Investigation of factors associated with low adherence to treatment of codependency in family members of psychoactive substance users / Investigação de fatores associados à baixa adesão ao tratamento da codependência de familiares de usuários de substâncias psicoativas

The aim of this study was to investigate possible factors that prevent adherence to the treatment of codependent family members of problem drug use individuals. A quasi-experimental study was carried out with 133 relatives of psychoactive substances users who called the Brazilian drug hotline (Ligue 132) between 2013 and 2015, from the five regions of Brazil. The following instruments were used: General service protocol; Family assistance protocol; Holyoake Codependency Index; Behavioral Adherence Scale; and Adherence Factor Questionnaire. Univariate analysis of data was performed for categorical variables and Chi-square test for comparison between variables, with p < 0.05. The sample showed a predominance of women (91.7%), especially mothers (82.7%). Among the investigated factors, alcohol as the substance involved in the problem showed a significant association with the non-adherence to treatment through teleintervention of family members.

O objetivo deste estudo foi investigar possíveis fatores impeditivos da adesão de familiares codependentes a um tratamento. Realizou-se um estudo quase experimental com 133 familiares de usuários de substâncias psicoativas que ligaram para o Ligue 132 no período de 2013 a 2015, sendo que a amostra tem representantes das 5 regiões do Brasil. Os instrumentos utilizados foram: Protocolo geral de atendimento; Protocolo de atendimento ao familiar; Holyoake Codependency Index; Escala de Adesão Comportamental e Questionário de Fatores sobre Adesão. Foram realizadas análises univariadas dos dados para as variáveis categóricas e teste Qui-quadrado para comparação entre as variáveis, p < 0,05. A amostra apresentou o predomínio de mulheres (91,7%) entre os familiares que buscaram ajuda, em especial de mães (82,7%). Dentre os fatores investigados, notou-se que o álcool, entre as substâncias utilizadas pelos usuários, apresentou associação significativa com a não adesão dos familiares a tele intervenção.

Characteristics of Brazilian women affected by a substance misusing relative.

As in many other health disorders, people who misuse substances tend to be assisted by female caregivers. Despite this, little is known about the characteristics of women affected by a substance misusing relative (SMR). Data from 2541 Brazilian female affected family members (AFM) were analyzed. The majority of participants were mothers, age 45 or above, in a relationship, responsible for the substance use treatment of the SMR, and were related to a male SMR. High levels of physical and psychological symptoms were associated with socioeconomic status, mothers, responsibility for the SMR's treatment, cocaine and crack-cocaine as substance of the preference of the SMR, and financial contraints as reasons for the delay to seeking help. Findings demonstrate the complex social systems associated with female AFMs and the need of gender sensitive approaches to address the AFM's coping responses to the substance misuse problem in the family.

Six-Month Outcomes of a Randomized, Motivational Tele-intervention for Change in the Codependent Behavior of Family Members of Drug Users.

Families of substance abusers may develop maladaptive strategies, such as codependency, to address drug-related problems. It is important for families to receive specialist treatment in order to contribute to the recovery process. The Tele-intervention Model and Monitoring of Families of Drug Users (TMMFDU), based on motivational interviewing and stages of change, aims to encourage the family to change the codependents' behaviors. A randomized clinical trial was carried out to verify the change in codependent behavior after intervention with 6 months of follow-up. Three hundred and twenty-five families with high or low codependency scores were randomized into the intervention group (n = 163) or the usual treatment (UT) (n = 162). After 6 months of follow-up, the family members of the TMMFDU group were twice as likely to modify their codependency behavior when compared to the UT group (OR 2.08 CI 95% 1.18-3.65). TMMFDU proved to be effective in changing codependent behaviors among compliant family members of drug users.

