Marcelo Santos Cruz

O adolescente e o uso de drogas

Universidade Federal de Sao Paulo (UNIFESP) Departamento de Psicobiologia Unidade de Dependencia de Drogas

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.

Exploring sex differences in drug use, health and service use characteristics among young urban crack users in Brazil

IntroductionStudies have shown important gender differences among drug (including crack) users related to: drug use patterns; health risks and consequences; criminal involvement; and service needs/use. Crack use is prevalent in Brazil; however, few comparative data by sex exist. We examined and compared by sex key drug use, health, socio-economic indicators and service use in a bi-city sample of young (18–24 years), regular and marginalized crack users in Brazil.MethodsStudy participants (total n = 159; n = 124 males and n = 35 females) were recruited by community-based methods from impoverished neighborhoods in Rio de Janeiro and Salvador. Assessments occurred by an anonymous interviewer-administered questionnaire and serum collection for blood-borne virus testing between November 2010 and June 2011. Descriptive statistics and differences for key variables by sex were computed; in addition, a ‘chi-squared automatic interaction detector’ (‘CHAID’) analysis explored potential primary factors differentiating male and female participants.ResultsMost participants were non-white, and had low education and multiple income sources. More women had unstable housing and income from sex work and/or panhandling/begging, whereas more men were employed. Both groups indicated multi-year histories of and frequent daily crack use, but virtually no drug injection histories. Men reported more co-use of other drugs. More women were: involved in sex-for-drug exchanges; Blood-Borne Virus (BBV) tested and HIV+. Both groups reported similar physical and mental health patterns; however women more commonly utilized social or health services. The CHAID analysis identified sex work; paid work; begging/panhandling; as well as physical and mental health status (all at p < 0.05) as primary differentiating factors by sex.ConclusionsCrack users in our study showed notable differences by sex, including socio-economic indicators, drug co-use patterns, sex risks/work, BBV testing and status, and service utilization. Results emphasize the need for targeted special interventions and services for males and female crack users in Brazil.

Comparing key characteristics of young adult crack users in and out-of-treatment in Rio de Janeiro, Brazil

BackgroundCrack use is prevalent among street drug users in Brazilian cities, yet despite recent help system reforms and investments, treatment utilization is low. Other studies have identified a variety of – often inconsistent – factors associated with treatment status among crack or other drug users. This study compared socio-economic, drug use, health and service use characteristics between samples of young adult crack users in- and out-of-treatment in Rio de Janeiro, Brazil.FindingsStreet-involved crack users (n = 81) were recruited by community-based methods, and privately assessed by way of an anonymous interviewer-administered questionnaire as well as biological methods, following informed consent. In-treatment users (n = 30) were recruited from a public service in-patient treatment facility and assessed based on the same protocol. Key indicators of interest were statistically cross-compared. Not-in-treatment users were less likely to: be white, educated, stably housed, to be involved in drug dealing, to report lifetime marijuana and current alcohol use, to report low mental health status and general health or addiction/mental health care; they were more likely to: be involved in begging and utilize social services, compared to the in-treatment sample (statistical significance for differences set at p < .05).ConclusionsIn-treatment and not-in-treatment crack users differed on several key characteristics. Overall, in-treatment users appeared to be more socio-economically integrated and connected to the health system, yet not acutely needier in terms of health or drug problems. Given overall low treatment utilization but high need, efforts are required to facilitate improved treatment access and use for marginalized crack users in Brazil.

Comparação entre usuários de crack e de outras drogas em serviço ambulatorial especializado de hospital universitário

O crescimento do consumo de crack e o perfil dos usuarios no Brasil estao bem documentados, mas faltam estudos na cidade do Rio de Janeiro. Conhecer o perfil sociodemografico e padrao do uso de drogas desses usuarios e fundamental para direcionar recursos, efetivamente. Foram estudados pacientes acolhidos no Programa de Estudos e Assistencia ao Uso Indevido de Drogas (Projad) do Instituto de Psiquiatria da Universidade Federal do Rio de Janeiro, entre marco de 2007 e setembro de 2008, e analisadas as diferencas entre pacientes com e sem relato de uso de crack na vida. Usuarios de crack sao significativamente mais jovens e solteiros. Apesar do predominio de baixa escolaridade e desemprego, esses resultados nao foram significativos. Houve crescimento de usuarios de crack que procuraram tratamento. Este e o primeiro estudo cientifico apontando a expansao do consumo de crack no Rio de Janeiro e pode subsidiar a implementacao de politicas publicas.The increase in crack abuse and the profile of these abusers are well documented in Brazil, but studies in Rio de Janeiro are lacking. Optimization of resource allocation for prevention and treatment requires a better characterization of abusers with respect to socio-demographic characteristics and drugs use pattern. Patients admitted to the Drug Abuse Research and Care Program (PROJAD) at the Psychiatric Institute of the Federal University of Rio de Janeiro between March 2007 and September 2008 were studied. Crack abusers were found to be significantly younger than other drug abusers and more frequently unmarried. Lower education level and unemployment were a trend in this group, although not statistically significant. The increase in the number of patients seeking treatment for crack abuse was documented. This is the first scientific study reporting on the expansion of crack abuse in Rio de Janeiro, which may provide information to put in practice public policies.

