Trauma precoce e impulsividade em mono e poliusuários de álcool, cocaína/crack : uma análise de rede

Os Transtornos por Uso de Substâncias (TUS) estão entre os transtornos psiquiátricos mais prevalentes no mundo. De acordo com a Organização Mundial de Saúde (OMS), cerca de 10% da população dos centros urbanos de todo o planeta usa, abusivamente, alguma substância psicoativa. Segundo dados do Global Drug Survey (GDS) COVID-19, no Brasil, durante a pandemia, observou-se o aumento nos consumos de 17.2% de maconha; 7.4% de cocaína e 12.7% de benzodiazepínicos, 13,1% de álcool (um pouco abaixo da média mundial de 13,5%). Entretanto, o uso abusivo pode acarretar na perpetuação do sofrimento psicológico, tornando-se assim, um ciclo vicioso. Em relação a traumas precoces, sua ocorrência em períodos prévios do desenvolvimento são associados a piores desfechos entre os usuários de Substâncias Psicoativas (SPAs) e maiores escores de impulsividade. O artigo 1 deste estudo buscou realizar uma comunicação breve a partir da literatura científica em relação ao aumento do uso de drogas fumáveis durante a pandemia de COVID-19 e demonstrou também os riscos ao organismo decorrentes de seu consumo, além do possível aumento de morbimortalidade, em caso de comorbidade com essa grave infecção viral. O artigo 2 avaliou o trauma infantil através do Childhood Trauma Questionnaire (CTQ) e os níveis de impulsividade pelo Barratt Impulsiveness Scale (BIS-11) através de Análise de Rede (AR) em 686 usuários de SPAs. Os resultados descobertos pelo artigo 1 mostraram o aumento do uso de SPAs fumáveis, o que implica em maior risco de contágio por COVID-19 e também em gravidade do TRS. Os resultados do artigo 2 apontam fraca relação entre traumas e impulsividade em todos os grupos, exceto entre monousuários de Crack/Cocaína (MC), sendo o aspecto motor desta, o eixo central da rede de impulsividade. Traumas de abuso físico e emocional possuem conexões próximas e fortes em todos os grupos, porém, os grupos MC e de Poliusuários de Álcool e Crack/Cocaína (PAC) apresentam maior intensidade em comparação a rede de monousuários de Álcool (MA). Em relação à impulsividade, em todas as redes, as centralidades foram evidenciadas pelo aspecto motor da impulsividade, entretanto, a rede MA apresentou menor intensidade em relação a rede MC e PAC. Nossos resultados sugerem que o trauma infantil e maiores níveis de impulsividade são comuns na população com TRS; não se pode estabelecer uma relação causal entre ambos, porém é sugerida a intervenção precoce em traumas atuais e anteriores, podendo melhorar o prognóstico de condições de sofrimento psíquico, independente da sua natureza.According to the World Health Organization (WHO), about 10% of the population in urban centers across the planet abuse some psychoactive substance. According to data from the Global Drug Survey (GDS) COVID-19, in Brazil, during the pandemic, there was an increase in consumption of 17.2% of marijuana; 7.4% cocaine and 12.7% benzodiazepines, 13.1% alcohol (slightly below the world average of 13.5%). However, an abusive use can lead to the perpetuation of psychological suffering, thus becoming a vicious cycle. In relation to early trauma, its occurrence in early developmental periods is associated with worse outcomes among users of Psychoactive Substances (PAS) and higher impulsivity scores. Article 1 of this study sought to make a brief communication from the scientific literature in relation to the increase in the use of smokable drugs during the COVID-19 pandemic and also demonstrated the risks to the organism of its consumption, in addition to a possible increase in morbidity and mortality, in case of comorbidity with this serious viral infection. Article 2 evaluated child trauma through the Childhood Trauma Questionnaire (CTQ) and the levels of impulsiveness by the Barratt Impulsiveness Scale (BIS-11) through Network Analysis (NA) in 686 users of SPAs. The results shown in article 1 showed a probable increase in the use of smokable SPAs, which implies a greater risk of contagion by COVID-19 as well as in severity of SUD. The results of article 2 show a weak relationship between trauma and impulsivity in all groups, except among monousers of crack/cocaine (MC), with the motor aspect of this being the central axis of the impulsivity network). Traumas of physical and emotional abuse have close and strong connections in all groups, however the MC and poli-users of alcohol, crack and cocaine (PAC) groups are more intense compared to the Alcohol Single Users network (MA). In relation to impulsivity, in all networks, the centralities were evidenced by the motor aspect of impulsivity, however, the MA network had less intensity in relation to the MC and PAC network. Our results suggest that childhood trauma and higher levels of impulsivity are common in the population with SUD; a causal relationship cannot be established between the two, but early intervention in current or early trauma can improv

