Submitted by Setor de Tratamento da Informa??o - BC/PUCRS (tede2@pucrs.br) on 2015-07-21T11:30:34Z No. of bitstreams: 1 472476 - Texto Completo.pdf: 2364616 bytes, checksum: c4b022cfc35016dfceaaa75088b36bcb (MD5) / Made available in DSpace on 2015-07-21T11:30:34Z (GMT). No. of bitstreams: 1 472476 - Texto Completo.pdf: 2364616 bytes, checksum: c4b022cfc35016dfceaaa75088b36bcb (MD5) Previous issue date: 2014-11-21 / Crack is a cocaine-??derived substance that acts as a stimulant of the central nervous system. It is characterized by low cost, quick action and high power dependency. Little is known about effects at the cellular level caused by the crack and body resilience of body during period of abstinence. Studies have shown an increased production of reactive oxygen species (ROS) after administration of cocaine. Oxidative stress occurs when there is an imbalance between the production of ROS and the ability of the antioxidant defense in combat or prevent its action. This condition can be harmful to cells, causing damage to biomolecules such as DNA, lipids and proteins. Aiming to better understand the action of crack and abstinence in redox state, this study enrolled thirty patients of program for detoxification and thirty volunteers who did not use drugs taken as control group. Blood samples were collected after 4th and the 18th day of treatment and plasma was used for biochemical analysis. Quantifications were performed oxidants markers such as protein carbonyl and protein thiols, both demonstrate protein modifications by ROS, and antioxidant markers such as glutathione peroxidase and superoxide dismutase and non-??enzymatic markers such reduced glutathione (GSH) and total reactive antioxidant potential (TRAP).Psychological variables were assessed through the scores obtained Cocaine Selective Severity Assessment, Fagerstrom Tolerance Questionnaire, Beck Depression Inventory version II (BDI-??II) and Addiction Severity Index. After four days of abstinence we observe observed an increase in oxidative markers compared to end of the treatment. After eighteen days of abstinence there is a recovery of antioxidant defenses. Also, we observed e a positive correlation between protein carbonyls and psychological variables and a negative correlation between the levels of TRAP levels and psychological variables. Thus, our results suggest that abstinence period may provide a recovery of antioxidant defenses, thereby reducing propensity for oxidative damage. / O crack ? uma subst?ncia derivada da coca?na que age como estimulante do sistema nervoso central. ? caracterizado pelo baixo custo, r?pida a??o e alto poder de depend?ncia. Pouco se sabe sobre os efeitos a n?vel celular causados pelo crack e sobre a capacidade de recupera??o do organismo no per?odo de abstin?ncia. Estudos tem demonstrado uma eleva??o da produ??o de esp?cies reativas de oxig?nio (EROS) ap?s a administra??o da coca?na. O estresse oxidativo ocorre quando h? um desequil?brio entre a produ??o de EROS e a capacidade do sistema de defesa antioxidante em combater ou prevenir sua a??o. Essa condi??o pode ser nociva para as c?lulas, causando danos a biomol?culas como DNA, lip?deos e prote?nas. Com o objetivo de melhor compreender a a??o do crack e da abstin?ncia no sistema de defesa antioxidante e no dano oxidativo, esse estudo recrutou trinta volunt?rias pacientes de um programa para desintoxica??o e trinta volunt?rias que n?o faziam uso de drogas tidas como grupo controle. Amostras de sangue foram coletadas ap?s o 4? e o 18? dia de tratamento e o plasma foi utilizado para as an?lises bioqu?micas. Foram realizadas quantifica??es de marcadores oxidantes, como prote?nas carboniladas e ti?is proteicos, ambos demonstram modifica??es proteicas feitas por EROS e marcadores antioxidantes, tanto enzim?ticos como glutationa peroxidase e super?xido dismutase quanto n?o enzim?tico como glutationa reduzida (GSH) e o potencial antioxidante reativo total (TRAP).As vari?veis psicol?gicas foram avaliadas atrav?s dos escores obtidos nos question?rios: Cocaine Selective Severity Assessment, Question?rio de Toler?ncia de Fagerstrom, Invent?rio de Depress?o de Beck vers?o II (BDI-??II) e o Addiction Severity Index. Ap?s o 4? dia de abstin?ncia observamos um aumento dos marcadores oxidantes em compara??o ao fim do tratamento. Ap?s dezoito dias de abstin?ncia h? uma recupera??o das defesas antioxidantes. Tamb?m evidenciamos uma correla??o positiva entre as prote?nas carboniladas e vari?veis psicol?gicas e uma correla??o negativa entre os n?veis de TRAP e as vari?veis psicol?gicas. Dessa forma, nossos resultados sugerem que o per?odo de abstin?ncia pode propiciar uma recupera??o das defesas antioxidantes, diminuindo assim, a propens?o ao dano oxidativo.

