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O uso de álcool entre motoristas é tema preocupante devido às graves conseqüências e aos altos índices de acidentes de trânsito que tem gerado. O presente estudo teve como objetivo identificar o uso do álcool entre motoristas nas estradas, bem como avaliar as condições de saúde entre os participantes da Campanha Saúde na Estrada em Ribeirão Preto, SP. A amostra foi composta por 1014 participantes, a maioria homens, com idade de 30 a 45 anos, casados, com baixo nível de escolaridade, procedente da Região Sudeste, religião católica. Entre os participantes, 81,5% são caminhoneiros. Quanto ao uso do álcool, 738 (72,7%) bebem de 2 a 4 vezes por mês, de 3 a 4 doses numa única ocasião e se embriagam semanalmente, índices considerados altos quando se trata de motoristas. Esses apresentam uso de bebidas alcoólicas em níveis de risco e de baixo risco. Entre os 229 (31%) motoristas que sofreram acidentes de trânsito, 19 (2,5%) acidentes ocorreram após o beber. Em relação às condições de saúde, 33% que apresentam hipertensão fazem uso de risco, quase 30% apresentam diabetes e também fazem uso de risco, no entanto, aqueles que expressaram ter pancreatite foram 74,5% e apresentaram colesterol acima de 200mg/dL 39,1% fazem uso de baixo risco. Na análise dos dados, avaliados através da pontuação do AUDIT maior que 8, ter idade menos que 30 e entre 30 e 45 anos, ser do sexo masculino, não ter religião, sobrepeso e obesidade foram considerados as características que contribuíram para os fatores de riscos entre os participantes. Ao passo que, ser evangélico, praticar religião, estar casado/amasiado e possuir nível superior foram os fatores de proteção para o uso abusivo de álcool. Esses dados nos fornecem subsídios para o desenvolvimento de campanhas preventivas pontuais sobre o beber e dirigir, como também ações educativas e informativas permanentes para essa clientela expostas aos riscos nas estradas. / The use of alcohol among drivers is a matter of concern because the serious consequences and the high rate of traffic accidents which has created. This study aims to identify the use of alcohol among drivers on the roads, as well as assess the health conditions among participants of the Campaign Health on the Road in Ribeirao Preto-SP. The sample was composed of 1014 (85.5%) participants, mostly men, aged 30 to 45 years old, married, with low level of education, founded the Southeast, Catholic religion. Among the participants 81.5% are truck drivers. Regarding the use of alcohol 738 (72.7%) drink from 2 to 4 times per month, 3 to 4 doses in a single occasion and that numbing weekly, indices considered high when it comes to drivers. They have use of alcohol at levels of risk and low risk. Among the 229 (31%) drivers who suffered traffic accidents, 19 (2.5%) occurred after drinking. Regarding the conditions of health 33% have hypertension make use of risk, almost 30% have diabetes also make use of risk, however those answered pancreatitis and 74.5% had cholesterol above 200 mg / dL 39.1% make use of low risk. In the analysis of the data, assessed by the AUDIT scores greater than 8, have less than age 30 and between 30 to 45 years old, being male, not having religion, overweight and obesity were contributing to the factors of risk between participants. While be evangelical, practicing religion, be married / roommate and Higher Education have been factors to protect the abuse of alcohol. These data give us subsidies for the development of preventive campaigns spot on the drinking and driving, as well as educational and informative permanent shares to this clientele at risk on the roads.

