Abordar a la persona entre trayectorias alcohólicas y tratamientos / Approaching the person between alcoholic trajectories and treatments

Este artículo es un trabajo de investigación etnográfica en el campo sanitario. Sus objetivos son reconstruir trayectorias de personas con trastornos mentales y de comportamiento por uso de alcohol y visibilizar representaciones y prácticas en los tratamientos brindados en el Hospital Vilardebó (Uruguay), en torno a dichos itinerarios. Las narrativas de los pacientes estudiados dan cuenta de una ruptura biográfica ocurrida mayoritariamente en la adolescencia, cuando comienza un consumo problemático de alcohol que lleva a una reorganización de la identidad social de orden simbólico; refirieren también, la mayoría de ellos, estar disconformes con la asistencia que se les brinda, y reclaman ser más escuchados. Por otra parte, en lo referente a las representaciones formuladas por los funcionarios entrevistados, a mayor formación y experiencia de ejercicio profesional, hay mayores críticas a la atención que se brinda a estos usuarios. De ahí que la confluencia de Antropología y Salud, ensamblando cultura y cuidado, permite integrar a las dimensiones físicas los aspectos emocionales, familiares, culturales y sociales.

This article is carries out ethnographic research in the sanitary field. Its objectives are to reconstruct the trajectories of people with mental and behavioral disorders due to alcohol use and to make visible representations and practices in treatments provided at Hospital Vilardebó (Uruguay). Patients' narratives show a biographical rupture occurring mainly during adolescence. Problematic alcohol use begins soon after, leading to a reorganization of symbolic social identity. Most patients are not satisfied with care provided, and demand to be listened to more extensively. As for health care workers' representations, the greater the training and professional expertise, the greater the criticism of provided care. Hence, the confluence of Anthropology and Health, combining culture and care, makes possible the emotional, family, cultural and social aspects to be integrated into the physical ones.

Primary care-based screening and management of depression amongst heavy drinking patients: Interim secondary outcomes of a three-country quasi-experimental study in Latin America.

INTRODUCTION: Implementation of evidence-based care for heavy drinking and depression remains low in global health systems. We tested the impact of providing community support, training, and clinical packages of varied intensity on depression screening and management for heavy drinking patients in Latin American primary healthcare. MATERIALS AND METHODS: Quasi-experimental study involving 58 primary healthcare units in Colombia, Mexico and Peru randomized to receive: (1) usual care (control); (2) training using a brief clinical package; (3) community support plus training using a brief clinical package; (4) community support plus training using a standard clinical package. Outcomes were proportion of: (1) heavy drinking patients screened for depression; (2) screen-positive patients receiving appropriate support; (3) all consulting patients screened for depression, irrespective of drinking status. RESULTS: 550/615 identified heavy drinkers were screened for depression (89.4%). 147/230 patients screening positive for depression received appropriate support (64%). Amongst identified heavy drinkers, adjusting for country, sex, age and provider profession, provision of community support and training had no impact on depression activity rates. Intensity of clinical package also did not affect delivery rates, with comparable performance for brief and standard versions. However, amongst all consulting patients, training providers resulted in significantly higher rates of alcohol measurement and in turn higher depression screening rates; 2.7 times higher compared to those not trained. CONCLUSIONS: Training using a brief clinical package increased depression screening rates in Latin American primary healthcare. It is not possible to determine the effectiveness of community support on depression activity rates due to the impact of COVID-19.

Ten seconds of my nights: Exploring methods to measure brightness, loudness and attendance and their associations with alcohol use from video clips.

