Smoking Cessation Treatment for Patients With Mental Disorders Using CBT and Combined Pharmacotherapy.

OBJECTIVES: The aim of this study was to investigate smoking treatment effectiveness and retention in a population with and without mental disorders (MD). Participants received cognitive behavioral therapy (CBT) plus nicotine patch alone or in combination with other medications (i.e., gum, bupropion, or nortriptyline) for smoking cessation treatment in a Brazilian Psychosocial Care Center unit (CAPS), taking into account sociodemographics and smoking profile covariates. METHODS: The study involved comparison of treatment success (seven-day point prevalence abstinence at the end of the treatment) and retention (presence of the individual in all of the four medical consultations and six group sessions) in two subsamples of patients with MD (n = 267) and without MD (n = 397) who were included in a six-week treatment provided by a CAPS from 2007 to 2013. The treatment protocol comprised group CBT and pharmacotherapy (nicotine patches, nicotine gums, and bupropion and nortriptyline available, prescribed by psychiatrists). RESULTS: Within patients with MD, CBT plus nicotine patch plus bupropion (aOR = 2.00, 95% CI [1.14, 3.50], p = .015) and CBT plus nicotine patch plus gum (aOR = 2.10, 95% CI [1.04, 4.23], p = .036) were associated with treatment success. Within patients without MD, female gender (aOR = 0.60, 95% CI [0.37, 0.95], p = .031) and lower Heaviness of Smoking Index score (aOR = 0.80, 95% CI [0.65, 0.99], p = .048) were associated with treatment success. No variable was associated with dropout or retention within patients with or without MD. CONCLUSION: Our findings support the use of CBT plus nicotine patch plus bupropion as well as CBT plus nicotine patch plus gum in samples with high rates of medical, psychiatric, and addiction disorders. These findings support those of previous studies in the general population. Pharmacological treatment associated with group CBT based on cognitive-behavioral concepts and combined with ongoing MD treatment seems to be the best option for smoking cessation treatment among patients with MD. Units that deal with patients with MD, such as CAPS in Brazil, should be encouraged to treat smoking addiction in this population. Future studies should investigate retention rates in other samples of patients with MD.

LIVER HEALTH IS OVERLOOKED BY ALCOHOL DRINKERS IN BRAZIL.

BACKGROUND: Chronic excessive use of alcohol is an important risk factor for several health and social conditions. METHODS: A cross-sectional survey, in a sample representative of the Brazilian population,was conducted to evaluate the frequency of consumption of alcoholic beverages and behaviors concerning liver diseases. Participants were prospectively interviewed using a questionnaire regarding alcohol consumption and actions toward liver health. The study accepted at most one sampling error of ±2 percentage points and considered a 95% confidence interval. RESULTS: One thousand nine hundred ninety-five subjects (1.048 women, mean age 44 years) from all Brazilian regions were interviewed. Most of the Brazilian subjects believe that alcohol abuse (63-87%) is the leading cause of cirrhosis and liver cancer, however, most responders (56%) had never been screened to assess liver damage related to alcohol consumption. A total of 55% of Brazilians drink alcoholic beverages. Among Brazilians who drink alcoholic beverages, 44% consume three or more drinks at a time, 11% consume more than 10 doses a day. Among those who consume 1 to 2 drinks a day, women (42%) consume more than men (32%) and more than the national average (37%). CONCLUSION: There is a high frequency of alcohol consumption, especially among young people, and individuals from lower social classes, with frequent consumption among women. Despite the knowledge of its adverse impact on liver health, less than half of the Brazilians have been evaluated at least once for liver disease. Education and prevention strategies need to be implemented to reduce theharmful use of alcohol.

Perceptions of and attitudes toward antidepressants: stigma attached to their use--a review.

