published_or_final_version / Sociology / Master / Master of Social Sciences

Existem no Brasil aproximadamente 370 mil usuários de cocaína fumada nas capitais nacionais e há cerca de dez anos o uso de crack e/ou cocaína atinge quatro em cada dez adolescentes brasileiros em situação de rua, gerando diversas consequências individuais, familiares e sociais, que fazem deste fenômeno um grave problema de saúde pública. O presente estudo foi realizado em três momentos que se consubstanciaram em um capítulo de livro, um artigo de revisão e um artigo empírico. O capítulo teve como objetivo a contextualização do panorama epidemiológico do consumo de drogas na sociedade brasileira, perpassando por uma caracterização geral do termo e suas especificidades, assim como uma reflexão acerca desse fenômeno à luz da Teoria Social Cognitiva. Discute-se que a noção de reciprocidade triádica que perpassa toda a concepção sociocognitivista, vem contribuindo para uma leitura dinâmica e sistêmica do consumo de drogas, que avança para além de uma compreensão puramente individual, seja biológica ou comportamental. O artigo de revisão de literatura foi sobre o Modelo Transteórico de Mudança (MTT) e o suporte familiar no cuidado ao usuário de crack, auxiliando na discussão sobre as estratégias para o lidar com dependência química. Neste foram analisados trabalhos que discorrem sobre as contribuições do Modelo Transteórico de Mudança no tratamento do comportamento adicto e a importância do entendimento sobre os estágios motivacionais e processos de mudança pelo usuário, família e equipe técnica, exigindo a atenção dos profissionais quanto ao entendimento e tratamento dos comportamentos de risco, demandando por sua vez a reformulação de estratégias de tratamento e cuidado para usuários que se encontram em qualquer estágio. O artigo empírico que se seguiu à revisão, abordou o tema central da dissertação e objetivou investigar a influência da percepção do suporte familiar, da crença de autoeficácia e do estágio motivacional do usuário de crack na adesão ao cuidado oferecido no Programa ATITUDE. Foi um estudo misto que primeiramente investigou 60 usuários de ambos os sexos que estavam acolhidos nas modalidades de assistência: apoio e intensivo. Na segunda fase foram entrevistados cinco participantes de ambos os sexos. Foram utilizados os seguintes instrumentos: Inventário de Percepção de Suporte Familiar (IPSF); Escala de Autoeficácia Geral Percebida (AEGP); University of Rhode Island Change Assesment Scale Escala URICA e entrevista semi-estruturada. Pela extração do alpha de Chronbach foram obtidos indicadores insatisfatórios de consistência interna das escalas AEGP e URICA, e elevados para o IPSF. A discussão perpassa pelo perfil singular da amostra, já que muitos dos usuários vivem na rua, com uma multiplicidade de carências de cuidados básicos e que, mesmo apresentando algum nível de escolarização, podem ter experienciado algum nível de incompreensão no sentido do que demandava a atividade em cinco alternativas de escolha, tendendo a se posicionar com certa facilidade quando a temática foi mais concreta, como no caso da família, tendo também essa escala um número de alternativas de escolha menor que as demais. Talvez um quantitativo maior de usuários pudesse diluir essas inconsistências encontradas nas duas primeiras escalas. Por fim, as entrevistas permitiram evidenciar a importância dos vínculos familiares para uma melhor compreensão do fenômeno do uso do crack em sua multiplicidade questionando e propondo um olhar ampliado sobre a família, como importante fonte de apoio aos usuários na continuidade de seu cuidado. / There are approximately 370 thousand users of cocaine smoked in Brazil in the national capitals, and for the last ten years the use of crack and / or cocaine has reached four out of every ten Brazilian adolescents in the street, generating a number of individual, family and social consequences. Of this phenomenon is a serious public health problem. The present study was carried out in three moments that consubstantiated in a chapter of book, a review article and an empirical article. The chapter aimed to contextualize the epidemiological panorama of drug use in Brazilian society, through a general characterization of the term and its specificities, as well as a reflection on this phenomenon in the light of Cognitive Social Theory. It is argued that the notion of triadic reciprocity that permeates the entire sociocognitive conception has been contributing to a dynamic and systemic reading of drug consumption, which goes beyond a purely individual understanding, be it biological or behavioral. The literature review article was about the Transtheoric Model of Change (MTT) and the family support in crack user care, helping to discuss strategies for dealing with chemical dependency. In this paper we analyze the contributions of the Transtheoric Model of Change in the treatment of addicted behavior and the importance of understanding the motivational stages and processes of change by the user, family and technical team, demanding the professionals' attention regarding the understanding and treatment Of risky behaviors, which in turn require the reformulation of treatment and care strategies for users who are at any stage. The empirical article that followed the review, addressed the central theme of the dissertation and aimed to investigate the influence of the perception of family support, the belief of self efficacy and the motivational stage of crack users in adherence to the care offered in the ATITUDE Program. It was a mixed study that first investigated 60 users of both sexes that were hosted in the assistance modalities: support and intensive. In the second phase, five participants of both genders were interviewed. The following instruments were used: Family Support Perception Inventory (IPSF); Perceived General Self-Efficacy Scale (AEGP); University of Rhode Island Change Assesment Scale - URICA scale and semi-structured interview. By extracting the Chronbach alpha, we obtained unsatisfactory indicators of internal consistency of the AEGP and URICA scales, and high for the IPSF. The discussion is based on the unique profile of the sample, since many of the users live on the street, with a multitude of basic care deficits and, even with some level of schooling, may have experienced some level of misunderstanding in the sense of what the activity demanded In five alternatives of choice, tending to position themselves with certain ease when the theme was more concrete, as in the case of the family, also having this scale a number of alternatives of choice smaller than the others. Perhaps a larger number of users could dilute these inconsistencies found on the first two scales. Finally, the interviews allowed to highlight the importance of family ties for a better understanding of the phenomenon of crack use in its multiplicity, questioning and proposing an extended view of the family, as an important source of support to users in the continuity of their care.

