Akwatu Khenti

Exploring child maltreatment and its relationship to alcohol and cannabis use in selected Latin American and Caribbean countries

OBJECTIVES Research from developed countries shows that child maltreatment increases the risk for substance use and problems. However, little evidence on this relationship is available from developing countries, and recognition of this relationship may have important implications for substance demand reduction strategies, including efforts to prevent and treat substance use and related problems. Latin America and the Caribbean is a rich and diverse region of the world with a large range of social and cultural influences. A working group constituted by the Inter-American Drug Abuse Control Commission and the Center for Addiction and Mental Health in June, 2010 identified research on this relationship as a priority area for a multinational research partnership. METHODS This paper examines the association between self-reported child maltreatment and use in the past 12 months of alcohol and cannabis in 2294 university students in seven participating universities in six participating countries: Colombia, El Salvador, Jamaica, Nicaragua, Panama and Uruguay. The research also considers the possible impact of religiosity and minimal psychological distress as factors contributing to resiliency in these samples. RESULTS The results showed that experience of maltreatment was associated with increased use of alcohol and cannabis. However, the effects differed depending on the type of maltreatment experienced. Higher levels of religiosity were consistently associated with lower levels of alcohol and cannabis use, but we found no evidence of an impact of minimal psychological distress on these measures. CONCLUSIONS This preliminary study shows that the experience of maltreatment may increase the risk of alcohol and cannabis use among university students in Latin American and Caribbean countries, but that higher levels of religiosity may reduce that risk. More work to determine the nature and significance of these relationships is needed.

Policonsumo simultâneo de drogas entre estudantes de graduação da área de ciências da saúde de uma universidade: implicações de gênero, sociais e legais, Santo André - Brasil

Cross sectional study that aims to understand the patterns of polydrugs use and its gender, social and legal implications among undergraduate students. 275 undergraduate students from the Faculty of Health Sciences from one university in Santo Andre, Brazil, participated in the study. The simultaneous polydrug use was detected in 27.9% of the sample. Combinations: alcohol + cannabis; alcohol + prescription drugs; alcohol + tobacco + cannabis; tobacco + cannabis; and tobacco + prescription drugs. Reasons: To help relaxing, to lose inhibitions, to help staying awake, to help on doing something upsetting, and to improve the effect of other substances. There was no observed association between legal and social circumstances, men used more poly consumption than women, and religion represented a protective factor to simultaneous polydrug use, which was lower than described in the literature. Considering that subjects in the represent future health care professionals, institutional policies should be discussed in order to reduce exposure and vulnerability to these substances. DESCRIPTORS: Students. Addictive behavior. Substance use-related disorders. Risk factors. Street Drugs.Cross sectional study that aims to understand the patterns of polydrugs use and its gender, social and legal implications among undergraduate students. 275 undergraduate students from the Faculty of Health Sciences from one university in Santo Andre, Brazil, participated in the study. The simultaneous polydrug use was detected in 27.9% of the sample. Combinations: alcohol + cannabis; alcohol + prescription drugs; alcohol + tobacco + cannabis; tobacco + cannabis; and tobacco + prescription drugs. Reasons: To help relaxing, to lose inhibitions, to help staying awake, to help on doing something upsetting, and to improve the effect of other substances. There was no observed association between legal and social circumstances, men used more poly consumption than women, and religion represented a protective factor to simultaneous polydrug use, which was lower than described in the literature. Considering that subjects in the represent future health care professionals, institutional policies should be discussed in order to reduce exposure and vulnerability to these substances. DESCRIPTORS: Students. Addictive behavior. Substance use-related disorders. Risk factors. Street Drugs.

The Canadian war on drugs: structural violence and unequal treatment of Black Canadians.

This paper examines the impact of Canadas war on drugs on segments of the Black community, specifically with respect to the impact of structural violence, over-policing, and high incarceration rates. It offers evidence of the systemic nature of these dynamics by examining the early context of the war, growing stigma against Blacks, globalizing influences, and the punitive focus of funding and policy. The paper also explores how Black men have been identified as the main enemy and how drug control efforts have served to diminish the health, well-being, and self-image of Black men via discriminatory and inequitable treatment before the law. The current high rates of imprisonment of Black men are an indicator of systematic deprivation of significant social capital, which will perpetuate socioeconomic harm and cycles of violence. This commentary calls for an immediate dissolution of policies regulating the war on drugs as the first step in remedying the injustices experienced by Black Canadians. Due to the lack of Canadian data in this important area, the paper also emphasizes the critical need for more research to shed more light on the Canadian-specific complexities.

