Cocaine Users In Brazil Research Articles

Acceptability and feasibility of incorporating contingency management into a public treatment program for homeless crack cocaine users in Brazil: A pilot study.

Homeless substance users are particularly hard to treat. In this pilot study, we evaluated the acceptability and feasibility of incorporating Contingency Management (CM) into a public Abstinent-Contingent Housing (ACH) treatment program developed to treat currently homeless crack cocaine users. A total of 21 homeless crack cocaine users were randomized to receive 12 weeks of ACH alone (n = 9) or ACH plus CM (ACH + CM) (n = 12). Twelve treatment providers in the ACH treatment program were trained to deliver the CM intervention. CM was rated as relatively (41.7%) or very (58.3%) easy to understand and relatively (50%) or very (50%) easy to conduct by the ACH treatment providers. On a 10-point Likert scale, providers rated the importance of incorporating CM into public treatment programs for crack cocaine at M = 8.3 (SD = 2). Participants exposed to CM rated as relatively (33.3%) or very (66.7%) easy to understand. One hundred percent liked receiving the intervention "a lot," and 78.9% believed it helped them achieve and maintain crack cocaine abstinence. Finally, compared to the ACH condition, the ACH + CM condition was consistently associated with better treatment retention and cocaine use outcome measures, yelling small to large effect sizes. However, possibly due to the small sample size, most of these differences did not achieve statistical significance. CM was well integrated into the ACH treatment program and was well accepted by both the providers and participants, suggesting the feasibility of incorporating CM into a public treatment program for homeless crack cocaine users from low- and middle-income countries. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Reasons for and Consequences of the Combined Use of Crack Cocaine and Alcohol in Brazil:

The objective of this study was to investigate, through the speeches of crack cocaine users, the reasons that lead them to combine crack cocaine with alcohol and the consequences of this combination, in Brazil. The lack of public policies and effective treatments has led crack cocaine users in Brazil to seek alternatives to cope with problems related to drug addiction. One adopted alternative is the consumption of crack cocaine together with other psychotropic drug. This study used the principles and instruments of qualitative research. A purposeful sample was constructed using key informants and gatekeepers whose sample size (N = 30) was defined by the theoretical saturation point. The study participants were subjected to in-depth interviews, and the responses were subjected to content analysis for the identification of thematic units. Alcohol use played many roles, including increasing the courage of drug users to go to the point of sale for psychotropic drugs, reducing thirst, and prolonging the positive effects of crack cocaine. The combination of alcohol and crack cocaine is commonly used to modulate the effects of the latter. A vicious cycle is established in which the consumption of alcohol stimulates the consumption of cocaine and vice versa. The participants also reported cost savings but admitted an increase in aggressiveness. The combined use of crack cocaine and alcohol can become a strong conditioned stimulus for the consumption of the former. The formation of the active metabolite cocaethylene in this drug combination may explain the prolongation of the effects of crack cocaine. Moreover, both drugs act in the mesolimbic dopaminergic system and consequently produce a synergistic effect. Severe outcomes such as cardiotoxicity, which can lead to death, in addition to aggression and the possibility of relapse to crack cocaine use, make this drug combination a public health problem that is greater than the individual consumption of these psychotropic drugs.

Profile of Help-seeking Crack Cocaine Users in Brazil: A Comparison of 2 Cross-sectional Studies From 1997 and 2013

Profile of Help-seeking Crack Cocaine Users in Brazil: A Comparison of 2 Cross-sectional Studies From 1997 and 2013

Crack cocaine users views regarding treatment with contingency management in Brazil