Made available in DSpace on 2015-04-14T13:22:12Z (GMT). No. of bitstreams: 1 447894.pdf: 1745624 bytes, checksum: 63d4be9335c9c7e3bca96098ac6b3d04 (MD5) Previous issue date: 2013-01-18 / The prevalence of smoking among illicit drug users is significantly higher than the prevalence of smoking in the general population. It is known that in patients who use tobacco and cocaine, tobacco exposure may activate and increase crack cocaine administration. When treating a patient in parallel with comorbid dependencies you need to understand the differences and specificities of each substance, and realize their internship and their motivational readiness to change for each one separately. The goal of the empirical study was to determine, among patients who were in treatment for cocaine and crack use and were smokers, readiness to change for illicit substances and tobacco and its possible association. A methodology descriptive and correlational design, quantitative and cross. From a simple probability sample of 88 patients were admitted to a Therapeutic Farm in the metropolitan region of Porto Alegre. The instruments used to check the readiness to change for illicit substances and tobacco were the Algorithm, the Ruler of Readiness and URICA, using also a socio-economic questionnaire semi-structured questionnaire and the Fagerstrom for nicotine dependence. Regarding the results identified significant differences between the readiness for tobacco and illicit substances (p <0.001). According to the three instruments, individuals are more ready to change in relation to illicit substances than tobacco. While the prevalence of pre-contemplation is among tobacco users (79.5%), the highest prevalence of action and maintenance are among users of illicit substances (33% and 28.4%) for the URICA. In relation to the algorithm for the tobacco sample also prevailed in the stage of precontemplation (39.3%), whereas for illicit substances, the majority (75.3%) was found in the preparation. Thus concludes that tobacco users are less ready to change with regard to readiness to change in crack and cocaine. We also performed a systematic review, which was aimed to investigate the association of smoking on treatment of cocaine users and crack. Regarding the results, there was a direct association between following smoking during treatment for cocaine and worst results for the same treatment in the short and long term. From the systematic review concluded that consuming tobacco negatively affects the outcome of treatment for cocaine users. Thus it is suggested that treatments are offered concurrently and that health professionals also consider the readiness for change in motivational approaches related to tobacco consumption. / A preval?ncia de tabagismo entre os usu?rios de drogas il?citas ? significativamente mais alta do que a preval?ncia de tabagismo na popula??o geral. Sabe-se que, em pacientes que consomem tabaco e coca?na, a exposi??o ao tabaco pode ativar a fissura e aumentar a administra??o de coca?na. Ao tratar paralelamente um paciente com depend?ncias com?rbidas ? preciso entender as diferen?as e especificidades de cada subst?ncia, assim como perceber o seu est?gio motivacional e a sua prontid?o para a mudan?a para cada uma, isoladamente. O objetivo do estudo emp?rico foi verificar, entre os pacientes que estavam em tratamento para uso de crack e coca?na e que eram tabagistas, a prontid?o para mudan?a para as subst?ncias il?citas e para o tabaco e sua poss?vel associa??o. Foi utilizada uma metodologia descritiva, com delineamento correlacional, quantitativo e transversal. A partir de uma amostra aleat?ria simples foram avaliados 88 pacientes internados em uma Fazenda Terap?utica da regi?o metropolitana de Porto Alegre. Os instrumentos utilizados para verificar a prontid?o para mudan?a para subst?ncias il?citas e para o tabaco foram o Algor?timo, a R?gua de Prontid?o e a URICA, utilizando-se, ainda, um question?rio socio-econ?mico semi-estruturado e o Question?rio de Fagerstrom para depend?ncia de nicotina. Em rela??o aos resultados se identificou diferen?a significativa entre a prontid?o para o tabaco e a para as subst?ncias il?citas (p<0,001). De acordo com os tr?s instrumentos utilizados, os indiv?duos encontram-se mais prontos para a mudan?a em rela??o ?s subst?ncias il?citas do que em rela??o ao tabaco. Enquanto que a maior preval?ncia de pr?