Multiple clinical risks for cannabis users during the COVID-19 pandemic

The pandemic caused by Sars-CoV-2 (COVID-19) has been a great concern for public and mental health systems worldwide. The identification of risk groups is essential for the establishment of preventive and therapeutic strategies, as for substance users. During COVID-19 pandemic, there was an increase in the use of psychoactive substances during the lockdown, including cannabis. This commentary reviews relevant findings and discusses scientific evidence on the risks of worse clinical and psychiatric complications due to coronavirus disease COVID-19 in subjects who use cannabis. Although they are not included as a risk group in the health recommendations for that disease, they may have a more vulnerable respiratory system to viral diseases. There are certain similarities between the harmful cardiovascular and respiratory effects of cannabis use and those of smoking. Due to the different modes of smoking, cannabis chemicals are retained in the body for longe and may also contain other toxic substances such as tar, a substance found in tobacco and which has been associated with the development of lung cancer, bronchitis and pulmonary emphysema. Therefore, we discuss if individuals who use cannabis regularly might be more vulnerable to COVID-19 infection. This population deserves more clinical attention worldwide and this manuscript can help clinicians become more aware of cannabis risks during pandemics and develop specific intervention strategies

High COVID-19 morbidity and mortality risk among smoked drug users in Brazil

In much of the West, including Brazil, drug use has increased since social distancing began in response to the pandemic. Use of smoked and modified drugs, and their impacts on health, may contribute to aggravate the effects of the pandemic. However, studies on the relationship between use of smoked drugs and the new coronavirus are still scarce and have not received enough attention in global health recommendations. This paper aims to briefly review the relationship between use of smoked drugs and acute respiratory syndrome coronavirus 2 [SARS-CoV-2]. Recent studies also suggest that drug consumption increases the risk of contamination by SARS-CoV-2 and leads to worse prognosis, particularly consumption of drugs that affect lung function. Use of smoked drugs, especially tobacco, is strongly associated with lung diseases that are risk factors for contamination by SARS-CoV-2. It is essential to develop strategies based on specific characteristics of drug users and for mental health professionals to be included in strategic teams. It is also necessary to invest in information campaigns regarding risks and prevention of harm caused by smoked drugs as well as to design strategies that facilitate access to psychosocial treatment during the pandemic

Predictive factors associated with driving under the influence among Brazilian drug-using drivers

The incidence of driving under the influence of psychoactive substances (DUI) and its recidivism can be curtailed by the proper identification of specific and predictive characteristics among drug users. In this sense, interpersonal violence (IV), psychiatric comorbidity and impulsivity seem to play an important role in DUI engagement according to previous studies. There are, however, limited data originated from low and middle income countries. In the present study, drug-using Brazilian drivers reporting DUI (n=75) presented a higher prevalence of bipolar disorders (BD; DUI: 8% vs. non-DUI: 0%, p < 0.001), lower prevalence of obsessivecompulsive disorder (OCD; DUI: 0% vs. non-DUI: 12.6%, p < 0.001), and higher prevalence of childhood trauma (DUI: 65.3% vs. non-DUI: 46.8%, p=0.022) than those not reporting DUI (n=79). The evaluation of impulsivity though the Barratt Impulsivity Scale, which give impulsivity scores ranging from 30 to 120, showed higher impulsivity scores in the DUI group (80.4 ± 8) than in the non-DUI group (77.2 ± 10, p=0.045). In general, subjects were young adults (mean age of 36 ± 9 years), Caucasians (58.4%), not married (61.0%), and with elementary schooling (40.3%) with no significant differences in demographic characteristics between drivers with and without DUI behavior A multiple Poisson regression model showed that individuals reporting IV as perpetrators and history of childhood trauma were more likely to report DUI (PR: 1.66, 95%CI 1.22–2.7; PR: 1.57, 95%CI 1.02–2.42, respectively). The overlapping of violent situations (childhood trauma, IV and DUI) in some individuals presented here corroborates literature data suggesting that DUI can be an externalizing expression of a range of risky behavior, such as impulsiveness and aggressiveness. Moreover, while BD and higher impulsivity scores seem to act as risk factors for DUI, OCD was shown as a protective factor. These results corroborate the hypothesis that individuals with high risk for DUI could probably be identified by multidimensional assessment of cognitive, risky taking, and personality traits, which perhaps could facilitate the development of focused interventions