This dissertation had three specific aims: to estimate the prevalence of adherence among drug users, to determine whether drug use was directly associated with adherence, and to assess whether factors drawn from the Behavioral Model of Health Care Utilization (BMHCU) are associated with adherence. The self-reported prevalence of adherence to prescribed health care recommendations in the past 12 months among the community sample of drug users and non-drug users from similar low-income areas in the study sample ranged from 53%-74%. Non-drug users consistently had higher rates of adherence than drug users, except for adherence to female health care recommendations, yet this difference was insignificant at the bivariate level. In the multivariate analysis, when controlling for all other variables within the BMHCU, only non-injection drug use was significantly associated with adherence to mental health care recommendations. In exploring its predictive utility, the BMHCU accounted for a range of 17% to 54% of the variance for the adherence measures. Although percentages accounted for by the BMHCU were substantial the fact that very few predictor variables were significant may indicate multicollinearity and other severe limitations with the data, such as small sample size, and the conceptualization of the adherence measure. The conceptualization of adherence remains an issue in need of further delineation. Further studies are needed in order to develop appropriate measures of adherence. Qualitative studies may be needed to further understand adherence among drug users.

The main objective of this thesis was to develop a substantive theory that explained the phenomenon of detoxification from psychoactive drugs such as alcohol, tranquillisers, opioids, and amphetamines in a medical treatment unit for licit and illicit drug users. The other objectives were to (a) determine if the differences reported in earlier studies between licit and illicit drug users in terms of socio-demographic and drug use variables remain extant, and (b) assess the extent of minor psychiatric morbidity among the participants. Both grounded theory and quantitative methods of data collection and analysis were used in the study.The findings of the quantitative component of the study indicated that there were significant differences between licit and illicit drug users in regard to age, drug use characteristics, and completing the treatment program. That is, illicit drug users were younger than licit drug users, more likely to be poly drug users, and drop out of the program. The prevalence of minor psychiatric morbidity among the participants was 93.6%, and was largely independent of socio-demographic and drug use variables. The high prevalence of minor psychiatric morbidity suggests that the majority of participants warranted further follow-up support in the community after they left the treatment unit. The uptake of referrals for follow-up support, however, was 55.9%.The basic or core social psychological problem identified by the constant comparative method of grounded theory was found to have two parts, both of which were interpreted as forms of disequilibrium. The first part of disequilibrium, which was a precursor to treatment, was conceptualised as Hitting the Wall. The events associated with the symbolic "wall" interrupted the participants' drug focussed lifestyles and induced them to enter treatment. These events and problems were not resolved whilst in ++ / treatment, they lingered with the participants while they were in the unit, and remained to be addressed when they left. Whilst undergoing detoxification the participants encountered the second part of disequilibrium which was categorised as Incompatibility. The problem of Incompatibility was related to the heterogeneity of the participants and the structure of the treatment program that in many cases was unable to accommodate individual differences and needs.The core or basic social psychological process was conceptualised as Seeking Balance through Hanging In. The participants engaged in this process to deal with the disequilibrium of the precursor problem of Hitting the Wall and the problem of Incompatibility encountered in the unit. Seeking Balance through Hanging In was found to have four phases. The phases were Making the Break, Submitting to Cleansing, Fitting In, and Moving On. The process was linear in that the phases were sequential, and failure to complete a phase meant dropping out of the detoxification program. The experience of detoxification was modified by several contextual conditions. These were the physical enviroment, the participants' expectations of withdrawal symptoms, and the workload of the staff.The substantive theory, Seeking Balance through Hanging In, integrated all emergent categories, and explained the experience of the phenomenon of withdrawal from psychoactive drugs in a particular context. Recommendations for further research include testing the described phases and relationships of the substantive theory in similar environments, exploring the importance of the modifying conditions on client outcomes, and undertaking follow-up studies to determine the outcomes of those who completed the program as compared to the outcomes of those who dropped out. In addition, further studies are recommended to assess the transientness of the level ++ / of minor psychiatric morbidity detected among the participants in this study.The findings of this study make an important contribution to understanding the experience of detoxification from the perspective of the participants. The substantive theory has implications for clinical practice, professional education, management, and further research.

