Submitted by Setor de Tratamento da Informa??o - BC/PUCRS (tede2@pucrs.br) on 2015-10-05T19:00:43Z No. of bitstreams: 1 475522 - Texto Parcial.pdf: 295790 bytes, checksum: 894ee0af17c806ed31db4e4c3ef21479 (MD5) / Made available in DSpace on 2015-10-05T19:00:43Z (GMT). No. of bitstreams: 1 475522 - Texto Parcial.pdf: 295790 bytes, checksum: 894ee0af17c806ed31db4e4c3ef21479 (MD5) Previous issue date: 2015-03-06 / The advent of crack cocaine has become worrying in the eyes of society and public health. The Science has been interested in the study of the phenomenon and also in the development of treatment approaches. In this sense, it is important to identify and anticipate what would be possible risk situations and how confident they feel users to follow and avoid relapse. This dissertation aims to study the coping skills and self-efficacy for abstinence in crack cocaine users through four studies. The first is entitled "Coping Skills and Self-efficacy in Abstinence Crack cocaine: A Literature Review". This study reviewed the scientific publications of the last five years (2010-2014), indexed in PubMed, PsycInfo, Lilacs, Proquest and Web of Science. The descriptors were coping skills, self-efficacy, abstinence, relapse prevention, drug abuse and crack cocaine. The descriptors in the English language were surveyed coping skills, self-efficacy, abstinence, relapse prevention, drug abuse and crack cocaine. Few were found specific articles to crack cocaine: parenting styles and the influence on coping skills, craving and crack cocaine and coping resources in women. It was concluded that the time of abstinence, coupled with appropriate approaches and self-efficacy can help in the positive treatment outcome. The crack cocaine, with its own characteristics, leads to many losses, but the cognitive improvement is possible, given the time of abstinence. Studies on coping skills and self-efficacy are relevant in the crack cocaine of the abstinence of context, but still incipient. The second study, "Coping and Self-efficacy Skills for Abstinence in Dependent Crack Cocaine", evaluated the coping skills and self-efficacy in the context of the crack cocaine abstinence in 189 subjects. This is a quantitative, descriptive and correlational with cross-sectional design. The sample consists of women: 44.4% (n = 84) and men: 55.6% (n = 105), aged 19 to 59 years and up to 5 years of formal schooling. Chi-square tests of Pearson and Fisher exact tests were used, the Student t and Mann Whitney test for variables with asymmetric distribution and analysis of variance (Two way) - Post Hoc Sheffe. The level of significance is 5%. The average age is 31.7 years, 58.3% (n = 109) has primary and economic classification for Brazil demonstrated Criterion is the class "C" (49.02%). The resulting mean Mini-Mental State Examination (MMSE) is higher in males (26.8 ? 2.6). In Factor 6 (Escape and Evade) the Coping Strategies Inventory occurred in females, significant correlation with Factor 2 (Feeling Expression) of Anticipatory Coping Inventory for Abstinence (IDHEA) (r = -0.250; p = 0.022). There are significant and positive correlations, especially among the factors 1 and 2 of IDHEA (Assertiveness and Feeling Expression) with all the factors of Self-efficacy Scale for Abstinence (EAAD) including your total score. Among the coping strategies and self-efficacy for abstinence EAAD in women, no significant correlations, and in men there is a positive correlation between self-efficacy factor for EAAD abstinence and the factors of coping strategies (Self and Resolution problems). It was found that women are more vulnerable to the use of crack cocaine and use more the Coping Strategies. More confident men are more self-controlled and have greater availability to solve problems. There are few studies that correlate the constructs presented in this study. The third study, titled "Relationship between Coping and the Abstinence Time Dependent on Crack Cocaine", correlated the Coping Strategies and the time of abstinence in men and women with severe disorder in crack cocaine use in treatment. This is a quantitative, descriptive and correlational with cross-sectional design and the sample consisted of 189 subjects: 84 women (44.4%) and 105 men (55.6%). Participants aged 19 to 59 have at least 5 years of formal study. The average age of age of 31.7 (? 8.8) years, have low school level and family income between 1 and 2 minimum wages (68.8%). The comparison of categorical variables in both groups occurred by chi-square tests of Pearson and Fisher exact. The significance level of 5% was adopted. The withdrawal period of 60 days was observed in 64.0% (n = 121). In assessing the Coping Strategies average higher in females, were Factor 1 (Head) (Men: 1.4 ? 