Protective strategies and motivations to control drinking among Brazilian college students: a qualitative study.

BACKGROUND: To develop prevention programs or early interventions to reduce alcohol consumption and related problems among college students, it is essential to understand their motivations for drinking and the spontaneous (effective and non-effective) strategies they employ to control, considering the social and cultural contexts influence. This study aimed to explore these factors and the student's application of selfcare in different situations and environments, as well as to identify their reasons for not drinking. METHODS: The students were invited to participate using a snowball sampling, up to the theoretical saturation point. Qualitative individual semi-structured interviews were carried out and the interviews contents were analyzed using the NVivo software. The participants were 23 college students between 18 and 24 years old, with diverse patterns of alcohol use (low-risk to suggestive of dependence). RESULTS: Data analysis highlighted three main themes: (a) Contexts (such as bars, "open bar" parties and others) and consumption patterns; (b) Protective Strategies (such as stop-drinking intervals, eating before or during drinking, returning home in the company of a friend); (c) Motivations to control drinking (such as sense of responsibility, bad previous experiences, family and religious issues). Protective strategies and motivation to control drinking were perceived to be less prominent in specific contexts that favor high alcohol consumption, as open bar parties. CONCLUSIONS: Motivations and protective strategies varied according to the drinkers' profile, social situations and settings in which they consumed alcohol. The results highlight the need for preventive interventions planned for specific drinking patterns and contexts.

Locomotor sensitization to ethanol impairs NMDA receptor-dependent synaptic plasticity in the nucleus accumbens and increases ethanol self-administration.

Although alcoholism is a worldwide problem resulting in millions of deaths, only a small percentage of alcohol users become addicted. The specific neural substrates responsible for individual differences in vulnerability to alcohol addiction are not known. In this study, we used rodent models to study behavioral and synaptic correlates related to individual differences in the development of ethanol locomotor sensitization, a form of drug-dependent behavioral plasticity associated with addiction vulnerability. Male Swiss Webster mice were treated daily with saline or 1.8 g/kg ethanol for 21 d. Locomotor activity tests were performed once a week for 15 min immediately after saline or ethanol injections. After at least 11 d of withdrawal, cohorts of saline- or ethanol-treated mice were used to characterize the relationships between locomotor sensitization, ethanol drinking, and glutamatergic synaptic transmission in the nucleus accumbens. Ethanol-treated mice that expressed locomotor sensitization to ethanol drank significantly more ethanol than saline-treated subjects and ethanol-treated animals resilient to this form of behavioral plasticity. Moreover, ethanol-sensitized mice also had reduced accumbal NMDA receptor function and expression, as well as deficits in NMDA receptor-dependent long-term depression in the nucleus accumbens core after a protracted withdrawal. These findings suggest that disruption of accumbal core NMDA receptor-dependent plasticity may represent a synaptic correlate associated with ethanol-induced locomotor sensitization and increased propensity to consume ethanol.

A randomized controlled trial of a brief intervention for illicit drugs linked to the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) in clients recruited from primary health-care settings in four countries.

AIMS: This study evaluated the effectiveness of a brief intervention (BI) for illicit drugs (cannabis, cocaine, amphetamine-type stimulants and opioids) linked to the World Health Organization (WHO) Alcohol, Smoking and Substance Involvement Screening Test (ASSIST). The ASSIST screens for problem or risky use of 10 psychoactive substances, producing a score for each substance that falls into either a low-, moderate- or high-risk category. DESIGN: Prospective, randomized controlled trial in which participants were either assigned to a 3-month waiting-list control condition or received brief motivational counselling lasting an average of 13.8 minutes for the drug receiving the highest ASSIST score. SETTING: Primary health-care settings in four countries: Australia, Brazil, India and the United States. PARTICIPANTS: A total of 731 males and females scoring within the moderate-risk range of the ASSIST for cannabis, cocaine, amphetamine-type stimulants or opioids. MEASUREMENTS: ASSIST-specific substance involvement scores for cannabis, stimulants or opioids and ASSIST total illicit substance involvement score at baseline and 3 months post-randomization. FINDINGS: Omnibus analyses indicated that those receiving the BI had significantly reduced scores for all measures, compared with control participants. Country-specific analyses showed that, with the exception of the site in the United States, BI participants had significantly lower ASSIST total illicit substance involvement scores at follow-up compared with the control participants. The sites in India and Brazil demonstrated a very strong brief intervention effect for cannabis scores (P < 0.005 for both sites), as did the sites in Australia (P < 0.005) and Brazil (P < 0.01) for stimulant scores and the Indian site for opioid scores (P < 0.01). CONCLUSIONS: The Alcohol, Smoking and Substance Involvement Screening Test-linked brief intervention aimed at reducing illicit substance use and related risks is effective, at least in the short term, and the effect generalizes across countries.

