Psychosocial factors related to dropout in substance use disorder inpatient treatment: a longitudinal study

Background: Substance use disorder (SUD) is associated with psychological, biological, and social problems. To date, existing treatments have a high dropout rate. Objective: This study aimed to investigate the psychosocial factors related to dropout from prolonged inpatient treatment due to SUD. Methods: A nine-week longitudinal follow-up study of 148 adult men inpatient for treatment for SUD. Psychosocial measures, aspects related to treatment, substance use, and sociodemographic data were collected using self-completed questionnaires. The main outcome was treatment dropout nine weeks after initial contact. Binomial logistic regression was used to evaluate the association of variables with dropout. Results: Prolonged inpatient treatment dropout was related to anxiety, depression, stress, self-judgment, expression of anger, positive and negative affect, negative urgency, lack of perseverance, and impulsivity, but not to sociodemographic characteristics or characteristics related to the substances consumed and the history of use. Conclusion: Psychological factors, such as negative emotional states and impulsivity, were the main predictors of dropout. These results highlight the relevance of emotional management skills to a male population in preventing the treatment dropout associated with SUD

Adverse effects of ayahuasca: Results from the Global Ayahuasca Survey

Introduction Ayahuasca is a plant-based decoction native to Amazonia, where it has a long history of use in traditional medicine. Contemporary ritual use of ayahuasca has been expanding throughout the world for mental health purposes, and for spiritual and personal growth. Although researchers have been conducting clinical trials and observational studies reporting medical and psychological benefits, most of these do not report ayahuasca’s immediate or medium-term adverse effects, so these are underrepresented in the literature. With the expansion of ayahuasca ceremonies from their traditional contexts to countries around the world, there is an important public health question regarding the risk/benefit balance of its use. Methods We used data from an online Global Ayahuasca Survey (n = 10,836) collected between 2017 and 2019 involving participants from more than 50 countries. Principal component analysis was performed to assess group effects. Logistic regression analysis was performed to test for adverse effects associated with history of ayahuasca use, clinical, context of use and spiritual effect variables. Results Acute physical health adverse effects (primarily vomiting) were reported by 69.9% of the sample, with 2.3% reporting the need for subsequent medical attention. Adverse mental health effects in the weeks or months following consumption were reported by 55.9% of the sample, however, around 88% considered such mental health effects as part of a positive process of growth or integration. Around 12% sought professional support for these effects. Physical adverse effects were related to older age at initial use of ayahuasca, having a physical health condition, higher lifetime and last year ayahuasca use, having a previous substance use disorder diagnosis, and taking ayahuasca in a non-supervised context. Mental health adverse effects were positively associated with anxiety disorders; physical health conditions; and the strength of the acute spiritual experience; and negatively associated with consumption in religious settings. Conclusions While there is a high rate of adverse physical effects and challenging psychological effects from using ayahuasca, they are not generally severe, and most ayahuasca ceremony attendees continue to attend ceremonies, suggesting they perceive the benefits as outweighing any adverse effects. Knowing what variables might predict eventual adverse effects may serve in screening of, or providing additional support for, vulnerable subjects. Improved understanding of the ayahuasca risk/benefit balance can also assist policy makers in decisions regarding potential regulation and public health responses

Uso recreacional de benzidamina como alucinógeno entre adolescentes em situação de rua no Brasil

