Personality-related factors among incarcerated recidivist drug dealers: A path analysis.

BACKGROUND: Although drug trafficking is one of the most prevalent crimes around the world, drug dealers used to be a hard-to-reach population far away from attention by public health programmes. Decisions to participate in such instrumental crimes, however, are based on external and internal factors that could be investigated and perhaps modified. AIM: To identify drug use problems and personality factors consistently related to the drug trafficking recidivism among incarcerated drug dealers. METHOD: Data were from 179 men serving a sentence for drug trafficking in two Brazilian penitentiaries who were asked to complete mainly self-ratings of alcohol and drug use, impulsiveness, personality and criminological features. Data were analysed using descriptive statistics and structured equation modelling. RESULTS: Incarcerated recidivist drug dealers are younger, more likely to be non-white, have more frequently used illicit drugs before the penalty and have higher alcohol use-severity than non-recidivists. Neuroticism, extraversion, severity of alcohol use and drug use before the penalty were each positively correlated with recidivism. Openness to experience was not associated with a history of recidivism but, rather, positively correlated with better school achievement. One third of the men took up the offer of feedback from the research assessment. CONCLUSIONS: Our study showed that social, drug-related and personality style variables come together to allow likely recidivist drug dealers to be distinguished from those unlikely to resume dealing after imprisonment. Given scarce resources for constructive intervention, this is important. We were impressed by the men's willingness to co-operate with the study, despite their reputation for being in thrall to the drug trade hierarchy, and by their curiosity about themselves. This bodes well for further investigation of relevant psychological indicators and consequently informed intervention.

Empathy and Sexual Impulsiveness among Medical Students Who Admit to Sexting Partners' Intimate Images / Empatia e impulsividade sexual entre estudantes de medicina que enviam imagens íntimas de parceiros

INTRODUCTION: Sexting behaviors among medical students have scarcely been researched. Although there are diverse types of sexting involving the exchange of different sexual content, two scenarios will be examined here: (a) the exchange of intimate images solely between two partners; and (b) sharing intimate images exchanged between partners with others outside the relationship. : The aim of this study was to verify empathy-related differences between sexting within consensual relationships and non-consensual distribution of intimate images. : This was a cross-sectional study in which participants provided information through a self-reported questionnaire. Inventories for empathy and sexual impulsiveness and measures of sociodemographic features and sexting behaviors were applied. : This study included 202 medical students. The groups of students engaged in sexting (with or without sharing partners' intimate images) demonstrated higher sexual impulsiveness and lower personal distress than the reference group. Only the students who admitted to sharing partners' intimate images showed lower empathic concern and perspective taking than the reference group (affective and cognitive empathy, respectively). Overall, the results of this study support previous findings that individuals engaged in sexting demonstrate lower personal discomfort with their actions than people not engaged in sexting. : Despite knowing the legal consequences of the exposure of intimate images from partners or colleagues, some students seem to prefer taking this risk

INTRODUÇÃO: A prática de sexting entre estudantes de Medicina tem sido pouco estudada. Embora existam diversos tipos de comportamento envolvendo a troca de imagens sexuais, dois cenários serão examinados aqui: (a) a troca de imagens íntimas somente entre parceiros eróticos; e (b) o compartilhamento de imagens íntimas trocadas por parceiros para outras pessoas fora do relacionamento. O objetivo do estudo foi verificar diferenças empáticas entre aqueles que praticam sexting dentro de um relacionamento consensual e os que, de forma não consensual, disseminam imagens íntimas do(a) parceiro(a) para terceiros. Trata-se de um estudo transversal no qual os participantes responderam a um questionário auto-responsivo. Inventários para avaliação de empatia e impulsividade sexual, questionário sobre dados sociodemográficos e questões sobre a prática de sexting foram aplicados. Este estudo incluiu 202 estudantes de Medicina. O grupo que admitiu engajar-se em sexting, independentemente se consensualmente ou não, demonstrou maior impulsividade sexual e menor desconforto do que aqueles que negaram a prática. Apenas os estudantes que admitiram compartilhar imagens íntimas do(a) parceiro(a) mostraram menor preocupação empática (empatia afetiva) e tomada de perspectiva (empatia cognitiva) do que o grupo que negou praticar sexting. Os resultados deste estudo apoiam prévios achados em que pessoas engajadas em sexting demonstram menor desconforto pessoal com suas ações do que aqueles que não praticam. Apesar de conhecer as consequências legais de expor imagens íntimas de terceiros sem consentimento, alguns estudantes parecem preferir o risco

Prevalence and correlates of cannabis use among athletes-A systematic review.

