Relapse in involuntary substance treatment: a transversal study.

OBJECTIVE: To evaluate the associations between relapse and admissions (voluntary and involuntary) in a sample of patients with substance dependence. METHODS: This is a cross-sectional study undertaken at a private medical therapeutic community specialised in treating addiction, located in a rural area of São Paulo, Brazil. Sociodemographic characteristics, the University of Rhode Island Change Assessment Scale (URICA), Stages Readiness and Treatment Eagerness Scale (SOCRATES), Beck Anxiety Inventory (BAI) and Beck Depression Inventory (BDI) and Structured Clinical Interview for DSM-IV-SCID were used. RESULTS: Relapse was associated with low family income (P=.006) and contemplation motivational stage (P<0.05). Nevertheless, no significant differences between individuals who were admitted involuntarily (64%) and voluntarily (54%) were observed (P=0.683) in terms of relapses. CONCLUSIONS: In this sample, the relapse outcome in involuntary admissions was no different from the voluntary ones.

Relapse in involuntary substance treatment: a transversal study

Objective: To evaluate the associations between relapse and admissions (voluntary and involuntary) in a sample of patients with substance dependence. Methods: This is a cross-sectional study undertaken at a private medical therapeutic community specialised in treating addiction, located in a rural area of São Paulo, Brazil. Sociodemographic characteristics, the University of Rhode Island Change Assessment Scale (URICA), Stages Readiness and Treatment Eagerness Scale (SOCRATES), Beck Anxiety Inventory (BAI) and Beck Depression Inventory (BDI) and Structured Clinical Interview for DSM-IV-SCID were used. Results: Relapse was associated with low family income (P = .006) and contemplation motivational stage (P<0.05). Nevertheless, no significant differences between individuals who were admitted involuntarily (64%) and voluntarily (54%) were observed (P = 0.683) in terms of relapses. Conclusions: In this sample, the relapse outcome in involuntary admissions was no different from the voluntary ones.

Objetivo: Evaluar las asociaciones entre recaída y admisiones (voluntarias e involuntarias) en una muestra de dependientes de sustancias. Métodos: Este es un estudio transversal realizado en una comunidad médica terapéutica privada, especializada en el tratamiento de la adicción, ubicada en una zona rural de São Paulo, Brasil. Se utilizaron las características sociodemográficas, la Escala de Evaluación de Cambios de la Universidad de Rhode Island (URICA), la Escala de Evaluación de la Etapa de Preparación y Tratamiento (SOCRATES), el Inventario de Ansiedad de Beck (BAI), el Inventario de Depresión de Beck (BDI) y la Entrevista Clínica Estructurada para DSM-IV-SCID. Resultados: La recaída se asoció con bajos ingresos familiares (p = 0,006) y contemplación de la etapa motivacional (p < 0,05). Sin embargo, no se observaron diferencias significativas entre los individuos que ingresaron involuntariamente (64%) y los voluntarios (54%) (p = 0,683) en términos de recaídas. Conclusiones: En esta muestra, el resultado de la recaída en admisiones involuntarias no fue diferente que en los voluntarios.

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.

Family members affected by a relative's substance misuse looking for social support: who are they?

BACKGROUND: This study proposes to describe family members in the city of Sao Paulo who are seeking support in mutual self-help groups to deal with a substance misusing relative. METHOD: Five hundred participants (one participant per family) completed a structured questionnaire collecting socio-demographic information, length of time taken to seek help, and where they sought help. Participants were recruited from the mutual self-help group 'Amor Exigente' in the city of Sao Paulo, Brazil. RESULTS: Parents of substance misusers counted as the largest group of family members. It took an average time of 3.7 years for the family members to discover their relatives' substance misuse. 42% had then sought help immediately; it took an average of 2.6 years for the remaining 58% of the sample to seek some form of support. A belief that the substance misuse of their relatives was just a transient problem or that they could cope with the situation by themselves were among the most indicated reasons for delay in seeking help. DISCUSSION: Findings stress the importance of implementing services that take into account the difficulties families have in finding help to deal with the substance misusing relative.

Alcohol and crack cocaine use in women: a 14-year cross-sectional study.

This article aims to describe the record type for first-time hospital admissions of 761 women at a single institution between 1997 and 2010 according to International Classification of Diseases, 10(th) revision, criteria, for mental and behavioral disorders due to psychoactive substance use (F10-F19). This cross-sectional study included a convenience sample of 4,736 patients in the Brazilian public health system, among whom 761 were women. Overall, the rate of alcohol-related hospitalizations decreased from 93.6% in 1997 to 50.9% in 2010. In contrast, the rate of crack cocaine-related hospitalizations increased in women from 2.8% in 1997 to 67.8% in 2010. The linear regression was R(2) = 0.8472. These data indicate a new trend in the pattern of psychoactive substance use in women.

