos dijeron beber en grandes cantidades episódicamente (binge). Los análisis de regresión logística y multifactorial indicaron que tanto para mujeres, como para hombres, la edad (quienes tenían entre 26 y 59 años), estado civil (soltero), diagnóstico de trastorno por consumo de alcohol, y beber en grandes cantidades episódicamente, son factores asociados al aumento de la probabilidad de victimización por violación, sin embargo, cuanto mayor era el nivel de educación (más de 9 años de estudios), mayor era la capacidad de disminuir las oportunidades de ocurrencia. La identificación de la dimensión de este problema de salud pública, así como la evaluación de la urgencia en la implantación de medidas preventivas y asistenciales, parten del conocimiento de las prevalencias y del perfil sociodemográfico de las víctimas.

This study presents the rape prevalence and its relationship with alcohol consumption based on the analysis of cross-sectional data from the 2012 Second National Alcohol and Drugs Survey, which used a cluster-stratified probabilistic sample of the Brazilian population. We included 1,918 men and 2,365 women, for a total sample of 4,283 individuals. Our results estimate the over-lifetime rape prevalence at 2.6% for the entire population, 1.7% for men and 3.5% for women. For both sexes, the highest prevalences were concentrated among those aged between 26 and 59 years (3.3%), those with low educational levels (3.8%), and those who were single, divorced or widowed (3.1%). Among individuals who were diagnosed with alcohol use disorder, according to the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders), 6% reported having been raped, as did 3.3% of those who reported binge drinking. Logistical and multivariate regression analyses showed that, for both women and men, age (those between 26 and 59 years), marital status (single), alcohol use disorder and binge drinking are factors associated with an increased probability of being raped, whereas a higher educational level (more than 9 years of schooling) was shown to be capable of reducing the odds of being raped. Awareness of prevalences and of victims' sociodemographic profiles is necessary in order to identify the scope of this public health problem as well as to evaluate the urgency of implementing preventative and supportive measures.

Sociodemographic Characteristics, Patterns of Crack Use, Concomitant Substance Use Disorders, and Psychiatric Symptomatology in Treatment-Seeking Crack-Dependent Individuals in Brazil.

Crack cocaine (crack) dependence is a severe disorder associated with considerable morbidity and mortality, constituting a major public health problem in Brazil. The aim of this study was to improve understanding of the profile of treatment-seeking crack-dependent individuals. We recruited 65 crack-dependent individuals from among those seeking treatment at an outpatient clinic for alcohol and drug treatment in the city of São Paulo, Brazil. Assessments, conducted between August 2012 and July 2014, focused on sociodemographic characteristics, the pattern/history of crack use, treatment history, concomitant substance use disorders, psychiatric symptomatology, and impulsivity. In the study sample, males predominated, as did unemployment, homelessness, and low levels of education. On average, the participants had smoked crack for 10 years. Most had previously been treated for crack dependence. Concomitant DSM-IV diagnoses of dependence on other substances were common, dependence on tobacco and alcohol being the most prevalent. Participants presented significant psychiatric symptomatology and impulsivity, with nearly half of the sample presenting psychotic symptoms, 90% presenting depressive symptoms, and 80% presenting anxiety symptoms. Most treatment-seeking crack-dependent individuals in Brazil are living in extremely poor social conditions and are struggling with the severe, chronic, and comorbid features of this disorder.

Crack cocaine users views regarding treatment with contingency management in Brazil.

BACKGROUND: Contingency management (CM) has recently shown efficacy in promoting abstinence and retention in treatment among crack cocaine users in Brazil. However, partially because of unawareness and resistance among health care providers, CM has not been widely employed. The objective of this study was to conduct a secondary analysis in order to evaluate how CM participants perceive their treatment experience. METHODS: Twenty-seven crack cocaine users, previously assigned to 12 weeks of CM treatment, were assessed with a structured questionnaire designed to assess their personal opinion of, difficulty in understanding, and acceptance of the CM intervention, as well as their opinion regarding its impact on their treatment responses. RESULTS: Descriptive analyses showed that 92.6% of the participants found it very easy to understand the CM protocol. All participants reported liking their CM experience quite a bit. For the perceived effects of CM on their treatment response, 81.5% of the participants stated that CM helped them considerably, the mean score for the impact of CM on treatment response (out of a maximum of 10) being 9 (SD = 1.5). When asked if they believed CM could help other people with crack cocaine dependence, 92.6% of the participants stated that CM could help such people a lot and 7.4% stated that it could help them a little. CONCLUSIONS: From the perspective of the patients, CM was easily assimilated, easily accepted, and had a direct positive effect on treatment response. These findings provide additional support for the incorporation of CM into substance abuse treatment services in Brazil.

