Preliminary results from Brazil's first recovery housing program.

INTRODUCTION: The recovery housing (RH) program was initiated in São Paulo with the objective of providing treatment for substance use disorders and addressing users' housing and employment problems. The purpose of this study was to describe the model based on its first 11 months of operation, it was launched in June 2016 in Brazil. METHOD: We carried out a retrospective analysis of the records of all subjects treated in the RH of the Restart Program (Programa Recomeço) since its creation, from June 2016 to May 2017. RESULTS: Sixty-nine subjects were included. Thirty-five (51%) remained in the household until the end of treatment or were reinserted in society. Thirty-four (49%) presented recurrence during their stay, of which 16 (47%) volunteered for treatment in a therapeutic community or psychiatric hospital, 8 (23.5%) chose to continue with outpatient treatment only, 6 (17.7%) returned to their families and continued to receive outpatient treatment, and 4 (11.8%) discontinued the treatment. Of the 35 subjects who completed the RH program, 28 (80%) were in employment and 7 (20%) received governmental support for permanent disability on medical or psychiatric grounds. CONCLUSION: RH can be an important component of integrated care and is used in several countries. Although controversial, the use of urine tests to control relapse seems to have a positive impact on adherence to treatment and maintenance of abstinence. These preliminary findings corroborate, with clear limitations, the evidence available in the literature showing that RH programs are effective for the treatment of addictions.

Preliminary results from Brazil's first recovery housing program / Dados preliminares do primeiro programa de moradia monitorada no Brasil

Abstract Introduction: The recovery housing (RH) program was initiated in São Paulo with the objective of providing treatment for substance use disorders and addressing users' housing and employment problems. The purpose of this study was to describe the model based on its first 11 months of operation, it was launched in June 2016 in Brazil. Method: We carried out a retrospective analysis of the records of all subjects treated in the RH of the Restart Program (Programa Recomeço) since its creation, from June 2016 to May 2017. Results: Sixty-nine subjects were included. Thirty-five (51%) remained in the household until the end of treatment or were reinserted in society. Thirty-four (49%) presented recurrence during their stay, of which 16 (47%) volunteered for treatment in a therapeutic community or psychiatric hospital, 8 (23.5%) chose to continue with outpatient treatment only, 6 (17.7%) returned to their families and continued to receive outpatient treatment, and 4 (11.8%) discontinued the treatment. Of the 35 subjects who completed the RH program, 28 (80%) were in employment and 7 (20%) received governmental support for permanent disability on medical or psychiatric grounds. Conclusion: RH can be an important component of integrated care and is used in several countries. Although controversial, the use of urine tests to control relapse seems to have a positive impact on adherence to treatment and maintenance of abstinence. These preliminary findings corroborate, with clear limitations, the evidence available in the literature showing that RH programs are effective for the treatment of addictions.

Resumo Introdução: O Programa Moradia Monitorada (MM) foi iniciado em São Paulo com o objetivo de prover tratamento para transotrnos de uso de substâncias e problemas relacionados a moradia e emprego. O objetivo do presente estudo foi descrever o modelo com base nos primeiros 11 meses de operação (o programa foi lançado em junho de 2016 no Brasil). Métodos: Realizamos um estudo retrospectivo utilizando os registros de todos os indivíduos tratados no MM do Programa Recomeço desde a sua criação. Resultados: Sessenta e nove indivíduos foram incluídos. Trinta e cinco (51%) permaneceram no tratamento até o fim ou foram reinseridos socialmente com sucesso. Trinta e quatro sujeitos (49%) apresentaram recidiva durante a permanência. Destes, 16 (47%) se voluntariaram para tratamento em comunidades terapêuticas ou hospitais psiquiátricos, 8 (23,5%) escolheram permanecer apenas no tratamento ambulatorial, 6 (17.7%) retornaram para suas famílias e continuaram o tratamento em uma unidade ambulatorial próxima ao domicílio, e 4 (11.8%) descontinuaram o tratamento. Dos 35 pacientes que completaram o tratamento, 28 (80%) estavam empregados em serviço regular e 7 (20%) recebiam aposentadoria por questões clínicas e/ou psiquiátricas. Conclusão: O modelo MM pode ser um componente importante na via de cuidados integrados e é utilizado em vários países. Apesar de controverso, o uso de análise de urina para vigilância da recidiva e da recorrência parece ter um impacto positivo na adesão ao tratamento e na manutenção da abstinência. Nossos achados preliminares corroboram, com claras limitações, os resultados reportados previamente na literatura, de que os programas de MM são efetivos no tratamento da dependência química.