A PESQUISA SOBRE O FENÔMENO DAS DROGAS NA PERSPECTIVA DOS ESTUDOS MULTICÊNTRICOS NA AMÉRICA LATINA E CARIBE

l fenomeno de las drogas constituye uno de los mayores desafios para los paises en el Siglo XXI. Essabido que el uso y abuso de las drogas tiene impactos y consecuencias adversas en la salud del individuo, dela familia y de la comunidad, asi como, en el desarrollo, estabilidad social y seguridad, tanto a nivel nacionalcomo internacionalThe drugs phenomenon is one of the greatest challenges countries are confronted with in the 21 century. It is well known that drugs use and abuse influence and negatively affect the health of people, families and communities, as well as national and international development, social stability and security. The globalization process can direct or indirectly facilitate drugs trade, as well as the development of money laundry mechanisms, contributing to increased drugs consumption in different population groups. That makes the drugs phenomenon a global problem. Many countries have emphasized the association between drugs and terrorism and have direct or indirectly reinforced drugs control laws. In the context of the black market, drugs are considered a lucrative source of money; at the same time, this market can be associated with arms trade and violence against civilians and governments all over the world. National policies highlight the importance of reducing drugs consumption, taking into account, for example, the risk of acquiring HIV/AIDS among injection drugs user, or greater accident risks, or the chronic damage that can be associated with drugs use. Psychoactive substance consumption affects users’ body and mind. These effects range from alterations in physiological functions to modified time and space perceptions, as well as alterations in states of awareness about the consumers’ environment. It can be affirmed that drugs abuse and addiction result from a combination of three factors: a product (alcohol and other drugs), a person with his history and individual vulnerabilities and a social, cultural, political and economic context. In particular, it is fundamental to integrate the importance of social determinants of health and development into the analysis of and answers given to substance consumption, including the strong inequities that exist in the region. Likewise, it should be considered that many people present comorbidities due to addiction and mental health problems at the same time. In view of the above, a comprehensive approach is needed, which does not remain limited to an emphasis on the substance alone. Hence, the drugs phenomenon is an old problem in a new context. Countries face difficulties to control production and trade and reduce demand. That makes drugs use and abuse into a paramount theme on the national and international agenda, due to the damage they cause in countries’ social, economic and political aspects. The current global context demands specialized professionals, who are capable of analyzing problems and presenting solutions and/or strategies with national and international perspectives, based on scientific data. Most OAS members states do not have specialized professional staff at their disposal, with scientific knowledge and sufficient research experience on drugs and related problems to work in national drugs commissions, research centers or academic professional training programs. In general, countries have neither established long-term programs or planning to research on the drugs phenomenon, nor have they managed to