Do attitudes about unhealthy alcohol and other drug (AOD) use impact primary care professionals' readiness to implement AOD-related preventive care?

INTRODUCTION AND AIMS: To explore the association between primary care professionals' (PCPs) attitudes towards unhealthy alcohol and other drug (AOD) use (from risky use through dependence) and readiness to implement AOD-related preventive care. DESIGN AND METHODS: Primary care professionals from five health centres in Sao Paulo were invited to complete a questionnaire about preventive care and attitudes about people with unhealthy AOD use. Logistic regression models tested the association between professional satisfaction and readiness. Multiple Correspondence Analysis assessed associations between stigmatising attitudes and readiness. RESULTS: Of 160 PCPs surveyed, 96 (60%) completed the questionnaire. Only 25% reported implementing unhealthy AOD use clinical prevention practices; and 53% did not feel ready to implement such practices. Greater satisfaction when working with people with AOD problems was significantly associated with readiness to implement AOD-related preventive care. In Multiple Correspondence Analysis two groups emerged: (i) PCPs ready to work with people with unhealthy AOD use, who attributed to such patients lower levels of dangerousness, blame for their condition and need for segregation from the community (suggesting less stigmatising attitudes); and (ii) PCPs not ready to work with people with unhealthy AOD use, who attributed to them higher levels of dangerousness, blame, perceived level of patient control over their condition and segregation (suggesting more stigmatising attitudes). DISCUSSION AND CONCLUSIONS: More stigmatising attitudes towards people with unhealthy AOD use are associated with less readiness to implement unhealthy AOD-related preventive care. Understanding these issues is likely essential to facilitating implementation of preventive care, such as screening and brief intervention, for unhealthy AOD use. [Amaral-Sabadini MB, Saitz R, Souza-Formigoni MLO. Do attitudes about unhealthy alcohol and other drug (AOD) use impact primary care professionals' readiness to implement AOD-related preventive care?

Process evaluation of the implementation of a screening and brief intervention program for alcohol risk in primary health care: An experience in Brazil.

INTRODUCTION AND AIMS: Screening and brief intervention (SBI) are considered good prevention strategies for alcohol-related problems in Primary Health Care (PHC). The aim of this study was to evaluate the process of an SBI implementation program for alcohol risk use and evaluate the factors that facilitated or impeded this implementation, in two PHC settings at the Brazilian city of Juiz de Fora. DESIGN AND METHODS: Case 1 public PHC services and case 2 the PHC service of the Military Police. Participants were trained on SBI strategies and supervised during 6 months. The qualitative methodology of action research was used. Data were analysed using thematic analysis. RESULTS: Case 1: 70 participants; facilitating factors: good expectations about the project; simplicity of SBI technique; collaborative way the project was planned. Barriers: lack of time; discomfort in dealing with alcohol issues; focus on alcohol-dependence; unstable political environment; other priorities; difficulties in patients' referral. Case 2: nine participants. Facilitating factors: simplicity of SBI technique; collaborative way the project was planned; importance of alcohol issues; data confidentiality and the voluntary work to do SBI. Barriers: only one health professional in the group; the variability of the institutional support; organisational culture about alcohol use. DISCUSSION AND CONCLUSIONS: The barriers and facilitators were related to two main factors: organisational culture and personal attitudes. The action research provided the opportunity to bridge the gap between research and practice, but it also showed that SBI faces significant challenges before it can be implemented as a routine procedure in PHC settings in Brazil.