Association between drug use and urban violence: Data from the II Brazilian National Alcohol and Drugs Survey (BNADS).

OBJECTIVE: To investigate the association of alcohol and cocaine use with urban violence (both as victim and as perpetrator) in a representative sample of the Brazilian population. METHOD: The Second Brazilian Alcohol and Drugs Survey (II BNADS) interviewed 4607 individuals aged 14 years and older from the Brazilian household population including an oversample of 1157 adolescents (14 to 18 years old). The survey gathered information on alcohol, tobacco and illegal substances use as well as on risk factors for abuse and dependence, behaviors associated with the use of substances and the possible consequences, as urban violence indicators. RESULTS: Approximately 9.3% of the Brazilian population has been victim of at least one form of urban violence. This proportion increases to 19.7% among cocaine users and to 18.1% among individuals with alcohol use disorders (AUD). Perpetration of violence was reported by 6.2% of the sample. Cocaine use and AUD increased in almost four times the chances of being an aggressor. Being religious and married decreased the chances of being a victim and/or perpetrador of urban violence. Higher education also decreased the chances of involvement in both victimization or perpetration of violence. Both Parallel Mediation Models considering cocaine use as a predictor of urban violence (victimization or perpetration) were valid and alcohol consumption and depressive symptoms were mediators of this relationship. CONCLUSIONS: This study presents relevant data of interest to Brazil as this country is one of the major consumer market of cocaine and also is among the most violent countries worldwide.

Pathways from witnessing parental violence during childhood to involvement in intimate partner violence in adult life: The roles of depression and substance use.

INTRODUCTION AND AIMS: The aims of this study were to determine the prevalence of witnessing parental violence (WPV) during childhood and of current intimate partner violence (IPV) victimisation and aggression in a Brazilian sample, in order to verify pathways between WPV and involvement in IPV as an adult. DESIGN AND METHODS: The mediating roles of substance use and depression were investigated. Data came from the Second Brazilian National Alcohol and Drugs Survey, a multi-cluster probabilistic household survey, which gathered information on the use of psychoactive substances, current depressive disorder, history of childhood direct and indirect exposure to domestic violence and IPV in a nationally representative sample. A subsample of 2120 individuals aged 14 years or older was analysed. Weighted prevalence rates, adjusted odds ratio and conditional path models were performed. RESULTS: Being a victim of IPV was reported by 6% of the sample. Thus being, 4.1% reported being IPV perpetrators; these rates were 16.6% and 7.3%, respectively, among those who reported WPV (13%). WPV was associated with being a victim of IPV in adult life, but not with becoming a perpetrator, regardless of being a victim of physical violence during childhood. There was a direct effect of WPV on IPV mediated by depressive symptoms. Alcohol and cocaine consumption and age of drinking initiation mediated only when combined with depressive symptoms. DISCUSSION AND CONCLUSIONS: Intergenerational transmission models of IPV through exposure during childhood can help to explain the high rates of domestic violence in Brazil. Our findings provide evidence to implement targeted prevention strategies where they are needed most: the victims of premature adverse experiences. [Madruga CS, Viana MC, Abdalla RR, Caetano R, Laranjeira R. Pathways from witnessing parental violence during childhood to involvement in intimate partner violence in adult life: The roles of depression and substance use. Drug Alcohol Rev 2017;36:107-114].

Prevalence of cocaine use in Brazil: data from the II Brazilian national alcohol and drugs survey (BNADS).

OBJECTIVE: To determine the current prevalence rates of cocaine use and dependence in a representative sample of the Brazilian population, and to investigate possible associations with sociodemographic factors. METHOD: The Second Brazilian Alcohol and Drugs Survey (II BNADS) interviewed 4607 individuals aged 14 years and older from the Brazilian household population including an over sample of 1157 adolescents (14 to 18 years old).The survey gathered information on alcohol, tobacco and illegal substances use as well as on risk factors for abuse and dependence. The Severity of Dependence Scale was used to evaluate cocaine dependence rates among users. RESULTS: Last year consumption of crack-cocaine was 2.2% in the overall population excluding the elderly group.Lifetime and last year prevalence rate of snorted cocaine was 3.9% and 1.7%, respectively. Smoked cocaine use in Brazil was estimated in 1.5% for lifetime and 0.8% for last year use. Cocaine addiction was identified in 41.4%between users in the prior year. CONCLUSIONS: The prevalence rates of snorted and smoked cocaine in Brazil suggests that the country is amongst the nations with greatest annual consumption rates becoming one of the biggest consumer markets of cocaine worldwide. Prevention and treatment policies should take this into consideration and strengthen the focus on cocaine use in the country.