As percepções de um usuário de substâncias psicoativas em abstinência sobre os motivos de recaída: um estudo de caso / The perceptions of a user of abstinence psychoactive substances on the reasons for relapse: a case study

Prevenção da recaída é a manutenção do processo de mudança de hábitos e automanejo. Tem como objetivo ensinar o indivíduo a lidar com seu problema e prever uma possível recaída, além disso se refere a mudança de qualquer comportamento relacionado ao problema. O objetivo deste estudo foi identificar de acordo com as percepções de um usuário em abstinência quais foram os motivos de recaída no consumo de substâncias psicoativas. Foi realizada uma pesquisa qualitativa por meio de um estudo de caso em uma instituição de apoio. A análise dos dados foi conduzida por análise de conteúdo que originou 5 categorias. Dentre elas, percepções dos motivos de recaída, a combinação de fatores de risco e proteção se mesclaram para os problemas apresentados por Gabriel e também para as resiliências que foram emergindo ao longo do percurso de vida. O processo de recuperação requer aprendizagem e manejo das adversidades que ocorrem em função dos TRSA. Neste estudo de caso, pode-se perceber que G. não se coloca em situações de risco no momento atual, pois aprimorou seus recursos de autoconhecimento e assertividade, dentre elas as estratégias de prevenção de recaída.(AU)

Preventing relapse is the maintenance of the process of changing habits and self management. It aims to teach the individual to deal with their problem and predict a possible relapse, in addition it refers to changing any behavior related to the problem. The objective of this study was to identify according to the perceptions of a user in abstinence what were the reasons for relapse in the consumption of psychoactive substances. A qualitative research was carried out by means of a case study in a support institution. The analysis of the data was conducted by content analysis that originated 5 categories. Among them, perceptions of the reasons for relapse. The combination of risk and protection factors blended into the problems presented by Gabriel and also to the resiliencies that have emerged along the course of life. The recovery process requires learning and managing the adversities that occur due to TRSA. In this case study, one can see that G. does not place himself in situations of risk at the present moment, since he has improved his resources of self-knowledge and assertiveness, among them the relapse prevention strategies.(AU)

Fatores de risco para episódios e sintomas depressivos em usuários de álcool e/ou cocaína / Risk factors for depressive episodes and symptoms in alcohol and/or cocaine users

Usuários de drogas tendem a ser mais depressivos do que não usuários. O objetivo deste estudo foi investigar os fatores de risco para episódios e sintomas depressivos em usuários de álcool e ou cocaína/crack que procuraram um serviço de telemedicina. Realizou-se um estudo transversal (n=838) com aplicação do Inventário de Depressão de Beck para mensuração dos sintomas depressivos e o Mini-International Neuropsychiatric Interview para episódio depressivo atual nos usuários no acompanhamento telefônico para cessação do consumo de drogas. O principal fator de risco entre os usuários para sintomas depressivos foi baixa escolaridade (OR=1,4 IC 95%:1,1-2,2). Para o episódio depressivo atual o maior risco entre os usuários foi ser do sexo feminino (OR=1,5 IC 95%:1,0-2,4). O consumo de crack estava associado a episódio depressivo atual (p=0,014). O uso do telefone é viável para detecção de fatores de risco para episódios e sintomas depressivos nos usuários de álcool e ou cocaína/crack. (AU)

Drug users tend to be more depressed than non-users. The aim of this study was to investigate the risk factors for episodes and depressive symptoms in users of alcohol and or cocaine/crack that called for the telemedicine service. We conducted a cross- sectional study (n = 838) with application of the Beck Depression Inventory to Measure depressive symptoms and the Mini International Neuropsychiatric Interview for current depressive episode in users on the telephone follow-up to cessation of drug use. The main risk factor among users for depressive symptoms was lower education (OR = 1.4; 95% CI: 1.1-2.2). For the current depressive episode the greatest risk among users was being female (OR = 1.5; 95% CI: 1.0-2.4). The crack use was associated with current depressive episode (p = 0.014). The use of the phone is feasible to detect risk factors for episodes and depressive symptoms in users of alcohol and or cocaine/crack.(AU)

Family functioning and health issues associated with codependency in families of drug users.