BackgroundContingency management (CM) has recently shown efficacy in promoting abstinence and retention in treatment among crack cocaine users in Brazil. However, partially because of unawareness and resistance among health care providers, CM has not been widely employed. The objective of this study was to conduct a secondary analysis in order to evaluate how CM participants perceive their treatment experience.MethodsTwenty-seven crack cocaine users, previously assigned to 12 weeks of CM treatment, were assessed with a structured questionnaire designed to assess their personal opinion of, difficulty in understanding, and acceptance of the CM intervention, as well as their opinion regarding its impact on their treatment responses.ResultsDescriptive analyses showed that 92.6% of the participants found it very easy to understand the CM protocol. All participants reported liking their CM experience quite a bit. For the perceived effects of CM on their treatment response, 81.5% of the participants stated that CM helped them considerably, the mean score for the impact of CM on treatment response (out of a maximum of 10) being 9 (SD = 1.5). When asked if they believed CM could help other people with crack cocaine dependence, 92.6% of the participants stated that CM could help such people a lot and 7.4% stated that it could help them a little.ConclusionsFrom the perspective of the patients, CM was easily assimilated, easily accepted, and had a direct positive effect on treatment response. These findings provide additional support for the incorporation of CM into substance abuse treatment services in Brazil.

Contingency management is effective in promoting abstinence and retention in treatment among crack cocaine users in Brazil: A randomized controlled trial.

Crack cocaine dependence has become a severe public health problem in Brazil, and current psychosocial approaches to this problem have shown little or no effectiveness. Although contingency management is among the most effective behavioral treatments for substance use disorders, it has never been applied in the treatment of crack cocaine-dependent individuals in Brazil. The aim of this study was to evaluate the efficacy of incorporating contingency management into standard outpatient treatment for crack cocaine dependence, as well as the impact that doing so has on treatment attendance, retention in treatment, maintenance of abstinence, and the frequency of substance use. We evaluated 65 treatment-seeking, crack cocaine-dependent individuals, randomized to receive 12 weeks of standard treatment plus contingency management (STCM; n = 33) or 12 weeks of standard treatment alone (STA; n = 32). Those in the STCM group received monetary incentives for being abstinent, earning up to US$235.50 if they remained abstinent throughout the entire treatment period. The STCM group participants attended a mean of 19.5 (SD = 14.9) treatment sessions, compared with 3.7 (SD = 5.9) for the STA group participants (p < .01). Those in the STCM group were 3.8, 4.6, and 68.9 times more likely to be retained in treatment at weeks 4, 8, and 12 than were those in the STA group. The likelihood of detecting 4, 8, and 12 weeks of continuous abstinence was 17.7, 9.9, and 18.6 times higher in the STCM group than in the STA group (p < .05). Compared to the STA group, the STCM group submitted a significantly higher proportion of negative samples for crack cocaine, delta-9-tetrahydrocannabinol, and alcohol (p < .001) when all expected samples were included in the denominator but not when only submitted samples were considered. The average monthly cost/participant for incentives was $29.00. Contingency management showed efficacy in a sample of Brazilian crack cocaine users. The intervention holds promise for broader application in international settings. (PsycINFO Database Record

Different patterns of drug use among crack and powder cocaine users in Brazil

s / Drug and Alcohol Dependence 156 (2015) e102–e182 e169 to explore the associationbetweennicotinedose assignment (usual brand, 0.8mg, 0.26mg, 0.12mg, 0.07mg, 0.04mg high tar, 0.03mg yield) andaffect,measuredby thePositive andNegativeAffect Scale (PANAS) and depression, measured by the Centers for Epidemiologic Studies Depression scale, outcomes. Results: Compared to those randomized to smoke their usual brand of cigarettes, participants who were randomized to smoke 0.8mg, 0.12mg, 0.07mg, and 0.03mg nicotine yield Spectrum cigarettes reported significantly less positive affect. Conversely, nicotine dose assignment did not impact negative affect experienced by participants. Nicotine dose assignment did not have an impact on depression during the study, either. Conclusions: Assignment to experimental cigarettes was associated with decreased positive affect compared to those who were assigned to smoke their usual brand cigarette.Nicotinedose assignment was not associated with differences in positive affect or depression. Financial support: This work was supported by T32 DA007209 and U54DA031659. http://dx.doi.org/10.1016/j.drugalcdep.2015.07.458 Crack users with conduct disorder have more association with violence, trauma and psychiatric comorbidities Mayra P. Pachado1, Daiane S. Souza4, Juliana N. Scherer5, Flavio P. Pechansky3, Felix Kessler3, Sibele Faller2 1 Psychiatric Dept, Center for Drug and Alcohol Research, Porto Alegre, Brazil 2 Center for Drug and Alcohol Research (CPAD) – Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil 3 Psychiatry, Center for Drug and Alcohol Studies at HCPA/UFRGS, Porto Alegre, Brazil 4 Psychiatric Dept, Federal University of Rio Grande do Sul, Porto Alegre, Brazil 5 Universidade Federal do Rio Grande do Sul, Porto