-contempla??o est? entre os usu?rios de tabaco (79,5%), a maior preval?ncia de a??o e manuten??o est? entre os usu?rios de subst?ncias il?citas (33% e 28,4%) pela URICA. Em rela??o ao algoritmo, para o tabaco a amostra prevaleceu tamb?m no est?gio de pr?-contempla??o (39,3%), ao passo que para as subst?ncias il?citas, a grande maioria (75,3%) se encontrou em prepara??o. Assim se conclui que os usu?rios de tabaco est?o menos prontos para mudar em rela??o ? prontid?o para mudan?a de usu?rios de crack e coca?na. Tamb?m foi realizada uma revis?o sistem?tica, cujo objetivou foi verificar a associa??o do tabagismo no tratamento de usu?rios de coca?na e crack. Em rela??o aos resultados, se verificou uma associa??o direta entre seguir fumando ao longo do tratamento para coca?na e piores resultados no tratamento para a mesma, em curto e longo prazos. A partir da revis?o sistem?tica se concluiu que consumir tabaco interfere negativamente no resultado de tratamento para usu?rios de coca?na. Dessa forma sugere-se que os tratamentos sejam oferecidos concomitantemente e que os profissionais da sa?de tamb?m considerem a prontid?o para mudan?a em abordagens motivacionais relacionadas ao consumo de tabaco.

Submitted by Automa??o e Estat?stica (sst@bczm.ufrn.br) on 2016-06-23T21:17:22Z No. of bitstreams: 1 SimoneReginaDeCarvalho_DISSERT.pdf: 2186853 bytes, checksum: 826bb3bb54b140e9bbf4a4bd298cdfcb (MD5) / Approved for entry into archive by Arlan Eloi Leite Silva (eloihistoriador@yahoo.com.br) on 2016-06-28T20:46:25Z (GMT) No. of bitstreams: 1 SimoneReginaDeCarvalho_DISSERT.pdf: 2186853 bytes, checksum: 826bb3bb54b140e9bbf4a4bd298cdfcb (MD5) / Made available in DSpace on 2016-06-28T20:46:25Z (GMT). No. of bitstreams: 1 SimoneReginaDeCarvalho_DISSERT.pdf: 2186853 bytes, checksum: 826bb3bb54b140e9bbf4a4bd298cdfcb (MD5) Previous issue date: 2015-11-16 / O estudo tem por objetivo analisar o efeito do topiramato sobre o craving em usu?rios de crack. Trata-se de um ensaio cl?nico aberto tipo crossover envolvendo usu?rios do Centro de Aten??o Psicossocial ?lcool e drogas (CAPSad) do munic?pio de Parnamirim/RN, aprovado pelo CEP CAAE: 38710614.1.0000.5537, respeitada a Resolu??o N? 466/2012/CNS. O estudo resultou em dois artigos cient?ficos, um ensaio te?rico e uma revis?o integrativa. No ensaio te?rico de Hinds, Chaves e Cypress, os contextos enfocam desde a problem?tica do uso individual ?s pol?ticas de enfrentamento deste consumo no Brasil, ressaltando que a situa??o de complexidade do fen?meno requerendo estrat?gias de enfrentamento a partir da aten??o integral ao usu?rio, fam?lia e sociedade. A revis?o integrativa captura, dentre os 902 registros trilingui recuperados, oito estudos apresentaram esquemas terap?uticos com efeitos positivos para o craving da coca?na, a partir do uso de nove drogas diferentes. N?o houveram resultados para o craving do crack. Os resultados da amostra do presente estudo foi composta predominantemente por usu?rios do sexo masculino, adultos e solteiros, totalizando 30 sujeitos que atenderam aos crit?rios de inclus?o: adultos, idade a partir de 18 anos, diagn?stico do Manual Diagn?stico e Estat?stico de Transtornos Mentais (DSM-IV) para coca?na/crack; capacidade cognitiva preservada; assiduidade ao servi?o, participar de, no m?nimo, tr?s consultas nos 12 meses anteriores ? coleta dos dados; e aceitar o acompanhamento ao tratamento proposto. Os dados foram coletados no per?odo de dezembro de 2014 a julho de 2015 e analisados por meio de estat?stica descritiva com o suporte do Statistical Package for Social Science (SPSS), atrav?s dos instrumentos: 