The aim of this study was to ascertain whether there is any evidence of stigma related to the use of antidepressants. Using the PubMed and MEDLINE databases, we searched for the terms stigma, antidepressants, and depression. A protocol was developed to extract information from the papers, which were identified and explored further. Thirty-two papers were identified. We found that the stigma against depression differs from stigma against the use of antidepressants. Stigma against depression does not impact on therapeutic adherence to antidepressant use. Stigma related to antidepressant use appears to be linked with perceived emotional weakness, severity of illness, an inability to deal with problems, and a lack of belief in the therapeutic efficacy of antidepressants. Stigma against medication can be a useful target for interventions, just like the stigma related to depression. However, clinicians must be careful in avoiding the medicalization of symptoms.

[Management of patients with substance use illnesses in psychiatric emergency department]. / Manejo do paciente com transtornos relacionados ao uso de substância psicoativa na emergência psiquiátrica.

OBJECTIVE: Substance use disorders are prevalent in emergency departments in medical and psychiatric services, reaching rates of 28% of cases in medical emergency departments. However, professionals in the emergency department identify less than 50% of cases of alcohol-related problems. This article aims to provide evidence-based interventions for the specific treatment to patients who meet diagnostic criteria for substance use disorders and who present to emergency rooms during intoxication or abstinence. METHOD: A literature review was performed on Medline database, using the descriptors "acute intoxication", "withdrawal", "alcohol", "cocaine", "cannabis", "opioid", "inhalant", "management", using English as the language. RESULTS: AND CONCLUSION: The care of persons with substance use disorders should include: comprehensive assessment (medical and psychiatric), treatment of diagnosed disorders (withdrawal, intoxication and clinical features that characterize an emergency), awareness of the patient to carry out treatment if necessary and referral.

Abstinence and retention outcomes in a smoking cessation program among individuals with co-morbid substance use and mental disorders.

Tobacco use is the leading cause of preventable death in the world. Although cigarette smoking prevalence has decreased, there are still disparities in morbidity and mortality experienced by individuals with substance use and/or mental disorders when compared to general population. The aim of this study was to compare treatment outcomes between three subgroups of smokers: individuals with substance use disorder (SUD-only), individuals with mental disorder without substance use disorders (MD-only), and individuals with co-morbid substance use and mental disorder (SUD + MD). Data of 498 smokers enrolled in a 6-week smoking cessation program in Brazil were analyzed. Sociodemographic, medical and tobacco use information were collected at baseline. Treatment included group cognitive behavioral therapy (CBT) and pharmacotherapy. The primary outcome was defined as "self-report 4-week quitter" (SR4WQ), a standardized measure to assess treatment success. Retention to treatment was also investigated. Associations between groups were analyzed using unadjusted and adjusted logistic regression models. The results showed that SUD + MD had worse outcomes when compared to the other two groups. After adjusting for level of smoking dependence and the use of medication, abstinence and retention to treatment of SUD-only became equivalent to SUD + MD. Because tobacco and other substance addictions share similar mechanisms, having history of SUD might impair successful results of conventional smoking programs. There is a need to further investigate specific variables associated with treatment success for a more resistant subgroup of individuals in mental health and perhaps to invest in more intensive actions, such as the use of combined pharmacotherapy and adapted CBT approaches.

Drug consumption among medical students in São Paulo, Brazil: influences of gender and academic year.

OBJECTIVE: To analyze alcohol, tobacco and other drug use among medical students. METHOD: Over a five-year period (1996-2001), we evaluated 457 students at the Universidade de São Paulo School of Medicine, located in São Paulo, Brazil. The students participated by filling out an anonymous questionnaire on drug use (lifetime, previous 12 months and previous 30 days). The influence that gender and academic year have on drug use was also analyzed. RESULTS: During the study period, there was an increase in the use of illicit drugs, especially inhalants and amphetamines, among the medical students evaluated. Drug use (except that of marijuana and inhalants) was comparable between the genders, and academic year was an important influencing factor. DISCUSSION: Increased inhalant use was observed among the medical students, especially among males and students in the early undergraduate years. This is suggestive of a specific behavioral pattern among medical students. Our findings corroborate those of previous studies. CONCLUSION: Inhalant use is on the rise among medical students at the Universidade de São Paulo School of Medicine. Because of the negative health effects of illicit drug use, further studies are needed in order to deepen the understanding of this phenomenon and to facilitate the development of preventive measures.