OBJECTIVE: To describe the recreational use of benzydamine, an anti-inflammatory drug, among street youth in Brazil. METHOD: Design: a descriptive, cross sectional survey. Setting: 93 welfare services for the street youth in 27 Brazilian capitals. Participants: 2807 street youth, 10 to 18 years old. Main outcome measures: demographic characteristics, drug use pattern (lifetime use, use in the past 30 days, frequency, and characteristics of use in the past month) and effects of benzydamine through the use of a questionnaire. RESULTS: 78 reported lifetime recreational benzydamine use (67 cases identified only in three capitals). Among the 30 respondents reporting drug use in the last month (the month preceding the survey), 66.7% (n = 20) used the drug on 4 or more days (in the month preceding the survey). The most frequently (50%) pleasure effects reported were hallucination and nonspecific sensory changes described as trips. Unwanted effects were reported by 75% of respondents, they were especially nausea and vomiting (21.4%). In the majority of the cases, drug was obtained from drugstores without a medical prescription. CONCLUSION: This study identifies the recreational use of benzydamine among street youth, mainly in the Northeast of Brazil, and also indicates the need for special controls on the dispensation of this substance.OBJETIVO: Descrever o uso recreacional de benzidamina, um medicamento antiinflamatório, entre adolescentes em situação de rua no Brasil. MÉTODO: Desenho: descritivo, transversal. Local: 93 instituições assistenciais para crianças e adolescentes em situação de rua nas 27 capitais do Brasil. Participantes: 2.807 crianças e adolescentes em situação de rua, com idade entre 10 e 18 anos. Principais medidas de interesse: características demográficas, padrão de uso (uso na vida, uso nos últimos 30 dias, frequência e características de uso no mês anterior à pesquisa) e efeitos da benzidamina usando um questionário. RESULTADOS: 78 relataram uso recreacional na vida de benzidamina (67 casos identificados somente em três capitais). Entre os 30 entrevistados que relataram uso recente da substância (no mês que precedia a investigação), 66,7% (n = 20) tomaram o medicamento em quatro dias ou mais no mês. Os efeitos desejados mais frequentemente reportados foram alucinações e alterações sensoriais inespecíficas como viagem (50%). Efeitos indesejados foram citados por 75% dos entrevistados, principalmente náuseas e vômitos (21,4%). Na maioria dos casos, o medicamento foi obtido de drogarias sem apresentação de prescrição médica. CONCLUSÃO: Os resultados observados neste estudo identificam o uso recreacional de benzidamina entre crianças e adolescentes em situação de rua, especialmente no Nordeste do Brasil, e indicam a necessidade de controle especial sobre a dispensação desta substância.Universidade Federal de São Paulo (UNIFESP) Brazilian Center of Information on Psychotropic DrugsUniversidade Federal de São Paulo (UNIFESP) Department of PsychobiologyUNIFESP, Brazilian Center of Information on Psychotropic DrugsUNIFESP, Department of PsychobiologySciEL

The effect of mindfulness on decision-making, inhibitory control, and impulsivity of substance use disorder in-treatment patients : A randomized clinical trial

This study aimed to investigate the effects of Mindfulness-Based Relapse Prevention (MBRP) in decision-making, inhibitory control and impulsivity compared to Treatment as Usual (TAU) for individuals with Substance Use Disorders (SUD's) in Brazil. A randomized clinical trial was conducted with participants from a therapeutic community (n = 122). Decision-making (Iowa Gambling Task), impulsivity dimensions (UPPS-P Scale), and inhibitory control (Stroop Color-Word Test) were assessed before and after the MBRP 8-week intervention. GLM Multivariate analysis was used to evaluate the effects of MBRP on different impulsivity measures. The results showed that MBRP+TAU improved the general decision-making score (p = 0,008) compared to TAU. However, no significant effects were found in impulsivity dimensions and inhibitory control in individuals with SUDs in the therapeutic community. This study found improvement in decision-making in the total IGT score; however, no effect for self-reported impulsivity and inhibitory control among middle-aged patients after an 8-weeks intervention of MBRP protocol in an inpatient setting. It adds information to the subject, with implications and possible directions to be followed by the next clinical trials with patients with SUDs in treatment. Trial registration: EnsaiosClinicos.gov.br: RBR-6c9njc

Fatores associados ao uso pesado de álcool entre estudantes das capitais brasileiras