1) Alcoohol, Smoking, and Substance Involvement Screening Test (ASSIST), aponta, entre outros resultados, que apenas 14% fizeram uso do crack/coca?na semanalmente durante o tratamento, enquanto 83% passaram a fazer uso diariamente ou semanalmente ap?s o per?odo de washout; 2) Escala de Impulsividade de Barratt, com uma m?dia de 80,23 e 77,47 com e sem o tratamento medicamentoso, respectivamente. Uma an?lise a partir do teste t de Student mostram que n?o h? diferen?a significativa na impulsividade com ou sem o uso do medicamento; e 3) Cocaine Craving Questionnaire-Brief (CCQ-Brief), indicando que o n?mero de usu?rios com n?vel de intensidade do craving ? expressivamente maior sem o tratamento medicamentoso (86%) do que com o tratamento (33%). A an?lise entre o craving e a grau de impulsividade mostram que h? uma baixa correla??o (Pearson) entre essas duas vari?veis com medicamento (0,282986) e sem (0,154614), demonstrando que a impulsividade tem baixainflu?ncia sobre o resultado do tratamento medicamentoso. Conclui-se que o topiramato produz efeito positivo para redu??o do craving em usu?rios de crack e que o seu uso constitui estrat?gia relevante para a efic?cia no tratamento de usu?rios de crack. / The study aims to analyze the effects of topiramato on the craving of crack users. It is an open crossover clinical trial involving users from the Psychosocial Care Center for Alcohol and Drugs (CAPSad) in city of Parnamirim, RN, approved by the CEP CAAE: 38710614.1.0000.5537, respecting the norms of the resolution n. 466/2012/CNS. The study produced preliminary two scientific papers: a theoretical essay and an integrative review, as a way of seeking the state of art. The first paper was based in the theoretical framework of Hinds, Chaves and Cypress, which focuses different contexts, from the issues of individual use to the coping policies in Brazil, highlighting that the situation and the complexity of the phenome requires coping strategies for the full attention to the user, family and society. As a result of the integrative review, among the 902 retrieved records, eight of them presented therapeutic schemes with positive effects for the craving of cocaine. They used nine different drugs. It is important to spot out that there was no result for the craving of crack. The data collection was conducted from December 2014 to July 2015 and has as sample predominantly single males. The sample was composed of 30 subjects who met the inclusion criteria: adults, age from 18 years, diagnosis of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) for cocaine/crack; cognitive capacity preserved; attendance to the service, participated at least three visits in the 12 months prior to data collection; and accepted to be monitored in the proposed treatment. Data was analyzed using descriptive statistics from the Statistical Package of Support for Social Sciences (SPSS) on the instruments: 1) Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST), pointing out, among other results, that only 14% used crack/cocaine weekly during treatment, while 83% used daily or weekly after the washout period; 2) Barratt Impulsiveness Scale, with an average of 80.23 and 77.47 with and without drug treatment, respectively. An analysis from the Student t test show no significant differences in impulsivity with or without the drug; and 3) Cocaine-Craving Questionnaire-Brief (CCK-B), indicating that the number of users with craving intensity level is significantly higher without drug treatment (86%) than with treatment (33%). The analysis between craving and level of impulsivity showed that there is a low correlation (Pearson) between these two variables during treatment and after the washout, demonstrating that impulsivity has low influence on the outcome of drug therapy. As conclusion, it was noted that the topiramate produces positive effect on reducing the craving for crack users and their use is a relevant strategy for efficacy in the treatment of crack users.