UNLABELLED: Substance abuse affects both the user and the family system as a whole, yet substance abuse treatment is centered on the user, leaving the family in the background. OBJECTIVE: To identify the symptoms of codependency and health issues in the codependent family members of drug users who called a toll-free telephone counseling service. In total, 505 family members participated in this cross-sectional study. Drug users' mothers and wives who had less than 8 years of education and those who were unemployed had a greater chance of high codependency. It was also determined that a high level of codependency imposed a significant burden on the physical and emotional well-being of those affected, resulting in poor health, reactivity, self-neglect and additional responsibilities. It was concluded that codependency has a negative impact on the family system and on the health of the family members of drug users.

Family functioning and health issues associated with codependency in families of drug users / Funcionamento familiar e questões de saúde associados com codependência em familiares de usuários de drogas

Abstract Substance abuse affects both the user and the family system as a whole, yet substance abuse treatment is centered on the user, leaving the family in the background. Objective: To identify the symptoms of codependency and health issues in the codependent family members of drug users who called a toll-free telephone counseling service. In total, 505 family members participated in this cross-sectional study. Drug users’ mothers and wives who had less than 8 years of education and those who were unemployed had a greater chance of high codependency. It was also determined that a high level of codependency imposed a significant burden on the physical and emotional well-being of those affected, resulting in poor health, reactivity, self-neglect and additional responsibilities. It was concluded that codependency has a negative impact on the family system and on the health of the family members of drug users.

Resumo A dependência química atinge o usuário e o sistema familiar como um todo, todavia o tratamento dessa condição é centrado no usuário, o que deixa a família em segundo plano. Objetivo: identificar os sintomas de codependência e questões de saúde em familiares codependentes de usuários de drogas que ligaram para um serviço telefônico de aconselhamento. No total, 505 familiares participaram de um estudo transversal. Mães e esposas de usuários de drogas que tinham menos de 8 anos de estudo e que estavam desempregadas apresentaram maior chance de alta codependência. Além disso, foi identificado que o nível alto de codependência interfere significativamente no bem-estar físico e emocional dos familiares, o que resultou em problemas de saúde, reatividade, autonegligência e sobrecarga de tarefas. Foi concluído que a codependência tem um impacto negativo no sistema familiar e na saúde dos familiares de usuários de drogas.

Non-adherence to telemedicine interventions for drug users: systematic review.

OBJECTIVE To estimate rates of non-adherence to telemedicine strategies aimed at treating drug addiction. METHODS A systematic review was conducted of randomized controlled trials investigating different telemedicine treatment methods for drug addiction. The following databases were consulted between May 18, 2012 and June 21, 2012: PubMed, PsycINFO, SciELO, Wiley (The Cochrane Library), Embase, Clinical trials and Google Scholar. The Grading of Recommendations Assessment, Development and Evaluation was used to evaluate the quality of the studies. The criteria evaluated were: appropriate sequence of data generation, allocation concealment, blinding, description of losses and exclusions and analysis by intention to treat. There were 274 studies selected, of which 20 were analyzed. RESULTS Non-adherence rates varied between 15.0% and 70.0%. The interventions evaluated were of at least three months duration and, although they all used telemedicine as support, treatment methods differed. Regarding the quality of the studies, the values also varied from very poor to high quality. High quality studies showed better adherence rates, as did those using more than one technique of intervention and a limited treatment time. Mono-user studies showed better adherence rates than poly-user studies. CONCLUSIONS Rates of non-adherence to treatment involving telemedicine on the part of users of psycho-active substances differed considerably, depending on the country, the intervention method, follow-up time and substances used. Using more than one technique of intervention, short duration of treatment and the type of substance used by patients appear to facilitate adherence.