OBJECTIVE: To evaluate the association between heavy use of alcohol among students and family, personal and social factors. METHODS: Cross-sectional study including public school students aged ten to 18 from 27 Brazilian capital cities in 2004. Data was collected using an anonymous, self-report questionnaire that was adapted from a World Health Organization instrument. A representative sample comprising 48,155 students was stratified by census tracts and clusters (schools). The associations between heavy alcohol use and the factors studied were analyzed using logistic regression at a 5% significance level. RESULTS: Of all students, 4,286 (8.9%) reported heavy alcohol use in the month prior to the interview. The logistic regression analysis showed an association between fair or poor relationship with the father (OR = 1.46) and the mother (OR = 1.61) and heavy use of alcohol. Following a religion (OR = 0.83) was inversely associated with heavy alcohol consumption. Sports practice and mother perceived as a "liberal" person had no significance in the model. However, a higher prevalence of heavy use of alcohol was seen among working students. CONCLUSIONS: Stronger family ties and religion may help preventing alcohol abuse among students.OBJETIVO: Analizar la asociación entre el uso pesado de alcohol entre estudiantes y los factores familiares, personales y sociales. MÉTODOS: Estudio transversal realizado con estudiantes de diez a 18 años de escuelas públicas de 27 capitales brasileras, en 2004. Los datos fueron colectados por medio de cuestionario anónimo, de auto-completación, adaptado de instrumento desarrollado por la Organización Mundial de la Salud. La muestra representativa, compuesta por 48.155 estudiantes, fue estratificada por sectores censitarios y por conglomerados (escuelas). Asociaciones entre el uso pesado de alcohol y los factores estudiados fueron analizadas por medio de regresión logística, considerando nivel de significancia de 5%. RESULTADOS: Del total de estudiantes, 4.286 (8,9%) hicieron uso pesado de alcohol en el mes anterior a la entrevista. El análisis por regresión logística mostró asociación entre relaciones malas o regulares con padre (OR= 1,46) y madre (OR =1,61) y uso pesado de alcohol. Seguir una religión (OR=0,83) se mostró inversamente asociado a este tipo de consumo de alcohol. La práctica de deportes y el hecho de que la madre se perciba como liberal, no mostraron significancia en el modelo. Hubo mayor prevalencia del uso pesado de alcohol entre los estudiantes que trabajaban. CONCLUSIONES: Uniones familiares más coherentes y seguir una religión pueden prevenir el uso abusivo de alcohol entre estudiantes.OBJETIVO: Analisar a associação entre o uso pesado de álcool entre estudantes e os fatores familiares, pessoais e sociais. MÉTODOS: Estudo transversal realizado com estudantes de dez a 18 anos de escolas públicas de 27 capitais brasileiras, em 2004. Os dados foram coletados por meio de questionário anônimo, de autopreenchimento, adaptado de instrumento desenvolvido pela Organização Mundial da Saúde. A amostra representativa, composta por 48.155 estudantes, foi estratificada por setores censitários e por conglomerados (escolas). Associações entre o uso pesado de álcool e os fatores estudados foram analisadas por meio de regressão logística, considerando nível de significância de 5%. RESULTADOS: Do total de estudantes, 4.286 (8,9%) fizeram uso pesado de álcool no mês anterior à entrevista. A análise por regressão logística mostrou associação entre relações ruins ou regulares com pai (OR=1,46) e mãe (OR=1,61) e uso pesado de álcool. Seguir uma religião (OR=0,83) mostrou-se inversamente associado a este tipo de consumo de álcool. A prática de esportes e o fato de a mãe se percebida como liberal não mostraram significância no modelo. Houve maior prevalência de uso pesado de álcool entre os estudantes que trabalhavam. CONCLUSÕES: Ligações familiares mais coesas e seguir uma religião podem prevenir o uso abusivo de álcool entre estudantes

Binge drinking : a pattern associated with a risk of problems of alcohol use among university students

