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.Palavras-chave: codependência, entrevista motivacional, telefone.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.Key words: codependency, motivational interviewing, telephone

Fatores de risco para episódios e sintomas depressivos em usuários de álcool e/ou cocaína

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

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 e substâncias utilizadas. O uso de mais de uma técnica de intervenção, tempo curto de tratamento e o tipo de substância utilizada pelos pacientes parecem facilitar a adesão

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

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