Association between drug use and urban violence: Data from the II Brazilian National Alcohol and Drugs Survey (BNADS).

OBJECTIVE: To investigate the association of alcohol and cocaine use with urban violence (both as victim and as perpetrator) in a representative sample of the Brazilian population. METHOD: The Second Brazilian Alcohol and Drugs Survey (II BNADS) interviewed 4607 individuals aged 14 years and older from the Brazilian household population including an oversample of 1157 adolescents (14 to 18 years old). The survey gathered information on alcohol, tobacco and illegal substances use as well as on risk factors for abuse and dependence, behaviors associated with the use of substances and the possible consequences, as urban violence indicators. RESULTS: Approximately 9.3% of the Brazilian population has been victim of at least one form of urban violence. This proportion increases to 19.7% among cocaine users and to 18.1% among individuals with alcohol use disorders (AUD). Perpetration of violence was reported by 6.2% of the sample. Cocaine use and AUD increased in almost four times the chances of being an aggressor. Being religious and married decreased the chances of being a victim and/or perpetrador of urban violence. Higher education also decreased the chances of involvement in both victimization or perpetration of violence. Both Parallel Mediation Models considering cocaine use as a predictor of urban violence (victimization or perpetration) were valid and alcohol consumption and depressive symptoms were mediators of this relationship. CONCLUSIONS: This study presents relevant data of interest to Brazil as this country is one of the major consumer market of cocaine and also is among the most violent countries worldwide.

Contingency management targeting abstinence is effective in reducing depressive and anxiety symptoms among crack cocaine-dependent individuals.

Although contingency management (CM) is effective in promoting abstinence and treatment retention among crack cocaine users who meet the criteria for cocaine dependence, less is known about its off-target effects. In this secondary analysis, we evaluated the impact of CM on depressive and anxiety symptoms in a sample of cocaine-dependent individuals under treatment. Sixty-five crack cocaine users who met the criteria for cocaine dependence were randomly assigned to receive 12 weeks of standard treatment alone (STA; n = 32) or 12 weeks of standard treatment plus CM (STCM; n = 33). The outcome measures of the secondary analysis were depressive and anxiety symptoms assessed with the Beck Depression Inventory-II (BDI-II) and the Beck Anxiety Inventory (BAI). At baseline, 59 (90.8%) of the participants reported at least mild depressive symptoms and 47 (72.5%) reported at least mild anxiety symptoms. The mean BDI-II (24.5 ± 12.1) and BAI (20.7 ± 13.5) scores in the sample as a whole was moderate. After treatment, the reported levels of depressive symptoms (ß = -9.6, p < .05) and anxiety symptoms (ß = -9.9, p < .05) were lower among the individuals receiving STCM than among those receiving STA. This study provides evidence that an STCM intervention targeting crack cocaine abstinence also produces significant reductions in depressive and anxiety symptoms. This low cost intervention also demonstrated significant promise and optimization potential for crack cocaine users in a setting of scarce resources and high mental health comorbidity. Relevance Statement: We found that the prevalence of depressive and anxiety symptoms were extremely high among crack cocaine users, and that, among such individuals, contingency management (CM) reduced depressive and anxiety symptomatology to a greater degree than did standard treatment. Our results suggest that CM targeting crack cocaine abuse can have off-target effects on psychiatric symptomatology. (PsycINFO Database Record

Brazilian cross-cultural adaptation and validation of the List of Threatening Events Questionnaire (LTE-Q)

Objective: To perform a construct validation of the List of Threatening Events Questionnaire (LTE-Q), as well as convergence validation by identifying its association with drug use in a sample of the Brazilian population. Methods: This is a secondary analysis of the Second Brazilian National Alcohol and Drugs Survey (II BNADS), which used a cross-cultural adaptation of the LTE-Q in a probabilistic sample of 4,607 participants aged 14 years and older. Latent class analysis was used to validate the latent trait adversity (which considered the number of events from the list of 12 item in the LTE experienced by the respondent in the previous year) and logistic regression was performed to find its association with binge drinking and cocaine use. Results: The confirmatory factor analysis returned a chi-square of 108.341, weighted root mean square residual (WRMR) of 1.240, confirmatory fit indices (CFI) of 0.970, Tucker-Lewis index (TLI) of 0.962, and root mean square error approximation (RMSEA) score of 1.000. LTE-Q convergence validation showed that the adversity latent trait increased the chances of binge drinking by 1.31 time and doubled the chances of previous year cocaine use (adjusted by sociodemographic variables). Conclusion: The use of the LTE-Q in Brazil should be encouraged in different research fields, including large epidemiological surveys, as it is also appropriate when time and budget are limited. The LTE-Q can be a useful tool in the development of targeted and more efficient prevention strategies.