INTRODUCTION: Most evidence on associations between alcohol use behaviors and the characteristics of its social and physical context is based on self-reports from study participants and, thus, only account for their subjective impressions of the situation. This study explores the feasibility of obtaining alternative measures of loudness, brightness, and attendance (number of people) using 10-second video clips of real-life drinking occasions rated by human annotators and computer algorithms, and explores the associations of these measures with participants' choice to drink alcohol or not. METHODS: Using a custom-built smartphone application, 215 16-25-year-olds documented characteristics of 2,380 weekend night drinking events using questionnaires and videos. Ratings of loudness, brightness, and attendance were obtained from three sources, namely in-situ participants' ratings, video-based annotator ratings, and video-based computer algorithm ratings. Bivariate statistics explored differences in ratings across sources. Multilevel logistic regressions assessed the associations of contextual characteristics with alcohol use. Finally, model fit indices and cross-validation were used to assess the ability of each set of contextual measures to predict participants' alcohol use. RESULTS: Raw ratings of brightness, loudness and attendance differed slightly across sources, but were all correlated (r = .21 to .82, all p < .001). Participants rated bars/pubs as being louder (Cohen's d = 0.50 [95%-CI: 0.07-0.92]), and annotators rated private places as darker (d = 1.21 [95%-CI: 0.99-1.43]) when alcohol was consumed than when alcohol was not consumed. Multilevel logistic regressions showed that drinking in private places was more likely in louder (ORparticipants = 1.74 [CI: 1.31-2.32]; ORannotators = 3.22 [CI: 2.06-5.03]; ORalgorithm = 2.62 [CI: 1.83-3.76]), more attended (ORparticipants = 1.10 [CI: 1.03-1.18]; ORalgorithm = 1.19 [CI: 1.07-1.32]) and darker (OR = 0.64 [CI: 0.44-0.94]) situations. In commercial venues, drinking was more likely in darker (ORparticipants = 0.67 [CI: 0.47-0.94]; ORannotators = 0.53 [CI: 0.33-0.85]; ORalgorithm = 0.58 [CI: 0.37-0.88]) and louder (ORparticipants = 1.40 [CI: 1.02-1.92]; ORalgorithm = 2.45 [CI: 1.25-4.80]) places. Higher inference accuracies were found for the models based on the annotators' ratings (80% to 84%) and the algorithms' ratings (76% to 86%) than on the participants' ratings (69% to 71%). CONCLUSIONS: Several contextual characteristics are associated with increased odds of drinking in private and commercial settings, and might serve as a basis for the development of prevention measures. Regarding assessment of contextual characteristics, annotators and algorithms might serve as appropriate substitutes of participants' in-situ impressions for correlational and regression analyses despite differences in raw ratings. Collecting contextual data by means of sensors or media files is recommended for future research.

A Geographically Distinct Case of Fatal Methanol Toxicity from Ingestion of a Contaminated Hand Sanitizer Product During the COVID-19 Pandemic.

The COVID-19 pandemic has triggered outbreaks of unanticipated toxicities, including methanol toxicity. Multiple methanol outbreaks have been described, including contaminated hand sanitizer in the southwest USA. In this case, we describe a fatal case of methanol toxicity from hand sanitizer ingestion, geographically separated from the outbreak in the southwest USA and prior to the announcement of nationwide warnings by the Food and Drug Administration (FDA). The product was identified as one later recalled by the FDA for methanol contamination. Additionally, the consumption in this case was related to a desire to conceal alcohol consumption from family members. This case of methanol toxicity should increase awareness of the ease of which contaminated products can be widely distributed and of the use of alternative ethanol-containing products to obscure relapse in alcohol use disorder.

Webpalestra: Álcool, ação depressora ou estimulante?

Conceito e classificação: ansiedade e depressão.

The Personality of the Alcoholic through Seven Perspectives.

The different personalities of alcoholics are expressed in the way they manifest certain traits of their personality. In addition to knowing the general and common characteristics of alcoholics, it is even more important for clinical practice to know the differences between them, thus allowing a personalized approach to each patient, as a unique personality. The division of the personalities of alcoholics may be viewed through the prism of seven perspectives: the disease perspective, the dimensional perspective, the cognitive-anxiety perspective, the behavioral perspective, the spiritual/transcendent perspective, the narrative and the systemic perspective. Each of these perspectives more clearly represents part of the personality of the alcoholic; together they give a clearer picture of the problem and accordingly offer different treatment options.

Parent socialization of emotion in a high-risk sample.