No description available.

This thesis is based on an Australian Research Council funded research grant. Fifty-one qualitative interviews were conducted with human service workers to gain an understanding of their interpretations of their clients’ ‘drug problems’ and of their own role, the service system and wider policies. Although harm minimisation has been Australia’s official drug policy since 1985, little is known about how harm minimisation is ‘enacted’ in the helping culture. To date human service workers have not been recognised in their constitutive role in harm minimisation discourse. Whilst a significant part of drug policy interventions are delivered via human services, the helping subject has not come under scrutiny. The drug using subject remains ill-conceived as a result of neglecting its partnering others or indeed its overlapping with other subject positions. Moving beyond recognising workers only in terms of staff opinions and attitudes, a relational and multi-level approach is adopted to introduce more complexity into the debate. After a brief historic discussion of the creation of the ‘human service worker’ and the ‘drug user’ (as client) and methodological considerations about discourse analysis, the thesis proceeds with the introduction of a conceptual framework consisting of four levels: the individual, relational, institutional and cultural political economic level. These levels are used to examine the existing literature on ‘drug problem factories’ and for the analysis of the data. By focusing on these levels the critical analysis of the interview material shows that ‘harm’ and ‘minimising’ are themselves contested categories and that different harms and different harm producing and minimising practices can be identified some of which have come into discourse, others are excluded or entirely absent. The human service workers struggle to make sense of their own role and to define how drug users are being ‘helped’ and could or should be helped. Their understanding of harm minimisation discourse aligns with, supports and/or resists other discourses such as (neo)liberalism, neoconservatism, prohibition and economic rationalism. The workers are portrayed as having substituted increasing complexity for initial simplicity in the course of working with ‘drug users’. In summary, this thesis offers a poststructuralist analysis of how harm minimisation is constituted, negotiated and undermined from the perspective of human service workers and shows how the service systems’ helping cultures enrol human service workers in harm producing and harm minimising practices. Harm minimisation consists of discursive and non-discursive elements and is a product of deliberate social forces as well as messy contingencies and unintended consequences.

Orientador: Elerson Gaetti Jardim Júnior / Banca: Alvimar Lima de Castro / Banca: Gilberto Aparecido Coclete / Banca: Cristina Berger Fadel / Banca: Luís Fernando Landucci / Resumo: Objetivo: esse estudo avaliou as condições de saúde de pacientes com dependência química correlacionando o efeito dessas drogas com alterações da normalidade das estruturas da cavidade bucal. Método: 108 pacientes que iniciaram terapia de desintoxicação foram avaliados clinicamente e obtidos dados sobre as condições de saúde, socioeconômicas, sobre o uso de drogas lícitas e ilícitas por meio de questionário estruturado e avaliação microbiológica. Resultados Dos pacientes avaliados 70,3% apresentavam alguma alteração significativa na cavidade bucal, sendo as mais prevalentes as alterações dentárias (atrição dentária, edentulismo) e periodontais (gengivite e periodontite). Também alterações em mucosa foram vistas (xerostomia, leucoplasias e ceratose), bem como alterações da microbiota bucal. Pode-se evidenciar que o uso de drogas inicia-se a partir de amigos com a intenção de diversão ou aceitação social. Dentre as alterações comportamentais destacam-se os problemas gerados pelas implicações sociais do uso de drogas bem como sintomas de depressão. Conclusão: Doenças infecciosas bucais e modificações comportamentais e cognitivas estão fortemente associadas a dependência química e muitas destas manifestações são pouco familiares dos profissionais da saúde, o que muitas vezes podem comprometer resultados de tratamentos médicos e odontológicos. / Abstract: Objective: This study assessed health of patients with chemical dependency correlating effect of these drugs with changes of normal structures of the oral cavity. Methods: 108 patients who initiated detoxification therapy were evaluated clinically and obtained data on the health, socioeconomic, on the use of licit and illicit drugs by means of a structured questionnaire and microbiological analyses. Results: Among the patients 70.3% had a significant change in the oral cavity, as most prevalent are dental (dental attrition, edentulism) and periodontal (gingivitis and periodontitis). Also mucosa alterations were seen (xerostomia, oral leukoplakia and keratosis) as well buccal microbiota alterations. One can show that drug use begins from friends with the intention of amusement or social acceptability. Among the behavioral changes highlight problems generated by the social implications of drug use and symptoms of depression. Conclusion: Infectious oral diseases and behavioral and cognitive changes are strongly associated with addiction and many of these manifestations are unifamiliar to health professionals, which often can compromise results of medical and dental treatments. / Doutor