BACKGROUND AND OBJECTIVES: Despite scientific evidence that marijuana impairs performance and mental health, there is evidence that some athletes are at higher risk for use. This review aims to identify possible risk factors associated with marijuana use in athletes. METHODS: A search was conducted in the PubMed database with the keywords: (marijuana OR cannabis OR tetrahydrocannabinol OR delta-9-tetrahydrocannabinol OR THC) AND (sports OR sport OR athlete OR athletes). We retrieved 186 studies. After applying the inclusion/exclusion criteria, 15 studies remained for review. RESULTS: The review revealed a number of potential risk factors for marijuana use among adult athletes, including being male, Caucasian, using sport performance-enhancing drugs, using marijuana to enhance recreation or non-sport performance, and practicing specific types of sports including skeleton, bobsleding, and ice hockey. Contrary to use patterns in the general population, among athletes marijuana appears to take the place of tobacco as the second most widely used drug, after alcohol. Many elite athletes denied the use of marijuana, which suggests that toxicological testing is an important tool for identifying users, because it is more accurate than self-report. Geography appears important, as in areas of high consumption, prevalence among athletes appears to be greater as well. CONCLUSION AND SCIENTIFIC SIGNIFICANCE: Contrary to the image that athletes do not use psychoactive drugs, this review suggests that a number of athletic subgroups are at increased risk for marijuana use. Surprisingly, a common rationale for use appears to be to enhance sports performance. As in the general population, experimentation starts early-in pre-adolescence-at an age that prevention and guidance programs could have positive influences. (Am J Addict 2016;25:518-528).

A validation study of the Brazilian version of the pornography consumption inventory (PCI) in a sample of female university students.

Although men constitute the widest consumer group of pornography, the Internet has facilitated both the production of and access to pornographic material by women as well. However, few measures are available to examine pornography-use constructs, which can compromise the reliability of statements regarding the harmful use of pornography. Our study aimed to confirm the factorial validity and internal consistency of the Pornography Consumption Inventory (PCI) in a sample of female university students in Brazil. The PCI is a four-factor, 15-item, five-point Likert-type scale. After translation and back-translation of the PCI, it was administered to 105 female medical students. Exploratory and confirmatory factor analyses were conducted to examine the construct validity. The results supported the four-factor model of the PCI. The model showed adequate internal reliability and good fit indices (comparative fit index (CFI) = 0.95, Tucker-Lewis index (TLI) = 0.94, root mean square error of approximation (RMSEA) = 0.07 (95% confidence interval (CI) = 0.04-0.09), and standardized root mean square residual (SRMR) = 0.08). Overall, the findings from this study support the use of the PCI in Portuguese-speaking women.

Factor Structure and Gender Stability of the Brazilian Version of the Pornography Consumption Inventory.

There are a few instruments available to measure pornograhy consumption-related constructs, and this lack of instruments can compromise the validity of research findings. The Pornography Consumption Inventory (PCI) assesses four motivations for pornography consumption, and it has been validated in hypersexual men and medical students. However, whether the psychometric properties of this instrument are comparable across genders remains unclear. Multigroup confirmatory factor analysis (MGCFA) was used to verify the invariance of the structure of the PCI across male (100) and female (105) university students. The confirmatory factor analysis (CFA) for each group showed a reasonably good fit of the data to the four-factor model. The MGCFA model included only factor loadings constrained to be equal between both genders (ΔCFI < 0.01 and p > 0.05). However, the ΔCFI did not support a strong and strict factorial invariance, ΔCFI > 0.01. Although both genders seemed to agree with the conceptualization of pornography and motivations for consuming it, the PCI was not gender-invariant, as men showed a stronger degree of motivation to consume pornographic material than women did. The implications of these findings regarding the measurement of motivations for pornography use are outlined.

A Preliminary Model of Motivation for Pornography Consumption Among Men Participating in Zoophilic Virtual Environments.