The abuse of substances by South African young people has led to the development of specialised residential treatment programmes. This qualitative and phenomenological study sought to explore child and youth care interventions which contributes towards children’s recovery from substance abuse/dependency. Data was collected through purposive sampling, with face -to -face interviews with a broad interview guide and it’s analysis was influenced by Patton and Creswell’s eight steps for qualitative data analysis and interpretation. The study confirmed the involvement of South African child and youth care workers in substance abuse programmes for young people. Specific interventions such as an existence of a therapeutic relationship between child and youth care workers, the use of the relationship as a model for other relationships, the availability and presence of the child and youth care worker, the adolescent development programme and young people’s involvement in their individual development programme that contributed to recovery from substance dependency were identified. / Social Work / M. Tech. (Child and Youth Care)

The susceptibility of adolescents to chemical addiction has become a major international concern. Approximately 25% of people in Central Asia and Eastern Europe who inject chemical substances are under the age of 20 years (Youth at the United Nations, 2006), while up to 75% of unintentional injuries among adolescents in America are related to substance abuse (Page & Page, 2003:196). On the national level, approximately 25% of adolescents under the age of 20 are involved in substance abuse (Western Cape Department of Social Services and Poverty Alleviation Transformation Plan, 2006:13). Focusing on the Western Cape, a report from the South African Epidemiology Network (2007:3) highlights that the youngest patient in in-patient treatment was nine years of age, and among 2 798 persons who received in-patient treatment, 27% were under the age of 20, more than any other age group in treatment. Treatment of adolescent chemical addiction should include preparation for treatment, treatment, and also aftercare services to ensure that the addicted adolescent develops skills to maintain sobriety (Meyer, 2005:292-293). Section Six of the South African Prevention and Treatment of Drug Dependency Act (1992) prescribes that chemically addicted persons should have access to professional aftercare services to ensure that treatment is not terminated prematurely. The motivation for this study was based on the fact that, despite this statutory requirement, the Western Cape Drug Forum (2005:3) identified the need for the development of aftercare services in 2005, indicating the lack of focus on aftercare as part of treatment. This concern was confirmed by practitioners in the field of adolescent chemical addiction and findings resulted from previous research regarding relapse experiences of chemically addicted adolescents (Van der Westhuizen, 2007:129-130). / Social Work / D. Phil. (Social Work)