0.6 vs. Women: 1.6 ? 0.6; p = 0.05); Factor 4 (Social Support) (Men: 1.6 ? 0.7 vs. Female: 2.0 ? 0.7; p = 0.001); Factor 6 (Escape and Evade) (Men: 1.5 ? 0.7 vs. Women: 1.8 ? 0.7; p = 0.014); Factor 5 (Liability of Acceptance) (Men: 1.9 ? 0.7 vs. Women: 2.1 ? 0.6; p = 0.011); and Factor 8 (positive reappraisal) (Men: 1.6 ? 0.6 vs. Women: 2.0 ? 0.7; p <0.001). Strategies for Coping correlated to the time of abstinence and sex, had a single significant effect on Factor 5 (Liability of Acceptance) for interaction between sex and abstinence time (F1, 189 = 5.318, p = 0.022, power = 0.631 ). There was borderline significance in Factors 3 (Self) (F1, 189 = 4.064, p = 0.072, power = 0.631) and 4 (Social Support) (F1, 189 = 4.031, p = 0.072, power = 0.615). Was no effect for sex factor evidenced for Factors 1 (Head) (F1, 184 = 8.357, p = 0.004, power = 0.820); 3 (Self) (F1, 184 = 4.450, p = 0.036, power = 0.555); 4 Social Support (F1, 189 = 5.574, p = 0.001, power = 0.931); 6 (Escape and Evade) (F1, 184 =; p = 0.011, power = 0.724); and 8 (positive reappraisal) (F1, 184 = 5.611, p <0.001, power = 0.953). Women have higher scores on Coping, regardless of the length of abstinence. Women with up to 60 days of abstinence have higher Acceptance of Responsibility (Factor 5 / Coping), and over 60 days decreased the Self (Factor 3 / Coping). Men over 60 days of abstinence increased social support (Factor 4 / Coping) in the group with less than 60 days. Differences in Coping strategies found between men and women in each withdrawal time range were not representative in this study. The fourth and final study, "Coping Skills, Self-efficacy and Crack Cocaine the Abstinence Time for Women", aimed to outline a dependent crack cocaine profile in women admitted in Therapeutic Communities, correlated variables Anticipatory Coping, Self-efficacy, Coping Strategies and abstinence time. This is a quantitative, descriptive and correlational with cross-sectional design. The sample is composed of 84 women. The distribution normality was verified using the Kolmogorov-Smirnov test with Lillifors correction, the relationship of linearity between the instruments was estimated using Pearson correlation coefficient and the comparative analysis by Student's t test. Statistical decision criteria we adopted the significance level of 5%. The results were 31.6 (? 9.1) years as the average age and low education in 57.1% (n = 48). Until intern, 40.5% (n = 34) of participants worked and 48.9% (n = 41) were classified as class "C" by Criterion Brazil. The 60 days of abstinence period was 62.9% (n = 66) and mean number of days without the use of drugs is 181.6 (? 294.7) days. Regarding the use of other substances, there was the association of crack cocaine to other drugs (alcohol 23.8%, 17.9% marijuana, cocaine 44.0% The weighted average of the results found in the cognitive screening by Intelligence Scale. Wechsler Adult (WAIS) were. cubes 11.4 (? 3.0); Codes 9.1 (? 2.4) and Digits 11.4 (? 3.3) the average score in the Mini State Examination mental (MMSE) is 25.8 in the evaluation of self-efficacy (EAAD), the highest average score occurred in Factor 3 (trust not use crack cocaine front of concerns: 3.6 ? 1.1). And the lowest in Factor 2 (trust not use crack cocaine to see others using: 3.2 ? 1.3). In assessing the anticipatory coping strategies to abstinence from crack cocaine (IDHEA), the highest scores are the factors 1 (Assertiveness and planning for high-risk situations: 2.3 ? 0.8) and 2 (positive sense of expression for abstinence maintenance: 2.3 ? 0.6), and the lowest mean score was the factor 3 (emotional Self-Control in situations adverse: 2.0 ? 0.8). The mean scores in coping strategies ranged between 1.6 and 2.1 points, and the established maximum score is 3 points. The maximum occur in the Acceptance of Responsibility (Factor 5 / Coping) (2.1 ? 0.6), the Social Support (Factor 4 / Coping) (2.0 ? 0.7) and positive reappraisal (Factor 8 / Coping) (2.0 ? 0.7). The minimum scores occur in the Head (Factor 1 / Coping) (1.6 ? 0.6) and Self (Factor 3 / Coping) (1.6 ? 