A saúde do fígado é negligenciada pelos consumidores de álcool no Brasil / Liver health is overlooked by alcohol drinkers in brazil

ABSTRACT Background: Chronic excessive use of alcohol is an important risk factor for several health and social conditions. Methods: A cross-sectional survey, in a sample representative of the Brazilian population,was conducted to evaluate the frequency of consumption of alcoholic beverages and behaviors concerning liver diseases. Participants were prospectively interviewed using a questionnaire regarding alcohol consumption and actions toward liver health. The study accepted at most one sampling error of ±2 percentage points and considered a 95% confidence interval. Results: One thousand nine hundred ninety-five subjects (1.048 women, mean age 44 years) from all Brazilian regions were interviewed. Most of the Brazilian subjects believe that alcohol abuse (63-87%) is the leading cause of cirrhosis and liver cancer, however, most responders (56%) had never been screened to assess liver damage related to alcohol consumption. A total of 55% of Brazilians drink alcoholic beverages. Among Brazilians who drink alcoholic beverages, 44% consume three or more drinks at a time, 11% consume more than 10 doses a day. Among those who consume 1 to 2 drinks a day, women (42%) consume more than men (32%) and more than the national average (37%). Conclusion: There is a high frequency of alcohol consumption, especially among young people, and individuals from lower social classes, with frequent consumption among women. Despite the knowledge of its adverse impact on liver health, less than half of the Brazilians have been evaluated at least once for liver disease. Education and prevention strategies need to be implemented to reduce theharmful use of alcohol.

RESUMO Contexto: O uso crônico e excessivo de álcool é um importante fator de risco para diversos problemas sociais e de saúde. Métodos: Foi realizado um estudo transversal, numa amostra representativa da população brasileira, para avaliar a frequência do consumo de bebidas alcoólicas e comportamentos relativos às doenças hepáticas. Participantes foram entrevistados, prospectivamente, com um questionário sobre consumo de álcool e ações voltadas à saúde do fígado. O estudo aceitou erro amostral máximo de ±2 pontos percentuais e considerou intervalo de confiança de 95%. Resultados: Foram entrevistados 1995 indivíduos (1.048 mulheres, média de idade de 44 anos) de todas as regiões brasileiras. A maioria dos brasileiros (63-87%) acredita que o abuso de álcool é a principal causa de cirrose e câncer de fígado, no entanto, a maioria dos participantes (56%) nunca havia sido examinado para avaliar danos hepáticos relacionados ao consumo excessivo de álcool. Um total de 55% dos brasileiros consomem bebidas alcoólicas. Entre os brasileiros que consomem bebidas alcoólicas, 44% consomem três ou mais doses por vez, 11% consomem mais de 10 doses por dia. Entre aqueles que consomem 1 a 2 doses por dia, as mulheres (42%) consomem mais que os homens (32%) e mais que a média nacional (37%). Conclusão: Há elevada frequência de consumo de álcool, principalmente entre jovens e indivíduos de classes sociais mais baixas, com consumo frequente entre mulheres. Apesar do conhecimento sobre o impacto adverso na saúde do fígado, menos da metade dos brasileiros foram avaliados, em pelo menos uma ocasião, para doença hepática. Estratégias de educação e prevenção precisam ser implementadas para reduzir o uso nocivo do álcool.

Experimentation with tobacco during adolescence as a factor influencing treatment of smoking in adulthood. A retrospective cohort.

