Flavio Pechansky

Alcohol use among adolescents: concepts, epidemiological characteristics and etiopatogenic factors

Alcohol is the most consumed substance among young people, and the onset of its use is starting at an earlier age, raising the risks of future dependence. The use of alcohol in adolescence is associated with a series of risk behaviors, besides raising the risk of involvement in accidents, sexual violence, and participating in gangs. Alcohol use by adolescents is strongly associated with violent death, poor academic performance, learning difficulties and damage in the development and structuring of cognitive-behavioral and emotional abilities. Alcohol consumption causes neurochemical modifications, with damage in memory, learning and impulse control. Professionals who deal with adolescents must be prepared for a thorough evaluation regarding the possible abusive use or dependence of alcohol in this age group. However, it is important to emphasize that the criteria utilized by some diagnostic tools for abuse and dependence were developed for adults, and must be applied with caution in adolescents. Thus, it is fundamental that these professionals be aware of the characteristics and peculiarities of adolescence and chemical dependence in this age-group.

Adaptation and construct validation of the Barratt Impulsiveness Scale (BIS 11) to Brazilian Portuguese for use in adolescents

OBJECTIVE Impulsivity is associated with different psychiatric disorders. The Barratt Impulsiveness Scale version 11 is one of the scales mostly used to measure impulsivity and it does not have a validated version for Brazilian Portuguese. The objective of this study is to adapt and conduct the construct validation of the Barratt Impulsiveness Scale version 11 for adolescents. METHOD The scale was translated and adapted into Portuguese and then back-translated into English. The psychometric proprieties, factor analysis and construct validity were evaluated in two samples: 18 bilingual undergraduate medical students and 464 male adolescents between 15 and 20 years old from a well-delimited geographical area in the city of Canoas, southern Brazil. RESULTS The adolescent sample had a mean age of 17.3 +/- 1.7 years. Intra-class correlation coefficient achieved a value of 0.90, and internal consistency had a of 0.62. Factor analysis did not identify the 3 factors of the original scale. Impulsivity scores from the Barratt Impulsiveness Scale version 11 had a correlation with scores for attention deficit/hyperactive disorder and oppositional defiant disorder and with number of symptoms of conduct disorder, suggesting an appropriate construct validity of the scale. CONCLUSION Even considering some limitations in the Portuguese version, Barratt Impulsiveness Scale version 11 can be used in male adolescents and should be tested in other populations.

Uma visão psiquiátrica sobre o fenômeno do crack na atualidade

No inicio da decada de 80, socioetnografosamericanos descreveram na literatura cientifica uma novae potente forma de uso de cocaina – a inalacao do vaporexpelido da queima de pedras, manufaturadas a partir do“cozimento” da pasta basica combinada com bicarbonatode sodio. Quando queimada em um cachimbo de vidroou outro recipiente, produzia um ruido tipico de estalo,tendo sido, por isso, chamada de

Psychometric properties of the World Health Organization Quality of Life instrument (WHOQoL-BREF) in alcoholic males: A pilot study

Objective: To evaluate criterion convergent and discriminant validity of the World Health Organization Instrument (WHOQoL-BREF) in evaluating quality of life and to verify its convergent validity with the Medical Outcomes study Short-forms (SF-36) and the Symptom Check List (SCL-90) instruments in male alcohol dependent patients who seek treatment at two Brazilian treatment centers. Methods: A cross-sectional study was performed, in which cases were divided in to two groups according to the severity of alcohol dependence, ascertained by the Short Form Alcohol Dependence Data scale (SADD). Results: The sample was comprised of 36 males, and 63.9% had severe dependence. Subjects with low/moderate dependence showed higher scores in all domains of the WHOQoL-BREF and in nearly all domains of the SF-36. Criterion validity and internal consistency in the WHOQoL-BREF were satisfactory. With regard to convergent validity between the WHOQoL-BREF and SF-36, most correlation coefficients were significant. Conclusions: The WHOQoL instrument proved to be satisfactory for evaluating quality of life in this sample.