Dissertação(mestrado) - Universidade Federal do Rio Grande, Programa de Pós-Graduação em Enfermagem, Escola de Enfermagem, 2010. / Submitted by eloisa silva (eloisa1_silva@yahoo.com.br) on 2012-12-21T13:00:40Z No. of bitstreams: 1 larissa.pdf: 1036956 bytes, checksum: 26ee417607200ce7b1bce069008add40 (MD5) / Approved for entry into archive by Bruna Vieira(bruninha_vieira@ibest.com.br) on 2013-01-08T17:53:10Z (GMT) No. of bitstreams: 1 larissa.pdf: 1036956 bytes, checksum: 26ee417607200ce7b1bce069008add40 (MD5) / Made available in DSpace on 2013-01-08T17:53:10Z (GMT). No. of bitstreams: 1 larissa.pdf: 1036956 bytes, checksum: 26ee417607200ce7b1bce069008add40 (MD5) Previous issue date: 2010 / Neste estudo objetivou-se conhecer o padrão de consumo de bebidas alcoólicas, os fatores que mais contribuem para a sua ingestão, bem como analisar as consequências relacionadas ao seu consumo entre universitários(as) dos cursos da área da saúde da Universidade Federal do Rio Grande (FURG). A amostra foi composta por 351 acadêmicos(as) matriculados(as) nos cursos de Ciências Biológicas Bacharelado, Ciências Biológicas Licenciatura, Educação Física, Enfermagem, Medicina e Psicologia da Universidade Federal do Rio Grande que ingressaram em 2010, e os que estão cursando o penúltimo ano, independentemente do tempo de duração dos referidos cursos e da forma de organização, ou seja, semestral ou anual. O projeto foi aprovado pelo Comitê de Ética em Pesquisa na Área da Saúde sob protocolo n. 71/2010. Para a obtenção dos dados foram utilizados dois questionários: um de abordagem sociodemográfica, elaborado pela autora especificamente para este estudo e o Teste para Identificação de Problemas Relacionados ao uso do Álcool (AUDIT). Analizaram-se os dados por meio da estatística descritiva, análise de variância, tabelas de contingência e o teste G. Os resultados demonstraram que a maioria dos estudantes era do sexo feminino (67,80%), solteiros(as) (86,03%) com idade entre 17 e 50 anos, católicos(as) (21,65%), residindo com a família (47,29%) e por ela mantidos(as) financeiramente. Em relação ao padrão de consumo de álcool, 80,90% foram classificados(as) como usuários(as) de baixo risco, 16,90% de risco moderado, 2,28% bebedores(as) de alto risco. Constatou-se ainda que o consumo problemático de álcool foi maior entre as mulheres com idade entre 19 e 24 anos, os(as) informantes solteiros(as) e aqueles(as) que não tinham religião. Dentre os problemas causados pelo beber problemático, identificou-se a ocorrência de apagões, coma alcoólico e acidentes automobilísticos. Esses resultados evidenciam a importância da continuidade do planejamento de estratégias de cunho preventivo no âmbito universitário, na tentativa de detectar precocemente aqueles com potencial para o abuso e possíveis problemas relacionados ao consumo dessa substância. Nesse sentido, acredita-se que seja de extrema importância a implementação de programas educativos junto aos(às) estudantes, abordando a Política Nacional do álcool, alertando-os(as) a respeito dos limites de consumo de baixo risco, dos problemas que podem ser causados pelo abuso e de sugestões para que, caso queiram continuar consumindo bebidas alcoólicas, o consumo seja feito com responsabilidade. / In the present study, we aimed to identify the pattern of alcohol consumption, the factors that contribute most to the ingestion, as well as analyzing the consequences related to its consumption among college students of the courses in the health area of the Universidade Federal do Rio Grande (FURG). The sample comprised 351 students enrolled in Biological Sciences Degree courses. Biological Sciences, Physical Education, Nursing, Medicine and Psychology, who joined in 2010 and who are enrolled in junior year, regardless of the duration of each course and form of organization, that is, semiannual or annual basis. The project was approved by the Ethics Committee in Research in the Field of Health under Protocol No 71/2010. To obtain the data we used two questionnaires: a social-demographic approach elaborated by the author specifically for this study and the Test for Identification of Problems Related to Alcohol use (AUDIT). Data were analyzed using descriptive statistics, analysis of variance, contingency tables and G test. The results showed that most students were female (67.80%), single (86.03%), aged between 17 and 50 years, Catholics (21.65%), living with family members (47.29%) and maintained by the family financially. Concerning the pattern of alcohol consumption, 80.90% were classified as low risk users, moderate risk of 16.90%, 2.28% high risk drinkers. It was further observed that the consumption of alcohol was higher among women aged between 19 and 24 years, single informants, and those who had no religion. Among the problems caused by drinking, we identified the occurrence of blackouts, alcohol poisoning and automobile