BACKGROUND: There are still few studies on predictors of smoking cessation in Brazilian samples. Experimentation with tobacco during adolescence (ETA) may be one of the important predictors. OBJECTIVE: This study aimed, within the context of a treatment-seeking group of subjects, to test the hypothesis that ETA negatively affects the outcome of smoking cessation during adulthood. DESIGN AND SETTING: Retrospective (historic) cohort study conducted at a psychosocial care center in São Paulo, Brazil, between 2007 and 2010. METHODS: Data on sociodemographics, smoking and medical profiles were obtained through self-report questionnaires that were completed at the baseline and at any follow-up appointment. Logistic regression models were constructed to describe factors associated with the outcome of smoking cessation, measured according to the self-reported four-week success rate among 367 outpatient smokers. RESULTS: ETA was found to be associated with not quitting smoking through the treatment (odds ratio = 0.57; 95% confidence interval = 0.33-0.96; P < 0.05), even after adjustment for dependence level, sociodemographics, nicotine patch use and number of years of smoking. CONCLUSIONS: Early exposure to nicotine may lead to higher risk of continuing smoking after treatment, in adulthood.

Distinct effects of cocaine and cocaine + cannabis on neurocognitive functioning and abstinence: A six-month follow-up study.

BACKGROUND AND AIMS: Cannabis use is frequent among individuals with cocaine use disorder. Despite recent non-controlled studies advocating a therapeutic role of smoked cannabis, there is a paucity of evidence-based data on potential therapeutic and cognitive side-effects of this association. METHODS: We examined 63 cocaine-addicted subjects who used cannabis more than 50 times in lifetime (COC + CAN), 24 cocaine-addicted patients who use cannabis less than 50 times (COC), and 36 controls (CON). Participants were evaluated with an extensive battery of neurocognitive tests after two weeks of supervised detoxification in an inpatient treatment program. Patients were followed up in one, three, and six months after discharge. RESULTS: Both groups of patients performed worse than CON on working memory, processing speed, inhibitory control, mental flexibility, and decision making. COC + CAN performed worse than COC on speed processing, inhibitory control and sustained attention, while COC performed worse than COC + CAN on mental flexibility. Concomitant cannabis use did not decrease relapses to cocaine use after one, three and six months. Among COC + CAN, earlier cocaine and cannabis use, and impaired executive functioning were predictive of relapse on cocaine after six months. CONCLUSION: Our results did not support the recommendation of smoked cannabis as a safe therapeutic approach for cocaine-addicted patients due to significant negative cognitive side-effects and absence of efficacy. Further studies investigating frontal brain morphology, neuromaturation, and prescription of the non-psychoactive constituent of cannabis sativa cannabidiol among cocaine-addicted patients who use cannabis are warranted.

Comparing serial and nonserial sexual offenders: alcohol and street drug consumption, impulsiveness and history of sexual abuse.

OBJECTIVE: To evaluate the differences between serial and nonserial sexual offenders in terms of alcohol and drug consumption, impulsivity, and personal history of being sexually abused. METHOD: A sectional and retrospective study carried out by the team of the outpatient clinic for the treatment of sexual disorders at Faculdade de Medicina do ABC - Santo André, Brazil. Three groups of subjects (n = 198) consisting of sexual offenders against one victim, two victims and three or more victims were examined. Convicts sentenced only for sexual crimes were evaluated with the Drug Addiction Screening Test, the CAGE, the Short Alcohol Dependence Data, the Barratt Impulsiveness Scale, the Sexual Addiction Screening Test, and the Static-99. RESULTS: Sexual offenders against three or more victims showed more frequent history of being sexually abused than the sexual offenders against one victim. A one-way analysis of variance indicated that sexual offenders against three or more victims evidenced significantly higher scores on the Barratt Impulsiveness Scale and on the Sexual Addiction Screening Test than did the sexual aggressors against one victim. After a multinomial logistic regression analysis, the Barratt Impulsiveness Scale and the history of being sexually abused were predicting factors for the group of aggressors against three or more victims in relation to the aggressors against one victim. CONCLUSIONS: Sexual offenders against three or more victims present different characteristics from other groups of sexual offenders and these findings can help to create proposals for the management of this type of inmates.