Evaluation of psychiatric symptoms in cocaine users in the Brazilian public health system: Need for data and structure

Few studies of comorbidity among cocaine users have been undertaken in Brazil, despite the fact that cocaine is one of the most commonly used illegal drugs in the country. The aim of this paper is to review existing data on psychiatric evaluations of cocaine users, and present data from two studies that have addressed this issue as it pertains to the Brazilian public health system. Review and results from two studies (cross-sectional and matched control). The Brazilian literature on PubMed, Lilacs, Psychinfo and DATASUS was searched using the key words: 'psychiatric symptoms', 'diagnosis', 'evaluation', 'assessment', 'cocaine disorders' and others related to this issue. Intake data from two studies of male and female cocaine users were also analysed with regard to psychiatric symptoms as measured by the Symptom Check List - 90 Revised (SCL-90). The literature review found no specific studies regarding psychiatric evaluation of cocaine users in Brazil. Analyses from the two studies presented showed high levels of psychiatric symptoms in this population. In the first study, psychiatric symptoms were measured at treatment entry and their prevalence was high, ranging from 27.4% to 53.4%. In the second study, SCL-90R scores at programme admission were higher in cocaine users than normal controls, with effect sizes ranging from moderate to high. To the authors' knowledge, this is the first article to discuss psychiatric evaluations of comorbidity among cocaine users in Brazil. The results indicate a need to: pay more attention to the evaluation of psychiatric symptoms in cocaine users; emphasize the importance of standardized data collection in this area; and evaluate the course of these symptoms, their impact on outcome, and how they are best addressed in treatment.

Cocaine craving questionnaire: Assessing craving among cocaine users in Brazil

The Cocaine Craving Questionnaire was administered to 205 cocaine addicts. A 6/5 cut-off corresponded to the scale's best performance. Reliability was 0.803. Receiver Operating Characteristic analysis resulted in an area under the curve of 0.7199 ± 0.0384, and dimensionality resulted in a three-factor solution. The scale is a reliable and valid instrument in identifying craving.

High mortality among young crack cocaine users in Brazil: a 5-year follow-up study.

Follow-up studies show that smokers, alcoholics and heroin addicts have high mortality rates, but there is little information on crack users. We have investigated the mortality rate among this population, including its risk factors and causes of death. A 5-year follow-up study. A cohort of 131 crack-dependent patients, admitted to a public detoxification unit in São Paulo between 1992 and 1994. Data collected from a structured personal interview and from a review of patients' hospital records, confirming the deaths from records held at the Municipal Offices. Of the 124 (94.6%) patients located, 23 (18.5%) had died (a mortality ratio of 7.6). Homicide was the most common cause of death (n = 13). Observed mortality rate, adjusted for age and sex, was 24.92 per 1000, while the expected all-cause mortality rate in São Paulo, also adjusted for age and sex, was 3.28 per 1000, giving an excess mortality rate of 21.64 per 1000. Survival analysis showed that the probability of being alive 5 years post-treatment was 0.80 (95% CI = 0.77-0.84). Cox's proportional hazards regression showed three factors predicted mortality: history of intravenous drug use (hazard ratio 3.28, 95% CI 1.42-7.59), unemployment at index admission (hazard ratio 3.48, 95% CI 1.03-11.80) and premature discharge from index admission (hazard ratio 2.21, CI 0.94-5.18). Community-based and tailored interventions should be considered to improve those patients' social support and permanence in treatment.

Overdoses among cocaine users in Brazil.

