Sibele Faller

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.

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.

Avaliação multidimensional do usuário de drogas e a Escala de Gravidade de Dependência

Abstract Introduction: Before initiating any treatment for substance abuse, the assessment of problems related to the consumption of those substances is of paramount importance. Considering the complexity of this evaluation, the instrument most widely used in the present days for a multidimensional approach to these patients is the Addiction Severity Index (ASI). Objective: The present study presents a literature review, a clinical case vignette, comments on different aspects of the scale, and the discussion of topics covered in the evaluation process, and aims at providing support to health professionals in the sense of systematizing the assessment of these patients. Methods: The literature review was conducted on MEDLINE, LILACS, and PsycINFO databases, using the keywords assessment and evaluation together with substance-related disorders and other terms presented as synonyms in the Medical Subject Headings. Results and conclusion: There is a paucity of articles in the literature focusing on the topic, and no other instruments designed to provide a general overview of substance users (as is the case with the ASI) are available in Brazil. The use of a scale with these characteristics may be useful for the Brazilian public health system, allowing for the early identi fi cation of problems and promoting an improvement in the quality of treatment provided to these patients.

Who seeks public treatment for substance abuse in Brazil? Results of a multicenter study involving four Brazilian state capitals.

OBJECTIVE To assess the characteristics of alcohol and drug users who seek treatment at the Brazilian Unified Health System in Brazil. METHOD A multicenter cross-sectional study involving five clinical and research centers located in four Brazilian state capitals was conducted with 740 in- and outpatients. The only exclusion criterion was the presence of neurological or severe psychiatric symptoms at the moment of the interview. The Addiction Severity Index (ASI-6) and the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) were used to assess the severity of substance use and the problems related. RESULTS There were significantly more men than women in the sample; mean age was 36 years. The drug most frequently used at all sites was alcohol (78%), followed by cocaine/crack (51%). Alcohol was the drug that most commonly motivated treatment seeking, at all centers. ASI-6 Summary Scores for Recent Functioning (SS-Rs) were quite similar among centers. SS-Rs were compared between users who had never received treatment for psychoactive substance abuse (n = 265, 36.1%) and those who had already been treated at one or more occasions (n = 470, 63.9%). This analysis revealed significant differences between the groups in the drug, psychiatric symptoms, legal, and family/social problems areas (p < 0.05). CONCLUSION Our findings confirm previous evidence suggesting that the management of patients seeking drug abuse treatment should take several different aspects into consideration, e.g., education, employment, and family relationships, which often appear as areas of concern for these individuals.

Transtorno de estresse pós-traumático em dependente do álcool

CONTEXTO: Os transtornos comorbidos entre dependentes quimicos tem se mostrado a regra e nao a excecao. O transtorno de estresse pos-traumatico (TEPT) e um transtorno de ansiedade que se desenvolve apos evento traumatico, com importante sintomatologia. Quase 100% dos dependentes quimicos que procuram tratamento relatam historia de traumas, e as prevalencias de TEPT tem variado entre 30% e 60%. Entre os alcoolistas, as prevalencias de TEPT variam de 10% a 40%. Apesar das altas prevalencias, tais transtornos carecem de investigacao pelos clinicos. OBJETIVOS: Tem-se como objetivo relatar o caso de um alcoolista com transtorno bipolar e sintomas de TEPT ha alguns anos, cujo resultado de tratamento deveu-se ao reconhecimento da ultima comorbidade e abordagem conjunta das patologias. METODOS: Paciente masculino, 40 anos, participou em uma pesquisa do Instituto de Prevencao e Pesquisa em Alcool e outras Dependencias (IPPAD), que investiga a exposicao a eventos traumaticos e TEPT em dependentes quimicos, respondendo a varios instrumentos. Realizou entrevistas com uma das pesquisadoras visando a este relato de caso. Os resultados foram avaliados por entrevistas com o paciente e aplicacao da Davidson Trauma Scale (DTS). RESULTADOS: A DTS foi respondida por ocasiao da participacao na pesquisa e um ano apos, para avaliar resultados de tratamento. No primeiro momento, o paciente pontuou um escore total de 75 pontos e, no segundo, de 40 pontos. A melhora deveu-se ao reconhecimento do TEPT e seu tratamento com psicoterapia psicodinâmica, terapia cognitivo-comportamental e abordagem familiar como estrategias terapeuticas utilizadas. Para o tratamento psicofarmacologico foram utilizados carbonato de litio, sertralina e clonazepan. CONCLUSOES: A investigacao de traumas e TEPT deve ser rotina no atendimento de alcoolistas. O reconhecimento precoce desta comorbidade pode prevenir sua cronicidade, favorecer a aderencia e promover o tratamento adequado.

The female crack users: Higher rates of social vulnerability in Brazil

ABSTRACT Female crack users who sought treatment are a hard to find part of the population. We studied sociodemographic and behavioral characteristics of crack users undergoing treatment in psychosocial care centers for alcohol and other drugs in six Brazilian cities. We carried out a cross-sectional study of 816 crack users and collected data with the Addiction Severity Index. Women were more likely to be in vulnerable situations: had worst levels of education, were not receiving money enough to their basic needs; more likely to be HIV positive (10.1%), to report sexual abuse (34%), and to be separated from their children (20%).

Factors Associated With a Quality of Life Decrease in Alcoholic Patients Who Sought Treatment

Objective: We investigate the quality of life (QoL) of subjects with alcohol abuse/dependence, and we focus on aspects that are associated with alcohol consumption. Methods: We included inpatients and outpatients (n=174) of an addiction treatment program. All of the patients had had problems related to alcohol within the last 30 days. We used the WHOQOL-BREF to measure the patients’ QoL, and we used the ASI-6 to investigate the severity of problems related to alcohol and substance use. The main outcome measures considered for the linear regression analyses were the WHOQOL-BREF domains. The independent factors were the scores in the ASI-6 areas. Results: We found a negative correlation between the WHOQOL-BREF and the ASI-6. Significant correlations were included in the multiple linear regression pattern, which considered p<0.05 to be the cut off of statistical significance. We examined the regression analyses between the ASI-6 summary scores and the WHOQOL-BREF domains using variables that presented statistical significance in the correlation analysis. All ASI-6 problem areas showed negative correlations with domains. Conclusion: The decrease in QoL was not directly linked to the severity of alcohol use but rather with its consequences. The ASI-6 medical area was associated with a lower QoL in all of its domains. Measures of the problems related to alcohol misuse seem to be a significant predictor of QoL scores; the more often that alcohol is a problem in a patient’s life, the worse the patient’s QoL will be. Instead of treatment, other strategies should be developed to address these problem areas to not only reduce substance use but also to significantly improve the QoL of alcoholics.