The abuse of substances by South African young people has led to the development of specialised residential treatment programmes. This qualitative and phenomenological study sought to explore child and youth care interventions which contributes towards children’s recovery from substance abuse/dependency. Data was collected through purposive sampling, with face -to -face interviews with a broad interview guide and it’s analysis was influenced by Patton and Creswell’s eight steps for qualitative data analysis and interpretation. The study confirmed the involvement of South African child and youth care workers in substance abuse programmes for young people. Specific interventions such as an existence of a therapeutic relationship between child and youth care workers, the use of the relationship as a model for other relationships, the availability and presence of the child and youth care worker, the adolescent development programme and young people’s involvement in their individual development programme that contributed to recovery from substance dependency were identified. / Social Work / M. Tech. (Child and Youth Care)

The susceptibility of adolescents to chemical addiction has become a major international concern. Approximately 25% of people in Central Asia and Eastern Europe who inject chemical substances are under the age of 20 years (Youth at the United Nations, 2006), while up to 75% of unintentional injuries among adolescents in America are related to substance abuse (Page & Page, 2003:196). On the national level, approximately 25% of adolescents under the age of 20 are involved in substance abuse (Western Cape Department of Social Services and Poverty Alleviation Transformation Plan, 2006:13). Focusing on the Western Cape, a report from the South African Epidemiology Network (2007:3) highlights that the youngest patient in in-patient treatment was nine years of age, and among 2 798 persons who received in-patient treatment, 27% were under the age of 20, more than any other age group in treatment. Treatment of adolescent chemical addiction should include preparation for treatment, treatment, and also aftercare services to ensure that the addicted adolescent develops skills to maintain sobriety (Meyer, 2005:292-293). Section Six of the South African Prevention and Treatment of Drug Dependency Act (1992) prescribes that chemically addicted persons should have access to professional aftercare services to ensure that treatment is not terminated prematurely. The motivation for this study was based on the fact that, despite this statutory requirement, the Western Cape Drug Forum (2005:3) identified the need for the development of aftercare services in 2005, indicating the lack of focus on aftercare as part of treatment. This concern was confirmed by practitioners in the field of adolescent chemical addiction and findings resulted from previous research regarding relapse experiences of chemically addicted adolescents (Van der Westhuizen, 2007:129-130). / Social Work / D. Phil. (Social Work)

Esta pesquisa teve como objetivo geral cartografar a experiência de usuários de crack no município de Recife. Este estudo foi desenvolvid o nos CAPSad e Instituto RAID. Os entrevistados foram usuários de crack do sexo masculino e feminino, com idade a partir dos 18 anos, que estavam em tratamento em decorrência desta substância nas instituições acima citadas durante a coleta de dados. Em cada CAPSad, foi entrevistado um usuário de crack indicado pela equipe técnica que tivesse uma boa organização nas ideias para descrever a sua experiência com o crack, e que se disponibilizou a contribuir com a pesquisa através de entrevista semi-estruturadas. No Instituto RAID foram entrevistados seis usuários escolhidos pelos mesmos critérios. A pesquisa desenvolvida foi qualitativa de inspiração fenomenológica pautada no pensamento de Husserl e no método proposto por A. Giorgi. Este método inclui, basicamente, os seguintes passos: O sentido do todo, a partir da leitura do depoimento do sujeito; Discriminação do depoimento em Unidades de Significados; Compreensão psicológica de cada Unidade de Significado; Síntese de cada depoimento expressa como estrutura da experiência; e a Composição de uma síntese geral que apresenta a essência do fenômeno para todos os sujeitos investigados. A identificação dessas Unidades de Significado nas experiências dos usuários apontou aspectos diversos sobre o tema tais como: A experiência de ser dependente do crack; o que levou os usuários a consumirem essa substância; qual o significado do crack na vida desses usuários; quais as sensações vividas no consumo desta droga; o prazer da morte pela pedra; a culpa sentida por ceder à compulsão; as perdas diante da pedra; a família como fator importante na busca por um tratamento; o crack e a violência; as dificuldades e sucessos no tratamento; o estigma do usuário de crack e o descontrole vivenciado por alguns usuários. Diante da complexidade das questões trazidas nas experiências dos usuários entrevistados, grandes desafios estão postos para as equipes que trabalham no tratamento dos usuários de crack. Torna-se fundamental uma reflexão contínua sobre essa prática / This research had as its main aim to portrait crack-cocaine users experience in the city of Recife. Subjects were crack-cocaine users, males and females, from 18 years old, undertaking treatment at drug addiction health services in Recife (CAPSad and Instituto RAID) during data collection. One subject from each CAPSad (06 in a whole) was interviewed and 06 subjects from Instituto RAID were interviewed. All designated by the health professional teams and with organized thoughts to describe their crack-cocaine use experiences, as well as with willingness to respond to a semi-structured interview. The research was qualitative with phenomenological background inspired by Husserls theory and Giorgis method. Basically, this method includes these steps: 1) reading the entire description of one subject in order to get a sense of the whole; 2) reading through the data a second time and marking those places in the description where a transition in meaning occurred from a psychological perspective (the meanings between transitions are called meaning units); 3) reading all of the meaning units and interrogating them from what they reveal about the phenomenon of interest, in this case, the crack-cocaine use experience, in order to grasp the relevance of the subjects own words for the phenomenon of using crack-cocaine in as direct a manner as possible (this step is called the transformation of the subjects lived experience into direct psychological expression); 4) presenting a situated or general structure of the experience (synthesis of each report expressed as structure of experience); and, 5) comprehending the general synthesis which represents the essence of the phenomenon to all subjects investigated. The identification of crack-cocaine users experience in meaning units pointed out to several themes such as: the experience of being a crack-cocaine user; what took them to use this drug; the meaning of crack-cocaine in their lives; crack-cocaine use sensations; crack-cocaine death pleasure; compulsion guiltiness; losses related to the drug; family as an important factor to seek treatment; crack-cocaine and violence; treatment challenges; crack-cocaine use stigma; and, loss of control experienced by users. These complex issues expressed by research subjects set great challenges to health professional teams treating crack-cocaine users and draw attention to the need of permanent reflection of their practices

