Maria Lucia Oliveira de Souza Formigoni

Validation of the alcohol, smoking and substance involvement screening test (ASSIST)

AIM The concurrent, construct and discriminative validity of the World Health Organizations Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) were examined in a multi-site international study. PARTICIPANTS One thousand and 47 participants, recruited from drug treatment (n = 350) and primary health care (PHC) settings (n = 697), were administered a battery of instruments. MEASUREMENTS Measures included the ASSIST; the Addiction Severity Index-Lite (ASI-Lite); the Severity of Dependence Scale (SDS); the MINI International Neuropsychiatric Interview (MINI-Plus); the Rating of Injection Site Condition (RISC); the Drug Abuse Screening Test (DAST); the Alcohol Use Disorders Identification Test (AUDIT); the Revised Fagerstrom Tolerance Questionnaire (RTQ); and the Maudsley Addiction Profile (MAP). FINDINGS Concurrent validity was demonstrated by significant correlations between ASSIST scores and scores from the ASI-Lite (r = 0.76-0.88), SDS (r = 0.59), AUDIT (r = 0.82) and RTQ (r = 0.78); and significantly greater ASSIST scores for those with MINI-Plus diagnoses of abuse or dependence (P < 0.001). Construct validity was established by significant correlations between ASSIST scores and measures of risk factors for the development of drug and alcohol problems (r = 0.48-0.76). Discriminative validity was established by the capacity of the ASSIST to discriminate between substance use, abuse and dependence. Receiver operating characteristic (ROC) analysis was used to establish cut-off scores with suitable specificities (50-96%) and sensitivities (54-97%) for most substances. CONCLUSIONS The findings demonstrated that the ASSIST is a valid screening test for identifying psychoactive substance use in individuals who use a number of substances and have varying degrees of substance use.

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.

Implantação de rotinas de rastreamento do uso de risco de álcool e de uma intervenção breve na atenção primária à saúde: dificuldades a serem superadas

The variety of problems related to the so-called hazardous patterns of alcohol use make the latter a prominent public health concern. Screening instruments associated with brief interventions in primary care provide one of the frequently recommended secondary prevention strategies. The objective of this study was to assess the implementation of this strategy as a routine practice in primary health care services in the city of Juiz de Fora, Minas Gerais State, Brazil. A qualitative design was employed, including the application of semi-structured interviews for managers and health care professionals in the citys public health system, in addition to content analysis and participant observation. Results point to difficulties in the effective implementation of such routines both by managers and health care professionals. Health care professionals limit the approach to alcohol-dependent patients and demonstrate lack of motivation for preventive work. Health services managers experience difficulties in the organization and administration of such instruments, despite affirming their interest in the project.

Avaliação dos padrões de uso de álcool em usuários de serviços de Atenção Primária à Saúde de Juiz de Fora e Rio Pomba (MG)

Uma parte significativa da populacao brasileira apresenta padroes de consumo de alcool associados a alto risco de desenvolvimento de problemas. Por tal razao, e fundamental avalia-los na populacao para tracar estrategias de prevencao primaria e secundaria ao seu uso. O objetivo deste estudo foi avaliar esse padrao de consumo dos usuarios de servicos da Atencao Primaria a Saude das cidades de Juiz de Fora e Rio Pomba, Minas Gerais. Foi aplicado um instrumento de rastreamento -o AUDIT- a 921 sujeitos recrutados durante as consultas de rotina. Considerando os dados em conjunto, 18,3% das pessoas avaliadas encontravam-se na faixa de uso de risco, 77,9% da amostra faziam uso de baixo risco ou eram abstemios, e 3,8% pontuaram na faixa sugestiva de dependencia. De modo geral, os homens apresentaram comportamento de risco em maior frequencia do que as mulheres, sendo mais prevalente na faixa etaria dos 38 aos 47 anos de idade.

O efeito das bebidas alcoólicas pode ser afetado pela combinação com bebidas energéticas? Um estudo com usuários

OBJETIVO: Avaliar em uma amostra de criterio, o padrao de uso de bebidas energeticas, isoladamente e em associacao com bebidas alcoolicas. METODOS: Cento e trinta e seis voluntarios (idade 24 ± 6 anos) que relataram ao menos um uso anterior de bebidas energeticas foram submetidos a uma entrevista padronizada sobre habitos de consumo de bebidas energeticas e alcoolicas. RESULTADOS: A maioria da amostra relatou usar bebidas energeticas tanto isoladamente (79%) como em combinacao com bebidas alcoolicas (76%), neste caso preferencialmente com uisque (90%), vodka (37%) ou cerveja (13%). Apos a ingestao isolada de bebidas energeticas, 61% relataram nao sentir nenhum efeito, 10% mencionaram aumento da alegria, 9% euforia, 9% insonia, 7% desinibicao e 24% aumento do vigor fisico. Dos que relataram uso combinado com alcool, 14% relataram nao sentir alteracao dos efeitos do alcool, mas 38% reportaram aumento de alegria, euforia (30%), insonia (11%), desinibicao (27%) e do vigor fisico (24%). Observou-se grande variabilidade no numero de usos de bebidas energeticas na vida (14 ± 16), mas certa regularidade na quantidade ingerida por ocasiao (1,5 ± 0,7 latas). CONCLUSOES: Os dados sugerem que os efeitos das bebidas energeticas sao bastante variaveis, dependendo provavelmente da dose ingerida e da sensibilidade individual. Alguns relatos sugerem que ha interacao com o alcool, expressa pelo aumento dos efeitos excitatorios ou reducao de seus efeitos depressores. Sao discutidos possiveis mecanismos farmacologicos subjacentes a esta combinacao.

