Thesis abstract Author's name: Vendula Perglerová School: Charles University in Prague, Philosophical Faculty, Department of Education Program: Master full-time study of education Title: Specifics of work with adolescent drug abusers Consultant: PhDr. M. Vítečková, Ph.D. Number of pages: 97 Key words: addiction, drug, adolescent drug users, therapy, case study The aim of this thesis is to understand the mechanisms of addiction in adolescent drug users, to describe their specifics and to provide on this basis a guide to choosing effective means of help in treatment of adolescent drug abusers. It monitors the process of origination and progress of substance addiction. It illustrates possibilities of treatment in individual phases of the addiction process. It introduces a concrete treatment program targeted on adolescent drug abusers. Practical part describes five individual cases of adolescent drug abusers, examines causes of substance abuse in each of them and characterizes individual treatment approach based on them.

Consumption rooms for drug users are implemented as a tool of tertiary prevention by a number of European countries. These services are based on harm reduction philosophy. The objectives of these programs include minimizing health risks, overdose prevention, motivating users to change their lifestyle. Consumption room has also effect in reduction of negative effects associated with open drug scenes such as the drug consumption in public places. The thesis is about a need analysis of a theoretical application of a consumption room in the capital city Prague. After a theoretical introduction, which introduces the background of the project, the project objectives and examples of foreign practice presented in a literature, are presented the results of qualitative research. The aim of the research, conducted by the technique of semi-structured interview, is to answer the basic questions of needs and expectations of potential users, experts in the treatment and prevention of addiction and other persons who may be considered as involved from the perspective of discussion about consumption. Based on the indicators of the need for drug consumption rooms and based on respondents answers, installation of this low-threshold program appears to be as appropriate in capital city Prague. Respondents of the research...

Introdução: A literatura sugere que o medo da dependência de opióides é uma barreira para o alívio da dor, especialmente quando há suspeita de uso desses fármacos. No entanto, essa hipótese carece de testes empíricos. Objetivos: Comparar a conduta de profissionais de enfermagem na administração de analgésicos opióides e não opióides, quando há ou não suspeita de que o paciente seja usuário de drogas; identificar a prevalência de pacientes com suspeita de uso de drogas e conhecer as características dos pacientes que os profissionais de enfermagem consideram como sugestivas de uso de drogas. Método Estudo transversal com pacientes e profissionais de enfermagem (auxiliares e técnicos). Foram incluídos 507 pacientes com trauma ortopédico e prescrição de analgésico opióide, internados em quatro hospitais de Londrina, Paraná, entre fevereiro de 2011 a março de 2012, e 199 profissionais responsáveis pela administração de medicamentos a esses pacientes. Cada paciente recebeu a avaliação de três profissionais e considerou-se paciente suspeito aquele indicado por pelo menos um profissional. O desfechos principais foram a 1) quantidade administrada de analgésicos opióides e não opióides prescritos em regime se necessário e em horário fixo nas últimas 24 horas; 2) prevalência de pacientes suspeitos de uso de drogas; 3) condutas dos profissionais frente à solicitação do opióide; 4) Características dos pacientes que os profissionais consideram sugestivas de uso de drogas. Nas análises utilizaram-se os testes de Qui quadrado, Fisher e Mann-Whitney, e nível de significância de 5%. Resultados: A prevalência de pacientes suspeitos foi de 6,86%, maior em homens (p<0.036) e jovens (p<0,001). Os pacientes suspeitos receberam mais opióides se necessário (p=0,037) e até 30% da dose máxima possível, contra até 20% para os não suspeitos. A administração entre suspeitos e não suspeitos não diferiu quanto aos opióides prescritos em horário fixo, no entanto, deixou-se de administrar 10% da dose para ambos os grupos. Entre os profissionais entrevistados, 75,6% relataram que mantêm a analgesia com opióide, mesmo quando há suspeita de o paciente ser usuário de droga, mas 28,9% deles disseram tentar reduzir a dose nesses casos. As características dos pacientes mais frequentemente