Lazer no tratamento da adicção de substâncias psicoativas / Leisure in the treatment of psychoactive substance addition

O trabalho objetiva conhecer como profissionais de equipe multidisciplinar se utilizam do lazer para tratamento e (re)educação de pessoas com transtornos por uso de subtâncias psicoativas. Ocorreu estudo de caso, no Hotel Fazenda e Clínica X, onde participaram de entrevistas semiestruturadas trabalhadores de diversas especialidades. Artigos selecionados em quatro revistas de envergadura nacional estruturadas por universidades federais no Brasil ­ Licere (UFMG); RBEL(UFMG); Motrivivência (UFSC) e Movimento(UFRGS) ­ auxiliaram nas reflexões realizadas, além de autores clássicos que tratam de lazer, drogas e educação não formal. Restou evidenciado que o lazer ocupa função de destaque no tratamento da adicção de psicoativos porque viabiliza socialização e mudança positiva de comportamento das pessoas em tratamento; contribui ao autocuidado e controle da ansiedade dentre outros.

The objective of this work is to know how professionals from a multidisciplinary team use leisure for the treatment and (re)education of people with disorders due to the use of psychoactive substances. A case study took place at Hotel Fazenda and Clínica X, where workers from different specialties participated in semistructured interviews. Articles selected in four magazines of national scale structured by federal universities in Brazil ­ Licere (UFMG); RBEL(UFMG); Motrivivência (UFSC) and Movimento (UFRGS) ­ helped in the reflections carried out, in addition to classic authors who deal with leisure, drugs and non-formal education. It remained evident that leisure occupies a prominent role in the treatment of psychoactive addiction because it enables socialization and a positive change in the behavior of people undergoing treatment; contributes to self-care and anxiety control, among others.

An analytical study of iboga alkaloids contained in Tabernanthe iboga-derived products offered by ibogaine treatment providers

Abstract Background Therapeutic properties of ibogaine in the treatment of addiction are attracting both clinicians and patients to its use. Since ibogaine is not an authorized medicine, the quality of these products is not always known, increasing the probability of adverse reactions. Objective This study collects different types of iboga-derived samples from treatment providers, vendors and online buyers to analyse their content. Methods Analysis of iboga products (n = 16) was performed using gas chromatography and mass spectrometry methods (GC/MS). Products included Iboga root bark, Total Alkaloids (TA), Purified Total Alkaloids (PTA HCl), ibogaine hydrochloride (ibogaine HCl) and one Voacanga africana root bark. Results The content of ibogaine was highly variable, ranging from 0.6% to 11.2% for products sold as iboga root bark, from 8.2% to 32.9% for products sold as TA, 73.7% for one sample sold as PTA and from 61.5% to 73.4% for products sold as ibogaine HCl. One sample did not show any iboga alkaloids. Other alkaloids and unknown substances were found in almost all samples. Discussion The purity of iboga products is highly variable. These results should be taken into consideration by suppliers and users, especially regarding correct dosing to avoid overdose, as well as potential interactions with other substances.

Analysis of psychiatrists' prescription of opioid, benzodiazepine, and buprenorphine in Medicare Part D in the United States

Abstract Introduction The opioid epidemic is a severe problem in the world, especially in the United States, where prescription opioid overdose accounts for a quarter of drug overdose deaths. Objective To describe psychiatrists' prescription of opioid, benzodiazepine, and buprenorphine in the United States. Methods We conducted a retrospective cross-sectional study of the 2016 Medicare Part D claims data and analyzed psychiatrists' prescriptions of: 1) opioids; 2) benzodiazepines, whose concurrent prescription with opioids can cause overdose death; 3) buprenorphine, a partial opioid agonist for treating opioid addiction; 4) and naltrexone microsphere, a once-monthly injectable opioid antagonist to prevent relapse to opioid dependence. Prescribers with 11 or more claims were included in the analysis. Results In Medicare Part D in 2016, there were a total of 1,131,550 prescribers accounting for 1,480,972,766 total prescriptions and 78,145,305 opioid prescriptions, including 25,528 psychiatrists (2.6% of all prescribers) accounting for 44,684,504 total prescriptions (3.0% of all prescriptions) and 131,115 opioid prescriptions (0.2% of all opioid prescriptions). Psychiatrists accounted for 17.3% of benzodiazepine, 16.3% of buprenorphine, and 33.4% of naltrexone microsphere prescriptions. The opioid prescription rate of psychiatrists was much lower than that of all prescribers (0.3 vs 5.3%). The buprenorphine prescription rate of psychiatrists was much higher than that of all prescribers (2.3 vs. 0.1%). There was a substantial geographical variation across the United States. Conclusions The results show that, proportionally, psychiatrists have lower rates of opioid prescription and higher rates of benzodiazepine and buprenorphine prescription.