Made available in DSpace on 2014-06-11T19:25:20Z (GMT). No. of bitstreams: 0 Previous issue date: 2012-12-12Bitstream added on 2014-06-13T20:32:45Z : No. of bitstreams: 1 ramos_mmb_me_araca.pdf: 301724 bytes, checksum: bb00a2999c72764f09ec221c57ea8686 (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / A dependência de drogas tem sérias consequências pessoais, econômicas e sociais, e seu consumo crescente por adolescentes tem sido negligenciado. Assim, esse estudo objetivou avaliar as condições de saúde bucal de pacientes com dependência química e o efeito dessas drogas sobre a ocorrência dos membros do complexo vermelho de Socransky na boca. Foram obtidos dados sobre as condições de saúde, socioeconômicas e sobre o uso de drogas lícitas e ilícitas de 108 pacientes de ambos os sexos que iniciaram a terapia de desintoxicação, bem como de 100 pacientes de ambos os sexos que não apresentavam dependência química, que constituíram o grupo controle. Exames clínicos intra e extrabucais foram realizados e amostras de biofilme supra e subgengival, saliva e das mucosas foram transferidas para água ultrapura no início do período de hospitalização. O mesmo foi realizado com os pacientes do grupo controle. As amostras presentes na água ultrapura foram submetidas à detecção de periodontopatógenos do complexo vermelho de Socransky através de PCR. Cálculos de Odds ratios foram realizados para determinar a relevância de inter-relações entre diferentes microrganismos e a significância dos parâmetros clínicos e microbiológicos foi determinada através de regressão logística multivariada. Observou-se que a maioria dos dependentes faz uso de diversos agentes químicos, lícitos e ilícitos, sendo que a maioria se recusou a declarar para quais agentes sentia dependência. A prevalência dos microrganismos estudados foi significativamente maior nos dependentes, embora a diferença entre os dois grupos, dependentes e controle, foi mais pronunciada entre os indivíduos sadios ou com gengivite, nos dois grupos. Os microrganismos estudados também mostraram relação com parâmetros clínicos das doenças periodontais... / Drug addiction has serious personal, economic and social consequences, and the growing narcotics consumption by teenagers has been neglected. Thus, this study aimed to assess the oral health status in patients with chemical subjection and the effect of these drugs on the Socransky red complex members occurrence in the mouth. Data have been obtained on health and socioeconomic conditions, and on the use of licit and illicit drugs in 108 patients of both genders who started detoxification therapy, as well as number of 100 patients of both genders who had no addiction, that constituted the control group. Intra and extra oral clinical examinations were performed, and supra and subgingival biofilm, saliva and mucous membranes samples were transferred to ultrapure water at the beginning of the hospitalization period. The same has been done with the control group patients. The samples present in ultrapure water were subjected to detection of Socransky red complex periodontal pathogens by PCR. Calculations of odds ratios were performed to determine inter-relationships relevance between different microorganisms, and the clinical and microbiological parameters significance were determined by multivariate logistic regression. It was observed the most of dependents makes use of various chemical agents, licit and illicit, and most of them refused to declare to which agents felt dependency. The studied microorganisms prevalence was significantly higher in dependent patients, although the difference between the two groups, dependent and controlled, was more pronounced among healthy individuals and with gingivitis, in both groups. The studied microorganisms also showed a relationship with clinical periodontal diseases parameters such as tooth mobility and bone loss. It was concluded that drug addiction can come to be... (Complete abstract click electronic access below)