consideradas pelos profissionais como sugestivas de uso de drogas pertenciam à categoria consequências emocionais/físicas/sociais e sinais de abstinência (70,6%) e insistência pelo opióide (55,9%), mais do que a aparência pessoal (0,0%). Conclusão: A prevalência de suspeitos foi semelhante a estudos realizados em departamentos de emergência, sugerindo que os auxiliares e técnicos de enfermagem foram cuidadosos na estimativa de suspeição. Os resultados obtidos contrariam a literatura, pois indicaram que os suspeitos de serem usuários de droga receberam mais analgésicos opióides. Assumindo-se a premissa de que os profissionais identificaram corretamente os usuários de drogas, pode-se explicar o maior recebimento de opióide pelos suspeitos, pelas características comportamentais e emocionais: maior inquietude, insistência verbal e talvez menor alívio da dor, pois usuários de droga podem desenvolver tolerância. A administração de analgésicos, especialmente em esquema se necessário, é uma decisão importante da enfermagem que pode contribuir para o alívio da dor, daí a importância de entender as motivações que influenciam os profissionais nessa decisão. / Introduction: The literature suggests that the fear of getting addicted to opiods can be a barrier to adequate pain relief, especially when there is a suspicious of drug use. However, this hypothesis needs to be tested empirically. Objectives: Compare the conduct of nursing professionals in administering analgesics when there is the suspicion that the patient is a drug user; identify the prevalence of patients with the suspicious of drugs use and knowing the characteristics of patients that nursing professionals consider as indicators of drug use. Method: Transversal study with patients and nursing professionals (aides and technicians). The study included 507 patients with orthopedics trauma to whom opiod analgesics were prescribed. They were admitted to four hospitals in Londrina, Paraná, Brazil, between February 2011 and 2012. Patients were seen by 199 professionals responsible for administering the medications. Each patient was evaluated by three professionals regarding drug use suspicion. The patient was classified as suspect when indicated by at least one of these professionals. The evaluation included 1) amount of opioid analgesics prescribed under the if necessary regime and at fixed times; 2) prevalence of patients being suspected of drug use and 3) professionals conduct when dealing with opioid prescriptions in the last 24 hours. The analysis used Chi Square, Fisher and Mann- Whitney tests at 5% of level of significance. Results: The prevalence of suspect patients was 6.86%, greater in men (p<0.036) and young people (p<0,001). When comparing the group of suspects with the group of non-suspects, the suspect patients received more opioids under the if needed regime (p=0.037) and up to 30% of the possible maximum dosage against 20% for the non suspects. There was no difference between suspects and non suspects regarding the administration of opioid analgesics prescribed as if necessary; however, 10% of the dosage was not administered to both groups. Among the interviewed nursing aides and technicians, 75,6% reported that they maintain analgesia with opioid even when there was a suspicion that the patient is a drug user; however, 28,9% said they tried to reduce the dosage in these cases. The patients characteristics most often considered by professionals as suggestive of drug use belonged to the emotional/physical/social consequences and withdrawal signs category (70,6%) and insistence by the opioid (55,9%), more than personal appearance (0,0%). Conclusion: The prevalence of suspects was similar to studies performed in emergency departments, suggesting that nursing aides and technicians were careful in estimating suspicion. The results contradict those mentioned in the literature, since they indicate that drug users suspects received more opioid analgesics. By accepting the assumption that nursing aides and technicians have identified illicit drug users correctly, the greater number of opioid administration by the suspects can be explained based on the behavioral and emotional characteristics of this group: greater restlessness, verbal insistence and perhaps less pain relief, since drug users may develop tolerance to certain drugs. Whether or not to administer analgesics, especially those with the if necessary regime, is an important decision for the nursing staff, since they can contribute to an adequate pain relief, thus the importance of understanding the motivations that lead professionals to take this decision.