incorporate research results into national drugs control policies. To solve this problem, however, some developing countries have linked up with developed ones to outline strategies for scientific advances in research on the drugs phenomenon. In that context, CICAD (Inter-American Drug Abuse Control Commission) has developed strategies to strengthen institutional capacities and human resources related to drugs demand reduction, security and money laundering in its member-states..O processo da globalizacao, direta ou indiretamente, pode facilitar o comercio de drogas, assim como o desenvolvimento de mecanismos de lavagem de dinheiro, contribuindo para o incremento do consumo de drogas entre diferentes grupos populacionais. Por isso, o fenomeno das drogas torna-se problema global. Muitos paises tem enfatizado a associacao entre drogas e terrorismo e tem reforcado as leis de controle de drogas, de forma direta ou indireta. No contexto do mercado negro de venta de drogas, as mesmas sao tidas como fonte lucrativa para ganhar dinheiro; ao mesmo tempo, tal mercado pode se associar a compra de armas, assim como a geracao de violencia contra a populacao civil e os governos em todo o mundo (3) . As politicas nacionais ressaltam a importância em se reduzir o consumo de drogas, considerando, por exemplo, o risco de adquirir HIV/AIDS entre usuarios de drogas injetaveis, ou maior risco de acidentes, ou o dano cronico que pode se associar ao uso de drogas (3) . O consumo de substâncias psicoativas tem efeitos no corpo e na mente dos usuarios. Esses efeitos vao desde alteracoes das funcoes fisiologicas, ate a modificacao da percepcao em relacao ao tempo e espaco, assim como alteracoes nos estados de consciencia sobre o entorno do consumidor. Pode-se afirmar que o abuso e a dependencia de drogas sao o resultado do encontro de tres fatores: um produto (alcool e outras drogas), uma pessoa com a sua historia e vulnerabilidades individuais e um contexto social, cultural, politico e economico. Em particular, e fundamental integrar na analise e nas respostas, frente ao consumo de sustâncias, a importância dos determinantes sociais de saude e desenvolvimento, incluindo as fortes iniquidades existentes na regiao. Igualmente, e necessario considerar que muitas pessoas apresentam comorbilidade por adicao e problemas de saude mental, simultaneamente. Pelo exposto, e necessario realizar abordagem integral que nao se limite somente a enfase na substância. Assim, o fenomeno das drogas e velho problema dentro de novo contexto. Os paises enfrentam dificuldades para o controle da producao, comercio e reducao da demanda. Por isso, o uso e abuso de drogas passam a ser tema primordial na agenda nacional e internacional, devido aos danos que causam nos aspectos sociais, economicos e politicos dos paises. O atual contexto mundial requer profissionais especializados, capazes de analisar problemas e apresentar solucoes e/ou estrategias com perspectivas nacionais e internacionais, baseadas em dados cientificos. A maioria dos Estados membros da OEA nao conta com quadro de profissionais especializados, com conhecimento cientifico e suficiente experiencia em pesquisa sobre drogas e os seus problemas relacionados, para trabalhar nas comissoes nacionais de drogas, em centros de pesquisa ou em programas academicos de formacao de profissionais. Em geral, os paises nao tem programas ou planejamento de longo prazo estabelecidos para pesquisar o fenomeno das drogas, e nem tem conseguido incorporar os resultados das pesquisas em politicas nacionais