0.6). Regarding the correlation of the instruments Coping strategies and anticipatory coping (IDHEA), it was found that Factor 1 IDHEA (Assertiveness and planning for high-risk situations) estimated significant correlations, positive of low degree with the strategies Coping Social Support (Factor 4 / Coping) (r = 0.221; p = 0.043), Responsibility Acceptance (Factor 5 / Coping) (r = 0.258; p = 0.018), Resolution Problems (Factor 7 / Coping) (r = 0.269, p = 0.013) and positive reappraisal (Factor 8 / Coping) (r = 0.291; p = 0.007); pointing out that high scores on Factor 1 IDHEA (Assertiveness and planning for high-risk situations) show up also correlated with high scores on factors of coping strategies. The most significant correlations between coping and anticipatory coping strategies are in emotional self in adverse situations (Factor 3 / IDHEA) and Social Support (Factor 4 / Coping) (r = -0.294; p = 0.007), Responsibility Acceptance (Factor 5 / Coping) (r = -0.232; p = 0.034), Problem Resolution (Factor 7 / Coping) (r = -0.311; p = 0.004), and positive reappraisal (Factor 8 / Coping) (r = -0.375; p <0.001). The Coping strategies and self-efficacy for abstinence vary independently in females. The average in Factor 2 Coping (Pitch) (1.6 ? 0.6) of participants up to 60 days of abstinence was higher (p = 0.026). There was borderline significance (0.05 <p <0.10) in Factor 5 / Coping (Liability of Acceptance) (p = 0.056) suggesting that the group average up to 60 days of abstinence (2.3 ? 0.6) may be showing higher compared to the group over 60 days of abstinence (2.0 ? 0.7). We conclude that self-efficacy is associated with proactive coping strategies, and see other people using drugs are considered the most critical factor. Women with emotional control can reframe experiences and seek social support. It is considered the need for further research into anticipatory coping skills and self-efficacy in women who use crack cocaine. This work may stimulate further studies on coping skills and self-efficacy in the crack cocaine of context. / O advento do crack tornou-se preocupante aos olhos da sociedade e da sa?de p?blica. A ci?ncia tem se interessado no estudo do fen?meno e tamb?m no desenvolvimento de abordagens de tratamento. Nesse sentido, torna-se relevante identificar e antecipar o que seriam poss?veis situa??es de risco e o qu?o confiantes sentem-se os usu?rios para seguir e evitar a reca?da. Esta disserta??o objetiva estudar as habilidades de enfrentamento e a autoefic?cia para a abstin?ncia em usu?rios de crack atrav?s de quatro estudos. O primeiro tem o t?tulo de ?Habilidades de Enfrentamento e Autoefic?cia na Abstin?ncia do Crack: uma Revis?o Bibliogr?fica?. Neste estudo foram revisadas as publica??es cient?ficas dos ?ltimos cinco anos (2010-2014), indexados nas bases de dados PubMed, PsycInfo, Lilacs, Proquest e Web of Science. Os descritores foram habilidades de enfrentamento, autoefic?cia, abstin?ncia, preven??o ? reca?da, abuso de drogas e crack. Foram pesquisados os descritores em l?ngua inglesa coping skills, self-efficacy, abstinence, relapse prevention, drug abuse and crack cocaine. Foram encontrados poucos artigos espec?ficos ao crack: estilos parentais e a influ?ncia nas habilidades de enfrentamento, craving e crack e recursos de enfrentamento em mulheres. Concluiu-se que o tempo de abstin?ncia, associado com abordagens adequadas e a autoefic?cia podem ajudar no desfecho do tratamento. O crack, com suas caracter?sticas pr?prias, causa diversos preju?zos, por?m a melhora cognitiva ? poss?vel levando-se em conta o tempo de abstin?ncia. Estudos sobre habilidades de enfrentamento e autoefic?cia s?o relevantes no contexto da abstin?ncia do crack, por?m ainda incipientes. O segundo estudo, ?Habilidades de Enfrentamento e Autoefic?cia para a Abstin?ncia em Dependentes de Crack?, avaliou as habilidades de enfrentamento e a autoefic?cia no contexto da abstin?ncia do crack em 189 sujeitos. Trata-se de um estudo quantitativo, descritivo e correlacional com delineamento transversal. A amostra ? constitu?da de mulheres: 44,4% (n=84) e homens: 55,6% (n=105), com idades entre 19 e 59 anos e com at? 5 anos de escolaridade formal. Foram utilizados os testes Qui-Quadrado de Pearson e Exato de Fisher, o t-Student e de Mann Whitney para as vari?veis com distribui??o assim?tricas e a an?lise de vari?ncia (Two way) ? Pos Hoc Sheffe. O n?vel de signific?ncia ? de 5%. A m?dia de idade ? 31,7 anos, 58,3% (n=109) tem ensino fundamental e a classifica??o econ?mica pelo Crit?rio Brasil demonstrada ? a classe ?C? (49,02%). A m?dia resultante do Mini Exame do Estado Mental (MEEM) ? mais elevada no sexo masculino (26,8?2,6). No Fator 6 (Fuga e Esquiva) do Invent?rio de Estrat?gias de Coping ocorreu, no sexo feminino, correla??o significativa com o Fator 2 (Express?o de Sentimento) do Invent?rio de Enfrentamento Antecipat?rio para a Abstin?ncia (IDHEAA) (r=-0,250; p=0,022). H? correla??es significativas e positivas, principalmente entre os Fatores 1 e 2 do IDHEAA (Assertividade e Express?o de Sentimento) com todos os fatores da Escala de Autoefic?cia para a Abstin?ncia (EAAD) incluindo seu escore total. Entre as estrat?gias de Coping e a autoefic?cia para a abstin?ncia (EAAD), no sexo feminino, n?o h? correla??es significativas, sendo que nos homens h? correla??o positiva entre os fatores da