Luciana Abeid Ribeiro

Fissura por crack: comportamentos e estratégias de controle de usuários e ex-usuários

OBJECTIVE To understand crack cocaine craving among users and describe craving behaviors and coping strategies. METHODOLOGICAL PROCEDURES Qualitative study with a non-random criterion sample consisting of 40 current and former crack cocaine users conducted in São Paulo, southeast Brazil, in 2007 and 2008. Respondents were selected using snowball sampling technique. In-depth semi-structured interviews were conducted until theoretical saturation was attained. All interviews were transcribed and content analysis was performed to construct inferences and hypotheses based on the narratives. ANALYSIS OF RESULTS The respondents showed a similar gender distribution, were 18 to 50 years of age, and had different levels of education. Most were from low-income background. In addition to craving resulting from crack cocaine withdrawal and environmental and emotional cue effects, it was found that crack cocaine itself triggers craving. The latter appeared to be a strong trigger of binge episodes. Binge episodes made them lose their moral values, and act dangerously to get more drug. The most common ways reported to get crack cocaine or money to buy it were: prostitution, manipulation of other people, go into debt, sell personal belonging to buy drug and theft. The respondents reported strategies to overcome their cravings as well as pharmacological and behavioral approaches to prevent cravings such as eating, having sex, playing soccer, working, avoiding social situations of crack use and taking depressants. CONCLUSIONS Crack cocaine binges are caused by a craving induced by the effects of crack cocaine itself. Users develop self-control strategies to cope with their cravings that may help improve their drug use and treatment effectiveness.OBJETIVO: Comprender el ansia de consumo por el usuario de crack, asi como describir las conductas desarrolladas y estrategias utilizadas para su control. PROCEDIMIENTOS METODOLOGICOS: Estudio cualitativo con muestra intencional por criterios de 40 usuarios y ex-usuarios de crack en Sao Paulo, Sureste de Brasil, en los anos de 2007 y 2008. Los entrevistados fueron reclutados por la tecnica de la bola de nieve y sometidos a la entrevista semi-estructurada en profundidad, hasta la saturacion teorica. Posterior a la transcripcion literal, se realizo el analisis de contenido de las entrevistas para elaboracion de inferencias e hipotesis cimentadas en estas narrativas. ANALISIS DE RESULTADOS: Los entrevistados estaban igualmente distribuidos con respecto al sexo, poseian edad entre 18 y 50 anos, abarcaron todos los niveles de escolaridad y la mayor parte poseia pocos recursos financieros. Se identifico sensacion de ansia de consumo en la abstinencia de crack, inducida por senales ambientales y emocionales, como efecto de la droga. Esta ultima aparecio como fuerte factor mantenedor de los consumos excesivos, que fueron los mayores responsables por el apocamiento de los valores del usuario, sujetandolos a practicas arriesgadas para la obtencion de drogas. Los metodos mas citados para la obtencion de crack o dinero para comprarlo fueron: prostitucion, manipulacion de personas, endeudamiento, cambio de pertenencias por crack y robo. Se relataron estrategias para el alivio del ansia de consumo y tacticas farmacologicas y conductuales para evitar su desarrollo, como: comer, tener relacion sexual, jugar futbol, trabajar, evitar el contexto social de uso de crack y usar drogas que causan somnolencia. CONCLUSIONES: Los consumos excesivos de crack son causados por el ansia de consumo inducido durante el uso de la droga. Las medidas creadas por el propio usuario para lidiar con su ansiedad mejoran su relacion con el crack y pueden ser herramienta importante para perfeccionar el tratamiento.

Surviving crack: a qualitative study of the strategies and tactics developed by Brazilian users to deal with the risks associated with the drug