Non-adherence to telemedicine interventions for drug users: systematic review / Não adesão em intervenções por telemedicina para usuários de drogas: revisão sistemática

OBJECTIVE To estimate rates of non-adherence to telemedicine strategies aimed at treating drug addiction. METHODS A systematic review was conducted of randomized controlled trials investigating different telemedicine treatment methods for drug addiction. The following databases were consulted between May 18, 2012 and June 21, 2012: PubMed, PsycINFO, SciELO, Wiley (The Cochrane Library), Embase, Clinical trials and Google Scholar. The Grading of Recommendations Assessment, Development and Evaluation was used to evaluate the quality of the studies. The criteria evaluated were: appropriate sequence of data generation, allocation concealment, blinding, description of losses and exclusions and analysis by intention to treat. There were 274 studies selected, of which 20 were analyzed. RESULTS Non-adherence rates varied between 15.0% and 70.0%. The interventions evaluated were of at least three months duration and, although they all used telemedicine as support, treatment methods differed. Regarding the quality of the studies, the values also varied from very poor to high quality. High quality studies showed better adherence rates, as did those using more than one technique of intervention and a limited treatment time. Mono-user studies showed better adherence rates than poly-user studies. CONCLUSIONS Rates of non-adherence to treatment involving telemedicine on the part of users of psycho-active substances differed considerably, depending on the country, the intervention method, follow-up time and substances used. Using more than one technique of intervention, short duration of treatment and the type of substance used by patients appear to facilitate adherence. .

OBJETIVO Estimar taxas de não adesão em intervenções com estratégias de telemedicina para tratamento de dependência química. MÉTODOS Foi realizada revisão sistemática de ensaios clínicos randomizados com diferentes métodos terapêuticos de dependência química que incluíam telemedicina. Foram consultadas as bases de dados PubMed, PsycINFO, SciELO, Wiley (The Cochrane Library), Embase e Clinical Trials e a plataforma Google Scholar no período de 18/4/2012 a 21/6/2012. Para avaliar a qualidade dos estudos, utilizou-se a escala Grading of Recommendations Assessment, Development and Evaluation . Os critérios avaliados foram: adequada sequência da geração de dados, ocultação da alocação, cegamento, descrição das perdas e exclusões e análises por intenção de tratar. Foram selecionados 274 estudos, dos quais 20 foram analisados. RESULTADOS As taxas de não adesão variaram entre 15,0% e 70,0%. As intervenções avaliadas possuíam no mínimo três meses de intervenção e, embora todos utilizassem a telemedicina como apoio, os métodos de tratamentos foram diferentes. Em relação à qualidade dos estudos, os valores também variaram entre muito baixa qualidade e alta qualidade. Os estudos com qualidade alta demonstraram maiores taxas de adesão, bem como aqueles que utilizaram mais de uma técnica de intervenção e tempo limitado de tratamento. Estudos com monousuários apontaram maiores taxas de adesão que estudos com poliusuários. CONCLUSÕES As taxas de não adesão a tratamentos para usuários de substâncias psicoativas por meio de telemedicina apresentaram consideráveis diferenças, dependendo do país, método da intervenção, tempo de seguimento ...

Abordagem motivacional para familiar de usuário de drogas por telefone: um estudo de caso / Motivational approach by phone for family member of drug user: a case study

A entrevista motivacional, intervenção colaborativa que estimula as razões à mudança, pode ser utilizada para ajudar os familiares de usuários de drogas a conduzir transformações na sua interação com o usuário. Os familiares podem desenvolver estratégias mal-adaptativas para manejarem esse problema, conhecido como codependência. Assim, os familiares necessitam receber intervenção, pois podem adoecer diante dos conflitos decorrentes dessa interação. Objetivou-se apresentar um modelo de intervenção breve motivacional por telefone para familiar de usuário. Realizou-se um estudo de caso em um serviço de telemedicina. Os instrumentos utilizados foram: protocolo de atendimento ao familiar, escalas Contemplation Ladder e Holyoake Codependency Index. Betânia, 46 anos, ligou para buscar ajuda para o seu marido usuário de álcool e crack. Após 6 meses, Betânia conseguiu perceber suas necessidades pessoais e as consequências de sua mudança na dinâmica da dependência química. A esposa do usuário reduziu a codependência e modificou comportamentos permissivos. Os serviços de telemedicina e as intervenções breves motivacionais podem promover mudanças comportamentais em familiares que necessitam de atenção e cuidados de saúde de uma forma acessível e abrangente(AU)