autoefic?cia para a abstin?ncia (EAAD) e os fatores das estrat?gias de Coping (Autocontrole e Resolu??o de Problemas). Conclui-se que as mulheres s?o mais vulner?veis ao uso de crack e usam mais as estrat?gias de Coping. Homens mais confiantes s?o mais autocontrolados e tem maior disponibilidade de resolver problemas. Faltam estudos que correlacionem os construtos apresentados neste estudo. O terceiro estudo, intitulado como ?Rela??o entre Coping e o Tempo de Abstin?ncia em Dependentes de Crack?, correlacionou as estrat?gias de Coping e o tempo de abstin?ncia em homens e mulheres com transtorno grave pelo uso de crack, em tratamento. Trata-se de um estudo quantitativo, descritivo e correlacional, com delineamento transversal e a amostra foi composta por 189 sujeitos: 84 mulheres (44,4%) e 105 homens (55,6%). Os participantes com idades entre 19 a 59 anos apresentam, no m?nimo, 5 anos de estudo formal. A idade m?dia de idade ? de 31,7 (?8,8) anos, apresentam n?vel escolar baixo e renda familiar entre 1 e 2 sal?rios m?nimos (68,8%). A compara??o entre vari?veis categ?ricas nos dois grupos ocorreu pelos testes Qui-quadrado de Pearson e Exato de Fisher. Adotou-se o n?vel de signific?ncia de 5%. O tempo de abstin?ncia de at? 60 dias foi observado em 64,0% (n=121). Na avalia??o das estrat?gias de Coping as m?dias mais elevadas, no sexo feminino, foram Fator 1 (Confronto) (Masculino: 1,4?0,6 vs. Feminino: 1,6?0,6; p=0,05); Fator 4 (Suporte Social) (Masculino: 1,6?0,7 vs. Feminino: 2,0?0,7; p=0,001); Fator 6 (Fuga e Esquiva) (Masculino: 1,5?0,7 vs. Feminino: 1,8?0,7; p=0,014); Fator 5 (Aceita??o de Responsabilidade) (Masculino: 1,9?0,7 vs. Feminino: 2,1?0,6; p=0,011); e Fator 8 (Reavalia??o Positiva) (Masculino: 1,6?0,6 vs. Feminino: 2,0?0,7; p<0,001). As estrat?gias de Coping, correlacionadas ao tempo de abstin?ncia e ao sexo, teve um ?nico efeito significativo no Fator 5 (Aceita??o de Responsabilidade) para a intera??o entre sexo e tempo de abstin?ncia (F1, 189 = 5,318; p=0,022; poder=0,631). Houve signific?ncia lim?trofe nos Fatores 3 (Autocontrole) (F1, 189 = 4,064; p=0,072; poder=0,631) e 4 (Suporte Social) (F1, 189 = 4,031; p=0,072; poder=0,615). Houve efeito para o fator sexo evidenciado para os Fatores 1 (Confronto) (F1, 184 =8,357; p=0,004; poder=0,820); 3 (Autocontrole) (F1, 184 =4,450; p=0,036; poder=0,555); 4 Suporte Social (F1, 189 =5,574; p=0,001; poder=0,931); 6 (Fuga e Esquiva) (F1, 184 =; p=0,011; poder=0,724); e 8 (Reavalia??o Positiva) (F1, 184 =5,611; p<0,001; poder=0,953). Mulheres t?m escores mais elevados no Coping, independente do tempo de abstin?ncia. Mulheres com at? 60 dias de abstin?ncia apresentam maior Aceita??o de Responsabilidade (Fator 5/Coping) e, com mais de 60 dias, diminu?ram o Autocontrole (Fator 3/Coping). Homens com mais de 60 dias de abstin?ncia aumentaram o Suporte Social (Fator 4/Coping) em rela??o ao grupo com menos de 60 dias. Diferen?as nas estrat?gias de Coping detectadas entre homens e mulheres em cada faixa de tempo de abstin?ncia n?o se mostraram representativas neste estudo. O quarto e ?ltimo estudo, ?Habilidades de Enfrentamento, Autoefic?cia e Tempo de Abstin?ncia do Crack em Mulheres?, objetivou tra?ar um perfil de mulheres dependentes de crack internadas em Comunidades Terap?uticas, sendo correlacionados vari?veis como Enfrentamento Antecipat?rio, Autoefic?cia, Estrat?gias de Coping e o tempo de abstin?ncia. Trata-se de um estudo quantitativo, descritivo e correlacional, com delineamento transversal. A amostra est? constitu?da de 84 mulheres. A distribui??o de normalidade foi verificada pelo teste de Kolmogorov-Smirnov com corre??o de Lillifors, a rela??o de linearidade entre os instrumentos foi estimada atrav?s do coeficiente de correla??o de Pearson e a an?lise comparativa pelo teste t-Student. Para crit?rios de decis?o estat?stica adotou-se o n?vel de signific?ncia de 5%. Os resultados encontrados foram 31,6 (?9,1) anos como a m?dia de idade e escolaridade baixa em 57,1% (n=48). At? internarem, 40,5% (n=34) das participantes trabalhavam e 48,9% (n=41) foram classificadas como classe ?C? pelo Crit?rio Brasil. O tempo de abstin?ncia de at? 60 dias ocorreu em 62,9% (n=66) e a m?dia de dias sem o uso de drogas ? de 181,6 (?294,7) dias. Quanto ao uso de outras subst?ncias, observou-se a associa??o do crack a outras drogas (?lcool 23,8%; maconha 17,9%; coca?na 44,0%. Os resultados ponderados das m?dias encontradas no screening cognitivo atrav?s da Escala de Intelig?ncia Wechsler para Adultos (WAIS) foram: Cubos 11,4 (?3,0); C?digos 9,1 (?2,4) e D?gitos 11,4 (?3,3). O escore m?dio apresentado no Mini Exame do Estado Mental (MEEM) ? de 25,8. Na avalia??o da autoefic?cia (EAAD), a pontua??o m?dia mais elevada ocorreu no Fator 3 (Confian?a em n?o usar crack frente a preocupa??es: 3,6?1,1) e a menor no Fator 2 (Confian?a em n?o usar crack ao ver outras pessoas usando: 3,2?1,3). Na avalia??o das estrat?gias de enfrentamento antecipat?rias para a abstin?ncia do crack (IDHEAA), as pontua??es mais elevadas est?o nos Fatores 1 (Assertividade e planejamento para situa??es de alto risco: 2,3?0,8) e 2 (Express?o de sentimento positivo para manuten??o da abstin?ncia: 2,3?0,6), sendo que o menor escore m?dio foi no fator 3 (Autocontrole emocional em situa??es adversas: 2,0?0,8). As pontua??es m?dias nas estrat?gias de Coping oscilaram entre 1,6 e 2,1 pontos, sendo que a pontua??o m?xima estabelecida ? de 3 pontos. As m?ximas ocorrem na Aceita??o de Responsabilidade (Fator 5/Coping) (2,1?0,6), no Suporte Social (Fator 4/Coping) (2,0?0,7) e na Reavalia??o Positiva (Fator 8/Coping) (2,0?0,7). As m?nimas pontua??es ocorrem no Confronto (Fator 1/Coping) (1,6?0,6) e no Autocontrole (Fator 3/Coping) (1,6?0,6). Em rela??o ? correla??o dos instrumentos estrat?gias de Coping e enfrentamento antecipat?rio (IDHEAA), verificou-se que o Fator 1 do IDHEAA (Assertividade e planejamento para situa??es de alto risco) estimou correla??es significativas, positivas de grau fraco com as estrat?gias de Coping Suporte Social (Fator 4/Coping) (r=0,221; p=0,043), Aceita??o de Responsabilidade (Fator 5/Coping) (r=0,258; p=0,018), Resolu??o Problemas (Fator 7/Coping) (r=0,269; p=0,013) e Reavalia??o Positiva (Fator 8/Coping) (r=0,291; p=0,007); apontando que pontua??es elevadas no Fator 1 IDHEAA (Assertividade e planejamento para situa??es de alto risco) mostram-se correlacionadas a pontua??es tamb?m elevadas nos fatores das estrat?gias de Coping. As correla??es mais expressivas entre estrat?gias de Coping e enfrentamento antecipat?rio est?o no autocontrole emocional em situa??es adversas (Fator 3/IDHEAA) e no Suporte Social (Fator 4/Coping) (r=-0,294; p=0,007), Aceita??o de Responsabilidade (Fator 5/Coping) (r=-0,232; p=0,034), Resolu??o Problemas (Fator 7/Coping) (r=-0,311; p=0,004), e Reavalia??o Positiva (Fator 8/Coping) (r=-0,375; p<0,001). As estrat?gias de Coping e a autoefic?cia para a abstin?ncia variam de forma independente no sexo feminino. A m?dia no Fator 2 do Coping (Afastamento) (1,6?0,6) dos participantes com at? 60 dias de abstin?ncia foi mais alta (p=0,026). Houve signific?ncia lim?trofe (0,05<p<0,10) no Fator 5/Coping (Aceita??o de Responsabilidade) (p=0,056) sugerindo que a m?dia do grupo com at? 60 dias de abstin?ncia (2,3?0,6) pode estar se mostrando mais elevada, quando comparada ao grupo com mais de 60 dias de abstin?ncia (2,0?0,7). Conclui-se que a autoefic?cia est? associada ?s estrat?gias de enfrentamento antecipat?rias, sendo que ver outras pessoas usando drogas ? considerado o fator mais cr?tico. Mulheres com controle emocional conseguem resignificar viv?ncias e buscar apoio social. Considera-se a necessidade de novos estudos sobre habilidades de enfrentamento antecipat?rio e da autoefic?cia em mulheres usu?rias de crack. Esta disserta??o poder? estimular novos estudos sobre habilidades de enfrentamento e autoefic?cia no contexto do crack.

Made available in DSpace on 2015-04-14T13:22:17Z (GMT). No. of bitstreams: 1 453433.pdf: 3650080 bytes, checksum: c204c042465350ee80f6b74d4fc6e3e6 (MD5) Previous issue date: 2013-12-12 / This doctoral thesis is about psychological treatments for cocaine/crack users, and has 4 articles, structured in the form of sessions. Session 1 is the theoretical chapter, which aimed to present a literature review of treatments offered for crack users, through a systematic review of international and national literature indexed in Medline, SciELO, LILACS, and Web of Science using the descriptors crack or cocaine or cocaine smokers (crack) and psychosocial treatment or psychotherapy or psychological treatment (psychological treatment) including articles published in the period of 2001-2011. The results show that there is no consensus on the effectiveness of crack users treatment, the few efforts to compare techniques resulted in evidence of little or no difference, although there are registered benefits in the application of any those. In session II, a randomized clinical trial is presented in order to evaluate the effectiveness of a group intervention program for cocaine/crack users. The findings of this study suggest that the intervention was effective for readiness for behavior change and for the maintenance of abstinence in the first two weeks post-treatment. Session III, aimed to evaluate and compare therapists skills for using the principles of motivational interviewing through Motivational Interviewing Treatment Integrity (MITI) scale. As a result it was found that the therapists