BackgroundDue to marginalization, trafficking violence, conflicts with the police and organic and social psychological problems associated with the drug, crack is one of the most devastating drugs currently in use. However, there is evidence that some users manage to stay alive and active while using crack cocaine for many years, despite the numerous adversities and risks involved with this behavior. In this context, the aim of the present study was to identify the strategies and tactics developed by crack users to deal with the risks associated with the culture of use by examining the survival strategies employed by long-term users.MethodA qualitative research method was used involving semi-structured, in-depth interviews. Twenty-eight crack users fulfilling a pre-defined enrollment criterion were interviewed. This criterion was defined as the long-term use of crack (i.e., at least four years). The sample was selected using information provided by key informants and distributed across eight different supply chains. The interviews were literally transcribed and analyzed via content analysis techniques using NVivo-8 software.ResultsThere was diversity in the sample with regard to economic and education levels. The average duration of crack use was 11.5 years. Respondents believed that the greatest risks of crack dependence were related to the drugs psychological effects (e.g., cravings and transient paranoid symptoms) and those arising from its illegality (e.g., clashes with the police and trafficking). Protection strategies focused on the control of the psychological effects, primarily through the consumption of alcohol and marijuana. To address the illegality of the drug, strategies were developed to deal with dealers and the police; these strategies were considered crucial for survival.ConclusionsThe strategies developed by the respondents focused on trying to protect themselves. They proved generally effective, though they involved risks of triggering additional problems (e.g., other dependencies) in the long term.

Crack cocaine craving: behaviors and coping strategies among current and former users

OBJECTIVE To understand crack cocaine craving among users and describe craving behaviors and coping strategies. METHODOLOGICAL PROCEDURES Qualitative study with a non-random criterion sample consisting of 40 current and former crack cocaine users conducted in São Paulo, southeast Brazil, in 2007 and 2008. Respondents were selected using snowball sampling technique. In-depth semi-structured interviews were conducted until theoretical saturation was attained. All interviews were transcribed and content analysis was performed to construct inferences and hypotheses based on the narratives. ANALYSIS OF RESULTS The respondents showed a similar gender distribution, were 18 to 50 years of age, and had different levels of education. Most were from low-income background. In addition to craving resulting from crack cocaine withdrawal and environmental and emotional cue effects, it was found that crack cocaine itself triggers craving. The latter appeared to be a strong trigger of binge episodes. Binge episodes made them lose their moral values, and act dangerously to get more drug. The most common ways reported to get crack cocaine or money to buy it were: prostitution, manipulation of other people, go into debt, sell personal belonging to buy drug and theft. The respondents reported strategies to overcome their cravings as well as pharmacological and behavioral approaches to prevent cravings such as eating, having sex, playing soccer, working, avoiding social situations of crack use and taking depressants. CONCLUSIONS Crack cocaine binges are caused by a craving induced by the effects of crack cocaine itself. Users develop self-control strategies to cope with their cravings that may help improve their drug use and treatment effectiveness.OBJETIVO: Comprender el ansia de consumo por el usuario de crack, asi como describir las conductas desarrolladas y estrategias utilizadas para su control. PROCEDIMIENTOS METODOLOGICOS: Estudio cualitativo con muestra intencional por criterios de 40 usuarios y ex-usuarios de crack en Sao Paulo, Sureste de Brasil, en los anos de 2007 y 2008. Los entrevistados fueron reclutados por la tecnica de la bola de nieve y sometidos a la entrevista semi-estructurada en profundidad, hasta la saturacion teorica. Posterior a la transcripcion literal, se realizo el analisis de contenido de las entrevistas para elaboracion de inferencias e hipotesis cimentadas en estas narrativas. ANALISIS DE RESULTADOS: Los entrevistados estaban igualmente distribuidos con respecto al sexo, poseian edad entre 18 y 50 anos, abarcaron todos los niveles de escolaridad y la mayor parte poseia pocos recursos financieros. Se identifico sensacion de ansia de consumo en la abstinencia de crack, inducida por senales ambientales y emocionales, como efecto de la droga. Esta ultima aparecio como fuerte factor mantenedor de los consumos excesivos, que fueron los mayores responsables por el apocamiento de los valores del usuario, sujetandolos a practicas arriesgadas para la obtencion de drogas. Los metodos mas citados para la obtencion de crack o dinero para comprarlo fueron: prostitucion, manipulacion de personas, endeudamiento, cambio de pertenencias por crack y robo. Se relataron estrategias para el alivio del ansia de consumo y tacticas farmacologicas y conductuales para evitar su desarrollo, como: comer, tener relacion sexual, jugar futbol, trabajar, evitar el contexto social de uso de crack y usar drogas que causan somnolencia. CONCLUSIONES: Los consumos excesivos de crack son causados por el ansia de consumo inducido durante el uso de la droga. Las medidas creadas por el propio usuario para lidiar con su ansiedad mejoran su relacion con el crack y pueden ser herramienta importante para perfeccionar el tratamiento.