Motivational interviewing, a collaborative intervention that stimulates the reasons to change, can be used to help family members of drug users to drive transformation in their interaction with the user. Families of drug users may develop maladaptive strategies for managing this problem, which is known as codependency. Thus, family members need to receive intervention, as they may get sick due to the conflicts arising from this interaction. The goal was to present a model of brief motivational intervention by telephone to the user's family. We conducted a case study of a telemedicine service. The instruments used were: family attendance protocol, Contemplation Ladder and Holyoake Codependency Index. Bethany, 46 years, called to get help for her husband, an alcohol and crack user. After 6 months, Bethany was able to realize her personal needs and the consequences of her change in the dynamics of addiction. The user's wife reduced codependency and modified permissive behavior. Telemedicine services and brief motivational interventions can promote behavioral changes in families that need attention and care in an accessible and comprehensive way(AU)

Assessment of changes in nicotine dependence, motivation, and symptoms of anxiety and depression among smokers in the initial process of smoking reduction or cessation: a short-term follow-up study.

INTRODUCTION: The first days of a quit attempt represent an important challenge to long-term abstinence, especially because of the changes that take place over this period. OBJECTIVE: To examine whether smokers who have recently changed their smoking behavior show changes in the intensity of nicotine dependence, motivational stage, or symptoms of anxiety and depression relative to smokers without recent changes in smoking behavior. METHODS: Smokers attending a support group for smoking cessation in Porto Alegre, southern Brazil, were invited to participate. The program consisted of four weekly sessions. Smokers answered questionnaires covering intensity of nicotine dependence, stage of motivation, and symptoms of anxiety and depression at baseline and in the fourth week. Urine was collected at both time points, tested for cotinine concentration, and used to determine the final status of smokers. RESULTS: Of the 54 smokers included in the study, 20 (37%) stopped smoking or decreased tobacco use. Both smokers who stopped or reduced tobacco use and those who did not change their behavior presented a decrease in nicotine dependence scores (p = 0.001). Conversely, only the smokers who changed behavior presented an increase in scores in the maintenance stage (p < 0.001). CONCLUSION: When modifying tobacco use, smokers face a difficult process, marked by several changes. A better understanding of these changes and their implications for treatment are discussed.

Assessment of changes in nicotine dependence, motivation, and symptoms of anxiety and depression among smokers in the initial process of smoking reduction or cessation: a short-term follow-up study / Avaliação de mudanças na dependência da nicotina, motivação e sintomas de ansiedade e depressão em fumantes no processo inicial de redução ou cessação do tabagismo: estudo de seguimento de curto prazo

Introduction: The first days of a quit attempt represent an important challenge to long-term abstinence, especially because of the changes that take place over this period. Objective: To examine whether smokers who have recently changed their smoking behavior show changes in the intensity of nicotine dependence, motivational stage, or symptoms of anxiety and depression relative to smokers without recent changes in smoking behavior. Methods: Smokers attending a support group for smoking cessation in Porto Alegre, southern Brazil, were invited to participate. The program consisted of four weekly sessions. Smokers answered questionnaires covering intensity of nicotine dependence, stage of motivation, and symptoms of anxiety and depression at baseline and in the fourth week. Urine was collected at both time points, tested for cotinine concentration, and used to determine the final status of smokers. Results: Of the 54 smokers included in the study, 20 (37%) stopped smoking or decreased tobacco use. Both smokers who stopped or reduced tobacco use and those who did not change their behavior presented a decrease in nicotine dependence scores (p = 0.001). Conversely, only the smokers who changed behavior presented an increase in scores in the maintenance stage (p < 0.001). Conclusion: When modifying tobacco use, smokers face a difficult process, marked by several changes. A better understanding of these changes and their implications for treatment are discussed.