Although zoophilic blogs and websites attract the attention of zoophiles and others who are curious about this sexual activity, the motivations for consuming this type of pornography are not clear. This study aimed to confirm the factorial validity of the Pornography Consumption Inventory in an online sample of men with sexual interest in animals, and to construct an association model between motivations for pornography consumption and the following psychological variables: depression, sexual impulsiveness, and strength of sexual interest in animals. In this cross-sectional study, we located a website that catered to a network of people with a sexual interest in animals. Subsequently, a questionnaire was made available online to members of this network. Results support the 4-factor model of the Pornography Consumption Inventory. Depression and strength of sexual interest in animals were negatively and positively correlated with the sexual curiosity factor, respectively. Sexual impulsiveness was positively associated with the emotional avoidance, excitement seeking, and sexual pleasure factors. Depression and sexual impulsiveness were positively correlated. Psychological factors can differently motivate the consumption of pornography among men who visit zoophilic blogs and websites. With these preliminary data, we can identify some characteristics of this population.

Validation of the Pornography Consumption Inventory in a Sample of Male Brazilian University Students.

Few measures are available to examine pornography use constructs, and this can compromise the reliability of statements regarding harmful use of pornography. This study aimed to confirm the factorial validity and internal consistency of the Pornography Consumption Inventory in a sample of male Brazilian university students. The inventory consists of a 4-factor, 15-item, 5-point Likert-type scale. After translation and back-translation of the inventory, it was administered to 100 male medical students. An initial model that included all 15 items of the inventory showed some substandard fit indices. Therefore, another model was tested, excluding an item that had loaded onto two different factors. Goodness-of-fit indices were better for the new model. Overall, findings from this study support using the inventory on Portuguese-speaking individuals. With additional replication across populations, other settings, and treatment-seeking patients, the Pornography Consumption Inventory could also potentially be shortened to 14 items.

Psychosocial pathways to sexual dysfunction among female inmates.

Although health surveys on sexual issues during incarceration have shown that women report having engaged in sexual activities while in prison, studies on sexual functioning in female inmates have been largely dismissed. This study aimed to assess sexual functioning among incarcerated women and determine the psychometric and sociodemographic features that are possibly related to the risk of sexual dysfunction. This was a cross-sectional study conducted inside a penitentiary for women in São Paulo, Brazil. From June 2006 to June 2010, 315 inmates convicted of robbery or homicide were recruited. High risk of female sexual dysfunction (HRFSD) was measured using the Female Sexual Function Index and participants were also evaluated for alcohol and drug misuse, impulsiveness, depressive symptoms, and psychosocial features. Descriptive statistics and multivariate logistic regression were utilized to analyze the data. Among the participants, 253 (80.32 %) met the criteria for HRFSD. Older age, total time of imprisonment, and depressive symptoms were related to a higher risk, while the status of being married, being Black, having sexual relations with other inmates, and receiving conjugal visits were associated with a lower risk. As only 110 (34.92 %) inmates admitted to having sexual relationships inside prison, we evaluated this sub-sample separately. For this sub-sample, 61 (55.45 %) women met the criteria for HRFSD and the main factors associated with this risk were total time of imprisonment and depressive symptoms. Incarcerated women are uniquely vulnerable because they often have histories of deprivation and violence stemming from multiple sources and experience considerable psychological symptoms as a consequence of imprisonment. With the affected population rarely receiving psychosocial management for sexual dysfunction, service delivery efforts should be intensified to target this high-risk population.

Order of onset of drug use and criminal activities in a sample of drug-abusing women convicted of violent crimes.

INTRODUCTION AND AIMS: This study aims to explore the temporal relationship between age of onset of substance use and criminal activity in women convicted of violent crimes as well as to subdivide them into clinically significant groups to which tailored treatment can be guided. DESIGN AND METHOD: Of the 353 female inmates randomised for this study, 38 (10.8%) refused to participate and 182 (51.6%) met inclusion criteria. Data were obtained only from substance-abusing female inmates serving a sentence for robbery or homicide in a female penitentiary in Brazil. Participant information was gathered through face-to-face interviews during which alcohol and drug abuse, impulsiveness levels, depressive symptoms, and criminological aspects were investigated. RESULTS: . Age of first alcohol and drug use significantly preceded the age of onset of criminal activities in the overall sample. Onset ages of alcohol and drug use problems significantly preceded the beginning of criminal activities in women convicted of homicide only. Latent Class Analysis resulted in two groups: cluster 1 (n = 122; 67%), early-onset alcohol and drug users; and cluster 2 (n = 60; 33%), late-onset alcohol and drug users. Higher depression levels, higher incidence of committing robbery and less official history of recidivism were associated with cluster 1 inmates. DISCUSSION AND CONCLUSIONS: The temporal relationship between the onset age of alcohol/drug use problems and age of the beginning of criminal activities can set apart women convicted of robbery from those convicted of homicide. Further, a distinctive therapeutic approach to early- and late-onset offenders may be valuable.

