Crack-cocaine users have less family cohesion than alcohol users

Objective: Many studies correlate characteristics of family functioning and the development of drug addiction. This study sought to evaluate and compare the family environment styles of two groups of psychoactive substance users: 1) alcohol-only users and 2) crack-cocaine users. Methods: Three hundred and sixty-four users of alcohol, crack-cocaine, and other drugs, recruited from research centers in four Brazilian capitals participated in this study. Subjects were evaluated through the Family Environment Scale and the Addiction Severity Index, 6th version (ASI-6). ASI-6 t-scores were compared by analysis of variance (ANOVA) and post-hoc tests. A final model was obtained using a logistic regression analysis. All analyses were adjusted for partner, age, and psychiatric t-score. Results: We found a significant difference between groups in the cohesion subscale (p = 0.044). The post-hoc test revealed a difference of 1.06 points (95%CI 0.11-2.01) between groups 1 (6.4560.28) and 2 (5.3860.20). No significant between-group differences were observed in the other subscales. However, categorical analyses of variables regarding family dynamic showed that crack users more often reported that sometimes people in their family hit each other (30.4% vs. 13.2%, p = 0.007) and that people in their family frequently compared each other regarding work and/or school achievement (57.2% vs. 42.6%, p = 0.041). Conclusion: These results suggest that families of crack-cocaine users are less cohesive than families of alcohol users. This type of family environment may affect treatment outcome, and should thus be adequately approached

As relações interpessoais dos usuários de crack e fatores de risco associados

O crack é a substância ilícita que mais leva à busca por tratamento para uso de substâncias no Sistema Único de Saúde (SUS). Os usuários frequentemente relatam dificuldades nos seus relacionamentos interpessoais, no entanto ter relacionamentos saudáveis é crucial para o processo de recuperação. As evidências até agora demonstram que além do uso de substâncias psicoativas, outros fatores da vida do sujeito, como características sociodemográficas, dificuldades emocionais, comportamentais e sociais podem se tornar barreiras para o resgate e cultivo de relacionamentos saudáveis. Sendo assim, a presente dissertação teve por objetivo investigar a associação entre severidade dos problemas no funcionamento interpessoal dos usuários de crack e fatores de risco associados, tais como características sociodemográficas, fatores relacionados ao uso de substâncias do paciente, de seus parceiros, familiares e amigos e comorbidades psiquiátricas. Este foi um estudo transversal multicêntrico, com a participação de homens e mulheres (N=407), em tratamento para problemas por uso de crack, na rede de saúde pública de seis capitais brasileiras. A magnitude de associação entre o desfecho (T-score: problemas na área Família/Social) e os fatores em estudo (características sociodemográficas, comorbidades psiquiátricas, exposição a eventos estressores na vida, uso recente de substâncias psicoativas, dados sobre o consumo de substâncias pelos usuários, seu parceiro, familiares adultos e amigos e envolvimento com atividades ilícitas) foi avaliada através da razão de prevalência (RP), estimada pela regressão de Poisson com variância robusta. Ter diagnóstico de abuso de álcool, transtorno de estresse pós-traumático, transtorno da personalidade antissocial, episódio depressivo atual e o número de dias consumindo crack no último mês estava significativamente associado com maior severidade nos problemas na área Família/Social. Os achados deste estudo demonstram uma relação entre maior frequência de uso de crack e co-morbidades psiquiátricas com ter mais problemas nos relacionamentos com parceiros, familiares e amigos. Sendo a reinserção social, uma conquista fundamental para a recuperação, nossos achados apontam que, além do uso de crack em si, outros elementos podem representar barreiras para o bom funcionamento social destas pessoas. Estes resultados advogam em favor do desenvolvimento de intervenções psicossociais que foquem na melhora do funcionamento interpessoal de usuários de crack e a inclusão de familiares e amigos nas abordagens terapêuticas. Além disso, sugere-se o oferecimento de tratamento concomitante para as comorbidades psiquiátricas.Crack-cocaine is the illicit psychoactive substance that most leads to substance use treatment seeking in the Unified Health System (SUS). Users frequently report difficulties in interpersonal relationships, yet having healthy relationships is crucial to the process of recovery. Evidence so far demonstrate that in addition to psychoactive substance use, other factors in the user’s life, such as sociodemographic characteristics, emotional, behavioral, and social problems, may become barriers to the rescue and cultivation of healthy relationships. Thus, the present dissertation aimed to investigate the association between severity of problems in interpersonal functioning of crack-cocaine users and related risk factors such as sociodemographic characteristics, consumption of psychoactive substances by users, partners, adult relatives and friends, and psychiatric comorbidities. This was a multicenter cross-sectional study, involving men and women (N = 407), undergoing treatment for their crack-cocaine use in public health facilities of six Brazilian capitals. The magnitude of association between the outcome (T-score: problems in the Family/Social area) and factors under study (sociodemographic characteristics, psychiatric comorbidities, exposure to lifetime stressful events, data regarding the use of psychoactive substances by users, their partner, adult relatives and friends and engagement in illicit activities) was evaluated by the prevalence ratio (PR), estimated by Poisson regression with robust variance. Having a comorbid diagnosis of alcohol abuse, posttraumatic stress disorder, antisocial personality disorder, current depressive episode and the number of days of crack use in the last month was significantly associated with greater severity in the problems in the Family/Social area. These findings demonstrate a relationship between higher frequency of use of crack cocaine and psychiatric comorbidities with more problems in relationships with partners, family and friends. Since social reintegration is a fundamental achievement for recovery, our findings indicate that, besides the use of crack itself, other elements may represent barriers to the social functioning of these people. These results support development of psychosocial interventions that focus in the improvement of interpersonal relationships of crack cocaine users and the inclusion of family and friends in the treatment. In addition, it is suggested that interventions should target concomitant treatment for psychiatric comorbidities