Addiction research centres and the nurturing of creativity. National institute on alcohol and drugs policies, Brazil.

The National Institute of Public Policy for Alcohol and Other Drugs (INPAD) is based at the Federal University of São Paulo, Brazil, and was created to collect scientific evidence regarding epidemiology, develop new therapeutic approaches, study health economics and provide education to subsidize the proper measures to change the Brazilian scenario of alcohol and drug consumption. Policies directed towards the control of alcohol and drugs in Brazil are fragmented, poorly enforced and therefore ineffective. The unregulated market of alcohol in Brazil has contributed to the worsening health of the Brazilian population. Since 1994, INPAD has participated actively in academic debates and discussions about alcohol and drug policies and their effects on the political welfare of the country. Many scientific papers and books have been published on this subject, and the internet and other media have provided excellent opportunities for the dissemination of specialized information to the general population.

Correlates of substance use during adolescent pregnancy in São Paulo, Brazil.

OBJECTIVE: To investigate the association of cocaine and marijuana use during adolescent pregnancy in São Paulo-SP, Brazil, with psychiatric disorders, social status and sexual history. METHOD: One thousand pregnant adolescents were assessed by using the Composite International Diagnostic Interview, and sociodemographic and socio-economic questionnaire at the obstetric center of a public hospital in São Paulo. Hair samples were collected for analysis. RESULTS: The following data were associated with cocaine and/or marijuana use during the third trimester of the pregnancy: being younger than 14 years of age, having a history of more than 3 sexual partners, and having psychiatric disorders, specifically, bipolar disorder, post-traumatic stress disorder, and somatoform disorder. CONCLUSION: In early adolescence pregnancy, having 3 or more sexual partners in life for this population is significantly associated with the use of cocaine or marijuana during gestation. This association suggests that specific intervention programs should target these young women.

Correlates of substance use during adolescent pregnancy in São Paulo, Brazil / Correlatos do uso de substâncias durante a gravidez na adolescência em São Paulo, Brasil

OBJECTIVE: To investigate the association of cocaine and marijuana use during adolescent pregnancy in São Paulo-SP, Brazil, with psychiatric disorders, social status and sexual history. METHOD: One thousand pregnant adolescents were assessed by using the Composite International Diagnostic Interview, and sociodemographic and socio-economic questionnaire at the obstetric center of a public hospital in São Paulo. Hair samples were collected for analysis. RESULTS: The following data were associated with cocaine and/or marijuana use during the third trimester of the pregnancy: being younger than 14 years of age, having a history of more than 3 sexual partners, and having psychiatric disorders, specifically, bipolar disorder, post-traumatic stress disorder, and somatoform disorder. CONCLUSION: In early adolescence pregnancy, having 3 or more sexual partners in life for this population is significantly associated with the use of cocaine or marijuana during gestation. This association suggests that specific intervention programs should target these young women.

OBJETIVO: Investigar, numa população de gestantes adolescentes de uma maternidade pública de São Paulo-SP, Brasil, a associação entre o consumo de cocaína e maconha durante a gravidez com distúrbios psiquiátricos, status social e história sexual. MÉTODO: Mil adolescentes grávidas foram avaliadas por meio do Composite International Diagnostic Interview e de um questionário sociodemográfico e socioeconômico no centro obstétrico de um hospital público de São Paulo. Destas, foi colhida amostra para análise de fios de cabelo. RESULTADOS: Os seguintes dados foram associados com o uso de cocaína e/ou maconha durante o terceiro trimestre de gravidez: ter menos de 14 anos, ter história de mais do que três parceiros sexuais e ter transtornos psiquiátricos, em especial, transtorno afetivo bipolar, transtorno do estresse pós-traumático e transtorno somatoforme. CONCLUSÃO: Na população de adolescentes grávidas avaliada, ter menos de 14 anos e ter três ou mais parceiros sexuais na vida está significativamente associado ao uso de maconha ou cocaína durante a gestação. Esta associação sugere que programas de intervenção específicos devem ser dirigidos a essas jovens.

Brief report: Prevalence of psychiatric disorders in pregnant teenagers.