Estudo descritivo exploratório, realizado nos Centros de Atenção Psicossocial Álcool e Drogas - CAPS AD Independência e Reviver -, localizados na cidade de Campinas -SP, com o objetivo de investigar a inclusão social de usuários em atendimento nestes serviços, sob a perspectiva dos profissionais que neles atuam. Esta pesquisa tem, como pressuposto, que a visão dos profissionais sobre os modelos de atenção para álcool e drogas influencia suas ações para a inclusão social dos usuários. A pesquisa foi realizada com 17 profissionais dos CAPS AD, atuantes nos locais há pelo menos três meses, sendo todos participantes voluntários. Os dados foram coletados por meio de entrevistas semiestruturadas realizadas com os participantes e observação participante, com registros no diário de campo. Com base nas informações coletadas, os dados foram organizados e analisados segundo o método de análise de conteúdo, na especificidade análise temática. A discussão fundamentou-se nos conceitos de reinserção social, trazidos pelas políticas em saúde mental e álcool e drogas, bem como nas concepções de reabilitação psicossocial de Saraceno, entre outros autores. Ainda, como parte de conceitos adotados para análise e compreensão dos resultados, recorreu-se ao conceito-processo de Sawaia sobre a \"dialética da inclusão/exclusão\" que, como forma de categoria de sua análise, baseia-se no sofrimento ético-político, porém aqui aplicado aos usuários de álcool e drogas. Desta forma, o processo de análise permitiu desdobramentos em três categorias temáticas: a visão do profissional sobre inclusão social dos usuários de álcool e drogas; o cuidado à inclusão social e os limites e potencialidades para inclusão social dos usuários de álcool e drogas. Da análise das informações coletadas emergiram que as percepções dos profissionais sobre inclusão social são diversas, e que o uso de uma única percepção não é suficiente para abarcar ações que sejam efetivamente de inclusão social; já sobre o cuidado dos profissionais no que se refere à inclusão social, evidenciou-se que as equipes atuantes ainda não dominam a temática, apresentando, portanto, dificuldades para identificar suas ações como sendo de inclusão social. Emergiram também limites e potencialidades para a inclusão social dos usuários de álcool e drogas apontados pelos profissionais sob três âmbitos: o primeiro seriam os fatores que dependem dos profissionais; o segundo, os aspectos que dependem da instituição CAPS AD; e o terceiro, aqueles que extrapolam a esfera da instituição CAPS AD. A pesquisa revelou ainda a influência dos modelos de assistência para usuário de álcool e drogas no posicionamento político-ideológico dos profissionais e, consequentemente, em suas perspectivas e ações para inclusão social, sendo ainda uma tema que deve ser mais amplamente discutido nas equipes, para que o cuidado em saúde mental para estes usuários seja mais qualificado / This is a descriptive, exploratory work aiming at investigating the social inclusion of drug users undergoing treatment, from the perspective of the professional sat the Independence and Revival Service of Psychosocial Attention and Care to alcohol and drug users (CAPS AD) in the city of Campinas, State of São Paulo, Brazil. This work is based on the assumption that professionals\' view about the models of \"Attention and Care to alcohol and drugs\" influence their actions towards social inclusion of users. Seventeen professionals, who work at CAPS AD for at least three months, participated voluntarily in this study. The data was collected through semi-structured interviews and participative observation, recorded on field diaries. The analysis was carried out with Thematic Analysis, within the theory and methodology of content analysis. We based our discussion on the concepts of Social Reinsertion in by mental health policies about alcohol and drugs, as well as concepts of psychosocial rehabilitation by Saraceno, among other authors. Still, among the concepts adopted for the analysis and interpretation of the data, we used the concept-process, by Sawaia, about the \"dialectic of exclusion/ inclusion\" which, as a form of analysis categorization, is based on the concept of ethical-political suffering, applied here to alcohol and drug users, however. Therefore, the analysis was unfolded into three categories: the professional\'s view about the social inclusion of alcohol and drug users; the Attention and Care to social inclusion; and the limits and potentiality to social inclusion of alcohol and drug users. The analysis shows that there are variations among professionals\' perceptions about social inclusion. Also, that the use of a single perception is not enough to comprehend effective actions of social inclusion. As for professionals\' procedures regarding social inclusion, it became clear that staff does not acknowledge the theme, showing difficulty to identify their own actions as of social inclusion procedures. The analysis also shows limits and potentiality of social inclusion of alcohol and drug users, pointed out by the professionals in three levels: firstly, factors depending on the professionals; secondly, aspects depending on the institution CAPS AD; thirdly, aspects which are beyond the realm the institution CAPS AD. This study also reveals the political-ideological influence of assistance models on the professionals at the Attention and Care of alcohol and drug users. Consequently, it exposes professionals\' perspectives and procedures towards social inclusion. That is still a theme to be widely discussed within the teams, so that mental health care for these users improves its quality

BACKGROUND: Quality of life is defined by WHO as an individual perception of one's own position in life, taking into account cultural aspects of the society and a system of values in which the individual lives, as well as his/her goals, standard of living and interests. Because quality of life measure is strongly a subjective measure, it can only be assessed by the individual himself/herself. AIMS: The aim of this thesis was to compare of the quality of life of drug users before and after institutional treatment. SAMPLE AND METHODS: WHOQOL- BREF questionnaire was employed to collect the data. A research sample consisted of all clients (both men and women) in the institutional treatment at the department of treatment of dependencies at the Clinic of Addictology, The clients filled the questionnaire in before treatment entry or within the first week after treatment entry, and at the release from the treatment. RESULTS: None of the clients was very satisfied with his/her quality of life before treatment. After treatment, the quality of life was perceived as positive rather by women. After treatment, 44% of women found their quality of life good, whereas it was assessed as very good by 13% of women. The overall perception of the quality of life in the male population has not changed much. Regarding the...