accidents. These results highlight the importance of continuity in the planning of preventive strategies in the university in an attempt to detect early those with potential for abuse and potential problems related to consumption of that substance. In this sense, we believe it is of utmost importance to implement educational programs to the next students, addressing the National Policy on alcohol, warning them about the limits of low-risk drinking, the problems that can be caused by abuse and suggestions for, if they want to continue consuming alcohol, the consumption must be done responsibly. / Este estudio tuvo como objetivo investigar el patrón de consumo de alcohol, los factores que más contribuyen a la ingesta, así como analisar las consecuencias relacionadas con su consumo entre los(as) estudiantes universitarios(as) de los cursos del área de la salud de la Universidad Federal de Río Grande (FURG). La muestra está compuesta por 351 alumnos(as) matriculados(as) en los cursos de Ciencias Biológicas Bacharelado, Ciencias Biológicas de la Licenciatura, Educación Física, Enfermería, Medicina y Psicología de la Universidad Federal de Río Grande que ingresaron en 2010, y los que están cursando el tercer año, independientemente de la duración de los referidos cursos y su forma de organización, es decir, semestral o anual. El proyecto fue aprobado por el Comité de Ética en la Investigación en el ámbito de la salud bajo Protocolo n. 71/2010. Para obtener los datos se utilizaron dos cuestionarios: un enfoque sociodemográfico elaborado por el autor específicamente para este estudio y el Test para la Identificación de Problemas Relacionados con el consumo de Alcohol (AUDIT). Se analizaron los datos por médio de la estadística descriptiva, análisis de varianza, tablas de contingencia y la prueba G. Los resultados mostraron que la mayoría de los(as) estudiantes era del sexo femenino (67,80%), solteros(as) (86,03%) con edades comprendidas entre 17 y 50 años, católicos(as) (21.65% ), que viven con la familia (47,29%), y por ella mantenidos(as) financieramente. En cuanto al patrón de consumo de alcohol, 80,90% fueron clasificados(as) como usuarios(as) de bajo riesgo, 16,90% de riesgo moderado, 2,28% bebedores(as) de alto riesgo. Se observó además que el consumo de alcohol fue mayor entre las mujeres de edades comprendidas entre 19 y 24 años, los(as) informantes solteros(as) y los(as) que no tenían religión. Entre los problemas causados por problemas con el alcohol, hemos identificado la ocurrencia de los apagones, coma alcohólico y accidentes de automóvil. Estos resultados resaltan la importancia de la continuidad en la planificación de estrategias preventivas en la universidad en un intento de detectar precozmente aquellos con potencial de abuso y problemas potenciales relacionados con el consumo de esa sustancia. En este sentido, creemos que es de suma importancia para poner en práctica programas educativos para los próximos(as) estudiantes, frente a la política nacional sobre el alcohol, alertandolos(as) sobre los límites de consumo de bajo riesgo, de los problemas que pueden ser causado por el abuso y sugerencias para que, si quieren seguir el consumo de alcohol, el consumo se hace responsable.

O uso de álcool entre motoristas é tema preocupante devido às graves conseqüências e aos altos índices de acidentes de trânsito que tem gerado. O presente estudo teve como objetivo identificar o uso do álcool entre motoristas nas estradas, bem como avaliar as condições de saúde entre os participantes da Campanha Saúde na Estrada em Ribeirão Preto, SP. A amostra foi composta por 1014 participantes, a maioria homens, com idade de 30 a 45 anos, casados, com baixo nível de escolaridade, procedente da Região Sudeste, religião católica. Entre os participantes, 81,5% são caminhoneiros. Quanto ao uso do álcool, 738 (72,7%) bebem de 2 a 4 vezes por mês, de 3 a 4 doses numa única ocasião e se embriagam semanalmente, índices considerados altos quando se trata de motoristas. Esses apresentam uso de bebidas alcoólicas em níveis de risco e de baixo risco. Entre os 229 (31%) motoristas que sofreram acidentes de trânsito, 19 (2,5%) acidentes ocorreram após o beber. Em relação às condições de saúde, 33% que apresentam hipertensão fazem uso de risco, quase 30% apresentam diabetes e também fazem uso de risco, no entanto, aqueles que expressaram ter pancreatite foram 74,5% e apresentaram colesterol acima de 200mg/dL 39,1% fazem uso de baixo risco. Na análise dos dados, avaliados através da pontuação do AUDIT maior que 8, ter idade menos que 30 e entre 30 e 45 anos, ser do sexo masculino, não ter religião, sobrepeso e obesidade foram considerados as características que contribuíram para os fatores de riscos entre os participantes. Ao passo que, ser evangélico, praticar religião, estar casado/amasiado e possuir nível superior foram os fatores de proteção para o uso