PURPOSE: To evaluate the prevalence of ICD-10 psychiatric disorders in a population of pregnant teenage women from a Brazilian public hospital. METHOD: 1000 pregnant teenage women were evaluated using the Composite International Diagnostic Interview, a structured interview which establishes diagnoses according to the International Classification of Diseases. RESULTS: 325 of the 1000 patients were found to have at least one psychiatric disorder; 33.2% of them had a second psychiatric diagnosis. The most prevalent disorders were depression (12.9%), post-traumatic stress disorder (10%), and tobacco dependence/harmful use (10.3%). The most prevalent co-morbidity was ICD-10 Affective Disorders versus Neurotic, Stress-related, and Somatoform Disorders. Substance-related disorders are significantly correlated with all of the ICD-10 psychiatric diagnoses but Psychotic Disorders. CONCLUSION: The prevalence of psychiatric disorders in this population is high, and one third of them had co-morbidities, a condition usually associated with a more serious course of illness. This finding has important implications for clinical management and prognosis, and demands preventive public policies.

Brief report: A socio-demographic profile of multiparous teenage mothers.

OBJECTIVE: Delineate a socio-demographic profile of multiparous teenage mothers at a public hospital in Brazil. METHOD: This is a cross-sectional study consisting of 915 interviews with teenage girls, including 170 multiparous subjects whose babies were born alive. RESULTS: The multiparous teenage mothers had the following average characteristics: 17.8 years old; first pregnancy at 16 years; beginning of sexual life at 14.2 years; dropped out of school at 13.6 years; attended school for 6 years with only 10% still attending school when they were interviewed; 87.4% had prenatal exams; monthly income was reported to be 0.3% less than the national minimum salary. CONCLUSION: Teenage mothers are in need of better social, educational, and health care in order to have a greater chance of a positive motherhood experience, thereby creating a better, healthier environment for their children.

Gravidez na adolescência: perfil sócio-demográfico e comportamental de uma população da periferia de São Paulo, Brasil / Teenage pregnancy: behavioral and socio-demographic profile of an urban Brazilian population

Com objetivo de identificar o perfil sócio-demográfico e comportamental de gestantes adolescentes, foram entrevistadas mil adolescentes, admitidas entre 24 de julho de 2001 e 27 de novembro de 2002, em um hospital municipal de São Paulo, Brasil, correspondendo a 24,3 por cento das internações para resolução da gestação. Setenta (7 por cento) adolescentes foram admitidas para curetagem pós-abortamento e 930 (93 por cento), para parturição, com idade média de 17 ± 1,5 anos. A maioria (72,4 por cento) residia próximo ao hospital e 93 por cento pertenciam às classes econômicas C, D e E. Na época da parturição, 627 (67,3 por cento) adolescentes não estudavam. Apenas 23,7 por cento das adolescentes faziam uso de método contraceptivo, 81,2 por cento não tinham planejado a gestação e 80,1 por cento eram primigestas. Dos partos, 67,4 por cento foram vaginais. Dos bebês, 13,3 por cento foram pré-termo e 15, 9 por cento, baixo peso. Durante a gestação, o consumo referido de tabaco, de álcool e de drogas ilícitas foi, respectivamente de 17,3 por cento, 2,8 por cento e 1,7 por cento. Conclui-se que gravidez na adolescência é um fenômeno complexo, associado a fatores econômicos, educacionais e comportamentais, precipitando problemas decorrentes da maternidade precoce. O presente estudo fornece subsídios para políticas públicas de saúde, visando a prevenir a gravidez na adolescência.

To identify the socio-demographic behavioral profile of low-income pregnant teenagers, 1,000 adolescents admitted to a Brazilian public maternity hospital from July 24, 2001, to November 27, 2002, were interviewed. Socio-demographic and behavioral variables were assessed through a questionnaire. Over the 492 days of the study, 24.3 percent of admissions were adolescents (930 for childbirth and 70 for miscarriage). Mean maternal age was 17 years. Most teenagers (72.9 percent) lived near the hospital. 930 (93 percent) belonged to socioeconomic classes C, D, and E. School dropout was identified in 67.3 percent of the total. 80.1 percent of the subjects were giving birth for the first time. 81.2 percent had not planned the pregnancy, and 23.8 percent had been using some contraceptive method. 67.4 percent had vaginal deliveries. Some 13.3 percent of the newborns were premature and 15.9 percent had low birth weight. 17.3 percent of these adolescent mothers reported smoking during pregnancy, with 2.8 percent reporting alcohol and 1.7 percent illicit drugs. Teenage pregnancy is a complex phenomenon associated with various economic, educational, and behavioral factors. The study provides importance references for public policies to prevent teenage pregnancy.

Prevalence of cocaine and marijuana use in the last trimester of adolescent pregnancy: socio-demographic, psychosocial and behavioral characteristics.