Death by drug overdose: impact on families.

Abstract Death by overdose is loaded with social/moral stigmas, in addition to strong feelings of anger, helplessness, guilt and shame in the families. The objective of this study was to analyze the impact of these feelings on families facing death by overdose. Qualitative methodology was used to study six families with a history of death by overdose of one of their members. The interview was open, and guided by the question “What did you feel with the death of your family member by overdose and what was the impact of this death on your family as a whole?” The families were grouped into two categories: families who knew about the drug use of their family member, and families who were not aware of it. The reports show that secrecy regarding drug use followed by death by overdose arouses feelings of anger, guilt, helplessness, and deprives the family members of information that could allow them to take action. As regards families that were aware of the drug use, there seems to be a “veiled preparation” for a possible death by overdose, bringing about ambivalent situations of grief and relief. The report stresses how disturbing it is to lose a family member by overdose, and points to the need for psychological support for those families.

Estratégias de rastreamento e intervenções breves para problemas relacionados ao abuso de álcool entre bombeiros

Deleterious effects of alcohol abuse are widely known and described. Prevention of alcohol abuse is particularly important in specific professional categories, i.e. workers subjected to constant risk and stressful situations, like firemen. Prevention may be crucial to reduce possible consequences arising from alcohol abuse in such professional categories. In the present paper we illustrate the use of a particular approach based on prevention, the Screening and Brief Intervention (TIB), on firemen from Juiz de Fora, MG. The TIB has been applied in association with other evaluation strategies and has proved to be viable and efficient as health care prevention in such context.

Crack-cocaine users have less family cohesion than alcohol users

Objective: Many studies correlate characteristics of family functioning and the development of drug addiction. This study sought to evaluate and compare the family environment styles of two groups of psychoactive substance users: 1) alcohol-only users and 2) crack-cocaine users. Methods: Three hundred and sixty-four users of alcohol, crack-cocaine, and other drugs, recruited from research centers in four Brazilian capitals participated in this study. Subjects were evaluated through the Family Environment Scale and the Addiction Severity Index, 6th version (ASI-6). ASI-6 t-scores were compared by analysis of variance (ANOVA) and post-hoc tests. A final model was obtained using a logistic regression analysis. All analyses were adjusted for partner, age, and psychiatric t-score. Results: We found a significant difference between groups in the cohesion subscale (p = 0.044). The post-hoc test revealed a difference of 1.06 points (95%CI 0.11-2.01) between groups 1 (6.45±0.28) and 2 (5.38±0.20). No significant between-group differences were observed in the other subscales. However, categorical analyses of variables regarding family dynamic showed that crack users more often reported that sometimes people in their family hit each other (30.4% vs. 13.2%, p = 0.007) and that people in their family frequently compared each other regarding work and/or school achievement (57.2% vs. 42.6%, p = 0.041). Conclusion: These results suggest that families of crack-cocaine users are less cohesive than families of alcohol users. This type of family environment may affect treatment outcome, and should thus be adequately approached.

Concepts of dependence among Brazilian alcohol- and drug-dependent patients.

Abstract Studies suggest that the concepts that drug dependent persons have about their problems could influence adherence to treatment and outcome. The objective of this study was to compare these concepts in different groups of patients. Three groups of drug-dependent patients (diagnosed according to DSM-III-R criteria) were compared: 64 dependent on alcohol only, 56 dependent only on other drugs and 39 dependent on both alcohol and drugs. They were asked: “What do you think about your problem?” and the responses were qualitatively analyzed and classified into themes. For the whole sample, the main themes mentioned were: the function of alcohol and drugs in their lives (50%), the etiology of dependence (32%) and reasons for initial use (21%). Patients dependent on alcohol associated their use with coping, while patients dependent on other drugs reported pleasure seeking. In regard to etiology, most patients classified their dependence as a habit. Patients dependent on alcohol tended to attribute an organic etiology to their problem, while those dependent on other drugs most frequently considered moral aspects as important. This study suggests that there are differences between these three groups in the appraisal of their problem. Professionals interested in treatment matching need to take these findings into account, as they may influence compliance and treatment outcome.