Made available in DSpace on 2014-08-27T14:36:46Z (GMT). No. of bitstreams: 0 Previous issue date: 2013-09-06Bitstream added on 2014-08-27T15:57:17Z : No. of bitstreams: 1 000749524.pdf: 2110569 bytes, checksum: a089412c59dc2cd7c7c1345335c419ff (MD5) / Objetivo: esse estudo avaliou as condições de saúde de pacientes com dependência química correlacionando o efeito dessas drogas com alterações da normalidade das estruturas da cavidade bucal. Método: 108 pacientes que iniciaram terapia de desintoxicação foram avaliados clinicamente e obtidos dados sobre as condições de saúde, socioeconômicas, sobre o uso de drogas lícitas e ilícitas por meio de questionário estruturado e avaliação microbiológica. Resultados Dos pacientes avaliados 70,3% apresentavam alguma alteração significativa na cavidade bucal, sendo as mais prevalentes as alterações dentárias (atrição dentária, edentulismo) e periodontais (gengivite e periodontite). Também alterações em mucosa foram vistas (xerostomia, leucoplasias e ceratose), bem como alterações da microbiota bucal. Pode-se evidenciar que o uso de drogas inicia-se a partir de amigos com a intenção de diversão ou aceitação social. Dentre as alterações comportamentais destacam-se os problemas gerados pelas implicações sociais do uso de drogas bem como sintomas de depressão. Conclusão: Doenças infecciosas bucais e modificações comportamentais e cognitivas estão fortemente associadas a dependência química e muitas destas manifestações são pouco familiares dos profissionais da saúde, o que muitas vezes podem comprometer resultados de tratamentos médicos e odontológicos. / Objective: This study assessed health of patients with chemical dependency correlating effect of these drugs with changes of normal structures of the oral cavity. Methods: 108 patients who initiated detoxification therapy were evaluated clinically and obtained data on the health, socioeconomic, on the use of licit and illicit drugs by means of a structured questionnaire and microbiological analyses. Results: Among the patients 70.3% had a significant change in the oral cavity, as most prevalent are dental (dental attrition, edentulism) and periodontal (gingivitis and periodontitis). Also mucosa alterations were seen (xerostomia, oral leukoplakia and keratosis) as well buccal microbiota alterations. One can show that drug use begins from friends with the intention of amusement or social acceptability. Among the behavioral changes highlight problems generated by the social implications of drug use and symptoms of depression. Conclusion: Infectious oral diseases and behavioral and cognitive changes are strongly associated with addiction and many of these manifestations are unifamiliar to health professionals, which often can compromise results of medical and dental treatments.

Orientador: Elerson Gaetti Jardim Júnior / Coorientador: Alvimar Lima de Castro / Banca: Gilberto Aparecido Coclete / Banca: Luís Fernando Landucci / Resumo: A dependência de drogas tem sérias consequências pessoais, econômicas e sociais, e seu consumo crescente por adolescentes tem sido negligenciado. Assim, esse estudo objetivou avaliar as condições de saúde bucal de pacientes com dependência química e o efeito dessas drogas sobre a ocorrência dos membros do complexo vermelho de Socransky na boca. Foram obtidos dados sobre as condições de saúde, socioeconômicas e sobre o uso de drogas lícitas e ilícitas de 108 pacientes de ambos os sexos que iniciaram a terapia de desintoxicação, bem como de 100 pacientes de ambos os sexos que não apresentavam dependência química, que constituíram o grupo controle. Exames clínicos intra e extrabucais foram realizados e amostras de biofilme supra e subgengival, saliva e das mucosas foram transferidas para água ultrapura no início do período de hospitalização. O mesmo foi realizado com os pacientes do grupo controle. As amostras presentes na água ultrapura foram submetidas à detecção de periodontopatógenos do complexo vermelho de Socransky através de PCR. Cálculos de Odds ratios foram realizados para determinar a relevância de inter-relações entre diferentes microrganismos e a significância dos parâmetros clínicos e microbiológicos foi determinada através de regressão logística multivariada. Observou-se que a maioria dos dependentes faz uso de diversos agentes químicos, lícitos e ilícitos, sendo que a maioria se recusou a declarar para quais agentes sentia dependência. A prevalência dos microrganismos estudados foi significativamente maior nos dependentes, embora a diferença entre os dois grupos, dependentes e controle, foi mais pronunciada entre os indivíduos sadios ou com gengivite, nos dois grupos. Os microrganismos estudados também mostraram relação com parâmetros clínicos das doenças periodontais... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Drug addiction has serious personal, economic and social consequences, and the growing narcotics consumption by teenagers has been neglected. Thus, this study aimed to assess the oral health status in patients with chemical subjection and the effect of these drugs on the Socransky red complex members occurrence in the mouth. Data have been obtained on health and socioeconomic conditions, and on the use of licit and illicit drugs in 108 patients of both genders who started detoxification therapy, as well as number of 100 patients of both genders who had no addiction, that constituted the control group. Intra and extra oral clinical examinations were performed, and supra and subgingival biofilm, saliva and mucous membranes samples were transferred to ultrapure water at the beginning of the hospitalization period. The same has been done with the control group patients. The samples present in ultrapure water were subjected to detection of Socransky red complex periodontal pathogens by PCR. Calculations of odds ratios were performed to determine inter-relationships relevance between different microorganisms, and the clinical and microbiological parameters significance were determined by multivariate logistic regression. It was observed the most of dependents makes use of various chemical agents, licit and illicit, and most of them refused to declare to which agents felt dependency. The studied microorganisms prevalence was significantly higher in dependent patients, although the difference between the two groups, dependent and controlled, was more pronounced among healthy individuals and with gingivitis, in both groups. The studied microorganisms also showed a relationship with clinical periodontal diseases parameters such as tooth mobility and bone loss. It was concluded that drug addiction can come to be... (Complete abstract click electronic access below) / Mestre

Class of 2015 Abstract / Objectives: Evaluate prescriber knowledge on naloxone use for opioid overdose reversals in intravenous drug users. Interview prescribers on their perceptions about intravenous drug users, syringe access programs, and other related topics. Subjects: Prescribers and medical professionals in the State of Arizona. Methods: Medical facilities were contacted by email, fax, or telephone requesting for prescribers to complete the survey and return by email or fax, or call to schedule a face-to-face appointment. The respondents of the survey were kept anonymous and were permitted to answer the survey in free text. Surveys were sent to the 68 selected medical facilities at least twice during the study period. Results: All of the six respondents were male, of the respondents had at least 11 years experience, with two having >30 years. A majority practiced in rehab centers or worked with drug abuse patients, however the number of patients treated per week by respondent varies from 10-320. Also of note five of the six respondents had a family member or relative with an addiction to opioids. The respondents seem to be in support of a naloxone distribution program however it is difficult to draw any conclusions since the number of responses was low. Conclusions: It appears that prescribers have a favorable perception of naloxone use and support harm reduction strategies, however response rate was too low to make any definitive conclusions.

No Brasil, políticas de saúde que incluem o cuidado aos usuários de álcool e outras drogas são recentes. Apesar da existência de serviços comunitários, a internação dos usuários é algo muito frequente. Nos últimos anos, as modalidades de internação compulsória e involuntária passaram a ser aplicadas em larga escala, principalmente, por meio de solicitações dos familiares de pessoas com problemas relacionados ao uso de drogas. Estudos demonstram que há poucas evidências científicas acerca da efetividade de tais internações. O objetivo deste estudo foi compreender como os sentidos sobre a internação involuntária e/ou compulsória da pessoa que usa álcool e outras drogas foram construídos com seus familiares. Para tanto, foi realizado um estudo qualitativo, com referencial teórico construcionista social. O corpus foi composto por 15 entrevistas semiestruturadas feitas com familiares de usuário de drogas que foram, anteriormente, internados involuntariamente e/ou compulsoriamente. A técnica utilizada para a seleção destes participantes foi a bola de neve. O projeto foi aprovado pelo Comitê de Ética em Pesquisa da FFCLRP-USP. Em primeiro lugar, foi realizada análise temática das entrevistas, considerando a construção dos sentidos dentro do contexto histórico-cultural, as experiências de vida e as interações sociais. A seguir, foi realizado um estudo de caso de uma das entrevistas realizadas, com o objetivo de analisar discursos envolvidos no processo de busca de internações involuntárias e compulsórias. Para isto, foi selecionada a entrevista de uma participante que havia solicitado 23 internações involuntárias e cinco compulsórias para seu filho. O corpus dessa análise consistiu