Objective:: to evaluate problems associated with alcohol use among university students who reported binge drinking in comparison to students who consumed alcohol without binging. Method:: a cross-sectional study among university students (N=2,408) who accessed the website about alcohol use. Logistic and linear regression models were included in the statistical analyzes. Results:: alcohol use in the last three months was reported by 89.2% of university students; 51.6% reported binge drinking. Compared to students who did not binge drink, university students who presented this pattern were more likely to report all evaluated problems, among them: black out (aOR: 5.4); having academic problems (aOR: 3.4); acting impulsively and having regrets (aOR: 2.9); getting involved in fights (aOR: 2.6); drinking and driving (aOR: 2.6) and accepting a ride with someone who had drunk alcohol (aOR: 1.8). Students who binged also had higher scores on the Alcohol Use Disorders Identification Test (b=4.6; p<0.001), more negative consequences (b=1.0; p<0.001) and a reduced perception of the negativity of the consequences (b=-0.5; p<0.01). Conclusion:: binge drinking was associated with an increase in the chances of manifesting problems related to alcohol use. The conclusions of this study cannot be generalized for all of the Brazilian population. Objetivo:: avaliar problemas associados ao uso de álcool entre universitários que relataram binge drinking em comparação a estudantes que consumiram álcool sem binge drinking. Método:: estudo transversal entre universitários (N=2.408) que acessaram website sobre o uso de álcool. Nas análises estatísticas incluíram-se modelos de regressão logística e linear. Resultados:: o uso de álcool, nos últimos três meses, foi relatado por 89,2% dos universitários e 51,6% referiram uso binge. Comparados a estudantes que não praticaram binge, universitários que apresentaram esse padrão tiveram maior chance de relatar todos os problemas avaliados, entre eles: incapacidade de lembrar o que aconteceu (aOR:5,4); problemas acadêmicos (aOR:3,4); agir impulsivamente e se arrepender (aOR:2,9); envolver-se em brigas (aOR:2,6); dirigir após beber (aOR:2,6) e pegar carona com alguém que bebeu (aOR:1,8). Estudantes que consumiram álcool no padrão binge também apresentaram maior pontuação no Alcohol Use Disorders Identification Test (b=4,6; p<0,001), mais consequências negativas (b=1,0; p<0,001) e menos percepção da negatividade das consequências (b=-0,5; p<0,01). Conclusão:: a prática de binge drinking esteve associada ao aumento das chances de manifestação de problemas relacionados ao uso de álcool. As conclusões deste estudo não podem ser reproduzidas para toda realidade brasileira. Objetivo:: evaluar problemas asociados al uso de alcohol entre estudiantes universitarios que relataron binge drinking en comparación a estudiantes que consumieron alcohol sin binge drinking. Método:: estudio transversal entre estudiantes universitarios (N=2.408) que visitaron una página web sobre el uso de alcohol. En los análisis estadísticos, fueron incluidos modelos de regresión logística y linear. Resultados:: el uso de alcohol, en los últimos tres meses, fue relatado por 89,2% de los estudiantes universitarios, y entre ellos 51,6% relataron uso binge. En comparación a estudiantes universitarios que no practicaron binge, los estudiantes que presentaron ese estándar tuvieron una mayor oportunidad de relatar todos los problemas evaluados, entre ellos: incapacidad de recordar lo que sucedió (aOR:5,4); problemas académicos (aOR:3,4); actuar por impulso y arrepentirse (aOR:2,9); involucrarse en peleas (aOR:2,6); manejar después de beber (aOR:2,6) y compartieron viaje con alguien que bebió (aOR:1,8). Estudiantes que consumieron alcohol dentro del estándar binge también presentaron una mayor puntuación en el Alcohol Use Disorders Identification Test (b=4,6; p<0,001), más consecuencias negativas (b=1,0; p<0,001) y menor percepción de la negatividad de las consecuencias (b=-0,5; p<0,01). Conclusión:: la práctica de binge drinking estuvo asociada al aumento de las oportunidades de manifestación de problemas relacionados al alcohol. Las conclusiones de este estudio no pueden ser adaptadas a toda la realidad brasileña