Childhood trauma in substance use disorder and depression: an analysis by gender among a Brazilian clinical sample.

OBJECTIVE: In this study, we compared the frequency and intensity of childhood traumas in alcohol- or other drug-dependent patients, in patients with depression, and in a control group without psychiatric diagnoses. METHODS: The study had a retrospective design of a clinical sample of men and women from the groups listed above. They were evaluated by the same standardized instrument: the "Childhood Trauma Questionnaire." RESULTS: A higher frequency and intensity of emotional, physical, and sexual abuse were found in alcohol- and other drug-dependent patients than in patients with depression, who, in turn, presented significantly higher proportions than the control group. In all of the cases, the frequency was higher among women than men. CONCLUSION: Because of the high frequency and intensity of childhood traumas among alcohol- or other drug-dependent patients and depressed patients, the assessment of problems due to childhood traumas among these patients is essential to a better understanding of the etiology of those disorders and to their treatment.

Avaliação multidimensional do usuário de drogas e a Escala de Gravidade de Dependência / Multidimensional evaluation of drug users and the Addiction Severity Index

INTRODUÇÃO: Antes de iniciar um tratamento para abuso de substâncias psicoativas (SPA), é primordial avaliar os prejuízos que estas acarretam na vida dos usuários. Considerando a complexidade dessa avaliação, o instrumento atualmente mais utilizado no mundo para a abordagem multidimensional de problemas relacionados ao abuso de SPA é a Escala de Gravidade de Dependência (Addiction Severity Index, ASI). OBJETIVO: Através da revisão da literatura sobre o tema, da apresentação de um caso clínico, de aspectos da ASI e da discussão de tópicos contemplados na avaliação de usuários de drogas, este trabalho tem como finalidade auxiliar o profissional de saúde a sistematizar a avaliação desses pacientes. MÉTODO: A revisão da literatura foi realizada nas bases de dados MEDLINE, LILACS e PsycINFO, utilizando os descritores assessment e evaluation, cruzados com o termo substance-related disorders dos Medical Subject Headings e subexpressões nele incluídas. RESULTADOS E CONCLUSÃO: Na literatura, há uma carência de artigos sobre o tema, e, no Brasil, ainda não existem instrumentos que se proponham a avaliar os usuários de drogas de forma tão ampla como a ASI. A utilização de uma escala com essas características pode ser útil para o sistema de saúde brasileiro, favorecendo a identificação precoce de problemas e propiciando melhora na qualidade da assistência prestada.

INTRODUCTION: Before initiating any treatment for substance abuse, the assessment of problems related to the consumption of those substances is of paramount importance. Considering the complexity of this evaluation, the instrument most widely used in the present days for a multidimensional approach to these patients is the Addiction Severity Index (ASI). OBJECTIVE: The present study presents a literature review, a clinical case vignette, comments on different aspects of the scale, and the discussion of topics covered in the evaluation process, and aims at providing support to health professionals in the sense of systematizing the assessment of these patients. METHOD: The literature review was conducted on MEDLINE, LILACS, and PsycINFO databases, using the keywords assessment and evaluation together with substance-related disorders and other terms presented as synonyms in the Medical Subject Headings. RESULTS AND CONCLUSION: There is a paucity of articles in the literature focusing on the topic, and no other instruments designed to provide a general overview of substance users (as is the case with the ASI) are available in Brazil. The use of a scale with these characteristics may be useful for the Brazilian public health system, allowing for the early identification of problems and promoting an improvement in the quality of treatment provided to these patients.

Psychometric and discriminative properties of the Teen Addiction Severity Index (Brazilian Portuguese version).