from the group (TTM + MI) were competent in the overall score of the MI spirit, in the percentage of complex reflections and in the percentage of MI adherent; when compared to the control group (Psychoeducation), there was significant difference in all MITI scale scores. The purpose of the session IV, was to verify possible associations and cognitive performance influence in readiness for change in cocaine/crack users. The WCST, WAIS-III subtests, the URICA, and the readiness to change scale were applied in a 113 users sample. The results showed significant correlations between the presence of cognitive deficits and lower degrees of motivation. Multiple regression analyzes showed levels of influence of cognitive tests performance increasing the subject s readiness to change. Thus, it can be inferred that cognitive performance correlates to readiness for behavior change in cocaine/crack users. / A presente tese de doutorado ? sobre tratamentos psicol?gicos para usu?rios de coca?na/crack, e possui quatro artigos, que foram estruturados sob a forma de se??es. A se??o I ? o cap?tulo te?rico, que teve como objetivo apresentar uma revis?o da literatura sobre tratamentos oferecidos para usu?rios de crack, atrav?s de uma revis?o sistem?tica de literatura internacional e nacional, indexada nas bases de dados Medline, Scielo, Lilacs e Web of Science, utilizando os descritores crack or crack cocaine or cocaine smokers (crack) and psychosocial treatment or psycotherapy or psychological treatment (tratamento psicol?gico), incluindo artigos publicados no per?odo de 2001 a 2011. Os resultados apontam que n?o existe consenso acerca da efetividade no tratamento de usu?rios de crack; os poucos esfor?os de compara??o entre t?cnicas resultaram em evid?ncias de pouca ou nenhuma diferen?a, ainda que se registre o benef?cio para os usu?rios na aplica??o de qualquer uma delas. Na se??o II, ? apresentado um ensaio cl?nico randomizado para avaliar a efetividade de um programa de interven??o em grupo para usu?rios de coca?na/crack. Os achados deste estudo sugerem que a interven??o foi efetiva quanto ? prontid?o para mudan?a de comportamento e quanto ? manuten??o da abstin?ncia nos primeiros 15 dias p?s-tratamento. A se??o III teve como objetivo avaliar e comparar as compet?ncias dos terapeutas para a utiliza??o dos princ?pios da entrevista motivacional atrav?s da escala Motivational Interviewing Treatment Integrity (MITI). Como resultados, foi poss?vel constatar que os terapeutas do grupo MTT+EM foram competentes tanto no escore global do esp?rito da EM, quanto no percentual de reflex?es complexas e no percentual de EM aderente; quando comparado com o grupo controle Psicoeduca??o, houve diferen?a significativa em todos os escores da escala MITI. O objetivo do artigo da se??o IV foi verificar as poss?veis associa??es e a influ?ncia do desempenho cognitivo na prontid?o para mudan?a em usu?rios de coca?na/crack. Em uma amostra de 113 usu?rios, foram aplicados o WCST, subtestes do WAIS-III, a URICA e a R?gua de Prontid?o para a Mudan?a. Os resultados apontaram correla??es significativas entre presen?a de d?ficits cognitivos e menores graus de motiva??o. An?lises de regress?o m?ltipla apontaram os n?veis de influ?ncia da performance nos testes cognitivos no aumento da prontid?o do sujeito para a mudan?a. Assim, pode-se inferir que o desempenho cognitivo correlaciona-se ? prontid?o para a mudan?a de comportamento em usu?rios de coca?na/crack.

Made available in DSpace on 2015-04-14T13:22:18Z (GMT). No. of bitstreams: 1 456142.pdf: 170016 bytes, checksum: 4b0bc07055b83f04f1d929a6d084f447 (MD5) Previous issue date: 2014-03-10 / BACKGROUND: Substance use-related disorders are characterized by social problems, thought to be the result of social cognition impairments. In particular, the ability to interpret the thoughts of other people - Theory of Mind (ToM) - seems to be impaired. In view of this, this study aimed to investigate ToM functioning in a cocaine dependent (COD) sample. METHOD: This dissertation comprised four studies. The first is a systematic review of ToM in substance users. The second and the third deal with the development of instruments for the ToM assessment. The second is the translation and adaption of the Reading the Mind in the Eyes Test (RMET) into the Brazilian Portuguese, and the third describes the validation of the Hinting task and the ToM Stories task. The fourth work represents the main study of this dissertation the investigation of the ToM of COD women. 