OBJECTIVE: To evaluate the prevalence of cocaine and marijuana use during the third trimester of pregnancy in a population of 1000 teenage women of a public hospital in São Paulo, Brazil using hair analysis in order to avoid underestimation of data that could happen by the use of self-report questionnaires and describe socio-demographic, psychosocial and behavioral characteristics of the drug users. RESULTS: Hair analysis has detected use of cocaine and/or marijuana in the third trimester of pregnancy in 6% of the patients: 4.0% used marijuana, 1.7% used cocaine and 3% used both drugs. They were about 17 years old, from low-income, poorly educated, unemployed, financially dependent and they had not planned the pregnancy. 10% of miscarriages have occurred in this population. CONCLUSION: This study shows the psychosocial impairment associated to teenage pregnancy and use of cocaine and marijuana during gestation by this low-income population with reliable data of prevalence obtained through hair analysis.

[Teenage pregnancy: Behavioral and socio-demographic profile of an urban Brazilian population]. / Gravidez na adolescência: perfil sócio-demográfico e comportamental de uma população da periferia de São Paulo, Brasil.

To identify the socio-demographic behavioral profile of low-income pregnant teenagers, 1,000 adolescents admitted to a Brazilian public maternity hospital from July 24, 2001, to November 27, 2002, were interviewed. Socio-demographic and behavioral variables were assessed through a questionnaire. Over the 492 days of the study, 24.3% of admissions were adolescents (930 for childbirth and 70 for miscarriage). Mean maternal age was 17 years. Most teenagers (72.9%) lived near the hospital. 930 (93%) belonged to socioeconomic classes C, D, and E. School dropout was identified in 67.3% of the total. 80.1% of the subjects were giving birth for the first time. 81.2% had not planned the pregnancy, and 23.8% had been using some contraceptive method. 67.4% had vaginal deliveries. Some 13.3% of the newborns were premature and 15.9% had low birth weight. 17.3% of these adolescent mothers reported smoking during pregnancy, with 2.8% reporting alcohol and 1.7% illicit drugs. Teenage pregnancy is a complex phenomenon associated with various economic, educational, and behavioral factors. The study provides importance references for public policies to prevent teenage pregnancy.

Teenage pregnancy: use of drugs in the third trimester and prevalence of psychiatric disorders.

OBJECTIVE: To determine the prevalence of psychiatric disorders during pregnancy, the prevalence of cocaine and marijuana use during the third trimester of gestation and the socio-demographic characteristics of a population of low-income teenagers. METHOD: One thousand pregnant teenagers were evaluated using the Composite International Diagnostic Interview, and a socio-demographic and socio-economic questionnaire at the obstetric center of a public hospital in São Paulo, Brazil. Hair sample was collected for analysis. RESULTS: Of the 1000 pregnant teenagers interviewed, 53.6% were poor, 90.4% were unemployed, 92.5% were financially dependent and 60.2% dropped out of school. Those using drugs during the third trimester of pregnancy were equal to 6% (marijuana: 4%, cocaine: 1.7%, both: 0.3%). Those having at least one psychiatric disorder equaled 27.6%. The most frequent diagnoses were depression (12.9%), posttraumatic stress disorder (10.0%) and anxiety disorders (5.6%). DISCUSSION: Unstructured families, dropping out of school, unemployment and a low level of professional training are all contributing factors to the maintenance of an unfavorable socio-economic environment in which there is a high prevalence of cocaine and marijuana use during the third trimester of pregnancy and an abnormally high incidence of psychiatric disorders.

Teenage pregnancy: use of drugs in the third trimester and prevalence of psychiatric disorders

OBJETIVO: Determinar, em adolescentes de baixa renda, a prevalência de transtornos psiquiátricos durante a gravidez, a prevalência de uso de cocaína e maconha no terceiro trimestre de gestação e descrever suas características sociodemográficas. MÉTODO: Mil adolescentes grávidas foram avaliadas por meio do Composite International Diagnostic Interview e de um questionário sociodemográfico e socioeconômico no centro obstétrico de um hospital público de São Paulo. Dessas, foi colhida amostra para análise de fios de cabelo.RESULTADOS: Das mil pacientes entrevistadas, 53,6% têm baixa renda, 60,2% abandonaram a escola, 90,4% estão desempregadas e 92,5% são financeiramente dependentes, 6% usaram drogas durante o terceiro trimestre da gravidez (maconha: 4%, cocaína: 1,7%, ambos: 0,3%) e 27,6% tiveram ao menos um transtorno psiquiátrico. Os diagnósticos mais freqüentes foram: depressão (12,9%), transtorno de estresse pós-traumático (10,0%) e ansiedade (5,6%). DISCUSSÃO: Famílias desestruturadas, evasão escolar, desemprego e baixa capacitação profissional são fatores que contribuem para a manutenção desta situação socioeconômica desfavorável, cenário no qual são elementos importantes a alta prevalência de uso de cocaína e maconha no 3º trimestre da gravidez e de transtornos psiquiátricos.