In this study we evaluated the internal consistency of the Brazilian Portuguese version of Teen Addiction Severity Index (T-ASI) and validated its "substance use" area. Evaluating 100 psychoactive substance abusers/dependent adolescents (SUD) and 108 adolescents without such diagnosis (NON-SUD), we found good correlations between the classification by the Composite International Diagnostic Interview (CIDI, used as "gold standard") and the severity (r = 0.73) and composite (r = 0.72) scores of the T-ASI. The area under the ROC curve was 0.88, showing a satisfactory correct classification rate. The internal consistency, evaluated by Cronbach's alpha coefficients, was considered good regarding the substance use (0.89), legal (0.81), and psychiatric (0.80) areas of the T-ASI. The Brazilian Portuguese version of T-ASI presented good internal consistency and a valid substance use area. A comparison between the groups regarding the answers to each question in all the areas was conducted in order to identify which questions in the T-ASI discriminate SUD from NON-SUD adolescents, to have a basis for the proposal of a shorter version of the instrument.

Ethanol-induced behavioral sensitization is associated with dopamine receptor changes in the mouse olfactory tubercle.

Accumulating evidence points to the mesolimbic and the nigrostriatal dopamine systems as critical to behavioral sensitization induced by several drugs of abuse. In the present study, we analyzed D1 and D2 binding to brain regions related to these dopaminergic systems during the expression of ethanol-induced behavioral sensitization. The first experiment was performed to demonstrate the effectiveness of the ethanol treatment schedule and challenge used to induce the expression of the behavioral sensitization phenomenon. The second experiment was conducted to study D1 and D2 alterations in several brain regions during the expression of this phenomenon. Mice were ip treated with ethanol or saline for 21 consecutive days and 24 h after the last injection they received an ethanol or a saline challenge injection. Five minutes later, the animals were observed in an open-field for locomotion quantification or were sacrificed and their brains were submitted to autoradiographic binding analyses. No differences among the groups were found for D1 binding levels in all the brain regions analyzed. However, ethanol-sensitized mice showed reduced levels of D2 binding in the olfactory tubercle when compared to the other groups. Our data suggest that D2 receptor changes in the olfactory tubercle seem to play an important role in the expression of ethanol-induced behavioral sensitization.

Versão em português da Family Environment Scale: aplicação e validação / Portuguese version of the Family Environment Scale: aplication and validation

OBJETIVO: Traduzir a Escala do Ambiente Familiar (Family Environment Scale) para a língua portuguesa e aplicar o instrumento para sua validação. MÉTODOS: A tradução foi aplicada a membros de famílias brasileiras, visando avaliação da consistência interna e a concordância entre membros da mesma família. Foram selecionados 154 voluntários não sujeitos a qualquer intervenção para lidar com problemas familiares, residentes na cidade de São Paulo, em 2003. As pontuações médias nas dez subescalas do instrumento foram comparadas entre homens e mulheres e entre membros da mesma família. Avaliou-se a consistência interna pelo alfa de Cronbach. RESULTADOS: A pontuação máxima possível era nove em cada subescala (bom funcionamento familiar), exceto em relação a conflito e controle. Na maioria das subescalas, a pontuação média da amostra estudada esteve entre 5,1 e 7,6 (homens) e entre 5,4 e 7,7 (mulheres). Nas subescalas conflito e controle as médias variaram entre 1,8 e 4,6 (homens) e entre 1,6 e 4,6 (mulheres), sendo semelhantes às relatadas em estudos internacionais, exceto maior pontuação nas subescalas coesão e organização, e menor na subescala conflito. Não houve diferença estatisticamente significativa entre as pontuações atingidas por homens e mulheres. A confiabilidade da escala avaliada pelo alfa de Cronbach variou entre 0,61 e 0,78 para as dez subescalas. CONCLUSÕES: Fatores culturais podem ter influenciado os resultados obtidos em algumas subescalas. A versão em português da Escala do Ambiente Familiar apresentou razoável consistência interna que permite sua utilização para avaliar alterações no ambiente ou funcionamento familiar, e após intervenções terapêuticas.