Submitted by Setor de Tratamento da Informa??o - BC/PUCRS (tede2@pucrs.br) on 2016-02-26T13:19:06Z No. of bitstreams: 1 TES_LEDA_RUBIA_MAURINA_COELHO_PARCIAL.pdf: 814117 bytes, checksum: 8c68bef5b0f98ac0f7aac41ad5e7a046 (MD5) / Made available in DSpace on 2016-02-26T13:19:07Z (GMT). No. of bitstreams: 1 TES_LEDA_RUBIA_MAURINA_COELHO_PARCIAL.pdf: 814117 bytes, checksum: 8c68bef5b0f98ac0f7aac41ad5e7a046 (MD5) Previous issue date: 2016-01-08 / This thesis describes the development and evaluation of the effects of a coping and social skills training ? CSST program for people who use crack, using as an intervention approach the Relapse Prevention Model. Initially the theoretical and practical contexts of the research are presented, addressing the issues that this thesis set out to answer. To clarify these questions the thesis was structured in three sections. In the first section, the mixed design study aimed to investigate the coping skills and strategies of individuals who use crack. Participants had a lower middle repertoire in the ?Invent?rio de Habilidades de Enfrentamento Antecipat?rio para a Abstin?ncia de ?lcool e outras Drogas ? IDHEA-AD? and from transcripts of the interviews were created four categories: "Coping skills and plans for risk situations", "Expression of feelings," "Emotional self-control" and "Avoidance strategies". The description of social skills repertoire, anticipatory coping skills and self-efficacy of crack users before, immediately after completion of the training program and after three months is presented in section II. The findings of this quasi-experimental study demonstrated that participants had higher self-efficacy CSST scores for maintaining abstinence afterwards intervention. As for the overall IDEA-AD scores and the factors 1 - "Assertiveness and planning for high-risk situations and substance consumption" and 2 - "Emotional expression of positive feelings for abstinence maintenance" presented themselves lower middle before CSST as repertoire below average at the end of the intervention, and in-depth repertoire above average after three months. For the factor 3 scores - "Emotional self-control in adverse situations" participants had a good repertoire of coping skills in the initial assessment, increasing to in-depth repertoire in the post-CSST and thus remaining at follow-up. In analysis of overall scores and IHS-Del-Prette factors participants retained the measures unchanged during the pursuance, presenting a good repertoire of social skills. In section III predictive factors in crack withdrawal were studied. In this prospective investigation the following variables were considered as predictive of abstinence: be working in the initial assessment, improved performance in block design and digit span WAIS-III subtests, higher grades in IDHEA-AD final score, and especially in Factor 1, which refers to the assertive coping skills and plans for drug use risk situations. Variables gender, age, be studying, education, family income, as well as symptoms of depression, anxiety and stress, self-efficacy for abstinence from illicit drugs and participation in CSST program did not predict crack withdrawal. / A presente tese aborda o desenvolvimento e a avalia??o dos efeitos de um programa de treinamento de habilidades sociais e de enfrentamento - THSE para pessoas que usam crack, utilizando como abordagem de interven??o o Modelo de Preven??o de Reca?da. Inicialmente s?o apresentados os contextos te?rico e pr?tico da pesquisa, abordando as quest?es que esta tese se prop?s a responder. Para elucidar estes questionamentos a tese foi estruturada em tr?s se??es. Na primeira se??o, o estudo de delineamento misto teve como objetivo investigar as estrat?gias e habilidades de enfrentamento de indiv?duos que usam crack. Os participantes apresentaram um repert?rio m?dio inferior no Invent?rio de Habilidades de Enfrentamento Antecipat?rio para a Abstin?ncia de ?lcool e outras Drogas - IDHEA-AD, e foram criadas quatro categorias a partir das transcri??es das entrevistas coletivas: ?Habilidades de enfrentamento assertivas e planos para situa??es de risco?, ?Express?o de sentimentos?, ?Autocontrole emocional? e ?Estrat?gias de evita??o?. A descri??o do repert?rio de habilidades sociais, habilidades de enfrentamento antecipat?rio, bem como a autoefic?cia de pessoas usu?rias de crack antes, imediatamente depois o t?rmino do programa de treinamento e ap?s tr?s meses ? apresentada na se??o II. Os achados deste estudo quase experimental demonstraram que os participantes do THSE apresentaram maiores escores de autoefic?cia para manuten??o da abstin?ncia ap?s a interven??o. J? os escores total IDHEA-AD e dos fatores 1 - ?Assertividade e planejamento para situa??es de alto risco e consumo de subst?ncias? e 2 - ?Express?o emocional de sentimentos positivos para manuten??o da abstin?ncia? apresentaram-se m?dio inferiores antes do THSE, como repert?rio abaixo da m?dia logo ao t?rmino da interven??o, e como repert?rio elaborado acima da m?dia ap?s tr?s meses. Para os escores do fator 3 - ?Autocontrole emocional em situa??es adversas? os participantes apresentaram um bom repert?rio de habilidades de enfrentamento na avalia??o inicial, passando para um repert?rio elaborado no p?s-THSE e mantendo-se assim no follow-up. Na an?lise dos escores total e dos fatores do IHS-Del- Prette os participantes conservaram as medidas inalteradas ao longo do seguimento, apresentando um bom repert?rio de habilidades sociais. Na se??o III foram estudados os fatores preditivos na abstin?ncia de crack. Nesta investiga??o prospectiva foram preditivas de abstin?ncia as seguintes vari?veis: estar trabalhando na avalia??o inicial, melhor desempenho nos subtestes WAIS-III de cubos e d?gitos, maiores pontua??es no escore total do IDHEA-AD, e especialmente no Fator 1 que refere-se as habilidades de enfrentamento assertivas e a planos para situa??es de risco de uso de drogas. As vari?veis sexo, idade, estar estudando, escolaridade, renda familiar, bem como sintomas de depress?o, ansiedade e estresse, autoefic?cia para abstin?ncia de drogas il?citas e a participa??o no programa de THSE n?o predisseram abstin?ncia de crack.