30 COD women and 30 healthy controls (HC) matched for sex, age, education, individual income and IQ took part in this study. All participants were assessed with the RMET, the Hinting Task and the ToM stories. Cognitive and clinical factors were also assessed in order to control for possible differences. RESULTS: The systematic review revealed that ToM deficits were present in substance use-related disorders. Besides that, the review indicated that these impairments were related to daily life and clinical features of substance use-related disorders. In addition, this dissertation advanced with regard the technological development, since it guaranteed a translated and adapted Brazilian version of the RMET. By the same token, in the third study the Hinting Task and the ToM Stories were shown to have convergent, predictive, concurrent, discriminative and diagnostic validity. Finally, in the fourth study, COD women were found to have impaired ToM in comparison with HC. Additionally, correlations indicated ToM was negatively associated with dependence chronicity. CONCLUSION: Results were consistent with the published literature, suggesting that COD like other drug dependence disorders, is associated with ToM deficits. In view of the results that suggested an association between ToM and social and clinical outcomes, we have proposed a framework in which there is a bidirectional, facilitative relationship between drug use and ToM impairments. The implications of the results for future research and potential interventions based on targeting the psychosocial problems found to be impaired in substance use disorders are discussed / INTRODU??O: Transtornos relacionados ao uso de subst?ncias s?o caracterizados por problemas sociais. Acredita-se que a origem de tais comprometimentos se deva a d?ficits em fun??es da cogni??o social. Em particular, a Teoria da Mente (ToM) capacidade de inferir e interpretar os pensamentos de outras pessoas parece estar prejudicada em dependentes qu?micos. Portanto, o objetivo deste trabalho foi investigar a ToM em uma amostra de mulheres dependentes de coca?na. M?TODO: Esta disserta??o ? composta por quarto artigos. O primeiro ? uma revis?o sistem?tica sobre a ToM em usu?rios de drogas. O segundo e terceiro foram dedicados ao desenvolvimento de instrumentos para a avalia??o da ToM. O segundo ? a tradu??o e a adapta??o ao portugu?s brasileiro do Reading the Mind in the Eyes Test (RMET), e o terceiro ? a valida??o do Hinting Task e do ToM Stories. O quarto trabalho representa o principal objetivo da disserta??o investigar a ToM de mulheres dependentes de coca?na. Participaram 30 mulheres com diagn?stico de depend?ncia de coca?na e 30 mulheres saud?veis, sendo os grupos pareados por sexo, idade, anos de estudo, renda e QI. Todas participantes responderam ao RMET, ao Hinting Task e ao ToM Stories. As participantes tamb?m foram avaliadas quanto ? sintomatologia psiqui?trica e ao desempenho neuropsicol?gico. RESULTADOS: A revis?o sistem?tica revelou que o uso de ?lcool e drogas ? relacionado a preju?zos na ToM, e que a ToM ? associada com aspectos do dia-a-dia e do curso da depend?ncia. No segundo estudo avan?ou-se no desenvolvimento tecnol?gico garantindo uma adequada vers?o traduzida e adaptada do RMET para o portugu?s brasileiro. Al?m disso, no terceiro artigo revelou-se as propriedades psicom?tricas do Hinting Task e do ToM Stories. Ambas tarefas demonstraram possuir validades convergente, preditiva, concorrente, discriminativa e diagn?stica. Por fim, o quarto estudo revelou que mulheres dependentes de coca?na obtiveram um desempenho significativamente inferior ao do grupo de mulheres saud?veis nas tarefas de ToM. A performance de ToM foi encontrada negativamente correlacionada com o n?vel de severidade da depend?ncia de coca?na. CONCLUS?ES: Os resultados indicam que mulheres dependentes de coca?na possuem desempenho inferior ao de mulheres saud?veis em tarefas de ToM. Tais achados s?o consistentes com os da literatura e corroboram com o fato da ToM estar relacionada com manifesta??es sintom?ticas da doen?a. Com base nos resultados, um modelo ilustrativo da participa??o bidirecional da ToM no curso da depend?ncia qu?mica foi proposto. O modelo sugere que por um lado, preju?zos na habilidade de inferir e interpretar os pensamentos de terceiros vulnerabilizam pessoas ao uso de subst?ncia, e, em contrapartida, o uso de subst?ncias causa eventos t?xicos ao c?rebro que acabam alterando circuitos neurobiol?gicos importantes para a integridade da ToM. As implica??es dos resultados e conclus?es desta disserta??o refor?am o potencial que interven??es que visem a promo??o de habilidades psicossociais possuem no tratamento de transtornos aditivos