The Socialization of Emotion (Eisenberg, Cumberland, & Spinrad, 1998; Eisenberg, Spinrad, & Cumberland, 1998) model creates a theoretical framework for understanding parents' direct and indirect influences on children's emotional development, including the influence of parent characteristics on subsequent emotion specific parenting. Large numbers of children live in families with fathers who have alcohol problems, setting the stage for cascading risk across development. For instance, fathers' alcohol problems are a marker of risk for higher family conflict, increased parental depression and antisociality, and less sensitive parenting, leading to dysregulated child emotion and behavior. We examined a conceptual model for emotion socialization in a community sample of alcoholic and nonalcoholic father families (N = 227) recruited in infancy (i.e., 12 months) with follow-ups to adolescence (i.e., 15-19 years), and examined if hypothesized paths differed by child sex or group status (alcoholic vs. nonalcoholic families). Results indicated significant indirect effects between parent psychopathology and sensitivity in early childhood to both adaptive (e.g., emotion regulation) and maladaptive (e.g., aggression and peer delinquency) outcomes in middle childhood to adolescence via child negative emotionality and supportive emotion socialization. There were significant differences by child sex and alcohol group status. Implications for intervention and prevention are discussed. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Malformation and death X Alcoholism: perspective of Nursing the Theory of Transitions for alcoholic pregnant women.

OBJECTIVE: To analyze the knowledge of women who are being treated in Psychosocial Care Centers for Alcohol and Drugs about the harm caused by alcohol consumption during pregnancy, especially regarding fetal malformation. METHOD: Qualitative, descriptive and exploratory study using the Life Narrative approach. Data was collected between February and May 2016, in the city of Rio de Janeiro, with an open interview with the guiding question: "Tell me about your life in relation to alcohol consumption during pregnancy and the guidance received in prenatal care". RESULTS: The narratives revealed lack of information and fear of malformation (physical) and fetal death due to alcohol consumption during pregnancy. DISCUSSION: Malformation or fetal death may trigger a transitional process in women. FINAL CONSIDERATIONS: Women have incipient knowledge about the effects of alcohol on the fetus. They consider that alcohol can only cause physical defects in the children.

Malformation and death X Alcoholism: perspective of Nursing the Theory of Transitions for alcoholic pregnant women / Malformación y muerte X Alcoholismo: Perspectiva de Enfermería con la Teoría De La Transición en embarazada / Malformação e morte X Alcoolismo: perspectiva da Enfermagem com a Teoria da Transição em gestantes

ABSTRACT Objective: To analyze the knowledge of women who are being treated in Psychosocial Care Centers for Alcohol and Drugs about the harm caused by alcohol consumption during pregnancy, especially regarding fetal malformation. Method: Qualitative, descriptive and exploratory study using the Life Narrative approach. Data was collected between February and May 2016, in the city of Rio de Janeiro, with an open interview with the guiding question: "Tell me about your life in relation to alcohol consumption during pregnancy and the guidance received in prenatal care". Results: The narratives revealed lack of information and fear of malformation (physical) and fetal death due to alcohol consumption during pregnancy. Discussion: Malformation or fetal death may trigger a transitional process in women. Final Considerations: Women have incipient knowledge about the effects of alcohol on the fetus. They consider that alcohol can only cause physical defects in the children.

RESUMEN Objetivo: Analizar el conocimiento que poseen las mujeres tratadas por alcohol y drogas en los Centros de Atención Sicosocial, sobre los perjuicios que éstos ocasionan en la gestación. Método: investigación cualitativa, descriptiva y exploratoria en la que se utilizó el método Narrativa de Vida, con datos recolectados entre febrero y mayo de 2016 en el municipio de Rio de Janeiro mediante entrevista abierta e interpelaciones orientadoras: "Hábleme al respecto del uso de bebida alcohólica durante la gestación y sobre las orientaciones recibidas en el prenatal". Resultados: falta de información y miedo de malformación (física) y muerte fetal. Discusión: La malformación y/o la muerte fetal pueden desencadenar un proceso transicional en las mujeres. Consideraciones Finales: Las mujeres tienen un conocimiento precario sobre los efectos del alcohol en el feto. Consideran que la bebida influencia más que nada en la aparición de defectos físicos en sus hijos.