Os jovens seguem usando narguilé apesar do conhecimento dos possíveis riscos à saúde / Young people continue to use hookah despite knowledge of possible health risks

É preocupante notar que os usuários sigam usando o narguilé, embora a literatura aponte que o seu uso cause danos irreversíveis à saúde. Esse estudo avaliou a percepção dos usuários de narguilé e a interferência do seu consumo sobre a saúde. Método Esse é um estudo qualitativo. Uma amostra intencional de usuários foi recrutada. Os participantes responderam a uma entrevista semiestruturada. Todas as entrevistas foram avaliadas pelo método de análise de conteúdo. Resultados A maioria dos discursos apontou que os entrevistados conhecem os malefícios à saúde advindos do uso de narguilé. Entretanto, os efeitos sobre a saúde mental raramente foram lembrados pelos entrevistados, embora muitos deles já estivessem em uso problemático de tabaco, álcool e ou de outras drogas. A percepção de controle sobre o uso, o poder reforçador dos efeitos e a ausência de experiências pessoais negativas com o narguilé são importantes motivadores para seguir o uso. Conclusão Campanhas educativas e medidas para a redução e o controle do uso devem ser encorajadas.

Although the scientific literature show that waterpipe tobacco smoking causes irreversible damage to health, users continue to use it. Method This study evaluates the users' perceptions about the effect of this consumption on health. This is a qualitative study. A purposeful sample of current users was recruited. Participants were invited to undertake an in-depth semi-structured interview. The interviews were evaluated by content analysis method. Results Most speeches pointed out that the interviewees are aware of the harm to health from using waterpipe tobacco smoking. Although most interviewees were already developing a problematic use of tobacco, alcohol or other drugs, they rarely related waterpipe tobacco smoking with mental health consequences. The essential motivators for its continued use were the perception of control over waterpipe tobacco smoking use, the reinforcing tobacco effects, and the absence of negative health experiences in life. Conclusion Understand that educational campaigns and control measures should be encouraged.

Smoking cessation treatment outcomes among people with and without mental and substance use disorders: An observational real-world study.

BACKGROUND: There is a lack of studies evaluating smoking cessation treatment protocols which include people with and without mental and substance use disorders (MSUD), and which allows for individuals with MSUD undergoing their psychiatric treatment. METHODS: We compared treatment success between participants with (n = 277) and without (n = 419) MSUD among patients in a 6-week treatment provided by a Brazilian Psychosocial Care Center (CAPS) from 2007 to 2013. Sociodemographic, medical and tobacco use characteristics were assessed at baseline. Tobacco treatment consisted of 1) group cognitive behavior therapy, which included people with and without MSUD in the same groups, and 2) pharmacotherapy, which could include either nicotine patches, nicotine gum, bupropion or nortriptyline. For participants with MSUD, tobacco treatment was integrated into their ongoing mental health treatment. The main outcome was 30-day point prevalence abstinence, measured at last day of treatment. RESULTS: Abstinence rates did not differ significantly between participants with and without MSUD (31.1% and 34.4%, respectively). Variables that were significantly associated with treatment success included years smoking, the Heaviness of Smoking Index, and use of nicotine patch or bupropion. CONCLUSION: The inclusion of individuals with and without MSUD in the same protocol, allowing for individuals with MSUD undergoing their psychiatric treatment, generates at least comparable success rates between the groups. Predictors of treatment success were similar to those found in the general population. Facilities that treat patients with MSUD should treat tobacco use in order to reduce the disparities in morbidity and mortality experienced by this population.