Is there a crack epidemic among students in Brazil?: comments on media and public health issues

In the past year, the Brazilian Federal Government and society have reported and acted on a crack use epidemic, which has been exacerbated by the media. This study hypothesized that crack use has not increased at the rate suggested by the Brazilian media. A cross-sectional survey was carried out in 2010 using a multistage probabilistic representative sample of Brazilian middle and high school students in the countrys 27 state capitals. A total of 50,890 valid questionnaires were weighted, analyzed and results compared to the 2004 national school survey dataset. Considering lifetime and past year crack use, no change in consumption was found between 2004 and 2010. Official data in Brazil on middle and high school students does not support the assertion of a crack epidemic widely publicized by the media. Government measures to treat and prevent crack use are encouraged; however, the term epidemic has been inappropriately used to represent the static prevalence of crack consumption among students.

Percepções e atitudes de professores de escolas públicas e privadas perante o tema drogas

No Brasil, apesar de os professores serem considerados como agentes potenciais para a prevencao do uso de drogas, ha mais de duas decadas os programas escolares de prevencao nao tem alcancado os resultados esperados. Com o intuito de auxiliar a identificacao da origem do problema, foram avaliadas as percepcoes/ atitudes de professores sobre o tema. Participaram da pesquisa vinte professores do Ensino Fundamental e Medio da cidade de Sao Paulo, com os quais foram realizadas entrevistas semiestruturadas. Embora esses profissionais se reconhecam como formadores de opiniao, nao se consideram suficientemente habilitados para tratar do tema com seus alunos, seja pela sua falta de informacao, interesse ou habilidade para abordar o assunto. Quanto a informacao sobre o tema, verificou-se haver uma baixa percepcao sobre o risco associado as drogas licitas. Perante estes resultados, sugere-se que os programas de prevencao destinados ao ambiente escolar sejam revistos e tenham a participacao de profissionais especializados.

Inhalants as Intermediate Drugs Between Legal and Illegal Drugs Among Middle and High School Students

The aims of this study are to: (1) describe the prevalence and sociodemographic characteristics of inhalant use among middle and high school students in Brazil, and (2) test the hypothesis of inhalants being intermediate drugs between legal and illegal drug use. A representative sample of 5226 students from private schools in São Paulo, Brazil, was selected to answer a self-report questionnaire. Weighted data was analyzed through Cox proportional hazards models. In the overall sample, inhalants seems to be an intermediate drug, since prior inhalant initiation was associated with first marijuana use, adjusted for previous alcohol and tobacco initiation.

Perceptions and attitudes among public school teachers towards the topic of drugs

No Brasil, apesar de os professores serem considerados como agentes potenciais para a prevencao do uso de drogas, ha mais de duas decadas os programas escolares de prevencao nao tem alcancado os resultados esperados. Com o intuito de auxiliar a identificacao da origem do problema, foram avaliadas as percepcoes/ atitudes de professores sobre o tema. Participaram da pesquisa vinte professores do Ensino Fundamental e Medio da cidade de Sao Paulo, com os quais foram realizadas entrevistas semiestruturadas. Embora esses profissionais se reconhecam como formadores de opiniao, nao se consideram suficientemente habilitados para tratar do tema com seus alunos, seja pela sua falta de informacao, interesse ou habilidade para abordar o assunto. Quanto a informacao sobre o tema, verificou-se haver uma baixa percepcao sobre o risco associado as drogas licitas. Perante estes resultados, sugere-se que os programas de prevencao destinados ao ambiente escolar sejam revistos e tenham a participacao de profissionais especializados.