Made available in DSpace on 2015-04-14T13:32:57Z (GMT). No. of bitstreams: 1 438709.pdf: 591072 bytes, checksum: 3c80d14d6ec2996c19fdb76174f0ad41 (MD5) Previous issue date: 2012-01-27 / Objectives : The objective of this study was to determine the frequency, type, and severity of cerebral lesions detected by transfontanellar ultrasonography in newborns exposed to crack during gestation.Materials and methods : This was a retrospective study, involving a review of the medical records of children born to crack-using mothers who were subjected to transfontanellar ultrasonography during their first days of life.Results : Transfontanellar ultrasonography revealed abnormalities in 45/129 newborns examined (34.9%). The changes detected were: subependymal cysts in 24 infants (18.6%), lenticulostriate vasculopathy in 18 infants (14%), subependymal hemorrhage in 9 infants (7%) and choroid plexus cysts in 9 infants (7%).Conclusion : All of the abnormalities found by ultrasound examination were discrete and likely without clinical significance for the babies. However, prospective studies, with a long period of tracking, are needed to determine whether there are consequences on the neurodevelopment of children with prenatal exposure to crack that appear at a later date. / Objetivos : Determinar a freq??ncia, o tipo e a severidade de les?es cerebrais detectadas por ultrassonografia transfontanelar em rec?m-nascidos expostos ao crack durante a gesta??o.Materiais e m?todos : Este foi um estudo retrospectivo, envolvendo revis?o dos prontu?rios m?dicos de rec?m-nascidos filhos de m?es usu?rias de crack, que realizaram ultrassonografia transfontanelar nos seus primeiros dias de vida.Resultados : A ultrassonografia transfontanelar revelou anormalidades em 45/129 rec?m-nascidos examinados (34,9%). As altera??es detectadas foram: cistos subependim?rios em 24 rec?m-nascidos (18,6%), vasculopatia lenticuloestriada em 18 (14%), hemorragias subependim?rias em 9 (7%) e cistos no plexo cor?ide em 9 (7%).Conclus?o : As anormalidades ultrassonogr?ficas encontradas podem ser consideradas discretas e normalmente n?o possuem significado cl?nico para os lactentes. Por?m, estudos prospectivos, com longo seguimento, s?o necess?rios para determinar se existem consequ?ncias tardias no neurodesenvolvimento de crian?as expostas pr?-natalmente ao crack.