Orientador: Ivete Dalben / Coorientador: Silvia Cristina Mangini Bocchi / Banca: Wilza Carla Spiri / Banca:Raul Aragão Martins / Banca: Luiz Roberto Romero / Banca: Maria Odete Simão / Banca: Regina Stella Spagnuollo / Banca: Maria Irene Bachega / Banca: Maria da Graça Girade Souza / Resumo: O consumo crescente e precoce de substâncias psicoativas acarretou, em todas as partes do mundo, importantes questões sociais e de saúde, demandando o aprofundamento compreensivo das experiências dos atores envolvidos no processo. Dessa forma, o presente trabalho objetivou compreender a interação de alunos adolescentes, com as substâncias psicoativas e desenvolver um modelo teórico representativo desta experiência. Teve como população alvo 21 alunos do terceiro ano do ensino médio de uma escola pública estadual do município de Penápolis/SP, mediante aprovação do Comitê de Ética em Pesquisa, UNESP-Araçatuba, com o referencial teórico Interacionismo Simbólico, referencial metodológico Grounded Theory ou Teoria Fundamentada em Dados (TFD) e técnica de coleta de dados grupos focais. O referencial metodológico possibilitou a identificação da categoria central representativa da experiência dos alunos com substâncias psicoativas, "Movendo-se entre a experimentação e a dependência: o autocontrole do adolescente como componente interveniente.". Este processo é constituído por três subprocessos ou categorias, que representam o significado simbólico da experiência dos alunos com as substâncias psicoativas: Iniciando a interação com o álcool e com o cigarro - o álcool é a substância inicial, consumida para acompanhar os amigos, superar tristezas, obter prazer e coragem e enfrentar as situações próprias da adolescência. As bebidas de predileção são a cerveja e vodka com energético, consumidas abusivamente em festas open bar, momento em que experimentam o cigarro e Narguile, com a possibilidade de agregar outros psicoativos. Mantendo o controle: Vivenciando a fase de experimentação - A incorporação da maconha e da cocaína é uma segunda fase de experimentação, que ocorre de modo coletivo em festas rotineiras. A maconha é a mais consumida, seguida pela cocaína que é ... / Abstract: The growing consumption of psychoactive substances and led early in all parts of the world, important social and health issues, requiring a deeper understanding of the experiences of the actors involved in the process. Thus, the present study aimed to understand the interaction of adolescent students with psychoactive substances and develop a theoretical model of this experience. Target population was 21 students of the third year of high school to a public school in the municipality of Penápolis / SP, with the approval of the Ethics Committee in Research, UNESP-Araçatuba, with Symbolic Interactionism theoretical, methodological reference Grounded Theory or Theory Based on data (TFD) and technical data collection focus groups. The methodological framework enabled the identification of the core category "Moving between experimentation and addiction: the self as a component of the adolescent actor.". This process consists of three sub-processes or categories, which represent the symbolic meaning of the students' experience with psychoactive substances: Starting interaction with alcohol and cigarettes - alcohol is starting substance, consumed to keep up with friends, overcome grief, get pleasure and courage and face the situations own adolescence. The predilection drinks are beer and vodka with energy consumed abusively open bar at parties, at which time try cigarettes and Narghile, with the possibility of adding other psychoactive. Keeping control: Experiencing the experimentation phase - Incorporation of marijuana and cocaine is a second phase of testing, which occurs at parties so collective routine. Marijuana is the most commonly used, followed by cocaine which is used as a strategy to stop the effects of alcohol abuse, finding no impediments to consumption. They point to the ease of access by ace drug availability and lack of supervision combined with the household consumption of alcohol, tobacco ... / Doutor