RESUMO Objetivo: Analisar o conhecimento das mulheres, tratadas nos Centros de Atenção Psicossocial para álcool e drogas, acerca dos malefícios ocasionados pelo álcool na gestação, principalmente em relação à malformação fetal. Método: Pesquisa qualitativa, descritiva e exploratória. Utilizou o método Narrativa de Vida. Dados coletados entre fevereiro e maio de 2016, no município do Rio de Janeiro, com entrevista aberta e questão norteadora: "Fale-me a respeito de sua vida que tenha relação com uso de bebida alcoólica durante a gestação e as orientações recebidas no pré-natal". Resultados: As narrativas revelaram falta de informação e medo de malformação (física) e morte fetal relacionados ao uso do álcool por gestantes. Discussão: Malformação ou morte fetal podem desencadear um processo transicional nas mulheres. Considerações Finais: As mulheres têm incipiente conhecimento de que o álcool pode acarretar danos ao feto. Consideram que a bebida pode influenciar, somente, no aparecimento de defeitos físicos nos filhos.

Family orientation group as a strategy for care in chemical codependency.

OBJECTIVES: To determine the importance of the family support group in the treatment of codependency, based in reports made by relatives of a therapeutic community for drug addicts. METHODS: Study conducted in a therapeutic community for alcohol and other drug addicts in a city in the southern extreme of Brazil. This is a qualitative, exploratory and descriptive research with eight drug addict relatives. Data collection occurred through semi-structured interviews and the use of a field diary, focusing on the family orientation group as a space for the health promotion of family members of psychoactive substance users. RESULTS: Through discursive analysis, it was found that the family orientation group constitutes an important tool of educational character, capable of responding to the family demands of chemical dependence, as well as rethinking and modifying attitudes and characteristic behaviors of co-dependence. CONCLUSIONS: The support group is fundamental as a care strategy for codependent families, and may act more effectively when professionals are trained to intervene in the phenomenon of codependency.

Learning to resist the urge: a double-blind, randomized controlled trial investigating alcohol-specific inhibition training in abstinent patients with alcohol use disorder.

BACKGROUND: Alcohol use disorder (AUD) leads to a significant individual and societal burden. To achieve higher therapy success rates, therapeutic interventions still need to be improved. Most current neuroscientific conceptualizations of AUD focus on the imbalance between an enhanced automatic reaction to alcohol cues and impaired inhibition. Complementary to traditional relapse prevention strategies, novel computerized training interventions aim to directly alter these processes. This study tests a computerized alcohol-specific inhibition training in a large clinical sample and investigates its effects on behavioral, experimental and neurophysiological outcomes. It also analyzes whether variations in inhibition difficulty and/or endogenous cortisol levels during training impact these effects. METHODS: This is a double-blind, randomized controlled trial (RCT) with 246 inpatients with AUD participating. After baseline assessment, participants are randomly assigned to one of three computerized Go-NoGo-based inhibition training interventions (two alcohol-specific versions with different Go/NoGo ratios, or neutral control training) and one of two intervention times (morning/afternoon), resulting in six study arms. All patients perform six training sessions within 2 weeks. Endogenous cortisol is measured in 80 patients before and after the first training session. Inhibitory control and implicit associations towards alcohol are assessed pre and post training, at which point electroencephalography (EEG) is additionally measured in 60 patients. Patients' alcohol consumption and relevant psychological constructs (e.g., craving, self-efficacy, treatment motivation) are measured at discharge and at 3-, 6- and 12-month follow-ups. Fifty healthy participants are assessed (20 with EEG) at one time point as a healthy control group. DISCUSSION: This study investigates the effects of a computerized, alcohol-specific inhibition training for the first time in patients with AUD. Results should give insight into the effectiveness of this potential add-on to standard AUD treatment, including proximal and distal measures and effects on behavioral, experimental and neurophysiological measures. Information about working mechanisms and potential optimizations of this training are gathered through variations regarding difficulty of inhibition training and training time. This study may thus contribute to a deepened understanding of AUD and the improvement of its evidence-based treatment. TRIAL REGISTRATION: ClinicalTrials.gov, ID: NCT02968537 . Registered on 18 November 2016.