Gender differences in simultaneous polydrug use among undergraduate students of one university, Kingston - Jamaica

This study sought to explore the simultaneous polydrug use pattern across genders of 1 st and 2 nd year undergraduate students in one university in Kingston, Jamaica. There were 295 study participants (58 males and 237 females) from the faculty of Medical Sciences at a local university. The study used a self administered questionnaire which addressed various aspects of drug use andsimultaneouspolydruguse.�Unadjustedresultsrevealedasignificantlyhighersimultaneouspolydruguseamongmalesthan� females�40.9%�and�14.3%�respectivelyinthelast�12�months�(χ2, p=0.009)�andinthelast�30�days�8.9%�vs.�1.7%�(χ2, p=0.014). These results suggestaprominenceofsimultaneouspolydrugusebehaviouramongmaleundergraduatestudentsinthispopulationcompared� with females, although further research is required. DESCRIPTORS:�Students.�Streetdrugs.�Behaviouraddictive.�Substance-Relateddisorders.�Riskfactors.

Estudo de comorbidade: sofrimento psíquico e abuso de drogas em pessoas em centros de tratamento, Macaé - Brasil

Study of prevalence and psychological distress among people attending a public day care service and two private in patientsservicesinthecityofMacae,�RiodeJaneiro,�Brazil.�Cross-sectionalstudy.�AquestionnaireadaptedbytheformEULAC-CICAD� was applied to characterize the participants. The scale of Kessler-10 was used as a screening tool for psychological distress. The sample was 60 people: 88.3% men and 51.5% between 24-39 years old. Depression was referred as the most important previous diagnosis in 35%, followed by anxiety in 33.33%. During the current treatment this relationship changed: anxiety was the main diagnosis in 38.3%, followed by depression in 28.3%. The 34% of the sample had severe psychological distress and 27.2% very severe psychological distress. The levels of psychological distress severe and very severe in 61.2% screened by K-10, a scale especially sensitive to anxiety and depression, are similar to international studies on this population. dEsCriptors: Comorbidity. Substance use-related disorders. Psychological distress. Mental health assistance.Study of prevalence and psychological distress among people attending a public day care service and two private in patients services in the city of Macae, Rio de Janeiro, Brazil. Cross-sectional study. A questionnaire adapted by the form EULAC-CICAD was applied to characterize the participants. The scale of Kessler-10 was used as a screening tool for psychological distress. The sample was 60 people: 88.3% men and 51.5% between 24-39 years old. Depression was referred as the most important previous diagnosis in 35%, followed by anxiety in 33.33%. During the current treatment this relationship changed: anxiety was the main diagnosis in 38.3%, followed by depression in 28.3%. The 34% of the sample had severe psychological distress and 27.2% very severe psychological distress. The levels of psychological distress severe and very severe in 61.2% screened by K-10, a scale especially sensitive to anxiety and depression, are similar to international studies on this population. dEsCriptors: Comorbidity. Substance use-related disorders. Psychological distress. Mental health assistance. Estudio dE la Comorbilidad: distrEs psiColOgiCo Y abuso dE drogas En pErsonas En CEntros dE tratamiEnto, maCae – brasil rEsumEn: Estudio de prevalencia de distres psicologicos entre personas que acuden a los servicios publicos de atencion de dia y dos centros de hospitalizacion privada en la ciudad de Macae, Rio de Janeiro, Brasil. Estudio transversal. Se aplico un cuestionario adaptado de lo formulario de la EULAC-CICAD para caracterizar a los participantes. Para la deteccion de los distres psicologicos se utilizo la escala de Kessler-10. Participaron 60 personas, y los hombres eran 88.3%. De la muestra total, el 51.5% tenian entre 24 a 39 anos de edad. La depresion fue el principal diagnostico relatado en 35%, seguido de la ansiedad en 33.33%. Durante el tratamiento actual la ansiedad fue el diagnostico principal en 38.3%, seguido de depresion en 28.3%. De los encuestados el 34% tenian niveles graves de distres psicologicos y el 27.2% niveles muy graves. Las conclusiones de que los niveles de distres psicologico grave y muy grave en 61.2% identificados pela escala K-10, especialmente sensibles a la ansiedad y la depresion, son similares a los estudios internacionales de esta poblacion. dEsCriptorEs: Comorbilidad. Distres psicologico. Trastornos relacionados con sustancias. Atencion en salud mental.

Características del policonsumo simultáneo de drogas en estudiantes de pregrado de carreras de ciencias de la salud de una universidad, Santiago - Chile

Cross sectional study whose objective was to establish the patterns of simultaneous poly-drug use among students in undergraduate medical and nursing careers, at a university in Santiago - Chile. A sample of 188 students was studied. Results: 42.3% of students refered simultaneous poly-drug use, average age of onset of 16 years; most common combinations were alcohol + tobacco + marijuana and tobacco + alcohol with prescription drugs. They learn about drug combinations through friends, consume in mixed groups outside the university (nightclubs) and do it to relax or enjoy the company of friends. It is essential to develop comprehensive strategies in order to improve the health of this population of youngsters, who will be responsible for the health of future generations. DESCRIPTORS: Students. Street drugs. Behavior addictive. Substance-Related disorders. Risk factors.