na entrevista semiestruturada e notas de campo que foram elaboradas a partir das conversas com a participante. A partir da análise temática foram construídos quatro temas: (1) Sentidos sobre internações involuntárias e compulsórias, em que as internações foram construídas como formas de educar, cuidar e proteger o usuário dos perigos da rua, dos traficantes, de ser preso e de morrer, alcançar abstinência e alívio principalmente para os familiares. (2) Consequências do uso problemático de drogas, como relatos de mudanças negativas no comportamento do usuário, acúmulo de perdas na vida do usuário e a percepção de estigma. (3) Sentimentos da família, envolvendo culpa, desespero, frustração, vergonha, medo e desesperança diante do problema. (4) Tentativas mal sucedidas de resolver o problema, diante do desconhecimento de serviços ambulatoriais e do foco apenas na abstinência. A partir do estudo de caso, foram construídas três narrativas: (1) discurso individualista e discurso do déficit sobre seu filho que ao ser posicionado como alguém que é definido pelas suas falhas passa a ser internado repetidamente; (2) Discurso individualista e culpabilização da mãe uma vez que ela é descrita como superprotetora, inadequada e impotente; (3) Discurso alternativo baseado na perspectiva relacional que convidaria mãe e filho a se engajar em uma conversa colaborativa, criando um contexto onde novas formas de entendimento poderão surgir. Considera-se que para reduzir o número de reinternações dos usuários de drogas é necessário apoiar seus familiares por meio da ampliação da rede de cuidados, orientação sobre tratamentos ambulatoriais e acolhimento dos sentimentos e angústias da família. / In Brazil, the health policies that include care for alcohol and other drug users are recent. Despite the existence of community services, the drug users hospitalization is very frequent. Over the last years, compulsory and involuntary hospitalization has been applied on a large scale, especially, requested by families of people who consume alcohol and drugs. Studies shown few scientific evidences of the efficiency of those hospitalizations. This study aims to understand how the meanings about the compulsory or involuntary hospitalization of the person that uses alcohol and other drugs were constructed with the families. To achieve this, it has been a qualitative study, with social constructionist referential. The corpus consisted in 15 semistructured interviews conducted with the families of drug users that were previously taken by involuntary or compulsory hospitalization. The selection participant technique was made through snowball selection. The project was approved in the Ethical Committee of FCLRPUSP. In first place, it was made thematic analysis of interviews, considering the construction of meanings inside the historic-cultural context, their experiences of life, and their social interactions. In second place, a case study was made through one of the interviews conducted in order to analyze discourses involved in the seeking process of involuntary and compulsory hospitalizations. To achieve this, it was selected an interview with a participant who had requested 23 involuntary and five compulsory hospitalizations for her son. The corpus of analysis consisted by the full transcription of this interview and the field notes referring to it. Through the thematic analysis was constructed four themes: (1) Meanings about involuntary and compulsory hospitalization, in which the hospitalizations were construed such as education, care, abstinence, relief mainly for family members, protection from the dangers of the street, from drug dealers, police, and death. (2) Problematic drug uses consequences, such as reports of changes in the user behaviors, accumulation of losses in the drug users life, and the perceived stigma. (3) Feelings of the family, involving guilt, despair, frustration, shame and hopelessness in the face of this problem. (4) Attempts to help the family member, due to not knowing the community services for drug treatment and to focus only on abstinence. Through the discourses analysis, it were constructed three narratives: (1) individualistic discourse and deficit discourse that helped to position her son as somebody who is defined by his failures, and resulting in new hospitalizations. (2) Individualistic discourse and blaming the mother since she was described as overprotective, flawed, and powerless. (3) Alternative discourse based on the relational perspective that invited the mother and son to engage in a collaborative conversation, creating a context where new forms of understanding can emerge. In order to reduce the number of hospitalizations of drug users, it is necessary to support their relatives by publicizing services for community treatment, and helping the family to deal with distress.