Crack across the Americas - A massive problem in continued search of viable answers: Exemplary views from the North (Canada) and the South (Brazil)

Centre for Applied Research in Mental Health and Addiction, Faculty of Health Sciences, Simon Fraser University, Vancouver, Canada Social and Epidemiological Research, Centre for Addiction and Mental Health, Toronto, Canada Department of Psychiatry, University of Toronto, Toronto, Canada Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil Infectious Diseases Division, University of Ottawa, Ottawa, Canada

Performance of rapid hepatitis C virus antibody assays among high- and low-risk populations

BACKGROUND Rapid tests for the detection of antibodies to hepatitis C virus (anti-HCV) can facilitate access to diagnosis. OBJECTIVES This study aimed to evaluate the performance of rapid tests for anti-HCV detection in the sera, whole blood, and oral fluid samples from individuals with different endemicity profiles and risk behaviors. STUDY DESIGN Three groups donated biological samples that were tested using three anti-HCV rapid tests (WAMA, Bioeasy and OraSure): (I) suspected cases of hepatitis C, (II) individuals who were living in remote areas in Brazil and (III) crack users and beauty professionals. Reproducibility, repeatability and cross-reactivity to other infectious agents (dengue, HIV, malaria, and syphilis) were also evaluated. RESULTS In group I, specificities varied from 93.75% to 100% and sensitivities varied from 76.03% to 93.84% according to the EIA results. When anti-HCV/HCV RNA-reactive sera samples were considered true-positive HCV cases, the sensitivities and specificities varied from 86.3% to 99.09% and 93.75% to 100%, respectively. In group II, the OraSure rapid test presented the best performance. In group III, the Bioeasy assay performed best using saliva and whole blood and the OraSure assay performed best using oral fluid samples. The reproducibility and repeatability of the WAMA and Bioeasy tests were excellent. The level of concordance between the HCV EIAs and the rapid tests using samples that were reactive for other infectious agents varied from 82.35% to 100% for the WAMA assay and 94.11% to 100% for the Bioeasy assay. CONCLUSION All of the rapid tests could be used to identify active HCV infection among individuals with different endemicity profiles and risk behaviors.

Adaptação transcultural multicêntrica da sexta versão da Escala de Gravidade de Dependência (ASI6) para o Brasil

1 Centro de Pesquisa de Droga e Alcool, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS. 2 Departamento de Psiquiatria, University of Pennsylvania, Filadelfia, EUA. 3 Departamento de Psicobiologia, Universidade Federal de Sao Paulo (UNIFESP), Sao Paulo, SP. 4 Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ. 5 Instituto de Psiquiatria, Escola de Medicina, Universidade de Sao Paulo (USP), Sao Paulo, SP. Financiamento: Este estudo foi apoiado pela Secretaria Nacional Antidrogas (SENAD), GPPG-HCPA no 05-460. Projeto aprovado pelo Comite de Etica.

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.

Differences in Addiction Severity Between Social and Probable Pathological Gamblers Among Substance Abusers in Treatment in Rio de Janeiro

There is a strong association between pathological gambling and substance abuse. The objective of this study is to identify the differences between substance abusers with and without gambling problems. A cross sectional study was conducted interviewing with Addition Severity Index (ASI) and South Oaks Gambling Screen (SOGS), alcohol and drug abusers (N = 147) who sought treatment in specialized treatment facilities. SOGS was used to access and classify individuals into two groups: social gamblers (n = 96) and probable pathological gamblers (n = 32). Scores on ASI provided data about severity on seven areas. Several differences were found between the two groups. Cocaine was the major reason for treatment among drug abusers with gambling problems. This group had more severity problems in the areas of drug use, psychiatric, legal and family-social. Furthermore, they had more suicidal ideas, parents with gambling problems and started to play earlier than the social gamblers group. These results indicate the need to improve the services that provide treatment to alcohol and drug abusers, including routines for screening to early identification and professional education on specific treatment to substance abusers with pathological gambling.