Sex differences in smoking cessation: a retrospective cohort study in a psychosocial care unit in Brazil

Abstract Introduction Despite the results of epidemiological and psychometric studies reporting comparable levels of tobacco dependence among males and females, some clinical studies have detected disparities. Some smoking cessation studies based on clinical setting programs reported poorer outcomes among women than men. Methods This retrospective cohort study aimed to compare treatment success and retention between men and women on a smoking cessation program (n = 1,014) delivered at a CAPS-AD unit in Brazil. The psychological intervention lasted 6 weeks for each group of 15 patients. Each patient had to participate in weekly group cognitive-behavioral therapy (CBT) sessions and individual medical appointments during this period. These appointments were focused on the possibility of prescribing pharmacological treatment (i.e., nicotine replacement therapy, bupropion, or nortriptyline) as adjuvants to group therapy. Results The women had lower smoking severity at baseline, more clinical symptoms, and lower prevalence of alcohol and drug use disorders and were older than the men. Females had significantly higher levels of success (36.6% vs. 29.7%) and retention (51.6% vs. 41.4%) than males. Sensitivity analysis showed that female gender was significantly associated with both retention and success, among those without drug use disorders only. Conclusion Depending on the smoking cessation setting (i.e., low and middle-income countries and mental health and addiction care units), females can achieve similar and even higher quit rates than males. Previous drug use disorder was an important confounding variable in the gender outcomes analyses. Future studies should try to replicate these positive smoking cessation effects of CBT-based group therapy plus pharmacotherapy in women.

Alcohol and drug use among university students: gender differences.

OBJECTIVE: This study compared the pattern of alcohol, legal and illegal drugs use among students of the Universidade de São Paulo (Brazil) in 1996 and 2001. METHOD: Samples of 2.564 (1996) and 2.837 (2001) students answered a questionnaire proposed by the World Health Organization, which characterizes the consumption of alcohol, legal and illegal drugs in lifetime, in the last 12 months and in the last 30 days. RESULTS: Men showed a significant increase in lifetime use of tobacco (44.8% to 50.9%), marijuana (33.7% to 39.5%) and hallucinogens (6.6% to 14.1%) between 1996 and 2001. No significant change was observed among women between 1996 and 2001 in tranquilizer use. Concerning the consumption reported in the last 12 months, both genders displayed significant increases in the consumption of marijuana (22.3% to 27.1% for men and 12.9% to 16.9% for women), amphetamines (1.9% to 5.0% for men and 3.4% to 5.6% for women), and inhalants (9.8% to 15.7% for men and 5.4% to 10.6% for women). The greatest gender difference was observed in consumption reported in the last 30 days with significant increases in male use of tobacco (19.6% to 23.5%), marijuana (15.8% to 20.5%), amphetamines (1.1% to 3.2%), and inhalants (4.0% to 7.9%). Substance use reported in the last 30 days remained stable among women between the 2 surveys. CONCLUSION: Rates of substance use among university students increased. These gender differences in substance consumption should be taken into account in the development of preventive and treatment strategies for undergraduate university students.

Intention to Drive After Drinking Among Medical Students: Contributions of the Protection Motivation Theory.

OBJECTIVE: The aim of this study was to investigate whether cognitive variables proposed by the protection motivation theory (PMT) were predictive of occasional and frequent intention to drive after drinking in medical students. METHODS: One hundred fifty-five students attending preclinical years at a Medical School in São Paulo, Brazil, participated in the study. They were asked about their last month substance use, history of drinking and driving, including driving after binge drinking, and risk perceptions based on a self-report questionnaire with statements about protection motivation, threat, and coping appraisals from the PMT model. RESULTS: Fifty-two students (33%) had previous experience of driving after drinking during the last year, and 54 students (35%) reported intention to drive after drinking within the next year. Regression analysis showed that higher scores in perception of personal vulnerability to risks were associated with occasional and frequent intention to continue pursuing this particular behavior. Poorer evaluations about short-term consequences of alcohol consumption and cognitions regarding external rewards were significantly associated with reported intention to continue driving after drinking. CONCLUSIONS: Considering the social and health impact of alcohol-impaired behaviors, our findings suggest the need of interventional efforts focused in increasing students' awareness about the negative consequences of drinking and driving aiming to enhance their motivation towards more adaptive behaviors.