Made available in DSpace on 2014-12-17T14:46:59Z (GMT). No. of bitstreams: 1 JoseERJ_DISSERT.pdf: 1457023 bytes, checksum: 208c09b56664138cc540abb5ba16a86c (MD5) Previous issue date: 2013-02-27 / This study aimed to analyze the phenomenon of abdication of monitoring/treatment of crack users in a CAPS AD in Campina Grande-PB. That s an exploratory , description approach ,whose theoretical focus was historical-dialect of public politics on alcohol and drugs. The information collected was realized by using the technique of semi-structured interviews, combined with the crack users registered in CAPS AD in Campina Grande between 2007 and 2011.The material collected was subjected to thematic analysis method, obtaining the extraction of the following categories and subcategories of analysis: CATEGORY 1: Factors of abdication of monitoring/treatment in CAPS AD in Campina Grande PB with subcategory 1.1. Abdication on their own , 1.2. To take work/employment, 1.3 . Search for more intensive treatment , 1.4. Due to relapse; CATEGORY 2 : Treatment/monitoring in CAPS AD to the subcategory, 2.1. The dependence of crack and family support as reasons that led to frequent CAPS AD. CATEGORY 3: Living with crack addiction without treatment/monitoring in CAPS AD with the subcategory, 3.1. Religiosity as a therapeutic tool .The results showed a distance between priority for community treatment and the reality where there is lack of information about this kind of treatment and the admission as a solution. The discourse about the abdication of treatment of crack users make reference to the importance of family support, to the influence for the phenomenon of relapse and the affection to religious conceptions. Although the subjects recognize the qualifications of CAPS AD treatment, they try by themselves or by family influence, another ways of hospitalization. This leads us to conclude that it is necessary reflection and assessment of the work of CAPS AD. Counting on the social changes and the need of answers that the phenomenon requires / O presente estudo teve como objetivo analizar o fen?meno de desist?ncia do acompanhamento/tratamento de usu?rios de crack em um CAPS AD no munic?pio de Campina Grande-PB. Trata-se de uma pesquisa explorat?ria, descritiva e de abordagem qualitativa, cujo marco te?rico foi o enfoque hist?rico-dial?tico das pol?ticas p?blicas de aten??o em ?lcool e drogas. A coleta das informa??es foi realizada empregando-se a t?cnica de entrevista semiestruturada, aliada ao levantamento de prontu?rios dos usu?rios de crack cadastrados no CAPS AD de Campina Grande-PB no per?odo de 2007 a 2011. O material colhido em campo foi submetido ao m?todo de an?lise tem?tica, obtendo-se a extra??o das seguintes categorias e subcategorias de an?lise: CATEGORIA 1: Fatores de desist?ncia do tratamento/acompanhamento no CAPS AD de Campina Grande-PB com as subcategorias 1.1. Desist?ncias por conta pr?pria , 1.2. Para assumir trabalho/emprego, 1.3. Em busca de tratamento mais intensivo , 1.4. Devido a reca?da; CATEGORIA 2: O tratamento/acompanhamento no CAPS AD com a subcategoria 2.1 A depend?ncia do crack e o apoio da fam?lia como motivos que levavam a frequentar o CAPS AD; CATEGORIA 3: Conv?vio com a depend?ncia de crack sem tratamento / acompanhamento no CAPS AD com a subcategoria 3.1. Religiosidade como instrumento terap?utico. Os resultados evidenciaram uma dist?ncia entre a refer?ncia de prioridade para o tratamento comunit?rio e a realidade onde ainda h? desinforma??o sobre esse tipo de tratamento e a busca da interna??o como solu??o. Os discursos acerca do abandono do tratamento de usu?rios de crack fazem larga refer?ncia ? import?ncia do apoio familiar para a perman?ncia no tratamento, a influ?ncia de amigos para o fen?meno da reca?da e o apego ? concep??es religiosas. Embora os sujeitos reconhe?am a qualifica??o do CAPS AD no tratamento, tentam por iniciativa pr?pria ou por influ?ncia da fam?lia, dispositivos de interna??o. Isso nos leva a concluir que se faz necess?rio a reflex?o e avalia??o do processo de trabalho do CAPS AD ? luz das transforma??es sociais e da necessidade de respostas que o fen?meno exige

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 2015-04-14T13:22:08Z (GMT). No. of bitstreams: 1 445275.pdf: 1278161 bytes, checksum: 9297acb13f9ba62c97d910039f33950c (MD5) Previous issue date: 2012-12-10 / his dissertation is about the study of the Processes of Change in drug users. The first section is the theoretical chapter of the thesis and aimed to conduct a literature review about the Transtheoretical Model of Change. The method used was a Literature Review, prepared from a survey in Databases PubMed, PsycINFO, Web of Science, and Lilacs. This section explained the concepts of the Stages of Change, Decisional Balance, Self-efficacy, Temptation to use and Processes of Change. The second section, entitled "Psychometric properties of the Brazilian version of the Processes of Change Questionnaire (EPM) in users of illicit psychoactive substances" presented the result of the translation and adaptation of the Brazilian Scale of Processes of Change (EPM) for drug