abusivo de álcool. Esses dados nos fornecem subsídios para o desenvolvimento de campanhas preventivas pontuais sobre o beber e dirigir, como também ações educativas e informativas permanentes para essa clientela expostas aos riscos nas estradas. / The use of alcohol among drivers is a matter of concern because the serious consequences and the high rate of traffic accidents which has created. This study aims to identify the use of alcohol among drivers on the roads, as well as assess the health conditions among participants of the Campaign Health on the Road in Ribeirao Preto-SP. The sample was composed of 1014 (85.5%) participants, mostly men, aged 30 to 45 years old, married, with low level of education, founded the Southeast, Catholic religion. Among the participants 81.5% are truck drivers. Regarding the use of alcohol 738 (72.7%) drink from 2 to 4 times per month, 3 to 4 doses in a single occasion and that numbing weekly, indices considered high when it comes to drivers. They have use of alcohol at levels of risk and low risk. Among the 229 (31%) drivers who suffered traffic accidents, 19 (2.5%) occurred after drinking. Regarding the conditions of health 33% have hypertension make use of risk, almost 30% have diabetes also make use of risk, however those answered pancreatitis and 74.5% had cholesterol above 200 mg / dL 39.1% make use of low risk. In the analysis of the data, assessed by the AUDIT scores greater than 8, have less than age 30 and between 30 to 45 years old, being male, not having religion, overweight and obesity were contributing to the factors of risk between participants. While be evangelical, practicing religion, be married / roommate and Higher Education have been factors to protect the abuse of alcohol. These data give us subsidies for the development of preventive campaigns spot on the drinking and driving, as well as educational and informative permanent shares to this clientele at risk on the roads.

Objective: We present the prevalence and incidence rates of alcohol, nicotine, and illicit substance use, abuse, and dependence in a sample of German adolescents and young adults. Patterns of onset, cohort trends, and use of various substance classes are also analyzed. Method: A prospective longitudinal epidemiological study with a representative sample of adolescents and young adults (n = 3,021; baseline age range = 14–24 years) was conducted in Munich, Germany. Participants were assessed between 1995 and 1999 with the Munich-Composite International Diagnostic Interview. Results: Cumulative lifetime incidence (up to age 28) of any substance abuse or dependence was 43.8%, and 12-month prevalence of any substance abuse or dependence was 24.4%. The lifetime incidence of nicotine dependence was most frequent (24.8%), followed by alcohol abuse (19.3%) and alcohol dependence (9.2%); 61.7% endorsed the regular use of a substance for at least one circumscribed period during their lifetime. Age-specific incidence rates and age at onset of substance use disorders differed by age cohorts. Furthermore, nicotine dependence was significantly associated with illicit substance use disorders (HR = 2.6, 95% CI 1.7–4.0). An interactive relationship between age, age at onset of nicotine dependence, and subsequent onset of illicit substance use disorders was found. Conclusions: Since the baseline investigation in 1995, high incidence rates of substance use disorders and substance use have been observed in this young German sample. Especially younger cohorts report significantly earlier ages at onset of abuse and dependence. There also seems to be a trend towards a secondary age at onset peak of nicotine dependence after the onset of illicit drug use disorders. Further investigations are needed to study these patterns in younger samples. However, results emphasize the need for a combined prevention of illicit drugs and nicotine dependence. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

O período da faculdade é relatado como fase de risco para uso problemático de álcool (UPA) e para transtorno mental comum (TMC). É importante avaliar a co-ocorrência entre UPA e TMC em estudantes de graduação considerando ser um tema pouco relatado na literatura. Este estudo transversal utilizou os instrumentos AUDIT e SRQ-20 para avaliação da prevalência de UPA e TMC e da co-ocorrência entre UPA e TMC em uma amostra de estudantes de graduação da área da saúde, com idade média de 22 anos e predominantemente feminina (65,6%). Também examinou a associação entre estas condições e a relação com a satisfação com aspectos da vida acadêmica. A prevalência de UPA foi de 23,5%, de TMC de 30,6% e de co-ocorrência de UPA e TMC de 7,3%. A média do escore total do AUDIT foi de 4,8 (DP=4,42) e do SRQ-20 de 4,0 (DP=4,0). Houve associação significante de TMC e de co-ocorrência entre UPA e TMC com a insatisfação com a carreira escolhida, insatisfação com