The Auckland alcohol detoxification outcome study: Measuring changes in quality of life in individuals completing a medicated withdrawal from alcohol in a detoxification unit.

AIM: To measure outcomes in Quality of Life in alcohol dependent patients' following a medicated withdrawal from alcohol. METHODS: 79 patients that were admitted to a detoxification unit in Auckland, New Zealand between March 2016 and September 2016 were assessed for severity of alcohol dependence using the Alcohol Use Disorders Identification Test (AUDIT) and Severity of Alcohol Dependency Questionnaire (SADQ) and Quality of Life (QOL) using the World Health Organisation Quality of Life-abbreviated version of the WHOQOL 100 New Zealand version (WHOQOL-BREF NZ). Patients were followed up at three months and 12 months and an estimate of drinking behavior and the WHO-QOL BREF NZ were completed via telephone interview. QOL domain scores were assessed from baseline to three months and baseline to 12 months in both relapse and abstinent groups. At three months, a single question was asked in order to collect qualitative data. RESULTS: At baseline, the study population had statistically significantly lower mean QOL domain scores than scores reported from the general population. QOL improved in patients following detoxification at three months and 12 months in both the relapse and abstinent groups; however, the change in scores from baseline was greater in the abstinent group compared to the relapse group. The majority of patients reported that the admission had been a positive experience. CONCLUSION: QOL improves in individuals following a medicated withdrawal from alcohol regardless of whether individual's relapse; however, those that remain abstinent have greater improvements in quality of life.

Percepção de familiares sobre a reabilitação psicossocial de alcoolistas / Percepción de la familia sobre la rehabilitación psicosocial de los alcohólicos / Family Perception about Psychosocial Rehabilitation of Alcoholic Patients

RESUMO Introdução: No contexto da Reforma Psiquiátrica Brasileira, a família tem sido convocada a ser corresponsável pela assistência aos usuários de álcool e outras drogas. Objetivo: Compreender a percepção de familiares sobre a reabilitação psicossocial de alcoolistas. Métodos: Estudo fenomenológico, fundamentado no referencial de Maurice Merleau-Ponty, desenvolvido no período de outubro a novembro do ano de 2013, por meio de entrevistas semi-estruturada com sete familiares de alcoolistas usuários de um Centro de Atenção Psicossocial Álcool e outras Drogas (CAPS ad), no estado da Bahia, Brasil. Utilizou-se a técnica Analítica da Ambiguidade para a compreensão dos dados. Resultados: Os resultados evidenciam que a família ao mesmo tempo em que espera a reabilitação e reinserção do alcoolista, não se identifica como corresponsável pelo cuidado; e a depender da postura, poderá tanto contribuir como interferir na efetivação do processo. Conclusões: É imprescindível o desenvolvimento de ações que reforcem a ruptura com a exclusão social nos planos de intervenção frente ao Alcoolismo, o que deve incluir o contexto familiar(AU)

RESUMEN Introducción: En el contexto de la Reforma Psiquiátrica Brasileña, la familia ha sido convocada a ser corresponsable por la asistencia a los usuarios del alcohol y otras drogas. Objetivo: Comprender la percepción de los familiares sobre la rehabilitación psicosocial de los alcohólicos. Métodos: Estudio fenomenológico basado en el studio de Maurice Merleau-Ponty, desarrollado en el periodo de octubre a noviembre de 2013, a través de entrevistas semi-estructuradas con siete familiares de pacientes alcohólicos atendidos en el Center for Psychosocial Care Alcohol and Other Drugs en el estado de Bahía, Brasil. Se usó la técnica analítica de ambigüedad para comprender los datos. Resultados: Los resultados evidencian que la familia al mismo tiempo que espera la rehabilitación y reinserción de su familiar alcohólico, no se identifica como corresponsable por el cuidado; y en dependencia de la postura, podrá tanto contribuir como interferir en la efectividad del proceso. Conclusiones: Es imprescindible el desarrollo de acciones que refuercen la ruptura con la exclusión social en los planes de intervención frente al alcoholismo, lo que debe incluir el contexto familiar(AU)