Introdução: Os primeiros dias de uma tentativa de parar de fumar representam um desafio importante para a abstinência a longo prazo, especialmente por causa das mudanças que ocorrem nesse período. Objetivo: Examinar se fumantes que mudaram recentemente seu hábito de fumar mostram mudanças na intensidade da dependência à nicotina, no estágio motivacional ou nos sintomas de ansiedade e depressão em comparação com fumantes sem mudanças recentes em seu hábito de fumar. Métodos: Fumantes participando de um grupo de apoio para a cessação do tabagismo em Porto Alegre, sul do Brasil, foram convidados a participar do estudo. O programa consistia de quatro sessões semanais. Os fumantes responderam a questionários que avaliaram a intensidade da dependência à nicotina, o estágio motivacional e sintomas de ansiedade e depressão no início do programa e na 4ª semana. Amostras de urina foram coletadas nos dois momentos para avaliar a concentração de cotinina para determinar o status final dos fumantes. Resultados: Dos 54 fumantes incluídos no estudo, 20 (37%) pararam de fumar ou reduziram o uso de tabaco. Tanto os fumantes que pararam ou reduziram o uso de tabaco quanto aqueles que não mudaram seu hábito apresentaram diminuição nos escores de dependência à nicotina (p = 0,001). Por outro lado, apenas os fumantes que mudaram seu hábito apresentaram aumento nos escores do estágio de manutenção (p < 0,001). Conclusão: Ao modificar o uso de tabaco, os fumantes enfrentam um processo difícil, marcado por várias mudanças. Um melhor entendimento dessas mudanças e suas implicações para o tratamento são discutidas.

Avaliação das crenças codependentes e dos estágios de mudança em familiares de usuários de drogas em um serviço de teleatendimento / Codependent beliefs and stages of change in family members of drug users in a helpline service

Introdução: A dependência de drogas é um fenômeno que atinge não somente o usuário, mas também o sistema familiar como um todo. Devido à complexidade dessa relação, a família pode desenvolver características conhecidas como codependência, entre elas: autoestima baixa, valorização das opiniões dos outros em detrimento das suas, dificuldade de identificar os sentimentos ou comportamentos que facilitam o uso de drogas. O objetivo deste estudo foi avaliar as crenças codependentes e o estágio de mudança em familiares de usuários de drogas que procuraram um serviço de teleatendimento. Métodos: Realizou-se um estudo transversal no VIVAVOZ Serviço Nacional de Orientações e Informações sobre a Prevenção do Uso Indevido de Drogas no período de junho a julho de 2007. A amostra incluiu 154 familiares de usuários de drogas. Os instrumentos utilizados foram as escalas Ladder, que avalia o estágio de mudança de comportamento frente ao familiar usuário e Holyoake Codependency Index. Esta avalia a codependência em 13 itens, sendo calculados pela soma de 3 elementos denominados: foco no outro, autosacrifício e reatividade. Resultados: 71% dos familiares apresentaram crenças codependentes. Dentre esses, 89% identificaram-se no estágio de contemplação, ou seja, percebiam a necessidade de mudança no seu comportamento em relação aos usuários. Conclusão: Este estudo reforça a importância de abordagens voltadas à família para motivar seus integrantes a diminuírem os comportamentos codependentes

Introduction: Drug addiction is a phenomenon that affects not only the user but also the family system as a whole. Due to the complexity of this relationship, the family can develop characteristics known as codependency, including: low self-esteem, appreciation of others’ opinions to the detriment of their own, and difficulty identifying feelings or behaviors that facilitate the use of drugs. The aim of this study was to evaluate the codependent beliefs and stage of change in family members of drug users who sought a helpline service. Methods: This was a cross-sectional study in the VIVAVOZ National Guidance and Information on Prevention of Drug Abuse in the period from June to July 2007. The sample included 154 families of drug users. The instruments used were the Ladder scale, which assesses the stages of changing behavior towards family-user, and the Holyoake Codependency Index, which assesses the codependence in 13 items, calculated from the sum of three elements, namely: Focus on the other, self-sacrifice, and reactivity. Results: 71% of relatives showed codependent beliefs. Among these, 89% identified themselves in the contemplation stage, i.e., they perceived the need for change in their behavior in relation to users. Conclusion: This study reinforces the importance of familyoriented approaches to motivate their members to lower co-dependent behaviors