Denise De Micheli

Estudo da efetividade da intervenção breve para o uso de álcool e outras drogas em adolescentes atendidos num serviço de assistência primária à saúde

OBJECTIVE The main purpose of this study was to evaluate the effectiveness of a brief intervention and a preventive orientation on the use of alcohol and other drugs directed towards adolescents. METHODS Ninety nine youths who sought medical assistance in an out patient service specialized in adolescents were classified, according to their level of consumption of substances, into users during the last month (UM) or non users during the last month (NUM). Each of these was divided into four groups: a control group of users in the last month (COUM), a control group of non users in the last month (CONUM), a Brief Intervention group (BI--in case they were regular users) and a Preventive Orientation group (PO--in case they were non users in the last month). The preventive orientation lasted 2-3 minutes and the brief intervention took about 20 minutes, both followed a structured schedule. All participants were followed-up and evaluated for a 6 months period. RESULTS In the 6-month follow-up, a significant increase in cannabis, alcohol and tobacco consumption, as well as in the intensity of related-problems, was observed in the CONUM group. The increase of alcohol and tobacco consumption observed in the PO group had a significantly lesser frequency and lower intensity than in the CONUM group. Moreover, no increase in cannabis consumption was observed in this group. The BI group showed a significant reduction in the number of users during the last month with respect to most substances, as well as in relation to substance-related problems. CONCLUSION Our results confirm that a single brief intervention session is effective in reducing consumption of psychoactive substances in adolescents. Although influence of other factors could not be discarded, preventive orientation reduced the increase of cannabis consumption but increased use of tobacco and alcohol. Further and more in depth studies are required to evaluate the usefulness of preventive programs on alcohol and other drug consumption, in order to bring to light more effective and comprehensive approaches.

Prevenção ao consumo abusivo de drogas na escola: desafios e possibilidades para a atuação do educador

O consumo de drogas e apontado como uma das principais preocupacoes da sociedade e a escola tem sido considerada um espaco privilegiado para o desenvolvimento da prevencao e a promocao da saude. No entanto, pairam duvidas e incertezas sobre o papel que a educacao escolar pode assumir nesse tema e sobre as possibilidades das acoes preventivas que professores devem empreender. Nesse sentido, este artigo apresenta resultados de uma pesquisa-acao realizada em duas escolas publicas da cidade de Sao Paulo, na qual se investigaram fatores que podem dificultar o desenvolvimento de acoes preventivas na escola, bem como o que e possivel e pertinente desenvolver nesse âmbito na visao dos participantes. Para tanto, foram utilizados diversos instrumentos de investigacao, tais como grupos focais, encontros de formacao e questionarios. O estudo teve como sujeitos professores que atuam no ensino fundamental II. O exame de seus enunciados permitiu sistematizar fatores que dificultam a prevencao do uso de drogas na escola e elementos que podem subsidiar processos formativos desses profissionais. Revela ainda que alguns de seus posicionamentos e conhecimentos previos encontram-se em consonância com os modelos preventivos considerados mais promissores, como o oferecimento de alternativas, a educacao para saude, a mudanca no ambiente escolar e o treinamento de habilidades para a vida. Considerar tanto seus saberes e representacoes sociais quanto os fatores que interferem na implementacao de acoes educativas pode qualificar projetos e programas de prevencao ao consumo de drogas a ser desenvolvidos na escola.

Evaluation of different school-based preventive interventions for reducing the use of psychotropic substances among students: a randomized study

Although many schools perform preventive interventions for reducing drug use, little is known about their implementation processes and results. Accordingly, this study aimed to evaluate the effectiveness of three different types of preventive intervention performed in the school setting for reducing substance use among students. The study comprised 1316 students from the 9th year of elementary school to the 3rd year of secondary school in 8 public schools in the city of Guarulhos, Sao Paulo state, Brazil. Students were randomly assigned to the intervention groups or a control group and were evaluated at two different time-points regarding substance use. The results indicated that interventions performed by teachers were most effective in reducing both substance use and the severity of substance-associated problems. Interventions performed by experts were partially effective, although they only reduced use among experimental users. The results of “Single lecture” interventions revealed that such approaches are counterproductive. In summary, preventive actions that were contextualized to the students reality and the school environment and that included the active involvement of both teacher and student were most effective at reducing the prevalence of substance use and the severity of associated problems in students.

Relationship between Stress Symptoms and Drug use among Secondary Students

The aim of this study was to evaluate the relationship between drug use and four kinds of stress symptoms in 954 Brazilian students from the 6th to the 11th grades, in 4 public and 5 private schools in the city of Sao Paulo. Based on their answers to the Drug Use Screening Inventory (DUSI-R) and to the Stress Scale for Adolescents (SSA), we compared regular drug users with non/occasional drug users regarding the frequency of four kinds of stress symptoms (psychological, cognitive, physiological, interpersonal), and the period in which it happened. When compared to non/occasional drug users, regular drug users presented higher levels of psychological, cognitive and physiological symptoms of stress and these symptoms were in the most severe spectrum of severity (near to exhaustion and exhaustion). The association between drug use and stress was even stronger in the youngest age group (11 to 13 years old). Most of the regular drug users were 16 years old and over, from upper-middle class families, had poor family relationships and more academic problems. These results confirm the association between drug use and stress in adolescents and highlight the need for early screening and intervention in both drug use and stressful situations.