OBJECTIVE: To translate the Family Environment Scale into Portuguese and apply the instrument to validate it. METHODS: The translation was applied to members of Brazilian families with the aim of evaluating its internal consistency and the concordance between members of the same family. One hundred and fifty-four volunteers living in the city of São Paulo in 2003 who were not receiving any kind of intervention for dealing with family problems were selected. The mean scores in the ten subscales of the instrument were compared between men and women, and between members of the same family. The internal consistency was evaluated by means of Cronbach's alpha. RESULTS: The maximum possible score in each subscale was nine (good family functioning), except in relation to conflict and control. In most of the subscales, the mean score of the sample studied ranged from 5.1 to 7.6 (men) and 5.4 to 7.7 (women). In the conflict and control subscales, the means ranged from 1.8 to 4.6 (men) and 1.6 to 4.6 (women). These were similar to scores reported in international studies, except for higher scores in the cohesion and organization subscales, and lower score in the conflict subscale. There were no statistically significant differences between the scores attained by men and women. The reliability of the scale, evaluated according to Cronbach's alpha, ranged from 0.61 to 0.78 for the ten subscales. CONCLUSIONS: Cultural factors may have influenced the results obtained in some of the subscales. The Portuguese version of the Family Environment Scale presented reasonable internal consistency that enables its use for evaluating changes in the family's environment and its functioning and after therapeutic interventions.

[Portuguese version of the Family Environment Scale: application and validation]. / Versão em português da Family Environment Scale: aplicação e validação.

OBJECTIVE: To translate the Family Environment Scale into Portuguese and apply the instrument to validate it. METHODS: The translation was applied to members of Brazilian families with the aim of evaluating its internal consistency and the concordance between members of the same family. One hundred and fifty-four volunteers living in the city of São Paulo in 2003 who were not receiving any kind of intervention for dealing with family problems were selected. The mean scores in the ten subscales of the instrument were compared between men and women, and between members of the same family. The internal consistency was evaluated by means of Cronbach's alpha. RESULTS: The maximum possible score in each subscale was nine (good family functioning), except in relation to conflict and control. In most of the subscales, the mean score of the sample studied ranged from 5.1 to 7.6 (men) and 5.4 to 7.7 (women). In the conflict and control subscales, the means ranged from 1.8 to 4.6 (men) and 1.6 to 4.6 (women). These were similar to scores reported in international studies, except for higher scores in the cohesion and organization subscales, and lower score in the conflict subscale. There were no statistically significant differences between the scores attained by men and women. The reliability of the scale, evaluated according to Cronbach's alpha, ranged from 0.61 to 0.78 for the ten subscales. CONCLUSIONS: Cultural factors may have influenced the results obtained in some of the subscales. The Portuguese version of the Family Environment Scale presented reasonable internal consistency that enables its use for evaluating changes in the family's environment and its functioning and after therapeutic interventions.

The importance of housing conditions on behavioral sensitization and tolerance to ethanol.

The differential outcomes of social isolation and crowding environment on the effects of single or repeated administration of ethanol on open-field behavior were examined in female mice. Whereas housing conditions did not alter the increase in locomotor activity induced by ethanol single administration, behavioral sensitization (a progressive increase of a drug effect following repeated drug administration) to the locomotor activating effect of ethanol was significantly greater in crowded mice as compared to isolated and control groups. Single administration of ethanol significantly decreased rearing frequency and increased immobility duration, there being tolerance to these ethanol behavior effects after repeated treatment. Social isolation attenuated the increase in immobility behavior induced by single administration of ethanol and potentiated the tolerance of ethanol-induced rearing decrease, verified after repeated treatment. These results point out that both sensitization and tolerance to the behavioral effects of ethanol can be critically influenced by housing conditions.

Can energy drinks reduce the depressor effect of ethanol? An experimental study in mice.

