Baseline cocaine demand predicts contingency management treatment outcomes for cocaine-use disorder.

Cocaine use disorder (CUD) is a significant public health issue. Behavioral interventions such as contingency management (CM) have been demonstrated to be highly effective in promoting cocaine abstinence. However, identifying individual characteristics associated with cocaine relapse may help improve treatment outcomes. Cocaine demand is a behavioral economic measure that shares a scientific foundation with CM. In the current study, we assessed baseline cocaine demand using a hypothetical cocaine purchasing task. Participants (N = 58) consisted of treatment-seeking individuals with CUD. All participants received 1 month of CM treatment for cocaine abstinence, and treatment responders were defined as presenting 6 consecutive cocaine negative urine samples from thrice weekly clinic visits. Demand data were well described by the exponentiated demand model. Indices of demand (intensity of demand [Q0], elasticity [α]) were significantly associated with recent (last 30 days) cocaine use. Importantly, linear regression revealed that CM treatment nonresponders presented significantly higher Q0 (p = .025). Subsequent quantile regression analyses examining the relationship between CM treatment response and Q0 revealed statistically reliable effects of being a nonresponder across 3 of the lower percentiles (i.e., 15, 25, and 30). Overall, these findings provide further support for the utility of exponentiated demand model. To our knowledge, this is the first study to demonstrate an association between baseline demand and contingency management response and systematically extend the findings of prior demand research to a novel drug class, cocaine. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Female crack cocaine users under treatment at therapeutic communities in southern Brazil: characteristics, pattern of consumption, and psychiatric comorbidities.

OBJECTIVE: To explore and describe sociodemographic characteristics, crack consumption patterns, and psychiatric comorbidities of female crack users receiving treatment at therapeutic communities. METHODS: This was a cross-sectional, descriptive, quantitative study. Forty-six women who abstained from crack use were assessed using a sociodemographic questionnaire, the Mini-Mental State Examination (MMSE), the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I), and a profile of crack use questionnaire. Descriptive statistical analyses were conducted. RESULTS: Participants had a mean age of 31.02 years (standard deviation [SD] = 7.73), most were single (76.1%), white (67.4%) and had complete or incomplete elementary education (43.5%). Before treatment, 65.2% of the women reported using crack every day; 46.3% smoked between 10 to 30 crack rocks per week. Mean treatment time was 63.56 days (SD = 75.85), with a mean of 80.41 days of abstinence (SD = 74.52) and 3.37 previous treatments (SD = 5.49). Mean age upon crack use initiation was 22.61 years (SD = 8.06), and the most frequent motivation to start using crack was curiosity (78.3%). The mean lifetime duration of crack use was 82.26 months (SD = 74.76), and the physical complications most frequently reported were weight loss (93.5%), followed by sleep problems (87%). In this study, the most prevalent psychiatric diagnoses were major depressive episode (60.87%), followed by post-traumatic stress disorder (52.17%) and generalized anxiety disorder (13.07%). CONCLUSIONS: Overall, a pattern of high consumption of crack was observed. The results show a high frequency of mood and anxiety disorders, with the highest frequencies found for major depressive episode and post-traumatic stress disorder.

O cuidado multiprofissional na prevenção de internações relacionadas ao uso de crack / Multiprofessional care towards the crack-related hospital admissions / Cuidado multiprofesional en la prevención de internaciones relacionadas al uso de crack

Objective: The study's purpose has been to analyze the relationship of multiprofessional care offered in a Psychosocial Care Center for Alcohol and other Drugs [Centros de Atenção Psicossocial Álcool e outras Drogas (CAPS-AD)] with the number of hospitalizations directly related to the consumption of drugs by crack users. Methods: It is a documentary study with a quantitative approach, which was through the assessment of 213 medical records of crack users of a CAPS-AD, concerning the socioeconomic profile, individual care, in group and hospital admissions. Data were processed on SPSS, version 22. Results: It was observed the predominance of men (76.5%), within the age group from 11 to 47 years old, who were single (60.8%), and had incomplete elementary education (53.5%). The most statistically significant interventions were nursing, psychiatry, medical clinic and nursing technician care, as well as groups of physical activity, art therapy and relapse prevention. Conclusion: Therefore, it is necessary to provide continuous and comprehensive assistance to the crack user, with a multiprofessional team acting in a complementary manner aiming to minimize drug related hospitalizations

Objetivo: Analisar a relação do cuidado multiprofissional ofertado em um Centro de Atenção Psicossocial para Álcool e Outras Drogas (CAPS AD) com o número de internação hospitalar relacionada diretamente com o consumo de drogas em usuários de crack. Métodos: Estudo documental com abordagem quantitativa, realizado com 213 prontuários de usuários de crack de um CAPS AD, referente ao perfil socioeconômico, atendimentos individuais, em grupo e internação hospitalar. As informações foram processadas no SPSS versão 22. Resultados: Observou-se predomínio de homens (76,5%), com idade entre 11 a 47 anos, solteiros (60,8%) que possuíam ensino fundamental incompleto (53,5%). Os atendimentos com maior significância estatística foram enfermagem, psiquiatria, clínica médica e técnico em enfermagem, bem como grupos de atividade física, arteterapia e prevenção de recaída. Conclusão: É necessário realizar assistência contínua e integral ao usuário de crack, com equipe multiprofissional atuando de forma complementar para minimizar as internações referentes ao consumo da droga