ABSTRACT Introduction: In the context of the Brazilian Psychiatric Reform, the family has been summoned to be co-responsible for providing assistance to consumers of alcohol and other drugs. Objective: To understand the perception of family members about the psychosocial rehabilitation of alcoholic patients. Methods: Phenomenological study based on the Maurice Merleau-Ponty study, developed in the period from October to November 2013, through semi-structured interviews with seven relatives of alcoholic patients who received care in the Center for Psychosocial Care Alcohol and Other Drugs in the state of Bahia, Brazil. The analytical technique of ambiguity was used to understand the data. Results: The results show that the family, while waiting for the rehabilitation and reintegration of their alcoholic relative, does not identify itself as co-responsible for the care; and depending on the position, it can both contribute and interfere in the effectiveness of the process. Conclusions: It is essential to develop actions that reinforce breaking with social exclusion as part of intervention plans against alcoholism, which should include the family context(AU)

Emotional and autonomic dysregulation in abstinent alcoholic men: An idiosyncratic profile?

Men who misuse alcohol tend to experience negative affect, which may entail difficulties in regulating emotions to cope effectively with stressful or anxiety-provoking situations, thus increasing the risk of alcohol relapse. This dysphoric state has been associated with alexithymia, which compromises an individual's abilities to acknowledge, recognize, and regulate emotional states. A physiological correlate of emotional regulation is autonomic flexibility, as shown by emotional dysregulation in men who misuse alcohol being correlated with reduced parasympathetic activation to control heart rate variability during stress and/or conflict situations. Hence, the main aim of this study was to investigate whether long-term abstinent alcoholic (LTAA) men exhibit higher levels of negative affect and sympathetic activation (cardiovascular and electrodermal) in response to acute standardized laboratory stress than non-alcoholic controls. In addition, we hypothesized that the higher the alexithymic traits, the greater would be the increase in negative affect and sympathetic activation in response to stress, especially in LTAAs. Our data demonstrated that LTAAs experienced slightly greater increases in anxiety, states of anger, and worsening of mood than controls. Moreover, they exhibited lower high-frequency heart rate variability, respiratory sinus arrhythmia values, shorter pre-ejection periods, and higher respiratory rates than controls. Finally, alexithymic traits imply greater worsening of mood and sympathetic predominance (shorter pre-ejection periods and smaller magnitude of response), with the associations being stronger in LTAAs. These findings indicate a different emotional and cardiovascular response to psychosocial stress in LTAA than non-alcoholic men. Improving our knowledge of the way this population reacts to stress may help identify risk factors for alcohol relapse.

Sex-specific association of depressive disorder and transient emotional states with alcohol consumption in male and female alcoholics.

BACKGROUND: We assessed the impact of comorbid depression and anxiety disorders as well as positive and negative emotional states on alcohol consumption in alcohol dependent men and women. METHODS: Per day alcohol consumption during 90 days before enrolment was assessed by the Time Line Follow Back (TLFB) in 287 men and 156 women meeting DSM-IV-TR criteria for alcohol dependence. Propensity to drink in negative/positive emotional states was assessed using the Inventory of Drug Taking Situations (IDTS). Psychiatric comorbidities, including major depressive disorder (MDD), substance-induced depression (SID), anxiety disorders (AnxD), or substance-induced anxiety (SIA) were identified by Psychiatric Research Interview of Substance and Mood Disorders (PRISM). RESULTS: In the combined group, increased number of drinks per day and number of heavy drinking days correlated with increased IDTS scores (all p < 0.0001), while the lifetime history of MDD was associated with fewer drinking days (p = 0.045) but not average number of drinks per day. Male sex was associated with higher alcohol consumption per day (p < 0.0001), but not with the number of drinking days (p > 0.05). Lifetime MDD history was associated with less drinking days (p = 0.0084) and less heavy drinking days (p = 0.021) in alcohol dependent men, while current MDD was associated with higher alcohol use per day in alcohol dependent women (p = 0.044). CONCLUSIONS: Our findings suggest that emotional states and lifetime MDD history have sex-specific impact on alcohol use in alcohol dependent men and women. The mechanisms underlying these findings and their relevance to treatment outcomes need to be examined in future studies.