Although the popularization of the combined use of alcoholic beverages and energy drinks (ED) containing caffeine, taurine and other substances has increased, there are no controlled experimental studies on the effects of ED alone or combined with ethanol. This work aimed at evaluating the effects of different doses of ED combined or not with ethanol, on the locomotor activity of Swiss mice. The administration of 3.57, 10.71 or 17.86 ml/kg of ED alone increased the locomotor activity of the animals in relation to a control group. Low doses of ethanol (0.5, 1.0 and 1.5 g/kg) alone or in combination with 10.71 ml/kg of ED did not affect their locomotor activity. However, the reduction of activity observed after 2.5 g/kg of ethanol was antagonized by 10.71 ml/kg of ED. Further studies on the mechanisms of this interaction are still needed.

Does an energy drink modify the effects of alcohol in a maximal effort test?

BACKGROUND: There are popular reports on the combined use of alcohol and energy drinks (such as Red Bull and similar beverages, which contain caffeine, taurine, carbohydrates, etc.) to reduce the depressant effects of alcohol on central nervous system, but no controlled studies have been performed. The main purpose of this study was to verify the effects of alcohol, and alcohol combined with energy drink, on the performance of volunteers in a maximal effort test (cycle ergometer) and also on physiological indicators (oxygen uptake, ventilatory threshold, respiratory exchange rate, heart rate, and blood pressure), biochemical variables (glucose, lactate, insulin, cortisol, ACTH, dopamine, noradrenaline, and adrenaline), and blood alcohol levels. METHODS: Fourteen healthy subjects completed a double-blind protocol made up of four sessions: control (water), alcohol (1.0 g/kg), energy drink (3.57 ml/kg Red Bull), and alcohol + energy drink, each 1 week apart. The effort test began 60 min after drug or control ingestion, and the dependent variables were measured until 60 min after the test. RESULTS: Heart rate at the ventilatory threshold was higher in the alcohol and alcohol + energy drink sessions in comparison with control and energy drink sessions. Although in comparison to the control session, the peak oxygen uptake was 5.0% smaller after alcohol ingestion, 1.4% smaller after energy drink, and 2.7% smaller after the combined ingestion, no significant differences were detected. Lactate levels (30 min after drug ingestion, 30 and 60 min after the effort test) and noradrenaline levels (30 min after the effort test) were higher in the alcohol and alcohol + energy drink sessions compared with the control session. CONCLUSIONS: The performance in the maximal effort test observed after alcohol + energy drink ingestion was similar to that observed after alcohol only. No significant differences between alcohol and alcohol + energy drink were detected in the physiological and biochemical parameters analyzed. Our findings suggest that energy drinks, at least in the tested doses, did not improve performance or reduce alterations induced by acute alcohol ingestion.

Resistance to ethanol sensitization is associated with increased NMDA receptor binding in specific brain areas.

Co-administration of N-methyl-D-aspartate (NMDA) receptor antagonists is known to block the development of behavioral sensitization to ethanol and other psychostimulants. Since ethanol sensitization in mice does not occur uniformly in all treated animals, the present study examined the possibility that NMDA receptor binding would be selectively altered in mice susceptible to ethanol sensitization. Mice received 2.4 g/kg ethanol or saline i.p. daily for 21 days and were sacrificed 24 h later. No differences in [3H]dizocilpine ([3H](+)MK-801) binding were found between sensitized and vehicle-treated mice in any of the brain regions analyzed. However, ethanol-treated mice that did not develop sensitization showed significantly higher binding in the nucleus accumbens core (+32% and +40% compared to controls and ethanol-sensitized mice, respectively; P<0.04) and the prefrontal cortex (+15% and +22%; P<0.02). In a separate experiment, sensitization resistant mice challenged with 0.25 mg/kg (+)MK 801 showed significantly less motor activation than saline-treated or ethanol-sensitized mice. These results point to a clear association between elevated NMDA receptor binding in specific brain regions and resistance to ethanol sensitization.