A survey of cocaine users was undertaken to study (i) the frequency of reported drug overdoses among cocaine users; and (ii) the frequency of witnessing drug overdoses in the same population. A cross-sectional study as part of the World Health Organization (WHO) Multi-city Study among injecting drug users (IDUs), phase II, was conducted in Santos Metropolitan Region, State of São Paulo, Brazil, in 1999. Three hundred and ninety-six exclusive users of cocaine in the Santos Metropolitan Region, São Paulo State, Brazil were surveyed concerning their past experience with drug overdoses. Eighty (20%) of the cocaine users reported having experienced one or more overdoses, and 50% reported that they knew one or more other cocaine users who had died of an overdose. On multivariate analysis, being female and having spent time in jail were associated with an increased likelihood of having had one or more overdoses. Cocaine overdoses are an important and under-recognized health problem in the Santos Metropolitan Region, and possibly in other areas of Brazil.

CROSS-CULTURAL APPROACHES TO HARM REDUCTION RESEARCH: SOME CONSIDERATIONS ON THE BRAZIL EXPERIENCE

Harm reduction initiatives for drug users comprise a range of approaches, including drug-user treatment, advocacy for changes in drug policy, needle exchange programs, bleach distribution, and broad-based interventions that focus on both safer drug use and less risky sexual behaviors. In many developing nations, harm reduction is a relatively new strategy, which focuses almost exclusively on the connections between drug use and the spread of HIV infection. In Brazil, harm reduction programs are few, and little has been documented about their scope, experience, and effectiveness. This paper reviews the status of Brazilian harm reduction initiatives in general, with a specific focus on lessons learned from the conduct of cross-national research in Rio de Janeiro. The study demonstrated the feasibility of implementing a community-based prevention program among an at-risk population of cocaine users in Brazil, and in other countries where there is little tradition of research with out-of-treatment drug users. Finally, the paper addresses aspects of the harm reduction movement that tend to hamper its progress in both developed and developing nations. [Translations are provided in the International s Section of this issue.]

Desenvolvimento de entrevista estruturada para avaliar consumo de cocaína e comportamentos de risco

OBJETIVO: Criar uma entrevista estruturada em português, sensível à cultura brasileira, para avaliar usuários de cocaína. MÉTODO: Uma revisão da literatura foi usada para desenvolver uma "agenda oculta" que dirigiria as entrevistas exploratórias com 20 usuários de cocaína. Essas entrevistas ajudaram no processo de conceituar e operacionalizar as perguntas que seriam utilizadas na primeira versão do instrumento. Essa versão foi submetida a um estudo piloto com 40 usuários de cocaína vindos de diversos serviços de atendimento. Após cada entrevista, o questionário foi revisado até não haver modificações significativas. RESULTADOS: Na versão final da entrevista havia 245 questões que, em sua maioria, eram fechadas com respostas dicotômicas, numéricas ou de múltipla escolha. A entrevista continha 13 seções, sendo: (1) dados sociodemográficos, (2) uso de drogas lícitas, (3) uso de drogas ilícitas, (4) iniciação no uso da cocaína, (5) transições na via de administração, (6) padrão de consumo durante o período de uso mais intenso, (7) atividades criminais, (8) uso recente de cocaína, (9) história de injetar drogas, (10) experiência de tratamento, (11) "overdose", (12) história familiar do uso de álcool e drogas e (13) comportamentos de risco para a transmissão do vírus HIV. CONCLUSÃO: Essa é a primeira entrevista estruturada, detalhada e sensível à cultura brasileira criada no Brasil para avaliar usuários de cocaína, e que teve um estudo piloto extenso com uma amostra grande e diversificada.

The Impact of an HIV Risk-Reduction Program Among Street Drug Users in Rio de Janeiro, Brazil

This article assesses the impact of an HIV risk-reduction program on risky behaviors in a population of street cocaine users in Rio de Janeiro, Brazil. Pre- and postintervention data were collected, and changes in the frequency of drug use, sexual risk behaviors, and other life-situation variables were examined. Participation in the program was associated with a significant decrease in the average number of days of cocaine use and a significant increase in employment and income. Significant increases in condom use were also documented. The data suggest that this population of street cocaine users was capable of understanding the severity of AIDS as well as learning and applying specific risk-reduction techniques to their behavior. The results further demonstrate the feasibility of conducting street research among an at-risk population of cocaine users in Brazil and in other countries in which there is little tradition of research with out-of-treatment drug users.