Rosemeri Siqueira Pedroso

Treatment of female and male inpatient crack users: a qualitative study

OBJECTIVE To map treatment trajectories in a sample of male and female crack users through their narratives about the course of treatment seeking and their attempts to access health care services in Brazil. METHODS Qualitative study of a purposive sample (five female and nine male hospitalized crack users) using semi-structured interviews. The interviews were transcribed and data explored using content analysis. RESULTS Respondents reported difficulties getting access to hospitalization, relapse after discharge, and abandonment of treatment. There seems to be a peculiar model of behavior for women and men while dealing with craving for crack: while women got involved with prostitution and consequently became infected with HIV, every men of the sample reported criminal involvement. CONCLUSIONS The relationship between relapse and a social environment conducive to consumption, associated with belief or disbelief in spiritual support, prostitution, and the legal complications arising from the use of crack, are relevant issues and should be taken into consideration in the development of preventive actions aimed at this specific population.

Validação psicométrica do Cocaine Craving Questionnaire-Brief - Versão Brasileira Adaptada para o Crack para dependentes hospitalizados

Background: The craving is a very important factor in the treatment of drug addiction. Objective: Validate the Cocaine Craving Questionnaire-Brief - Brazilian Crack Adapted Version. Method: Subjects enrolled in this experimental study were randomized into groups: experimental for this group was shown an image of a subject using crack (G1) and control (G2) for this group no pictures were shown. The sample was composed of 109 subjects (G1 = 50 and G2 = 59), males, crack/cocaine dependent inpatients. The assessment instruments were: Clinical Interview with social and demographic data, CCQ-B - Crack Adapted Version; Visual Analogic Scale for Craving, Anxiety and Depression Beck and Inventories Visual Cue to elicit craving. Results: On the factorial analysis two factors were found: Factor 1, related to craving itself, and Factor 2, the perceived lack of control of crack use. The two-factor factorial analysis presented a total variation of 68.84%, and the correlation between these factors was significant and of low intensity (r = 0.204; p = 0.041). A Cronbach’s alpha value from total of points of scale was 0.85. We observed a correlation between the scale total score and the Visual Analogic Scale (r = 0.515; p < 0.01). Conclusion: The Cocaine Craving Questionnaire-Brief - Brazilian Crack Adapted Version proved to be an adequate psychometric instrument for use in research and in clinical settings.

Tratamento de exposição a estímulos e treinamento de habilidades como coadjuvantes no manejo do craving em um dependente de crack

OBJECTIVE An increased prevalence of crack cocaine users has been observed in clinical samples over the past years, underscoring the need for conducting research and developing treatment strategies aimed at this population. The objective of this study was to describe the case of a crack cocaine addict (inpatient) submitted to cue exposure treatment (CET) and coping skills training (CS) as adjuvant approaches to the conventional addiction treatment. CASE DESCRIPTION A male patient, 29 years old, single, with complete high school, was dependent on crack cocaine and marijuana and also had a diagnosis of harmful alcohol use. The patient had been hospitalized for 2 weeks and had undertaken a protocol comprising four motivational interview and relapse prevention sessions. Six sessions of CET and CS were carried out over 2 weeks, including both in vivo and imaginal exposure to stimuli evoking craving for crack cocaine, such as a crack pipe, a lighter, and simulated crack cocaine rocks (in vivo exposure), or remembering places and friends associated with drug use (imaginal exposure). The patient was also trained to use strategies for the management of craving. Three months after hospital discharge, toxicological screening was performed to assess abstinence. CET and CS were considered by the patient to be important techniques for the maintenance of abstinence and of a low level of craving 3 months after discharge. COMMENTS These findings suggest that the two techniques may be useful as adjuvant therapies in the treatment of crack cocaine dependents. CET and CS should be assessed in clinical trials in order to demonstrate their real benefits.

Marijuana Craving Questionnaire (MCQ-SF/Versão Brasil): validação semântica

OBJECTIVE: The aim of this study was to translate and adapt culturally the Marijuana Craving Questionnaire (MCQ-SF)10 which evaluates the craving for marijuana in a Brazilian sample. METHOD: The Marijuana Craving Questionnaire (MCQ-SF) was translated from English to Portuguese, administered to 10 subjects, submitted to a brainstorming in a group of three people for individual and verbal reproduction, item by item. Back-translation was executed, a translation for the original language, based on first translation and from brainstorming. Soon after, it was translated again into Portuguese. A committee of specialists analyzed all translations. RESULTS: After the committee considerations and a pilot study with 30 subjects, the final version of MCQ-SF/Versao Brasil was built. CONCLUSION: The results showed a satisfactory semantic equivalence between versions. The MCQ/Versao Brasil can be useful to evaluate the craving for marijuana on the dependents of this substance.

Following Up Crack Users after Hospital Discharge Using Record Linkage Methodology: An Alternative to Find Hidden Populations.