Ayahuasca en el tratamiento de adicciones: Estudio de cuatro casos tratados en IDEAA, desde una perspectiva interdisciplinaria / Ayahuasca in the treatment of addictions: Study of four cases treated in IDEAA, using an interdisciplinary perspective

La ayahuasca es una sustancia psicoactiva de origen amazónico, usada tradicionalmente con fines espirituales, médicos y religiosos. En la década de los ‘90 adquiere gran popularidad, tanto a través de las redes internacionales de espiritualidad y religiosidad, como en el denominado renacimiento de los estudios psicodélicos, donde se retoma la investigación y experimentación sobre los posibles usos clínicos de estas sustancias. El presente artículo tiene como objetivo la descripción y análisis de los procesos de cura de cuatro casos de adicciones tratados en el Instituto de Etnopsicología Amazónica Aplicada (IDEAA), un centro dedicado al tratamiento de adicciones, con pacientes españoles llevados al Amazonas de Brasil. El procedimiento ha implicado una metodología cualitativa del tipo biográfica, bajo una mirada interdisciplinaria que integra enfoques cognitivos y culturales. En los resultados, se describen el proceso de intervención utilizado en el centro y las narrativas biográficas de los casos estudiados. Se realiza una descripción de los distintos tipos de experiencias recurrentes durante los rituales de ayahuasca: revisiones biográficas, insights psicológicos, experiencias emocionales y/o trascendentales. Se analiza la importancia de la memoria de la experiencia, en tanto disparadora de nuevas reconfiguraciones en las narrativas biográficas de los sujetos, mostrándose la centralidad de dicha dinámica en el proceso terapéutico. Se analizan otros mecanismos específicos interviniendo en el proceso de cura de cada caso: psicosomáticos, simbólicos, de cognición social y psiconeuroinmunológicos. Se concluye sobre la relevancia terapéutica del contexto ritual, social y cultural, así como de las estrategias de integración de la memoria de la experiencia en las narrativas biográficas de los sujetos.

Ayahuasca is an Amazon psychoactive compound traditionally used for spiritual, religious, and medical purposes. In the 1990s the brew gains popularity, both through the transnational networks of religiosity/spirituality and the renaissance of psychedelic studies, where these kinds of substances are investigated for its possible clinical applications. The goal of the current article is to describe and analyze the therapeutic process of four cases from IDEAA, a center located in the Brazilian Amazon forest, dedicated to the treatment of addicts taken from Spain. An interdisciplinary perspective is proposed, combining cognitive and cultural insights from different fields (medical anthropology, cognitive science of religion, psychoneuroimmunology, qualitative sociology, cultural psychology). Ritual of ayahuasca will be considered as a way of producing a variety of experiences, and the memories of these experiences as ways of producing new biographic narratives. Biographic narratives are considered as a higher mental competence that includes functions related to self-knowledge, episodic memory, reflexivity, and psychosocial homeostasis. Under the appropriate set & setting, this process of narrative reconstruction helps the individual to cope with difficult situations, including addictions. The procedure used in this research consisted in a qualitative biographic methodology. The four cases described were treated in the period between 2000 and 2007. They started as poly drug users in the 1980s, at the end of the dictatorship period, when heroin made its entrance to Spain. The results describe the process of intervention used in the center, and the biographic narratives of each case. Most common types of experiences are mentioned: biographical revisions, psychological insights, emotional and transcendental experiences. Specific therapeutic mechanisms are also described. In the first case, a psychosomatic style of expression, where the subject describes strong embodied experiences of suffering his illnesses, and embodied expressions of coping with them. In the second case, a therapeutic process that includes the recognition of the former biographic narrative as a “lie”, and a symbolic way of producing new narratives of the self that spins around the presence of the jaguar. This animal acted as symbolic figure that triggered different meanings, useful for there covery of the patient. The third case is a subject who was involved in drug traffic, robberies, and violent activities. Experiences related to social cognition (e.g. empathy, shame, self-forgiveness) played a major role in his therapeutic process. Last, the narrative of a woman addicted to heroin is analyzed. Biographical remembrances and self-forgiveness played an importantrole, but also her symbolic experiences with the proximity of death, related to her medical conditions (addiction to heroin, hepatitis C, HIV). The case is also a good example of how the treatment had a positive psychoneuroimmunology impact in the HIV viral load of the patient. As we will analyze, the effect cannot be explained by ayahuasca itself (in fact, the scientific literature suggest a negative or neutral impact), but by the therapeutic strategy as a whole, with its various components. The article concludes addressing the importance of the “memory of the experience” of the ritual as catalyzer of new meanings in the biographic narratives of the patients. The new narratives can be considered assystem for self-regulation in the different, psychological, social, and cultural levels. Besides, it can also triggers different top-down psychoneuroimmunology and psychosomatic effects. The production of new narratives is related to what is usually called “integration”, and involves different psychological, social and cultural elements that are of great importance for a positive or negative therapeutic outcome.