Impulsivity, age of first alcohol use and substance use disorders among male adolescents: a population based case–control study

AIMS To evaluate the association between impulsivity, age of first alcohol consumption (AFD) and substance use disorders (SUD) in a non-clinical sample of adolescents. DESIGN AND SETTING Population-based case-control study of male adolescents between 15 and 20 years of age nested in a community survey in southern Brazil. PARTICIPANTS Cases were drug or alcohol abusers/dependents defined according to DSM-IV abuse/dependence criteria (n = 63). Individuals who had experienced alcohol use but where non-abusers served as controls (n = 355). Cases and controls completed a structured face-to-face interview. MEASUREMENTS The Mini International Neuropsychiatric Interview (MINI) was completed during the original survey and used to identify cases and controls. Impulsivity was measured by means of the Barratt Impulsivity Scale (BIS 11). Self-reported AFD and socio-demographic data were collected and analyzed through logistic regression according to a hierarchical model. FINDINGS Impulsivity and AFD were significantly associated with SUD. Both higher impulsivity [odds ratio (OR) 3.3, 95% confidence interval (CI) 1.4-7.8] and earlier AFD (OR 1.2, 95% CI 1.0-1.3) remained associated with SUD after model adjustments. CONCLUSIONS The findings from this population-based case-control study suggest that impulsivity and age of first alcoholic drink are associated strongly with alcohol and drug problems. Additionally, impulsivity seems to contribute to a premature exposure to alcohol by hastening the AFD. If the temporal effect of these associations is confirmed in longitudinal designs including broader population groups, our findings may contribute to the development of clinical and policy interventions aiming at reducing the incidence and morbidity associated with substance-related problems among adolescents.

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.

Psychometric properties of the sixth version of the Addiction Severity Index (ASI-6) in Brazil

BACKGROUND There are few research tools in Brazil to assess more broadly the alcohol and other drug related problems. OBJECTIVE To test the psychometric properties of ASI in its sixth version (ASI-6). METHODS A multicenter cross-sectional study was conducted in four Brazilian state capitals. Four research centers interviewed 150 adult inpatients or outpatients, and one research center interviewed 140 patients. A total of 740 substance abusers were selected. Training and supervision of interviewers were performed to assure the quality of dada collected. RESULTS Most areas of the ASI showed good reliability between the instrument and the interviewers, with no statistically significant differences between the ASI-6 Summary Scores for Recent Functioning (SS-Rs) of both interviews. Cronbachs alpha for ASI-6 subscales ranged from 0.64 to 0.95. Correlations between the ASI-6 Alcohol and Drug scores and the concurrent instrument (ASSIST) were high (0.72 and 0.89, respectively). There was a significant negative correlation between the scores in psychiatric, medical and drug areas and the scores of WHOQOL. CONCLUSION Analysis of the psychometric properties of ASI-6 both in outpatients and inpatients in Brazil indicate a good reliability and validity of this instrument for the Brazilian culture. The development of this instrument in Brazil is an important advancement, which will certainly have implications for the prevention, clinical research, and social rehabilitation fields.INTRODUCAO: Existem poucos instrumentos de pesquisa no Brasil que avaliam de forma mais ampla os problemas relacionados ao alcool e a outras drogas. OBJETIVO: Testar as propriedades psicometricas da ASI, em sua sexta versao (ASI-6). METODOS: Um estudo transversal e multicentrico foi conduzido em quatro capitais de estados brasileiros. Quatro centros de pesquisa entrevistaram 150 pacientes adultos internados ou em tratamento ambulatorial. Foram selecionados um total de 740 abusadores de substâncias. A qualidade dos dados coletados foi assegurada pelo treinamento e supervisao aos entrevistadores. RESULTADOS: A maioria das areas da ASI mostraram boa confiabilidade entre o instrumento e os entrevistadores, sem diferencas estatisticamente significativas entre os Escores Sumarios de Funcionamento Recente da ASI-6. O alfa de Cronbach para as subescalas da ASI-6 variou de 0,64 a 0,95. Correlacoes entre os escores da area Alcool e Drogas da ASI-6 e o instrumento concorrente (ASSIST) foram altas (0,72 e 0,89, respectivamente). Existiu uma correlacao negativa estatisticamente significativa entre os escores nas areas psiquiatrica, medica e drogas, e os escores da WHOQOL. CONCLUSAO: A analise das propriedades psicometricas da ASI-6 tanto em sujeitos internados quanto em tratamento ambulatorial no Brasil apontam para uma boa confiabilidade e validade deste instrumento para a cultura brasileira.