Objetivo: Analizar la relación del cuidado multiprofesional ofrecido en un Centro de Atención Psicosocial para Alcohol y Otras Drogas (CAPS AD) con el número de internación hospitalaria relacionado directamente con el consumo de drogas en usuarios de crack. Métodos: Estudio documental con abordaje cuantitativo, realizado con 213 historiales de usuarios de crack de un CAPS AD, referente al perfil socioeconómico, atendimientos individuales, en grupo e internación hospitalaria. Las informaciones fueron procesadas en el SPSS versión 22. Resultados: Se observó predominio de hombres (76,5%), con edad entre 11 y 47 años, solteros (60,8%) con enseñanza primaria incompleta (53,5%). Los atendimientos con mayor relevancia estadística fueron enfermería, psiquiatría, clínica médica y técnico en enfermería, así como grupos de actividad física, arteterapia y prevención de recaída. Conclusión: Es necesario realizar asistencia continua e integral al usuario de crack, con equipo multiprofesional actuando de forma complementaria para minimizar las internaciones referentes al consumo de drogas

Female crack cocaine users under treatment at therapeutic communities in southern Brazil: characteristics, pattern of consumption, and psychiatric comorbidities / Mulheres usuárias de crack-cocaína em tratamento em comunidades terapêuticas no sul do Brasil: características, padrão de consumo e comorbidades psiquiátricas

Abstract Objective To explore and describe sociodemographic characteristics, crack consumption patterns, and psychiatric comorbidities of female crack users receiving treatment at therapeutic communities. Methods This was a cross-sectional, descriptive, quantitative study. Forty-six women who abstained from crack use were assessed using a sociodemographic questionnaire, the Mini-Mental State Examination (MMSE), the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I), and a profile of crack use questionnaire. Descriptive statistical analyses were conducted. Results Participants had a mean age of 31.02 years (standard deviation [SD] = 7.73), most were single (76.1%), white (67.4%) and had complete or incomplete elementary education (43.5%). Before treatment, 65.2% of the women reported using crack every day; 46.3% smoked between 10 to 30 crack rocks per week. Mean treatment time was 63.56 days (SD = 75.85), with a mean of 80.41 days of abstinence (SD = 74.52) and 3.37 previous treatments (SD = 5.49). Mean age upon crack use initiation was 22.61 years (SD = 8.06), and the most frequent motivation to start using crack was curiosity (78.3%). The mean lifetime duration of crack use was 82.26 months (SD = 74.76), and the physical complications most frequently reported were weight loss (93.5%), followed by sleep problems (87%). In this study, the most prevalent psychiatric diagnoses were major depressive episode (60.87%), followed by post-traumatic stress disorder (52.17%) and generalized anxiety disorder (13.07%). Conclusions Overall, a pattern of high consumption of crack was observed. The results show a high frequency of mood and anxiety disorders, with the highest frequencies found for major depressive episode and post-traumatic stress disorder.

Resumo Objetivo Explorar e descrever características sociodemográficas, padrão de consumo e comorbidades psiquiátricas em mulheres usuárias de crack recebendo tratamento em comunidades terapêuticas. Método Estudo transversal, descritivo e quantitativo. Quarenta e seis mulheres abstinentes de crack responderam a um questionário sociodemográfico, ao Mini-Exame do Estado Mental (MEEM), à Entrevista Estruturada do DSM-IV para Transtornos do Eixo I (SCID-I) e a um questionário sobre padrão de consumo de crack. Foram realizadas análises estatísticas descritivas dos dados. Resultados As participantes tinham média de 31,02 anos [desvio padrão (DP) = 7,73], eram na maioria solteiras (76,1%), brancas (67,4%) e tinham ensino fundamental completo ou incompleto (43,5%). Antes do tratamento, 65,2% das mulheres relataram usar crack todos os dias; 46,3% fumavam entre 10 e 30 pedras de crack por semana. O tempo médio de tratamento foi de 63,56 dias (DP = 75,85), com média de 80,41 dias em abstinência (DP = 74,52) e 3,37 (DP = 5,49) tratamentos anteriores. A idade média de início do uso de crack foi de 22,61 anos (DP = 8,06), e a motivação mais frequente para iniciar o uso de crack foi a curiosidade (78,3%). A duração média de uso de crack na vida foi de 82,26 meses (DP = 74,76), e as complicações físicas mais frequentemente relatadas foram perda de peso (93,5%), seguida por problemas de sono (87%). Neste estudo, os diagnósticos mais prevalentes foram episódio depressivo maior (60,87%), seguido por transtorno de estresse pós-traumático (52,17%) e transtorno de ansiedade generalizada (13,07%). Conclusões Em geral, observamos um padrão de alto consumo de crack. Os resultados mostram alta frequência de transtornos de humor e ansiedade, com maiores frequências para episódio depressivo maior e transtorno de estresse pós-traumático.