Comparative study of drug use among undergraduate students at the University of São Paulo--São Paulo campus in 1996 and 2001.

OBJECTIVE: To compare the rate of drug use prevalence and to investigate opinions regarding such use among undergraduate students at the University of São Paulo--São Paulo campus in 1996 and again in 2001. METHODS: Both studies followed the same procedures of sampling and data collection. A random sample of undergraduate students, divided into the areas Humanities, Exact Sciences and Biologic Sciences, responded to an anonymous and self-report survey regarding the use of licit and illicit drugs within the last 30 days, within the last 12 months and over the lifetime of the subject. The two surveys were compared through the construction of (95%) confidence intervals for the prevalence differences for each substance by area and by total number of students. The Wald test for homogeneity was applied in order to compare the prevalences. RESULTS: High approval of regularly trying and using cocaine, crack, amphetamines and inhalants was observed. The drugs that showed statistic significant increasing were:lifetime use: alcohol, tobacco, marijuana, inhalants, hallucinogens, amphetamines, anti cholines, barbiturics and any illicit drug;last-12-month use: marijuana, inhalants, amphetamines, hallucinogens and any illicit drug;last-30-day use: marijuana, inhalants, amphetamines and any illicit drug. DISCUSSION: The observed difference in the use of some drugs between the two surveys appears to be a consequence of the higher rates of favorable opinions regarding trying and regularly using some psychoactive substances, a finding that mirrors global trends in drug use.

[Brazilian guideline for the treatment of patients with opioids dependence syndrome]. / Diretrizes para o tratamento de pacientes com síndrome de dependência de opióides no Brasil.

There is a relatively low prevalence of opioid use in Brazil, particularly involving the non-medical use of codeine and opiate-containing syrups. However, opioid dependence syndrome shows a significant total impact on mortality and morbidity. Over the past 20 years, scientific progress has changed our understanding of the nature of opioid addiction and its various possible treatments. Addiction is a chronic illness treatable if the treatment is well-delivered and tailored to the needs of the particular patient. There is indeed an array of treatments that can effectively reduce drug use, help manage drug cravings, prevent relapses and restore people to productive social functioning. The treatment of drug addiction will be part of long-term, medical, psychological, and social perspectives. This guideline aims at providing guidance to psychiatrists and other mental health professionals who care for patients with opioid dependence syndrome. It comments on the somatic and psychosocial treatment that is used for such patients, and reviews scientific evidences and their strength. Also, the essential historical, epidemiological and neurobiological aspects of opioid dependence are reviewed.

Polydrug use among college students in Brazil: a nationwide survey.

OBJECTIVE: To estimate the frequency of polydrug use (alcohol and illicit drugs) among college students and its associations with gender and age group. METHODS: A nationwide sample of 12,544 college students was asked to complete a questionnaire on their use of drugs according to three time parameters (lifetime, past 12 months, and last 30 days). The co-use of drugs was investigated as concurrent polydrug use (CPU) and simultaneous polydrug use (SPU), a subcategory of CPU that involves the use of drugs at the same time or in close temporal proximity. RESULTS: Almost 26% of college students reported having engaged in CPU in the past 12 months. Among these students, 37% had engaged in SPU. In the past 30 days, 17% college students had engaged in CPU. Among these, 35% had engaged in SPU. Marijuana was the illicit drug mostly frequently used with alcohol (either as CPU or SPU), especially among males. Among females, the most commonly reported combination was alcohol and prescribed medications. CONCLUSIONS: A high proportion of Brazilian college students may be engaging in polydrug use. College administrators should keep themselves informed to be able to identify such use and to develop educational interventions to prevent such behavior.