Neural Development in Adolescence

The development of the central nervous system involves several stages of maturation according to age. Several authors asserted that although human beings are born with a huge number of neurons approximately half of them are lost within the two first years of life. The rationale underlying this process is that the brain does not need an excessive number of nerve cells but need to amplify the already existing connections, increasing the number of synapses. In other words, during the course of development, the nervous system prioritizes qualitative aspects (improved transmission among and integration of neurons via synapses) over quantitative aspects (a large number of neurons with rather isolated actions). Recently, Brazilian researchers elaborated new techniques to count neurons and found that their number is approximately 86 billion in healthy human beings. In certain brain areas, neurogenesis continues throughout life, particularly in the case of the hippocampus, a memory and learning critical area. That process is exacerbated during adolescence. Some authors have found higher levels of hippocampal neurogenesis in adolescent mice than in adults. In addition, this process seems to be highly sensitive to the action of drugs, such as alcohol.

Impact of distance-learning training on substance use screening and brief intervention among health professionals and on their beliefs and attitudes toward drug use

Screening for alcohol and other drug (AOD) use followed by brief intervention (SBI) represents a useful tool for health professionals, since most people who are in the early stages of substance-related problems receive no guidance before developing significant consequences. In order to disseminate the techniques of SBI among Brazilian health professionals, the National Secretary on Drug Policy (SENAD), in partnership with the Drug Dependence Unit of UNIFESP, developed the distance learning program SUPERA. The aim of this study was to assess whether health professionals who participated in SUPERA changed their beliefs and behaviors related to AOD after completing the training. Health professionals from the Brazilian public health network who successfully completed the course (N = 1062) participated in the study. They answered a questionnaire on their beliefs and attitudes regarding AOD use before and after the course. After completing it, 91% of participants reported feeling more able to use SBI techniques than before, and 60% (compared with 37% pre-training) reported believing that demonstrating concern for patients’ AOD use could help reduce their consumption. Seventy-three percent (versus 50% pre-training) believed in the importance of BI to reduce AOD use, and 60% (versus 30%) reported believing in patients’ capacity to reduce AOD use. Most of the participants (66% after training versus 28% before) considered themselves to have an adequate level of knowledge about AOD use, and 83% (versus 22%) reported high confidence in their ability to detect AOD use. These data indicate positive changes in health professionals’ knowledge and attitudes regarding AOD use after the course, suggesting that distance learning is adequate to train health professionals in SBI.

Evaluation of the Implementation of Brief Interventions to Substance Abuse in a Socieducative Context

Objective: To evaluate the knowledge and the difficulties of professionals who work in socio-educational contexts on the performing of screening and brief intervention (SBI) with youth in conflict with the law. Method: One hundred two professionals filled a specific questionnaire regarding SBI. Results: lack of time for application of SBI as well as the belief that this procedure is not efficient for these youths were the main difficulties observed. Those who concluded a prior course about substance abuse had fewer chances of adherence. Besides, the difficulties observed for applying SBI reduced their motivation to perform it. Conclusion: These data indicate the necessity to change some components of these training programs by introducing an environment for dialogue as well as supervision of all procedures adopted.

Perception of freedom in leisure among substance users and nonusers

Abstract The aim of this study was to verify that substance use among adolescents would be linked to perceptions of freedom in leisure. It was selected for convenience sampling 186 adolescents at Projeto Quixote in a public school in Guarulhos. It used as questionnaire Data Sociodemographic and Leisure, The Leisure Diagnostic Battery, version B (PLL) to measure Perceived Freedom in Leisure and Drug Use Screening Inventory for classification of substance use, all self-administered. Based on 165 reviews analyzed, the frequency of use of ecstasy and marijuana in the last month were related to higher rates of PLL. The number of substances used in the last month had no significant effect. These data suggest specific components of leisure related to the frequency of substance use, such as perceived control and need at leisure.

Percepção de liberdade no lazer entre usuários e não usuários de substâncias

Abstract The aim of this study was to verify that substance use among adolescents would be linked to perceptions of freedom in leisure. It was selected for convenience sampling 186 adolescents at Projeto Quixote in a public school in Guarulhos. It used as questionnaire Data Sociodemographic and Leisure, The Leisure Diagnostic Battery, version B (PLL) to measure Perceived Freedom in Leisure and Drug Use Screening Inventory for classification of substance use, all self-administered. Based on 165 reviews analyzed, the frequency of use of ecstasy and marijuana in the last month were related to higher rates of PLL. The number of substances used in the last month had no significant effect. These data suggest specific components of leisure related to the frequency of substance use, such as perceived control and need at leisure.

La percepción de la libertad en el ócio entre usuarios y no usuarios de sustâncias

Abstract The aim of this study was to verify that substance use among adolescents would be linked to perceptions of freedom in leisure. It was selected for convenience sampling 186 adolescents at Projeto Quixote in a public school in Guarulhos. It used as questionnaire Data Sociodemographic and Leisure, The Leisure Diagnostic Battery, version B (PLL) to measure Perceived Freedom in Leisure and Drug Use Screening Inventory for classification of substance use, all self-administered. Based on 165 reviews analyzed, the frequency of use of ecstasy and marijuana in the last month were related to higher rates of PLL. The number of substances used in the last month had no significant effect. These data suggest specific components of leisure related to the frequency of substance use, such as perceived control and need at leisure.