Silvia Chwartzmann Halpern

Limites e alternativas para a implementação de um programa para dependentes químicos em risco para infecção pelo HIV utilizando o conceito de Rede Social

Os autores descrevem as etapas de execucao de um programa de acoes preventivas para usuarios de drogas sob risco de infeccao pelo virus da imunodeficiencia humana (HIV), utilizando como paradigma de intervencao um modelo de abordagem de redes sociais. Sao descritos os passos de instalacao do projeto dentro de um grande hospital universitario do sul do Brasil, com enfase nos metodos e tecnicas originais desenvolvidos pela equipe de atendimento. As dificuldades de implementacao do projeto sao discutidas ao longo das secoes, buscando identificar os motivos pelos quais o programa obteve exito apenas parcial. Os autores destacam alguns pontos criticos, tais como a utilizacao de uma tecnica ainda nao difundida em nosso meio, a dificuldade de reter em tratamento usuarios de drogas injetaveis, a falta de estrutura para atendimentos imediatos, e as dificuldades em motivar equipes e pacientes para o tratamento. Ao final do texto, sao feitas sugestoes com o objetivo de facilitar o desenvolvimento de novos projetos que busquem utilizar o mesmo modelo conceitual.The authors describe the development of a preventive program focused on intravenous drug users at risk of HIV infection using the Social Network Approach as the intervention model. The authors describe the project’s steps in a large university hospital in southern Brazil emphasizing the unique methods and techniques developed by the treatment staff. Problems encountered during the project development are discussed aimed at identifying the reasons why the program only achieved partial success. The authors identify critical issues such as the use of a new technique not previously tried in Brazil difficulties in maintaining IV drug users in treatment lack of infrastructure for walk-in treatment and the challenge of motivating staff and patients to continue treatment. The authors conclude by listing suggestions aimed at facilitating the development of new projects based on the same conceptual model. (authors)

Childhood Trauma and Resilience: Vulnerabilities to Develop Crack/CocaineDependence

Background: Crack cocaine dependence is a health problem of epidemic proportions and there is lack of evidence concerning vulnerability factors that could lead to crack cocaine use. The aim of this study is to investigate characteristics of resilience in a group of crack cocaine users and its association with childhood trauma and PTSD. Method: This is a case-control study in which we evaluated 218 crack cocaine inpatients users and 215 healthy controls, recruited from the capital city of the southern State of Brazil. Childhood Trauma was evaluated with the Childhood Trauma Questionnaire; resilience was evaluated with the Resilience Scale; and post-traumatic stress disorder (PTSD) was evaluated with the Mini-International Neuropsychiatric Interview. Results: Childhood trauma was significantly higher among crack cocaine users in all trauma domains (p<0.001), except for sexual abuse. Most resilience scores was lower among crack cocaine users (p<0.01). Having higher scores of childhood trauma and lower scores of resilience increase the odds to become a crack cocaine user (p<0.001), despite the diagnosis of PTSD. Discussion: Childhood trauma appears to be a risk factor to become a crack cocaine user while resilience features may be a protection factor. To understand factors of vulnerabilities in this population is important for the development of more efficacious treatment and preventive strategies.

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.