Made available in DSpace on 2017-06-01T18:08:33Z (GMT). No. of bitstreams: 1 dissertacao_renata_barreto.pdf: 1209055 bytes, checksum: 2ee6794692af99ee898228274042d265 (MD5) Previous issue date: 2011-03-01 / This research had as its main aim to portrait crack-cocaine users experience in the city of Recife. Subjects were crack-cocaine users, males and females, from 18 years old, undertaking treatment at drug addiction health services in Recife ( CAPSad and Instituto RAID ) during data collection. One subject from each CAPSad (06 in a whole) was interviewed and 06 subjects from Instituto RAID were interviewed. All designated by the health professional teams and with organized thoughts to describe their crack-cocaine use experiences, as well as with willingness to respond to a semi-structured interview. The research was qualitative with phenomenological background inspired by Husserl s theory and Giorgi s method. Basically, this method includes these steps: 1) reading the entire description of one subject in order to get a sense of the whole; 2) reading through the data a second time and marking those places in the description where a transition in meaning occurred from a psychological perspective (the meanings between transitions are called meaning units ); 3) reading all of the meaning units and interrogating them from what they reveal about the phenomenon of interest, in this case, the crack-cocaine use experience, in order to grasp the relevance of the subject s own words for the phenomenon of using crack-cocaine in as direct a manner as possible (this step is called the transformation of the subject s lived experience into direct psychological expression); 4) presenting a situated or general structure of the experience (synthesis of each report expressed as structure of experience); and, 5) comprehending the general synthesis which represents the essence of the phenomenon to all subjects investigated. The identification of crack-cocaine users experience in meaning units pointed out to several themes such as: the experience of being a crack-cocaine user; what took them to use this drug; the meaning of crack-cocaine in their lives; crack-cocaine use sensations; crack-cocaine death pleasure; compulsion guiltiness; losses related to the drug; family as an important factor to seek treatment; crack-cocaine and violence; treatment challenges; crack-cocaine use stigma; and, loss of control experienced by users. These complex issues expressed by research subjects set great challenges to health professional teams treating crack-cocaine users and draw attention to the need of permanent reflection of their practices / Esta pesquisa teve como objetivo geral cartografar a experiência de usuários de crack no município de Recife. Este estudo foi desenvolvid o nos CAPSad e Instituto RAID. Os entrevistados foram usuários de crack do sexo masculino e feminino, com idade a partir dos 18 anos, que estavam em tratamento em decorrência desta substância nas instituições acima citadas durante a coleta de dados. Em cada CAPSad, foi entrevistado um usuário de crack indicado pela equipe técnica que tivesse uma boa organização nas ideias para descrever a sua experiência com o crack, e que se disponibilizou a contribuir com a pesquisa através de entrevista semi-estruturadas. No Instituto RAID foram entrevistados seis usuários escolhidos pelos mesmos critérios. A pesquisa desenvolvida foi qualitativa de inspiração fenomenológica pautada no pensamento de Husserl e no método proposto por A. Giorgi. Este método inclui, basicamente, os seguintes passos: O sentido do todo, a partir da leitura do depoimento do sujeito; Discriminação do depoimento em Unidades de Significados; Compreensão psicológica de cada Unidade de Significado; Síntese de cada depoimento expressa como estrutura da experiência; e a Composição de uma síntese geral que apresenta a essência do fenômeno para todos os sujeitos investigados. A identificação dessas Unidades de Significado nas experiências dos usuários apontou aspectos diversos sobre o tema tais como: A experiência de ser dependente do crack; o que levou os usuários a consumirem essa substância; qual o significado do crack na vida desses usuários; quais as sensações vividas no consumo desta droga; o prazer da morte pela pedra; a culpa sentida por ceder à compulsão; as perdas diante da pedra; a família como fator importante na busca por um tratamento; o crack e a violência; as dificuldades e sucessos no tratamento; o estigma do usuário de crack e o descontrole vivenciado por alguns usuários. Diante da complexidade das questões trazidas nas experiências dos usuários entrevistados, grandes desafios estão postos para as equipes que trabalham no tratamento dos usuários de crack. Torna-se fundamental uma reflexão contínua sobre essa prática