users. The method used in this section was a quantitative research, cross-sectional and instrumental, with a sample of 328 drug users. According to the results, the process of translation and adaptation of instruments for Brazilian Portuguese proved satisfactory and with a good final version. Furthermore, it was noted that the Brazilian version to the Scale of Processes of Change for drug users is an instrument with adequate reliability and validity. In the third Section ("Intervention to drug users based on the Transtheoretical Model of Change: study intervention group") there were two main objectives. The first one was to conduct a Brazilian adaptation of the Manual "Group Treatment for Substance Abuse: a stages-of-change therapy manual" (Velasquez, Maurer, Crounch & DiClemente, 2001) for drug users. The second was to empirically test the effectiveness of this manual adaptation. The adaptation of the intervention was adequate, and a program with 8 sessions was constructed. According to the results of the empirical testing of this new intervention program, it was possible to see that the intervention proposed in the Experimental Group shows good results against the problem of crack cocaine use and a potential effectiveness. The fourth and last section entitled "Applicability of the Transtheoretical model of change in addiction: correlations among constructs" aimed to determine whether there is a statistical relationship between the main constructs MTT. This research tried to prove if the theory has correlation with the practice in Brazilian drug users. The sample was 142 crack users in treatment. The results showed that there is empirical relationship between the constructs of MTT. The Processes of Change, Self-efficacy, Temptation to use and Stages of Change have significative correlation as in the theory / Esta Tese de doutorado trata sobre o Estudo dos processos de Mudan?a, conforme os construtos do Modelo Transte?rico de Mudan?a, em dependentes qu?micos. A Se??o I ? o cap?tulo te?rico da presente Tese e teve como objetivo realizar uma Revis?o de Literatura sobre o Modelo Transte?rico de Mudan?a. O m?todo utilizado foi a Revis?o Bibliogr?fica, elaborada a partir de uma pesquisa nas Bases de Dados Pubmed, Psycinfo, Web of Science e Lilacs. Os descritores utilizados foram transtheorical model, processes of change, drug, validity e treatment. Foram explicados os conceitos dos Est?gios de Mudan?a, Balan?a Decisional, Auto-efic?cia, Tenta??o para o uso e Processos de Mudan?a. A Se??o II, intitulada Propriedades psicom?tricas da vers?o brasileira da escala de processos de mudan?a (EPM) em usu?rios de subst?ncias psicoativas il?citas apresenta o resultado da tradu??o e adapta??o para a realidade brasileira da Escala de Processos de Mudan?a (EPM) em usu?rios de drogas. O m?todo utilizado foi de um estudo quantitativo e transversal, de cunho instrumental. A amostra foi constitu?da de 328 sujeitos usu?rios de subst?ncias psicoativas il?citas. De acordo com os resultados, o processo de tradu??o e adapta??o dos instrumentos para o portugu?s brasileiro se mostrou satisfat?rio e a vers?o final apresentou linguagem adequada ?s necessidades da popula??o. Al?m disso, p?de-se constatar que a vers?o brasileira da Escala de Processos de Mudan?a para usu?rios de drogas ? um instrumento com valores de fidedignidade e validade satisfat?rios. A Se??o III ( Interven??o para usu?rios de drogas baseada no modelo transte?rico de mudan?a: estudo de adapta??o de interven??o grupal ) teve dois objetivos centrais. O primeiro foi de realizar uma adapta??o brasileira do Manual Group Treatment for Substance Abuse: a stages-of-change therapy manual (Velasquez, Maurer, Crounch & DiClemente, 2001) para usu?rios de drogas. O segundo foi de testar empiricamente a efetividade desta adapta??o. A adapta??o da interven??o foi realizada de forma adequada em rela??o ? tradu??o e condensa??o do Manual original, obtendo-se um programa de oito sess?es. De acordo com os resultados do estudo emp?rico de testagem do novo programa de interven??o, foi poss?vel perceber que a Interven??o proposta no Grupo Experimental demonstra bons resultados frente ao problema do uso de crack e um interessante potencial de efetividade. No entanto, os resultados obtidos ainda n?o podem estar relacionados a uma comprova??o de efetividade. A Se??o IV, intitulada Aplicabilidade do modelo transte?rico de mudan?a na depend?ncia qu?mica: correla??es entre os construtos objetivou averiguar se h? uma rela??o estat?stica entre os principais construtos do MTT, tentando comprovar se a correla??o te?rica se aplica ? pr?tica em usu?rios de drogas no Brasil. Participaram deste estudo 142 sujeitos usu?rios de crack internados em unidades de tratamento para Depend?ncia qu?mica Os resultados mostraram a exist?ncia emp?rica da rela??o entre os construtos do MTT. Os Processos de Mudan?a, Autoefic?cia, Tenta??o para uso e Est?gios de Mudan?a apresentaram correla??es significativas, conforme postulado teoricamente.

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 2015-04-14T13:22:21Z (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.