Impact of Sex and ADHD Status on Psychiatric Comorbidity in Treatment-Seeking Alcoholics.

Objective: To assess for intrasex and intersex differences in psychiatric comorbidity according to ADHD status in treatment-seeking adults with alcohol use disorders (AUDs). Method: This study was a secondary analysis of data utilizing descriptive statistics from 472 treatment-seeking alcoholics who completed the Psychiatric Research Interview for Substance and Mental Disorders (PRISM). Results: The prevalence of ADHD in males and females was 6.0% and 6.4%, respectively. Males with ADHD and AUDs had higher rates of current and lifetime drug use disorders, current depressive disorders, and current and lifetime anxiety disorders than male alcoholics without ADHD. No intrasex differences in psychiatric comorbidities were identified in female alcoholics with respect to ADHD status. Males with ADHD and AUDs were more likely to have had opioid dependence than ADHD-positive females. No other intersex differences were found. Conclusion: Positive ADHD status was associated with increased psychiatric comorbidity among treatment-seeking alcoholic men.

Characterizing chronic pain and alcohol use trajectory among treatment-seeking alcoholics.

Accumulating evidence indicates pain may be an important risk factor for development of alcohol use disorder (AUD) and risk of relapse for people recovering from AUD. This study was conducted to characterize the prevalence and severity of significant recurrent pain and various chronic pain conditions in treatment-seeking alcoholics. In addition, we sought to examine associations between alcohol use trajectory and pain presence/severity. Four hundred fifty-one treatment-seeking alcoholics were recruited for this study. Participants completed a battery of assessments, including measures of demographics, affect, alcohol and other drug use, presence/absence of significant recurrent pain, recent pain severity, and chronic pain type. Analyses indicated significant recurrent pain was highly prevalent in the study sample (53.66%), and was significantly more common among women (62.57%) than men (47.35%; p = 0.001). Typical drinking prior to treatment did not differ by pain status, but participants with pain were more likely to report current opioid use. Individuals with pain reported greater depression and anxiety than those without (p < 0.0008), and pain tended to be more severe among women than men (p = 0.035). Both men and women with pain indicated that pain had affected their substance use. In addition, both later age of first treatment and longer transition time from alcohol dependence to treatment were associated with greater pain severity, especially among men. These data suggest chronic pain is highly prevalent among treatment-seeking alcoholics, especially women, and that delays to first treatment are associated with pain presence and intensity. These results highlight the importance of effective pain management for the subset of treatment seekers with pain.

Self-defining memories related to alcohol dependence and their integration in the construction of the self in a sample of abstinent alcoholics.

Using a self-defining memory task, this work studies the exact moment in which abstinent alcoholics perceived themselves as addicted. Phenomenological variables involved in the memory were obtained asking participants to evaluate their cognitions, perceptions and emotions associated with that self-defining memory. The sample consisted of 12 female and 31 male ex-alcoholics, with abstinence ranging from 6 months to 23 years. Mean age was 52.91 years. Our findings showed that awareness of the alcoholic self emerges in the context of uncontrolled consumption or an ultimatum from family members. This type of memory had a positive valence for most of the participants, regardless of the memory perspective (actor versus spectator). Those who remembered from an actor perspective, perceived the event as providing higher growth and personal learning. These results show the importance of exploring situations of uncontrolled consumption and family dynamics in the self-recognition of alcohol dependence. In addition, reinforcing an actor perspective compared to a spectator perspective might results in higher levels of personal enrichment, which may help maintain a patient's long-term recovery. These results support the use of autobiographical memory techniques to enhance awareness of the addicted self, and suggest the need to include these interventions in rehabilitation programmes.