The proposed research aims to explore and describe the experiences, challenges and coping strategies of fathers, parenting children, abusing illegal substances. The use and abuse of illegal substances became national and global dilemmas. The impact and damage caused when drugs are widely used over time is irreversible, as it influences the lives of users and those of their families, their communities, and the country. This research provides an opportunity for fathers, parenting children, abusing illegal substances to share their experiences and challenges. Data are collected by conducting in-depth and face-toface interviews with the participants. The collected data are analysed by following the eight steps of Tesch in Creswell (2009:186). Data are analysed using Lincoln and Guba’s model of trustworthiness of qualitative research for validation. The study endeavours to obtain an understanding of the experiences and challenges encountered by fathers, parenting children, abusing illegal substances and how social workers could assist in addressing this dilemma. / Social Work / M.A. (Social Work)

The history of heroin use disorder intervention has been characterised by fads and fashions. Some of the treatments that have been used have been, at best ineffective, and at worst harmful, and occasionally even dangerous. It is a sad reflection upon the field that practices and procedures for the treatment of heroin use disorders can so easily be introduced and applied without (or even contrary to) evidence. In South Africa, the field of heroin use disorder intervention has been `in transition' since the outbreak of the heroin epidemic. Yet despite growing evidence of an association between heroin dependents use of supplementary intervention services (such as psychosocial and pharmacological/medical care) and intervention outcomes, and the fact that international emerging standards for substance use disorder intervention have called upon treatment intervention providers to enhance traditional substance use disorder services with services that address clients' psychological and social needs, heroin use disorder intervention programmes in South Africa generally fail to meet these research-based intervention standards. Much of what is currently delivered as intervention is based upon current best guesses of how to combine some science-based (for example, cognitive-behavioural therapy and pharmacotherapies) and self-help (12-step programmes) approaches into optimal intervention protocols. As progression is made in the twenty-first century, scientific information is now beginning to be used to guide the evolution and delivery of heroin use disorder care internationally. Regrettably, a scarcity of heroin use disorder intervention research is noted in South Africa. The present study delved into the insights of ten heroin use disorder specialists, and synthesised the findings with the results of a previous study undertaken by the author relating to forty long-term voluntarily abstinent heroin dependents. In terms of theory and practice, findings of the study suggest that the field is less in transition now than it was in 1995. It is an imperative that law-enforcement action be followed by an integrated programme of psychological, social and pharmacological outreach. These programmes will have to be expanded to address new demands and will need to include specialised skills training. Many interventions and procedures have begun to be integrated routinely into clinical practice. / Psychology / (D. Phil. (Psychology))