This paper presents the probabilistic record linkage (PRL) methodology as an alternative way to find or follow up hard-to-reach population as crack users. PRL was based on secondary data from public health information systems and the strategy used from standardization; phonetic encoding and the rounds of matching data were described. A total of 293 patient records from medical database and two administrative datasets obtained from Ministry of Health Information Systems were used. Patient information from the medical database was the identifiers to the administrative datasets containing data on outpatient treatment and hospital admissions. 40% of patient records were found in the hospital database and 12% were found in the outpatient database; 95% of the patients were hospitalized up to 5 times, and only 10 out of them had outpatient information. The record linkage methodology by linking government databases may help to address research questions about the path of patients in the care network without spending time and financial resources with primary data collection.

Inventário de expectativas de resultados em usuários de maconha (IERUM): construção e validação

Introduction: This study presents the development and validation of the Inventory of Outcome Expectancy in Marijuana Users (Inventario de Expectativas de Resultados em Usuarios de Maconha, IERUM), which evaluates the outcome expectancy regarding marijuana use, and may be useful in the treatment and prognosis of marijuana-dependent individuals. Method: The sample comprised 181 male (n = 145) and female (n = 36) marijuana users. Their age ranged from 18 to 55 years old (28.34±8.57). One hundred and eighteen patients were hospitalized at a chemical dependency unit, 23 were being treated in an outpatient clinic, 25 were receiving treatment in a self-help group (drug addicts anonymous, alcoholic anonymous), and 15 were not being treated. The 17-item scale was developed based on the experience related to chemical dependency and scale validation, with the semantic validation being the first phase of the process. Results: According to the factor analysis, the IERUM was divided into five factors (emotional aspects, perception, craving, cognitive aspects, and sexual aspects) that accounted for 60.18% of the variance. Conclusion: The IERUM showed good psychometric properties and can be used to evaluate the outcome expectancy related to marijuana use.

Confirmatory factor analysis (CFA) of the Crack Use Relapse Scale (CURS)

Background When it comes to crack/drug use, relapse is a relatively common event in the first weeks after the end of treatment. However little is known about what happens to patients who relapse after discharge. Objective To report the confirmatory factor analysis (CFA) of the Crack Use Relapse Scale (CURS) in an inpatient population. Methods A five-point Likert scale with 25 items and, initially, 9 theoretical factors was generated and utilized in a cross-sectional study with a sample of 333 hospitalized male crack users. Results CFA indicated a well-fitting model for the CURS. Discussion The CFA shows that the CURS model is appropriate and well-fitting for assessment of latent variables common to psychiatric and psychological constructs – in this case, relapse of crack cocaine use after inpatient treatment.

High rates of relapse in adolescents crack users after inpatient clinic discharge

Objetivo O objetivo do presente estudo foi avaliar 88 adolescentes usuarios de crack no que se refere a hospitalizacao e dar-lhes seguimento apos a alta, para investigar as recaidas e os fatores associados ao tratamento. Metodos Coorte (30 e 90 dias apos a alta) de um hospital psiquiatrico e uma clinica de reabilitacao, para o tratamento de dependencia quimica em Porto Alegre, entre 2011 e 2012. Instrumentos: entrevista semiestruturada, realizada para avaliar o perfil sociodemografico da amostra e descrever o padrao de uso de substâncias psicoativas; Escala de Recaida dos Usuarios de Crack/ERUC; Questionario de Seguimento de Usuarios de Crack/QSUC; K-SADS-PL. Resultados No primeiro periodo de seguimento (30 dias apos a alta), 65,9% dos participantes recairam. No segundo periodo de seguimento (90 dias apos a alta), 86,4% dos participantes tiveram recairam. Conclusao Este e um dos primeiros estudos que mostram a prevalencia extremamente alta de recaida precoce em adolescentes usuarios de crack apos a alta, questionando o custo-beneficio do tratamento em regime de internacao para essa populacao. Alem disso, esses resultados corroboram estudos que sugerem que usuarios de psicoestimulantes jovens podem precisar de um adaptado Tratamento Ambulatorial Intensivo, com manejo de contingencias e outras estrategias comportamentais, a fim de aumentar a adesao, reduzir o uso da droga ou recaida ao crime. No entanto, essa modalidade terapeutica especifica ainda e escassa e deve ser desenvolvida no Brasil.

Induction and comparison of craving for tobacco, marijuana and crack

Background The literature findings report that use of multiple substances can produce adverse clinical and behavioral effects, which may affect craving and the results of drug treatment. Also, the understanding of craving construct and its interaction in the use of smoked substances is underexplored. Objectives To induce and compare craving for tobacco, marijuana and crack-cocaine on hospitalized dependents whose drug of choice is crack-cocaine. Methods Quasi-experimental study with a convenience sample consisting of 210 males divided into 3 equal groups (Group-1: craving induced by crack; Group-2: craving induced by tobacco; and Group-3: craving induced by marijuana). All participants met ICD-10 dependence criteria for cocaine/crack, marijuana and tobacco, were aged between 18 and 65 and had used these substances for at least one year. Photos were used to induce craving and self-report instruments to evaluate possible alterations. Results This study showed that craving for tobacco was more intense than for marijuana and crack, when the groups were compared by VAS. Using specific scales, both craving for tobacco and craving for marijuana were more intense than craving for crack. Discussion These results would imply interventions at the initial stages of abstinence with cognitive-behavioural techniques and pharmacotherapy in order to reduce craving.