Anderson Ravy Stolf

Crack Users Show High Rates of Antisocial Personality Disorder, Engagement in Illegal Activities and Other Psychosocial Problems

The aim of this study was to compare three groups of Brazilian psychoactive substance (PAS) abuse patients (crack cocaine users, cocaine snorters, and non-cocaine PAS users) in terms of psychiatric comorbidities and severity of psychosocial problems. A cross-sectional, multi-center study was conducted at five Brazilian research centers. A total of 738 current PAS abusers seeking specialized treatment (outpatient and inpatient clinics) were assessed using the sixth version of the Addiction Severity Index (ASI-6): 293 patients using crack cocaine were compared with 126 using powder cocaine and 319 using non-cocaine PAS (mostly alcohol and marijuana). Psychiatric comorbidities were assessed in a smaller sample (290 cases), originating from three of the centers, using the Mini International Neuropsychiatric Interview Plus (MINI-Plus). Crack and powder cocaine users were significantly younger than non-cocaine PAS users (31.1 ± 8.1 and 32.9 ± 8.8 vs. 42.4 ± 12, respectively; p < .001). Crack users presented a higher rate of antisocial personality disorder (25%) than powder cocaine (9%) and non-cocaine PAS users (9%), even when adjusted for confounding factors (Pr = 2.6; 95% CI 1.10-6.40). According to ASI-6 summary scores, crack users presented a significantly higher rate of occupational, family, and legal problems and reported more illegal and violent activities such as burglary and theft (23%) and threatening or assaulting (32%) than non-cocaine PAS users. Our findings, combined with the recent increase observed in the prevalence of crack use in Brazil, highlight the severity of psychiatric symptoms and psychosocial problems related to this powerful drug and corroborate the already suggested association between crack/cocaine, violence, and legal problems. Treatment programs for crack users should routinely consider the possibility of associated psychiatric comorbidities, such as antisocial personality disorder, which may affect treatment outcomes.

Crack Cocaine Users Show Differences in Genotype Frequencies of the 3′ UTR Variable Number of Tandem Repeats of the Dopamine Transporter Gene (DAT1/SLC6A3)

Background: Due to the mechanism of action of the dopamine transporter (DAT) in drug addiction, the DAT1 gene is a potential candidate for molecular studies. This paper aims to compare the prevalence of allele and genotype frequencies created by the 3′ UTR variable number of tandem repeats (VNTR) of this gene between crack cocaine users and controls. Methods: A cross-sectional sample of 237 current adult crack cocaine abusers or dependents (DSM-IV TR criteria) from in- and outpatient clinics in southern Brazil and 205 community controls were compared. The subjects were evaluated using the Adult ADHD Self-Report Scale, the Mini-International Neuropsychiatric Interview - short version, and the Wechsler Intelligence Scale. DNA samples were genotyped for the DAT1 3′ VNTR. Results: Logistic regression analysis was performed to compare the frequency of the 10.10 genotype (the putative risk genotype) to those of other genotypes. A significant difference (p = 0.04, OR = 1.758, CI = 1.026-3.012) indicating an increased frequency of the 10.10 genotype in the cases (59.9%) compared to the controls (49.3%) was verified using clinical and demographic covariates. Conclusions: This is one of the first genetic association studies on crack cocaine users in the literature. The results suggest an influence of the DAT1 gene, namely the 3′ VNTR 10.10 genotype. However, more analyses will confirm and clarify its contribution as a possible risk factor for crack cocaine dependence.

The Effects of ADHD in Adult Substance Abusers

The aim of this study was to evaluate the psychiatric comorbidities and different areas of life functioning in substance abusers with attention deficit hyperactivity disorder symptoms. A cross-sectional, multi-center study involving 285 adult substance abusers from outpatient and inpatient clinics was performed. The Adult ADHD Self-Report Scale, the sixth version of the Addiction Severity Index, and the Mini International Neuropsychiatry Interview were used for data collection. Individuals with comorbid attention deficit hyperactivity disorder and substance use disorders showed increased addiction severity when compared with individuals without attention deficit hyperactivity disorder (53.3 ± 7.3 vs. 48.4 ± 8.4, respectively). Our results suggest that comorbid attention deficit hyperactivity disorder and substance use disorders is associated with a more severe course of substance use and with social and psychiatric impairment.