Predictors of drug use in prison among women convicted of violent crimes.

BACKGROUND: Worldwide, some prisoners consume illicit drugs while in prison. There is now some recognition of risk factors for this among male but not female prisoners. AIM: The aim was to identify variables associated with drug use by women in prison after conviction for violent crimes. METHOD: Data were obtained from 315 women serving a sentence for robbery or homicide in the Penitentiary of Sant'Ana, São Paulo State, Brazil. Mainly self-report assessments of alcohol and drug misuse, sexual and general impulsiveness, depression, and psychosocial and criminological features were completed. Data were analysed using descriptive statistics and multivariate logistic regression. RESULTS: Thirty-five (11%) women reported illicit drug use in prison. Younger age, history of childhood sexual abuse, having committed robbery (rather than homicide), earlier onset of criminal activities, higher scores on sexual impulsiveness, drug-related problems prior to incarceration and having same-sex relationships inside prison were associated with a higher risk of using drugs in prison. In a multiple logistic regression, only prior drug history and having same-sex relationships in prison were independently associated with in-prison drug use. CONCLUSIONS: Illicit drug use in prison impairs rehabilitative goals. Identification of risk factors for this can help to recognise people with high treatment needs. We found that in-prison drug users seemed to be an exceptionally needy group, likely to have more wide ranging historical problems than their similar offending peers. It is essential to check for history of drug use outside prison. The strong association with active sexual behaviour in the prison highlighted another area of vulnerability, requiring sensitive in-prison attention to safeguard these women. Further research to understand the reasons for this relationship is recommended.

Substance misuse subtypes among women convicted of homicide.

BACKGROUND: The proportion of women incarcerated is growing at a faster pace than that for men. The reasons for this important increase have been mainly attributed to drug-using lifestyle and drug-related offenses. About half of female inmates have history of substance misuse and one third demonstrate high impulsiveness levels. The objectives of this study were to (a) identify subtypes of alcohol and drug problems and impulsiveness among women convicted of homicide, and (b) examine the association between psychosocial and criminological features and the resulting clusters. METHODS: Data come from 158 female inmates serving a sentence for homicide in the Penitentiary of Sant'Ana in São Paulo State, Brazil. Latent class analysis was used to group participants into substance misuse and impulsiveness classes. RESULTS: Two classes were identified: nonproblematic (cluster 1: 54.53%, n = 86) and problematic (cluster 2: 45.57%, n = 72) ones. After controlling for several psychosocial and criminological variables, cluster 2 inmates showed an earlier beginning of criminal activities and a lower educational level than their counterparts. CONCLUSIONS: To recognize the necessities of specific groups of female offenders is crucial for the development of an adequate system of health politics and for the decrease of criminal recidivism among those offenders who have shown higher risk.

A pilot study of full-dose ondansetron to treat heavy-drinking men withdrawing from alcohol in Brazil.

Ondansetron has emerged as a promising medication for the treatment of alcohol dependence, mainly among early-onset alcoholics. This research primarily aimed to evaluate the efficacy and safety of ondansetron at a 16mg/day dosage to treat alcohol-dependent outpatients. A double-blind, placebo-controlled, 12-week study was carried out at the University of São Paulo, Brazil. The total sample comprised 102 men, 18-60 years of age, with an International Classification of Diseases (ICD-10) diagnosis of alcohol dependence. Half of our sample discontinued the treatment and the main outcome measures (proportion of abstinent days and proportion of heavy drinking days) were analyzed using the treatment adherents as well as with an imputed sample. The main factors associated with treatment retention were older age and smoking status. Although there were no significant differences between the main outcome measures of both medication groups in the adherents, ondansetron demonstrated a slight but significant superiority over the placebo regarding the proportion of heavy drinking days in the imputed sample (7.8% versus 11.7%, respectively). It appears that the optimal dosage to treat alcoholism has yet to be determined. Further, ondansetron may only be useful in treating some types of alcoholics. Ondansetron was well tolerated and no serious adverse events were registered.