Percepciones y actitudes de profesores de escuelas públicas y privadas ante el tema de las drogas

No Brasil, apesar de os professores serem considerados como agentes potenciais para a prevencao do uso de drogas, ha mais de duas decadas os programas escolares de prevencao nao tem alcancado os resultados esperados. Com o intuito de auxiliar a identificacao da origem do problema, foram avaliadas as percepcoes/ atitudes de professores sobre o tema. Participaram da pesquisa vinte professores do Ensino Fundamental e Medio da cidade de Sao Paulo, com os quais foram realizadas entrevistas semiestruturadas. Embora esses profissionais se reconhecam como formadores de opiniao, nao se consideram suficientemente habilitados para tratar do tema com seus alunos, seja pela sua falta de informacao, interesse ou habilidade para abordar o assunto. Quanto a informacao sobre o tema, verificou-se haver uma baixa percepcao sobre o risco associado as drogas licitas. Perante estes resultados, sugere-se que os programas de prevencao destinados ao ambiente escolar sejam revistos e tenham a participacao de profissionais especializados.

Ansia de consumo por crack: conductas y estrategias de control de usuarios y ex-usuarios

OBJECTIVE To understand crack cocaine craving among users and describe craving behaviors and coping strategies. METHODOLOGICAL PROCEDURES Qualitative study with a non-random criterion sample consisting of 40 current and former crack cocaine users conducted in São Paulo, southeast Brazil, in 2007 and 2008. Respondents were selected using snowball sampling technique. In-depth semi-structured interviews were conducted until theoretical saturation was attained. All interviews were transcribed and content analysis was performed to construct inferences and hypotheses based on the narratives. ANALYSIS OF RESULTS The respondents showed a similar gender distribution, were 18 to 50 years of age, and had different levels of education. Most were from low-income background. In addition to craving resulting from crack cocaine withdrawal and environmental and emotional cue effects, it was found that crack cocaine itself triggers craving. The latter appeared to be a strong trigger of binge episodes. Binge episodes made them lose their moral values, and act dangerously to get more drug. The most common ways reported to get crack cocaine or money to buy it were: prostitution, manipulation of other people, go into debt, sell personal belonging to buy drug and theft. The respondents reported strategies to overcome their cravings as well as pharmacological and behavioral approaches to prevent cravings such as eating, having sex, playing soccer, working, avoiding social situations of crack use and taking depressants. CONCLUSIONS Crack cocaine binges are caused by a craving induced by the effects of crack cocaine itself. Users develop self-control strategies to cope with their cravings that may help improve their drug use and treatment effectiveness.OBJETIVO: Comprender el ansia de consumo por el usuario de crack, asi como describir las conductas desarrolladas y estrategias utilizadas para su control. PROCEDIMIENTOS METODOLOGICOS: Estudio cualitativo con muestra intencional por criterios de 40 usuarios y ex-usuarios de crack en Sao Paulo, Sureste de Brasil, en los anos de 2007 y 2008. Los entrevistados fueron reclutados por la tecnica de la bola de nieve y sometidos a la entrevista semi-estructurada en profundidad, hasta la saturacion teorica. Posterior a la transcripcion literal, se realizo el analisis de contenido de las entrevistas para elaboracion de inferencias e hipotesis cimentadas en estas narrativas. ANALISIS DE RESULTADOS: Los entrevistados estaban igualmente distribuidos con respecto al sexo, poseian edad entre 18 y 50 anos, abarcaron todos los niveles de escolaridad y la mayor parte poseia pocos recursos financieros. Se identifico sensacion de ansia de consumo en la abstinencia de crack, inducida por senales ambientales y emocionales, como efecto de la droga. Esta ultima aparecio como fuerte factor mantenedor de los consumos excesivos, que fueron los mayores responsables por el apocamiento de los valores del usuario, sujetandolos a practicas arriesgadas para la obtencion de drogas. Los metodos mas citados para la obtencion de crack o dinero para comprarlo fueron: prostitucion, manipulacion de personas, endeudamiento, cambio de pertenencias por crack y robo. Se relataron estrategias para el alivio del ansia de consumo y tacticas farmacologicas y conductuales para evitar su desarrollo, como: comer, tener relacion sexual, jugar futbol, trabajar, evitar el contexto social de uso de crack y usar drogas que causan somnolencia. CONCLUSIONES: Los consumos excesivos de crack son causados por el ansia de consumo inducido durante el uso de la droga. Las medidas creadas por el propio usuario para lidiar con su ansiedad mejoran su relacion con el crack y pueden ser herramienta importante para perfeccionar el tratamiento.