Avaliação multidimensional do usuário de drogas e a Escala de Gravidade de Dependência

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

Who seeks public treatment for substance abuse in Brazil? Results of a multicenter study involving four Brazilian state capitals.

OBJECTIVE To assess the characteristics of alcohol and drug users who seek treatment at the Brazilian Unified Health System in Brazil. METHOD A multicenter cross-sectional study involving five clinical and research centers located in four Brazilian state capitals was conducted with 740 in- and outpatients. The only exclusion criterion was the presence of neurological or severe psychiatric symptoms at the moment of the interview. The Addiction Severity Index (ASI-6) and the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) were used to assess the severity of substance use and the problems related. RESULTS There were significantly more men than women in the sample; mean age was 36 years. The drug most frequently used at all sites was alcohol (78%), followed by cocaine/crack (51%). Alcohol was the drug that most commonly motivated treatment seeking, at all centers. ASI-6 Summary Scores for Recent Functioning (SS-Rs) were quite similar among centers. SS-Rs were compared between users who had never received treatment for psychoactive substance abuse (n = 265, 36.1%) and those who had already been treated at one or more occasions (n = 470, 63.9%). This analysis revealed significant differences between the groups in the drug, psychiatric symptoms, legal, and family/social problems areas (p < 0.05). CONCLUSION Our findings confirm previous evidence suggesting that the management of patients seeking drug abuse treatment should take several different aspects into consideration, e.g., education, employment, and family relationships, which often appear as areas of concern for these individuals.

Association between the Intron 8 VNTR Polymorphism of the DAT1 Gene and Crack Cocaine Addiction

Background: This study aims to compare allele and genotype frequencies of a 30-bp variable number of tandem repeats (VNTR) polymorphism of the DAT1 gene, located at intron 8, between adult crack cocaine users and nonaddicted individuals. Due to its involvement in drug addiction, this gene is a good candidate for molecular studies. Methods: A cross-sectional sample of 239 current adult crack abusers or dependents from in- and outpatient clinics and 211 control individuals was collected in Brazil. They were evaluated using ASRS, ASI-6, WAIS-III, and MINI assessments. DNA samples extracted from whole blood were genotyped for the intron 8 VNTR in DAT1. Results: Logistic regression analysis was performed and controlled for gender, age, ethnicity, educational level, and comorbidities of clinical interest (generalized anxiety disorder, suicide risk, major depressive episode, and attention deficit/hyperactivity disorder). This analysis showed that the 6R6R genotype was associated with crack cocaine addiction (OR = 1.844; CI = 1.101–3.089; p = 0.020). Conclusions: Our results are consistent with the role of DAT1 in the neurobiology of drug addiction. Nevertheless, the study of other genes, environmental factors, and their interactions is also important to gain a broader understanding of this condition.

Factors Associated With a Quality of Life Decrease in Alcoholic Patients Who Sought Treatment

Objective: We investigate the quality of life (QoL) of subjects with alcohol abuse/dependence, and we focus on aspects that are associated with alcohol consumption. Methods: We included inpatients and outpatients (n=174) of an addiction treatment program. All of the patients had had problems related to alcohol within the last 30 days. We used the WHOQOL-BREF to measure the patients’ QoL, and we used the ASI-6 to investigate the severity of problems related to alcohol and substance use. The main outcome measures considered for the linear regression analyses were the WHOQOL-BREF domains. The independent factors were the scores in the ASI-6 areas. Results: We found a negative correlation between the WHOQOL-BREF and the ASI-6. Significant correlations were included in the multiple linear regression pattern, which considered p<0.05 to be the cut off of statistical significance. We examined the regression analyses between the ASI-6 summary scores and the WHOQOL-BREF domains using variables that presented statistical significance in the correlation analysis. All ASI-6 problem areas showed negative correlations with domains. Conclusion: The decrease in QoL was not directly linked to the severity of alcohol use but rather with its consequences. The ASI-6 medical area was associated with a lower QoL in all of its domains. Measures of the problems related to alcohol misuse seem to be a significant predictor of QoL scores; the more often that alcohol is a problem in a patient’s life, the worse the patient’s QoL will be. Instead of treatment, other strategies should be developed to address these problem areas to not only reduce substance use but also to significantly improve the QoL of alcoholics.