Orientador: Silvio Yasui / Banca: Cristina Amélia Luzio / Banca: Ricardo Sparapan Pena / Resumo: O presente estudo tem como objetivo conhecer os itinerários terapêuticos dos usuários de álcool e outras drogas de um município de grande porte no Estado de São Paulo e investigar a percepção dos gestores e trabalhadores da saúde sobre a rede de atenção à saúde ao usuário de álcool e outras drogas e identificar quais os serviços que compõem essa rede. Foi realizada uma pesquisa de campo, de outubro de 2013 a março de 2014, em um centro de Atenção Psicossocial álcool e drogas (CAPSad), Hospital Psiquiátrico, Atenção Básica (AB) e Direção Regional de saúde (DRS). Os sujeitos da pesquisa foram quatro usuários de álcool e outras drogas, três trabalhadores da saúde e três gestores. Foi utilizado, como instrumento de coleta de dados, o roteiro de entrevista aberta para que os participantes pudessem produzir as narrativas. Os resultados mostram que o itinerário terapêutico dos participantes é plural, contemplando o cuidado informal dos familiares, a crença religiosa e os cuidados profissionais, não se restringindo somente às instituições de saúde mental. Os sujeitos tendem a recorrer simultaneamente a diversos lugares em busca do cuidado. Verificou-se que os usuários circulam em uma rede de cuidados pouco articulada, que reflete diretamente no itinerário terapêutico deles, fixando-os em determinados serviços. Concluímos que a rede ao usuário, muitas vezes, é compreendida somente como serviços especializados, como o CAPSad e lugares para internação. Frente aos resultados, destaca-se a necessidade de aprimorar a atenção ao usuário de álcool e outras drogas por meio de uma rede de atenção à saúde articulada e que atue na lógica da atenção psicossocial / Abstract: This study aimed to assess the therapeutic itineraries of users of alcohol and other drugs from a large city in the state of São Paulo and investigate the perception of managers and health workers on the network of health care to the user of alcohol and other drugs and identify which services make this network. A field survey was held from October 2013 to March 2014 in a center of Psychosocial Care alcohol and drugs (CAPSad), Psychiatric Hospital, Primary Care (AB) and Regional Health Directorate (DRS). Survey subjects were four users of alcohol and other drugs, three health workers and three managers. Was used as data collection instrument the interview script opened to the subjects to produce narratives. The results showed that the therapeutic path of participants is plural, contemplating the informal care of family, religious beliefs and professional care, not limited mental health institutions only. The subjects tend to resort simultaneously to several places in search of care. However users circulating in a network of little articulated care, which directly reflects the therapeutic itinerary of these users, fixing them in certain services. We conclude that the network to the user, it is often understood only as specialized services such as CAPSad and places to hospital. Based on the results stands out the need to improve the attention to the user of alcohol and other drugs; through a network of articulated attention to health and that they act in the logic of psychosocial care / Mestre

<p>The purpose of this thesis is to improve our knowledge of substance users in the normal population. The main concern is with how the meaning of drug use is constructed. To answer this, the thesis draws on different theoretical principles and mixed methods design.</p><p>The thesis is made up of four sub-studies, with interconnected foci. The first three papers are based on a qualitative research project in which 44 socially integrated drug users in Stockholm were interviewed. The fourth paper is a cross-national quantitative analysis of nationally representative student samples.</p><p>The first of the three qualitative papers explores the construction of the informant’s self-identity. The second paper analyses the informant’s perceptions of drug-related risk, whilst the third paper analyses the drug users’ perception of differences between men’s and women’s drug use. The fourth paper sets the detailed analyses of the first three papers in a broader comparative frame, exploring differences in the correlates of drug use, in light of the different levels of drug use in Sweden and Switzerland.</p><p>The thesis reveals that the drug users are striving to be understood as normal integrated citizens of Swedish society. They present themselves as inherently different from drug abusers and the informants’ risk perceptions are based on a modified form of core Swedish cultural ideals of conscientiousness. The informants also waver back and forth when called upon to discuss gender and drug-taking. On the one hand they were explicit about existing differences between men’s and women’s drug use; on the other hand they were quite uncomfortable having to explicitly explain them, as this meant that they needed to draw on conservative gender roles, something which in Swedish society is a strong sign of being politically incorrect. Furthermore, the thesis shows that young drug abstainers and cannabis users are quite similar in regards to conventional social bonds.</p>