O álcool dentro dos agravos em urgências e emergências: um estudo de representações sociais / The aggravations in health services of urgencies and emergencies having alcohol as the leading cause: a study of social representations / El alcohol dentro de trastornos en urgencies y de emergencia. un estudio de representación social

Objetivo: Compreender as representações sociais dos usuários de álcool e suas complicações para os agravos dentro das urgências e emergências. Métodos: Estudo do tipo descritivo, com abordagem qualitativa, utilizando o aporte das Representações Sociais de Moscovici para compreender as representações acerca das urgências e emergências traumáticas relacionadas ao uso abusivo do álcool. Resultados: Foram identificados três núcleos direcionadores: impressões e experiências quanto ao uso do álcool, representações quanto as consequências e/ou agravos do acidente e representações quanto a visão da família. Conclusão: As falas dos participantes revelam um grande sofrimento das famílias e usuários devido ao consumo e ao abuso de bebida alcoólica, aonde este estudo visou contribuir para o conhecimento frente ao comportamento das pessoas que fazem o uso do álcool com frequência, auxiliando no seu enfrentamento e na prevenção de agravos

Objetivo: Comprender las representaciones sociales de los usuarios de alcohol y sus complicaciones a las quejas dentro de las urgencias y emergencias. Métodos: Estudio descriptivo, con enfoque cualitativo, mediante la aportación de las representaciones sociales de Moscovici comprender las representaciones sobre las emergencias de emergencia y traumáticos relacionados con el abuso de alcohol. Resultados: Se identificaron tres conductores principales: impresiones y experiencias en relación con el uso del alcohol, las representaciones sobre las consecuencias y / o lesiones del accidente y representaciones como la visualización de la familia. Conclusión: Los discursos de los participantes revelan un gran sufrimiento de las familias y los usuarios debido al consumo y abuso de alcohol, donde tuvo el propósito de contribuir al conocimiento contra el comportamiento de las personas que consumen alcohol con frecuencia, ayudando en su superación y la prevención de enfermedades

Objective: The study's purpose has been to gain further understanding with regards to the social representations of alcohol users, and also to assess its complications within the health services of urgencies and emergencies. Methods: This is a descriptive study with a qualitative approach, which used the Moscovici's Social Representations in order to understand the representations about urgencies and traumatic emergencies related to alcohol abuse. Results: Based on the findings, the following three support meaning centers were identified: impressions and experiences with regards to alcohol intake; representations related to either the consequences or aggravations of the accident; and, representations by considering the family viewpoint. Conclusions: The participants' statements reveal a pronounced suffering of both the families and users due to the consumption and the abuse of alcoholic beverages. This study aimed to contribute towards improving the scientific knowledge about people's behavior, particularly, those who use alcohol regularly. Therefore, through this research, the health professionals may find a solid scientific support to helping them to stand against this issue, as well as preventing people's health aggravations

Cost of a community mental health service: a retrospective study on a psychosocial care center for alcohol and drug users in São Paulo.

BACKGROUND: Psychosocial care centers for alcohol and drug users (CAPS-ad) are reference services for treatment of drug users within the Brazilian National Health System. Knowledge of their total costs within the evidence-based decision-making process for public-resource allocation is essential. The aims here were to estimate the total costs of a CAPS-ad and the costs of packages of care (according to intensity of care); to ascertain the ratio between total CAPS-ad costs and the federal funding allocated; and to describe the methods for estimating unit costs for each CAPS-ad cost component. DESIGN AND SETTING: Retrospective study conducted in a public community mental health service. METHODS: This was a retrospective cost description study on a CAPS-ad located in a city in the state of São Paulo, using a public healthcare provider perspective and a top-down approach, conducted over a 180-day period from March 1 to August 30, 2015. RESULTS: The total mean monthly costs of the CAPS-ad were BRL 64,017.54. Healthcare staff accounted for 56.5% of total costs. The mean costs per capita and per month for intensive and non-intensive care packages were, respectively, BRL 668.34 and BRL 37.12. CONCLUSIONS: The federal budget allocation covered 62.1% of the CAPS-ad costs and the remaining 37.9% end up funded by the municipal government. The cost of the intensive package of care was 18 times greater than the non-intensive package. Developing criteria for using services and different packages of care based on patients' needs, and optimizing human resources according to specific actions, may improve people's mental health and avoid wasted resources.