As relações interpessoais dos usuários de crack e fatores de risco associados

O crack é a substância ilícita que mais leva à busca por tratamento para uso de substâncias no Sistema Único de Saúde (SUS). Os usuários frequentemente relatam dificuldades nos seus relacionamentos interpessoais, no entanto ter relacionamentos saudáveis é crucial para o processo de recuperação. As evidências até agora demonstram que além do uso de substâncias psicoativas, outros fatores da vida do sujeito, como características sociodemográficas, dificuldades emocionais, comportamentais e sociais podem se tornar barreiras para o resgate e cultivo de relacionamentos saudáveis. Sendo assim, a presente dissertação teve por objetivo investigar a associação entre severidade dos problemas no funcionamento interpessoal dos usuários de crack e fatores de risco associados, tais como características sociodemográficas, fatores relacionados ao uso de substâncias do paciente, de seus parceiros, familiares e amigos e comorbidades psiquiátricas. Este foi um estudo transversal multicêntrico, com a participação de homens e mulheres (N=407), em tratamento para problemas por uso de crack, na rede de saúde pública de seis capitais brasileiras. A magnitude de associação entre o desfecho (T-score: problemas na área Família/Social) e os fatores em estudo (características sociodemográficas, comorbidades psiquiátricas, exposição a eventos estressores na vida, uso recente de substâncias psicoativas, dados sobre o consumo de substâncias pelos usuários, seu parceiro, familiares adultos e amigos e envolvimento com atividades ilícitas) foi avaliada através da razão de prevalência (RP), estimada pela regressão de Poisson com variância robusta. Ter diagnóstico de abuso de álcool, transtorno de estresse pós-traumático, transtorno da personalidade antissocial, episódio depressivo atual e o número de dias consumindo crack no último mês estava significativamente associado com maior severidade nos problemas na área Família/Social. Os achados deste estudo demonstram uma relação entre maior frequência de uso de crack e co-morbidades psiquiátricas com ter mais problemas nos relacionamentos com parceiros, familiares e amigos. Sendo a reinserção social, uma conquista fundamental para a recuperação, nossos achados apontam que, além do uso de crack em si, outros elementos podem representar barreiras para o bom funcionamento social destas pessoas. Estes resultados advogam em favor do desenvolvimento de intervenções psicossociais que foquem na melhora do funcionamento interpessoal de usuários de crack e a inclusão de familiares e amigos nas abordagens terapêuticas. Além disso, sugere-se o oferecimento de tratamento concomitante para as comorbidades psiquiátricas.Crack-cocaine is the illicit psychoactive substance that most leads to substance use treatment seeking in the Unified Health System (SUS). Users frequently report difficulties in interpersonal relationships, yet having healthy relationships is crucial to the process of recovery. Evidence so far demonstrate that in addition to psychoactive substance use, other factors in the user’s life, such as sociodemographic characteristics, emotional, behavioral, and social problems, may become barriers to the rescue and cultivation of healthy relationships. Thus, the present dissertation aimed to investigate the association between severity of problems in interpersonal functioning of crack-cocaine users and related risk factors such as sociodemographic characteristics, consumption of psychoactive substances by users, partners, adult relatives and friends, and psychiatric comorbidities. This was a multicenter cross-sectional study, involving men and women (N = 407), undergoing treatment for their crack-cocaine use in public health facilities of six Brazilian capitals. The magnitude of association between the outcome (T-score: problems in the Family/Social area) and factors under study (sociodemographic characteristics, psychiatric comorbidities, exposure to lifetime stressful events, data regarding the use of psychoactive substances by users, their partner, adult relatives and friends and engagement in illicit activities) was evaluated by the prevalence ratio (PR), estimated by Poisson regression with robust variance. Having a comorbid diagnosis of alcohol abuse, posttraumatic stress disorder, antisocial personality disorder, current depressive episode and the number of days of crack use in the last month was significantly associated with greater severity in the problems in the Family/Social area. These findings demonstrate a relationship between higher frequency of use of crack cocaine and psychiatric comorbidities with more problems in relationships with partners, family and friends. Since social reintegration is a fundamental achievement for recovery, our findings indicate that, besides the use of crack itself, other elements may represent barriers to the social functioning of these people. These results support development of psychosocial interventions that focus in the improvement of interpersonal relationships of crack cocaine users and the inclusion of family and friends in the treatment. In addition, it is suggested that interventions should target concomitant treatment for psychiatric comorbidities