Global mental health: transformative capacity building in Nicaragua

Background Mental health is increasingly recognised as integral to good public health, but this area continues to lack sufficient planning, resources, and global strategy. It is a pressing concern in Latin America, where social determinants of health aggravate existing inequities in access to health services. Nicaragua faces serious mental health needs and challenges. One key strategy for addressing gaps in mental health services is building capacity at the primary healthcare and system levels. Objective Using the framework of best practice literature, this article analyses the four-year collaborative process between the National Autonomous University of Nicaragua in León (UNAN-León) and the Centre for Addiction and Mental Health (CAMH) in Canada, which is aimed at improving mental healthcare in Nicaragua. Design Based on a critical analysis of evaluation reports, key documents, and discussion among partners, the central steps of the collaboration are analysed and main successes and challenges identified. Results A participatory needs assessment identified local strengths and weaknesses, expected outcomes regarding competencies, and possible methodologies and recommendations for the development of a comprehensive capacity-building programme. The partners delivered two international workshops on mental health and addiction with an emphasis on primary healthcare. More recently, an innovative Diploma and Master programme was launched to foster interprofessional leadership and effective action to address mental health and addiction needs. Collaborative activities have taken place in Nicaragua and Canada. Discussion To date, international collaboration between Nicaragua and CAMH has been successful in achieving the jointly defined goals. The process has led to mutual knowledge sharing, strong networking, and extensive educational opportunities. Evidence of effective and respectful global health capacity building is provided. Lessons learned and implications for global health action are identified and discussed.Background Mental health is increasingly recognised as integral to good public health, but this area continues to lack sufficient planning, resources, and global strategy. It is a pressing concern in Latin America, where social determinants of health aggravate existing inequities in access to health services. Nicaragua faces serious mental health needs and challenges. One key strategy for addressing gaps in mental health services is building capacity at the primary healthcare and system levels. Objective Using the framework of best practice literature, this article analyses the four-year collaborative process between the National Autonomous University of Nicaragua in León (UNAN-León) and the Centre for Addiction and Mental Health (CAMH) in Canada, which is aimed at improving mental healthcare in Nicaragua. Design Based on a critical analysis of evaluation reports, key documents, and discussion among partners, the central steps of the collaboration are analysed and main successes and challenges identified. Results A participatory needs assessment identified local strengths and weaknesses, expected outcomes regarding competencies, and possible methodologies and recommendations for the development of a comprehensive capacity-building programme. The partners delivered two international workshops on mental health and addiction with an emphasis on primary healthcare. More recently, an innovative Diploma and Master programme was launched to foster interprofessional leadership and effective action to address mental health and addiction needs. Collaborative activities have taken place in Nicaragua and Canada. Discussion To date, international collaboration between Nicaragua and CAMH has been successful in achieving the jointly defined goals. The process has led to mutual knowledge sharing, strong networking, and extensive educational opportunities. Evidence of effective and respectful global health capacity building is provided. Lessons learned and implications for global health action are identified and discussed.

Diversidad y complejidad en el fenómeno de las drogas: el policonsumo simultáneo en estudiantes universitarios en una universidad, Cundinamarca - Colombia

A utilizacao simultânea de mais de uma substância psicoativa, ao mesmo tempo e um tema que diversifica e complexifica o fenomeno das drogas na sociedade contemporânea. Foi realizado um estudo quantitativo e transversal, a fim de descrever os padroes de policonsumo simultâneo de substâncias psicoativas entre 975 estudantes de graduacao da area da saude, em uma universidade em Cundinamarca, Colombia. Foi observado um alto indice de estudantes da amostra que relataram o uso simultâneo de multiplas drogas, destacando a combinacao de alcool e tabaco. Diferentes comportamentos sao evidentes na utilizacao simultânea de multiplas drogas, relacionadas com a idade de inicio do uso; do consumo de multiplas drogas; o ano letivo estudado; as substâncias utilizadas no consumo de multiplas drogas e a transicao do consumo para o policonsumo de drogas. Sugerem a inclusao deste tema na formacao de recursos humanos em saude e na pesquisa.

Policonsumo simultáneo de drogas en estudiantes de pregrado del área de la salud en una universidad, León - Nicaragua

Las drogas constituyen una seria amenaza para la salud internacional. Este estudio tuvo como objetivo explorar los patrones de policonsumo simultaneo y sus implicaciones legales y sociales entre estudiante de pregrado. El estudio fue de corte transversal, y en el participaron 357 estudiantes de pregrado del area de la salud de una universidad. El 52.1% de los participantes dijo haber usado sustancias psicoactivas alguna vez en su vida, y el 42.6% dijo haber consumido en los ultimos 12 meses. En el ultimo ano, un 80.3% refirio haber consumido alcohol, un 34.2% tabaco, un 5.9% drogas de prescripcion, un 4.6% cannabis, y un 3.9% cocaina/crack. En relacion al consumo simultaneo en los ultimos 12 meses, las cifras de reportadas fueron de 14.7% para alcohol + tabaco + cannabis, y de 8.8% para las todas las siguientes combinaciones: alcohol + cannabis, alcohol + cocaina, y cannabis + cocaina. Factores asociados al consumo fueron identificados. Se sugieren programas preventivos e investigacion adicional en el tema.