Psychosocial and clinical predictors of retention in outpatient alcoholism treatment / Preditores psicossociais e clínicos de retenção ao tratamento para alcoolismo

OBJECTIVE: One of the factors associated with low rates of compliance in the treatment for alcoholism seems to be the intensity of craving for alcohol. This study aimed to evaluate the associations between alcohol craving and biopsychosocial addiction model-related variables and to verify whether these variables could predict treatment retention. METHODS: The sample consisted of 257 male alcoholics who were enrolled in two different pharmacological trials conducted at the Universidade de São Paulo in Brazil. Based on four factors measured at baseline - biological (age, race, and family alcoholism), psychiatric (depression symptoms), social (financial and marital status), and addiction (craving intensity, severity of alcohol dependence, smoking status, drinking history, preferential beverage, daily intake of alcohol before treatment) - direct logistic regression was performed to analyze these factors' influence on treatment retention after controlling for medication groups and AA attendance. RESULTS: Increasing age, participation in Alcoholics Anonymous groups, and beer preference among drinkers were independently associated with higher treatment retention. Conversely, higher scores for depression increased dropout rates. CONCLUSION: Health services should identify the treatment practices and therapists that improve retention. Information about patients' characteristics linked to dropouts should be studied to render treatment programs more responsive and attractive, combining pharmacological agents with more intensive and diversified psychosocial interventions.

OBJETIVO: Um dos fatores associados com baixas taxas de adesão ao tratamento para alcoolismo parece ser a intensidade da fissura pelo álcool. Este estudo objetiva avaliar a associação entre a fissura pelo álcool e variáveis relacionadas ao modelo biopsicossocial de dependência, bem como verificar se estas variáveis prevêem retenção ao tratamento. MÉTODO: A amostra foi composta por 257 homens dependentes de álcool que participaram de dois diferentes estudos clínicos que foram desenvolvidos na Universidade de São Paulo, Brasil. Baseado em quatro fatores medidos no início do tratamento - biológico (idade, raça e alcoolismo familiar), psiquiátrico (sintomas depressivos), social (condição econômica e status marital) e relacionado à dependência (intensidade da fissura, gravidade da dependência do álcool, status de ser fumante, tempo de consumo regular e problemático de bebidas alcoólicas, bebida preferencial, quantidade de etanol consumido ao dia) - um modelo de regressão logística direta foi desenvolvido para analisar o efeito destas variáveis sobre a retenção ao tratamento, controlando para a influência das medicações utilizadas e da participação em grupos de alcoólicos anônimos. RESULTADOS: Mais idade, participação em grupos de alcoólicos anônimos e preferência por cerveja foram fatores independentemente associados a maior retenção ao tratamento. Maior escore em depressão aumentou a chance de abandono. CONCLUSÃO: Serviços de saúde devem identificar práticas e profissionais que proporcionem melhora nas taxas de retenção. Informação sobre as características dos pacientes relacionadas ao abandono devem ser usadas para tornar programas de tratamento mais eficientes e atraentes, combinando agentes farmacológicos com mais intensivas e diversificadas intervenções psicossociais.

Criminal career-related factors among female robbers in the state of São Paulo, Brazil, and a presumed 'revolving-door' situation.

INTRODUCTION: Risk-taking behaviors, family criminality, poverty, and poor parenting have been frequently associated with an earlier onset of criminal activities and a longer criminal career among male convicts. OBJECTIVE: This study aims to identify factors related to the onset and recurrence of criminal behavior among female robbers in the State of São Paulo - Brazil. METHOD: It was a cross-sectional study carried out inside a feminine penitentiary in São Paulo. From June 2006 to June 2010, 175 inmates convicted only for robbery were recruited to be evaluated about family antecedents of criminal conviction, alcohol and drug misuse, impulsiveness, depressive symptoms, and psychosocial features. RESULTS Having family antecedents of criminal conviction consistently predicted an earlier onset of criminal activities and a longer criminal career among female robbers. Drug use in youth and the severity of drug misuse were significantly related to the initiation and recurrence of criminal behavior, respectively. DISCUSSION: Prisons must systematically screen detainees and provide treatments for those with health problems in general. Children of inmates should obtain help to modify the negative consequences of their parents' incarceration in order to mitigate the negative consequences of pursuing this 'static' factor.