Changing patterns of cocaine use and hiv risks in the south of Brazil.

Abstract For well over a decade, researchers in Porto Alegre, Brazil, have been documenting the extent of the AIDS epidemic in the region, with a specific focus on the linkages between drug use and HJV seropositivity. Virtually all of the studies conducted during those years found injection drug use (IDU) to be the major vector for HIV seropositivity in this population. However, recent research found that the number of IDUs had declined significantly. Qualitative interviews and focus groups suggested many reasons for this decline: (1) many had died, because they had never heard of AIDS or HIV, and were unaware of how HIV is transmitted. As a result, they had become infected through the sharing of injection paraphernalia. (2) The quality of street cocaine had declined, making injection difficult. (3) Because of a fear of AIDS, some shifted to the smoking of crack, which had become a newly availability commodity in the street culture. Within this context, this article describes the qualitative data describing the decline of cocaine injecting and the corresponding emergence of crack use in Porto Alegre, Brazil, and related HIV risks.

Psychiatric and substance-use comorbidities associated with lifetime crack cocaine use in young adults in the general population

OBJECTIVE To assess the association between lifetime crack cocaine use and psychiatric (post-traumatic stress disorder, current depression, current dysthymia, generalized anxiety disorder, panic disorder with agoraphobia, social phobia, as well as SRQ scores and suicide risk) and substance-use disorders (tobacco, alcohol, cannabis, cocaine, amphetamine, inhalants, sedatives, hallucinogens and opioids) in youth in the general population of the city of Pelotas, RS. METHOD This was a cross-sectional population-based study, involving 1560 participants between 18 and 24 ears old. Lifetime substance use and abuse were investigated using the ASSIST inventory. Psychiatric comorbidities were assessed using the Mini-International Neuropsychiatric Interview and symptoms of common mental disorders were evaluated with the Self-Reported Questionnaire (SRQ). RESULTS The prevalence of lifetime crack cocaine use in the sample was 2.5%. Its use was associated with total SRW scores and the presence of post-traumatic stress disorder, antisocial personality disorder and suicide risk in the final regression model. Tobacco, alcohol, cannabis, cocaine, amphetamine and cocaine dependence were also associated with lifetime use of crack cocaine. DISCUSSION Youth with a history of crack cocaine use had a higher prevalence of psychiatric conditions such as post-traumatic stress disorder, as well as an increased risk of tobacco, alcohol, cannabis, cocaine, amphetamine and inhalant use and dependence.

Highly reported prevalence of drinking and driving in Brazil: data from the first representative household study

OBJECTIVE Brazil lacks information about driving under the influence of alcohol (DUI) originated from representative samples obtained from the general population. METHOD 333 subjects with a valid drivers license and drinking in the last 12 months were drawn from a multistaged sample of 2,346 adults from the first Brazilian Household Survey of Patterns of Alcohol Use. A multivariate analysis was conducted to understand the associations between risk factors and driving after drinking three or more drinks. RESULTS the overall DUI prevalence reported in the sample was 34.7% - 42.5% among males and 9.2% among females. Being male (OR = 6.0, 95% CI 2.9-12.6), having a previous DUI accident (OR = 7.9, 95% CI 2.5-24.9), binging in the last year (OR = 2.2, 95% CI 1.03-4.5) and having an unfavorable opinion towards policies (OR = 2.9, 95% CI 1.4-6.2) remained associated with heavy drinking and driving after model adjustments. DISCUSSION This was the first study evaluating driving under the influence of alcohol in a representative sample of the Brazilian population. The prevalence of DUI found is alarming, and possibly underestimated in the sample. Results demonstrate the need for more studies on this association and show directions towards preventive strategies for the specific high-risk group of male drivers with previous problems with alcohol and unfavorable opinions about prevention policies.