Made available in DSpace on 2015-04-14T13:22:21Z (GMT). No. of bitstreams: 1 458155.pdf: 149400 bytes, checksum: 50aab838f152b6e740315982e26b115c (MD5) Previous issue date: 2014-01-16 / BACKGROUND: Both childhood maltreatment (CM) and substance abuse, especially cocaine, have robust effects on the inflammatory system. Considering that CM have been described as an important risk factor for addiction, this study aimed to investigate peripheral levels of inflammatory mediators during early abstinence from female crack cocaine dependents with and without history of CM. METHOD: This dissertation consists of two empirical studies. The first is a follow-up study that investigated three adipocytokines in 104 dependent on crack cocaine and 18 healthy controls. Plasma levels of adiponectin, resistin and leptin were evaluated every seven days for three weeks by ELISA. The second is a cross-sectional study that investigated the TNF-alpha and four members of the TNF superfamily, by ELISA and flow cytometry in 44 dependent on crack cocaine and 25 healthy controls. Both studies used the Childhood Trauma Questionnaire (CTQ) to retrospectively assess history of CM of participants. RESULTS: The first study revealed that users of crack increased plasma leptin levels during early abstinence, although concentrations have remained lower compared with the control group. In relation to the levels of adiponectin, the group of women who had suffered CM reduced compared with users without CM levels. Moreover, only the group of users without CM had increased plasma levels of adiponectin during detoxification. The second study showed that users with CM had higher levels of TNF-alpha and lower levels of TWEAK compared with users without CM and the control group. sTNFRII was high, but only in comparison with the group using crack and controls. TRAIL levels were slightly elevated in the group with CM, and it was not found differences between the groups in the levels of sTNFRI. In addition, the plasma level of TNF-alpha was positively predicted by craving and CM gravity. CONCLUSION: The present work corroborates the knowledge about the association between early life stress and peripheral pro-inflammatory mediators. The results showed inflammatory abnormalities in crack addiction and explores the cumulative effects in relation to CM as a relevant factor for this deregulation. / JUSTIFICATIVA: Estudos recentes t?m demonstrado que tanto o estresse precoce, quanto o abuso de drogas, especialmente a coca?na, tem fortes efeitos sobre o sistema inflamat?rio. Considerando que maus-tratos na inf?ncia (MI) t?m sido descrito como um importante fator de risco para a depend?ncia, este estudo teve como objetivo investigar n?veis perif?ricos de mediadores inflamat?rios durante a abstin?ncia inicial de coca?na tipo crack em usu?rias do sexo feminino, com e sem hist?ria de MI. M?TODO: A presente disserta??o ? composta por dois estudos emp?ricos. O primeiro ? um estudo de follow-up que investigou tr?s adipocitocinas em 104 dependentes de coca?na tipo crack e 18 controles saud?veis. Os n?veis plasm?ticos de adiponectina, resistina e leptina foram avaliados a cada sete dias, durante tr?s semanas, atrav?s de ELISA. O segundo ? um estudo transversal que investigou o TNF-alfa e quatro membros da superfam?lia do TNF, atrav?s de ELISA e citometria de fluxo em 44 dependentes de coca?na tipo crack e 25 controles saud?veis. Ambos os estudos utilizaram o Childhood Trauma Questionnaire (CTQ) para avaliar retrospectivamente hist?ria de maus tratos na inf?ncia das participantes. RESULTADOS: O primeiro estudo destacou que as usu?rias de crack aumentaram os n?veis plasm?ticos de leptina durante a abstin?ncia inicial, apesar de as concentra??es terem se mantido mais baixas em compara??o com o grupo controle. J? em rela??o aos n?veis de adiponectina, o grupo de usu?rias que sofreu MI apresentou n?veis reduzidos em rela??o ?s usu?rias sem MI. Al?m disso, somente o grupo de usu?rias sem MI tiveram aumento dos n?veis plasm?ticos de adiponectina durante a desintoxica??o. J? o segundo estudo evidencia que as usu?rias com MI tinham n?veis mais elevados de TNF-alfa e menor de TWEAK em compara??o com as usu?rias sem MI e o grupo controle. sTNFRII estava elevado, mas apenas em compara??o com os grupos de usu?rias de crack e controles. Os n?veis de TRAIL estavam levemente elevados no grupo com MI, enquanto n?o foram encontradas diferen?as entre os grupos nos n?veis de sTNFRI. Al?m disso, o n?vel plasm?tico de TNF-alfa foi predito positivamente pela gravidade de craving e de MI. CONCLUS?O: A presente disserta??o corrobora com o conhecimento sobre a associa??o entre o estresse precoce e os n?veis pr?-inflamat?rios perif?ricos atrav?s de resultados in?ditos na literatura para a popula??o estudada. Os resultados mostram anomalias inflamat?rias na depend?ncia de crack e explora os efeitos cumulativos em rela??o aos maus-tratos na inf?ncia como fator relevante para esta desregula??o.