The purpose of this thesis is to improve our knowledge of substance users in the normal population. The main concern is with how the meaning of drug use is constructed. To answer this, the thesis draws on different theoretical principles and mixed methods design. The thesis is made up of four sub-studies, with interconnected foci. The first three papers are based on a qualitative research project in which 44 socially integrated drug users in Stockholm were interviewed. The fourth paper is a cross-national quantitative analysis of nationally representative student samples. The first of the three qualitative papers explores the construction of the informant’s self-identity. The second paper analyses the informant’s perceptions of drug-related risk, whilst the third paper analyses the drug users’ perception of differences between men’s and women’s drug use. The fourth paper sets the detailed analyses of the first three papers in a broader comparative frame, exploring differences in the correlates of drug use, in light of the different levels of drug use in Sweden and Switzerland. The thesis reveals that the drug users are striving to be understood as normal integrated citizens of Swedish society. They present themselves as inherently different from drug abusers and the informants’ risk perceptions are based on a modified form of core Swedish cultural ideals of conscientiousness. The informants also waver back and forth when called upon to discuss gender and drug-taking. On the one hand they were explicit about existing differences between men’s and women’s drug use; on the other hand they were quite uncomfortable having to explicitly explain them, as this meant that they needed to draw on conservative gender roles, something which in Swedish society is a strong sign of being politically incorrect. Furthermore, the thesis shows that young drug abstainers and cannabis users are quite similar in regards to conventional social bonds.

Recent advances in HIV antiretroviral therapy and the availability of prophylaxis for opportunistic infections, combined with the opportunity to prevent perinatal HIV infection, underscores the value of early diagnosis of HIV infection. HIV antibody home test kits offer individuals the opportunity to collect a blood sample, send it anonymously to a laboratory, and receive counseling and referral over the phone. Home HIV testing may reduce barriers to testing that have precluded individuals from learning their HIV serostatus, and if seropositive, from taking advantage of efficacious therapeutic and preventive regimens. This study employed a randomized-controlled prospective field trial design to determine if the availability of home testing increased HIV testing relative to traditional counseling and testing among injecting drug users in three HIV prevention/drug treatment contexts; methadone maintenance, hospital-based detoxification, and syringe exchange. Theoretical correlates to HIV testing were also evaluated. Multivariate analyses demonstrated that participants randomized to home testing were 2.2 times more likely than those randomized to traditional counseling and testing to test for HIV antibodies in this study after controlling for demographic, HIV risk, and theoretical variables. No differences were observed between testing methods with regard to obtaining HIV test results. The relationship between HIV testing and test type was moderated by drug treatment context and history of homeless, with home testing resulting in increased testing among methadone participants and persons without a history of homelessness. Analyses of theoretical variables suggested that prevention education stressing the benefits of HIV testing, personal risk of HIV infection, and efficacy of available treatments could increase HIV testing among injecting drug users. Participants randomized to home testing were more satisfied with testing and telephone-based counseling than were those receiving traditional testing and face-to-face counseling. Home testing was associated with increased testing perhaps due to reduced barriers to testing. To further reduce barriers to testing and to increase testing among injecting drug users, consideration should be given to incorporating oral fluid testing and rapid result capability in home test kits. Counseling could be made available as needed, delivered by telephone, and contingent upon the volitional control of the testing consumer.