Criminal career-related factors among female robbers in the state of São Paulo, Brazil, and a presumed 'revolving-door' situation / Fatores relacionados à carreira criminal em mulheres condenadas por roubo no estado de São Paulo, Brasil, e uma situação presumível de "porta giratória"

INTRODUCTION: Risk-taking behaviors, family criminality, poverty, and poor parenting have been frequently associated with an earlier onset of criminal activities and a longer criminal career among male convicts. OBJECTIVE: This study aims to identify factors related to the onset and recurrence of criminal behavior among female robbers in the State of São Paulo - Brazil. METHOD: It was a cross-sectional study carried out inside a feminine penitentiary in São Paulo. From June 2006 to June 2010, 175 inmates convicted only for robbery were recruited to be evaluated about family antecedents of criminal conviction, alcohol and drug misuse, impulsiveness, depressive symptoms, and psychosocial features. RESULTS Having family antecedents of criminal conviction consistently predicted an earlier onset of criminal activities and a longer criminal career among female robbers. Drug use in youth and the severity of drug misuse were significantly related to the initiation and recurrence of criminal behavior, respectively. DISCUSSION: Prisons must systematically screen detainees and provide treatments for those with health problems in general. Children of inmates should obtain help to modify the negative consequences of their parents' incarceration in order to mitigate the negative consequences of pursuing this 'static' factor.

INTRODUÇÃO:Comportamentos de correr riscos, criminalidade familiar, pobreza e pais inadequados foram frequentemente associados a um início mais precoce de atividades criminais e a uma carreira criminal mais longa em presos do sexo masculino. OBJETIVO:Esse estudo visa identificar os fatores relacionados ao início e à recorrência do comportamento criminal em mulheres assaltantes no estado de São Paulo, Brasil. MÉTODO: Este foi um estudo em corte transversal realizado dentro de uma penitenciária feminina em São Paulo. De junho de 2006 a junho de 2010, 175 internas condenadas apenas por roubo foram recrutadas para avaliação quanto a antecedentes familiares de condenação por crimes, uso inadequado de drogas e álcool, impulsividade, sintomas depressivos e características psicossociais. RESULTADOS: Ter antecedentes familiares de condenação por crimes predisse consistentemente um início mais precoce de atividades criminais e uma carreira criminal mais longa em mulheres assaltantes. O uso de drogas na juventude e a gravidade do uso de drogas estavam significativamente relacionados respectivamente ao início e à recorrência do comportamento criminal. DISCUSSÃO: As prisões deveriam avaliar sistematicamente os presos e proporcionar tratamento para aqueles com problemas de saúde em geral. Os filhos dos internos deveriam obter ajuda para modificar as consequências do encarceramento de seus pais e reduzir as consequências negativas da evolução desse fator 'estático.'.

Role of two clusters of male alcoholics in treatment retention.

AIMS: This study aimed to classify alcohol-dependent outpatients on the basis of clinical factors and to verify if the resulting types show different treatment retention. METHODS: The sample comprised 332 alcoholics that were enrolled in three different pharmacological trials carried out at São Paulo University, Brazil. Based on four clinical factors - problem drinking onset age, familial alcoholism, alcohol dependence severity, and depression - K-means cluster analysis was performed by using the average silhouette width to determine the number of clusters. A direct logistic regression was performed to analyze the influence of clusters, medication groups, and Alcoholics Anonymous (AA) attendance in treatment retention. RESULTS: Two clusters were delineated. The cluster characterized by earlier onset age, more familial alcoholism, higher alcoholism severity, and less depression symptoms showed a higher chance of discontinuing the treatment, independently of medications used and AA attendance. Participation in AA was significantly related to treatment retention. DISCUSSION: Health services should broaden the scope of services offered to meet heterogeneous needs of clients, and identify treatment practices and therapists which improve retention. Information about patients' characteristics linked to dropout should be used to make treatment programs more responsive and attractive, combining pharmacological agents with more intensive and diversified psychosocial interventions.

Psychosocial and clinical predictors of retention in outpatient alcoholism treatment.