Conceptions and practices of an integrative treatment for substance use disorders involving Amazonian medicine: traditional healers' perspectives

Objective: The harmful use of psychoactive substances represents one of today's largest public health problems. Yet, in spite of its global relevance, current treatment for substance use disorders (SUDs) is still not entirely successful. The purpose of this study was to investigate alternative treatments and conceptions from traditional Amazonian medicine adapted to SUDs. Methods: We conducted semi-structured interviews with 13 practicing experts at a well-established addiction treatment center in the Peruvian Amazon and performed qualitative content analysis on the collected data. Main categories were deductively defined and corresponding subcategories inductively developed. Results: Our findings revealed characteristic features and consequences, causes and antecedents, and treatment methods of SUDs as the main categories. Overall, concepts of disease etiology bore resemblance with contemporary biopsychosocial models of SUDs. The Amazonian therapeutic means however differed markedly from current Western ones. The main methods involved dietary retreats, healing ceremonies, and purging rituals. The integral application of Amazonian methods, as well as their traditional implementation according to prescribed ritual protocols, were emphasized by the experts as crucial for efficacy and safety of treatment delivery. Conclusion: We suggest further scientific attention to these therapies, including clinical studies, for which our results provide conceptual underpinnings. Findings from this research expand the cross-cultural understanding of SUDs and, in the long run, may enhance its treatment options.

Impacto del apoyo familiar en la adherencia terapéutica de los pacientes hipertensos / Impact of family support on the therapeutic adherence of hypertensive patients", "_i": "

La hipertensión arterial es un problema de salud pública a nivelmundial, una de sus causas radica en la baja adhesión altratamiento. Se desea conocer si existe asociación entre adherenciaterapéutica y apoyo familiar en personas hipertensas.Se realizó un estudio descriptivo, transversal, correlacionalaplicado a personas hipertensas de la consulta externa del InstitutoNacional de Cardiología Ignacio Chávez (INCICH). Seaplicaron los Instrumentos para medir el estilo de vida (IMEVID)(α = 0.81) y la Escala de Efectividad en el Funcionamiento Familiar(E-EFF), (α = 0 .83). El α del instrumento fue de 0.82.Se observó que la mayoría tienen más de 55 años, son casadosy padecen hipertensión arterial desde hace más de 30 años.Más de la tercera parte combina medicamentos, ejercicio y dietapara controlar su enfermedad, pero algunos utilizan sólomedicamentos. Asimismo, el 46.7% tiene un nivel socioeconó-mico bajo y el 33.3% sólo tienen primaria. El 73% de la poblacióntiene alta adherencia terapéutica y el 63.3% alto apoyo familiar.La r de Spearman obtenida para estas variables fue de0.643 (p = 0.000). No existe ninguna asociación entre las variablesdemográficas y la adherencia terapéutica. El apoyo familiares un factor importante para el éxito del tratamiento,destacando que ni las cuestiones económicas, edad, nivel académicoo estado civil actúan como limitantes para ello.

Hypertension is a public health problem worldwide, a causelies in the low adherence to treatment. You want to know ifthere is an association between therapeutic adherence and familysupport in hypertensive persons. We performed a descriptive,cross-correlation applied to hypertensive individualsin the outpatient LTD. IMEVID instruments wereapplied (α = 0.81) and E-EFF (α = 0 .83). The α instrumentwas 0.82. It was noted that most are over 55 years, are marriedand have high blood pressure for over 30 years. Morethan a third of combining medications, exercise and diet tocontrol their disease, but some use only medicines. Also,46.7% have a low socioeconomic level and 33.3% have onlyprimary education. 73% of the population has high adhesiontherapy and 63.3% high family support. Spearman’s r for thesevariables was obtained from 0,643 (p = 0.000). There is noassociation between demographic variables and therapeuticadherence. Family support is an important factor in treatmentsuccess, noting that neither the economic, age, educationallevel and marital status act as constraints for this.