Assessment of inhibitory control in crack and/or cocaine users: a systematic review

Abstract Objective Impairments involving inhibitory control have been considered central deficits in drug users, but it appears that dysfunctions may be specific to users’ drug of choice. This article aims to review recent findings on inhibitory control impairment in samples of crack and/or cocaine users. Methods Searches were conducted on the PubMed, PsycINFO, and Web of Knowledge databases in two stages according to eligibility criteria. Initially, databases were searched and the titles and abstracts of results were analyzed and then selected articles were read in full. Inclusion criteria were: empirical articles written in English, Portuguese, or Spanish, published in the last ten years and involving the assessment of inhibitory control in crack and/or cocaine users. Results The database searches returned a total of 3,796 titles, 56 of them were selected initially and then a further 20 were excluded. Thirty-six articles were included in this review. In 90% of the studies reviewed the presence of inhibitory control deficits was reported, verified by impaired cognitive processing and response monitoring, as well as high levels of impulsiveness, regardless of the pattern of crack and/or cocaine consumption (recreational or chronic). Former users showed high levels of impulsiveness even after long periods of abstinence. Conclusions Crack and/or cocaine users may have inhibitory control deficits, irrespective of different consumption patterns. High levels of impulsiveness can represent a factor of vulnerability to drug use and relapse

Avaliação do controle inibitório em usuários de cocaína e/ou crack : uma revisão sistemática

Objective: Impairments involving inhibitory control have been considered central deficits in drug users, but it appears that dysfunctions may be specific to users’ drug of choice. This article aims to review recent findings on inhibitory control impairment in samples of crack and/or cocaine users. Methods: Searches were conducted on the PubMed, PsycINFO, and Web of Knowledge databases in two stages according to eligibility criteria. Initially, databases were searched and the titles and abstracts of results were analyzed and then selected articles were read in full. Inclusion criteria were: empirical articles written in English, Portuguese, or Spanish, published in the last ten years and involving the assessment of inhibitory control in crack and/or cocaine users. Results: The database searches returned a total of 3,796 titles, 56 of them were selected initially and then a further 20 were excluded. Thirty-six articles were included in this review. In 90% of the studies reviewed the presence of inhibitory control deficits was reported, verified by impaired cognitive processing and response monitoring, as well as high levels of impulsiveness, regardless of the pattern of crack and/or cocaine consumption (recreational or chronic). Former users showed high levels of impulsiveness even after long periods of abstinence. Conclusions: Crack and/or cocaine users may have inhibitory control deficits, irrespective of different consumption patterns. High levels of impulsiveness can represent a factor of vulnerability to drug use and relapse.Objetivo: Prejuízos envolvendo o controle inibitório têm sido considerados déficits centrais em usuários de substâncias psicoativas, contudo parece haver disfunções específicas de acordo com a droga de escolha. Este artigo teve por objetivo revisar os achados recentes sobre alterações do controle inibitório em amostras de usuários de cocaína e/ou crack. Método: A pesquisa foi realizada nas bases de dados PubMed, PsycINFO e Web of Knowledge, em duas etapas, de acordo com os critérios de elegibilidade: inicialmente foi feita uma pesquisa nas bases de dados com análise dos títulos e resumos; após, os artigos foram lidos na íntegra. Os critérios de inclusão foram: artigos empíricos publicados em inglês, português ou espanhol, nos últimos 10 anos e que tenham avaliado o controle inibitório em usuários de cocaína e/ou crack. Resultados: Do total de 3.796 resultados, 56 títulos foram selecionados, sendo 20 excluídos. Como resultado, 36 artigos foram incluídos na revisão. Em 90% dos estudos revisados, foi relatada a presença de déficits de controle inibitório, verificados através de prejuízos no processamento cognitivo e no monitoramento de respostas, além de níveis elevados de impulsividade, independentemente do padrão de consumo de cocaína e/ou crack (uso recreativo ou crônico). Usuários em abstinência apresentaram níveis elevados de impulsividade, mesmo após longos períodos sem uso da droga. Conclusão: Usuários de cocaína e/ou crack podem apresentar prejuízos de controle inibitório apesar dos diferentes padrões de consumo. Níveis elevados de impulsividade podem constituir fator de vulnerabilidade para o uso de drogas e para a recaída

Re-Addressing Dementia by Network Medicine and Mechanism-Based Molecular Endotypes

Alzheimer's disease (AD) and other forms of dementia are together a leading cause of disability and death in the aging global population, imposing a high personal, societal, and economic burden. They are also among the most prominent examples of failed drug developments. Indeed, after more than 40 AD trials of anti-amyloid interventions, reduction of amyloid-ß (Aß) has never translated into clinically relevant benefits, and in several cases yielded harm. The fundamental problem is the century-old, brain-centric phenotype-based definitions of diseases that ignore causal mechanisms and comorbidities. In this hypothesis article, we discuss how such current outdated nosology of dementia is a key roadblock to precision medicine and articulate how Network Medicine enables the substitution of clinicopathologic phenotypes with molecular endotypes and propose a new framework to achieve precision and curative medicine for patients with neurodegenerative disorders