OBJECTIVE: One of the factors associated with low rates of compliance in the treatment for alcoholism seems to be the intensity of craving for alcohol. This study aimed to evaluate the associations between alcohol craving and biopsychosocial addiction model-related variables and to verify whether these variables could predict treatment retention. METHODS: The sample consisted of 257 male alcoholics who were enrolled in two different pharmacological trials conducted at the Universidade de São Paulo in Brazil. Based on four factors measured at baseline - biological (age, race, and family alcoholism), psychiatric (depression symptoms), social (financial and marital status), and addiction (craving intensity, severity of alcohol dependence, smoking status, drinking history, preferential beverage, daily intake of alcohol before treatment) - direct logistic regression was performed to analyze these factors' influence on treatment retention after controlling for medication groups and AA attendance. RESULTS: Increasing age, participation in Alcoholics Anonymous groups, and beer preference among drinkers were independently associated with higher treatment retention. Conversely, higher scores for depression increased dropout rates. CONCLUSION: Health services should identify the treatment practices and therapists that improve retention. Information about patients' characteristics linked to dropouts should be studied to render treatment programs more responsive and attractive, combining pharmacological agents with more intensive and diversified psychosocial interventions.

A psychosocial study of male-to-female transgendered and male hustler sex workers in São Paulo, Brazil.

This study examined sociodemographic variables, personality characteristics, and alcohol and drug misuse among male sex workers in the city of Santo André, São Paulo, Brazil. A total of 45 male-to-female transgender sex workers and 41 male hustlers were evaluated in face-to-face interviews at their place of work from 2008 to 2010. A "snowball" sampling procedure was used to access this hard-to-reach population. Male-to-female transgender sex workers reported fewer conventional job opportunities, fewer school problems, and higher harm avoidance and depression levels than male hustlers. Also, transgender sex workers reported earning more money through sex work and more frequently living in hostels with peers than their counterparts. As biological male sex workers are a heterogeneous population, attempts to classify them into distinctive groups should be further carried out as a way to better understand and identify their behavior, design effective health interventions, and consequently minimize the likelihood of unintended adverse outcomes. Our study showed that gender performance can be an important variable to be considered by researchers and policy makers when working with sex workers and developing HIV/AIDS prevention and public health programs, given that transgender and male sex workers not only display distinctive behavior and physical appearance but also reveal differences on specific psychological measures, such as personality traits and depression levels. We recommend that counselors working with this population strike a balance between facilitating self-disclosure and establishing more evidence-based directive interventions.

Ethical conflicts over the management of transsexual adolescents--report of two cases.

INTRODUCTION: The diagnosis and the treatment of transsexualism, particularly during adolescence, generate considerable discussion among specialists. Many health and legal professionals have not yet reached a strong consensus on medical treatment for juvenile transsexuals. Hormonal therapy cannot only represent a medical procedure to adjust the somatic sex to the psychological gender, but can also be a reasonable means of preventing some juvenile transsexuals from engaging in undesirable and risky behavior. AIM: To report the cases of two transsexual adolescents who resorted to prostitution to afford hormonal medications when treatment was denied because of age criteria. RESULTS: Hormonal medications were not recommended by the endocrinology staff because specific laws regulating this medical procedure for juvenile transsexuals in Brazil are lacking. In response, these adolescents chose to use illegally obtained sex hormones to treat themselves. CONCLUSIONS: We propose "harm reduction" as a means of coping with this dilemma in some cases.

Effects of topiramate or naltrexone on tobacco use among male alcohol-dependent outpatients.

BACKGROUND: A high smoking prevalence has been registered among alcoholics. It has been pointed out that alcoholic smokers may have a more severe course and greater severity of alcoholism. This study aims at comparing smoking and non-smoking alcoholics in terms of treatment outcomes and verifying the efficacy of topiramate and naltrexone to decrease the use of cigarettes among alcoholic smokers. METHODS: The investigation was a double-blind, placebo-controlled, 12-week study carried out at the University of São Paulo, Brazil. The sample comprised 155 male alcohol-dependent outpatients (52 non-smokers and 103 smokers), 18-60 years of age, with an International Classification of Diseases (ICD-10) diagnosis of alcohol dependence. After a 1-week detoxification period, the patients randomly received placebo, naltrexone (50mg/day) or topiramate (up to 300 mg/day). Only the alcoholic smokers who adhered to the treatment were evaluated with reference to the smoking reduction. RESULTS: Cox regression analysis revealed that the smoking status among alcoholics increased the odds of relapse into drinking by 65%, independently of the medications prescribed, using the intention-to-treat method. Topiramate showed effectiveness to reduce the number of cigarettes smoked when compared to placebo among adherent patients (mean difference=7.91, p<0.01). There were no significant differences between the naltrexone group and the placebo group. CONCLUSIONS: The results of this study confirm that the treatment is more challenging for smoking alcoholics than for non-smoking ones and support the efficacy of topiramate in the smoking reduction among male alcoholic smokers who adhered to the treatment.