o curso na faculdade e insatisfação com o desempenho como estudante. Não houve correlação entre UPA e TMC nesta amostra. A co-ocorrência entre UPA e TMC está presente em estudantes de graduação e as conseqüências são prejuízos para a saúde mental e insatisfação com as conquistas acadêmicas, o que, ocorrendo nesta fase importante da vida, poderá limitar o futuro destes adultos jovens. Os achados deste estudo referentes à ausência de associação entre UPA e TMC devem ser interpretados com cuidado quanto a sua generalização, considerando-se o caráter de estudo transversal de rastreamento em população de adultos jovens. / The study time at the university is reported as a risky phase for problematic use of alcohol (UPA) as well for common mental disorders (TMC). It is important to evaluate the topic of co-occurrence of UPA and TMC amongst university students considering that this topic has been scarcely mentioned in scientific papers. This cross-sectional study used the AUDIT and SRQ-20 screening instruments in order to assess the prevalence of UPA and TMC and the co-occurrence of UPA and TMC in a sample of university students of the health area, characterized by mean of age of 22 years and mostly female (65.6%). Also it examined the association between these conditions and their relationship with satisfaction regarding aspects of the academic life. The prevalence of UPA was of 23.5%, TMC of 30.6% and co-occurrence of UPA and TMC of 7.3%. The average total score of AUDIT was of 4.8 (SD=4.42) and the SRQ-20 of 4.0 (SD=4.0). Significant associations of TMC as well the co-occurrence between UPA and TMC have been found with: - dissatisfaction with the selected career, dissatisfaction with the academic program and dissatisfaction with the own performance as student. No correlation between UPA and TMC has been found in this sample. The co-occurrence of UPA and TMC is present amongst undergraduate students and its consequences are mental health problems and frustration with academic achievements which occurring in this important phase of life it can impair the future of these young people. The findings of this study shall be carefully interpreted concerning its generality, considering the type of the study being a cross-sectional screening study on a population of young adults.

Submitted by Cristiane Chim (cristiane.chim@ucpel.edu.br) on 2018-08-08T12:13:43Z No. of bitstreams: 1 Louise Halla Reydams.pdf: 1479930 bytes, checksum: dbeb9959b561b6b01f81682d8d0dd3b9 (MD5) / Made available in DSpace on 2018-08-08T12:13:43Z (GMT). No. of bitstreams: 1 Louise Halla Reydams.pdf: 1479930 bytes, checksum: dbeb9959b561b6b01f81682d8d0dd3b9 (MD5) Previous issue date: 2018-04-27 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES# / #2075167498588264571# / #600 / Substance use disorder is related to numerous mental and physical health problems, associated with several functional impairments that affect several aspects of the life of the individual with the disorder. The objective of this study was to evaluate the relationship between psychoactive substances and biological rhythm in a community sample of young people. It is a cross-sectional population-based study with adults aged 24 to 30 years living in the urban area of the city of Pelotas, RS. The sample selection was performed by multi-stage conglomerates. Socio-demographic data were collected from the sample and substance abuse or dependence was assessed through the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST), as well as the biological rhythm was evaluated through the Biological Rhythm Interview of Assessment Neuropsychiatry (BRIAN). A total of 1241 subjects were evaluated. The prevalence of substance use disorders in the sample was as follows: alcohol 14.1% (n=175), tobacco 30.8% (n=382), cannabis 10.5% (n=130), cocaine/crack 8.4% (n=104) and other psychoactive substance use disorder 9.2% (n=114). In the model of linear regression adjustment, alcohol use disorder was able to predict change in sleep/social pattern (p<0.001), activity (p=0.024), eating pattern (p=0.049) and overall rhythm (p<0.001). Other psychoactive substance use disorder was also predictive of changes in the sleep/social pattern (p <0.001), activity (p<0.001), eating pattern (p<0.001) and overall rhythm (p<0.001). Our findings suggest that individuals with alcohol and other psychoactive use disorders presented greater changes in sleep/social patterns, activity and food patterns, as well as greater disruptions in maintaining the overall biological rhythm. / O transtorno por uso de substâncias está relacionado a inúmeros problemas de saúde mental e física, associado a diversos prejuízos funcionais que afetam diversos aspectos da vida do indivíduo portador do transtorno. O objetivo deste estudo foi avaliar a relação entre substâncias psicoativas e ritmo biológico em uma amostra comunitária de jovens. Trata-se de um estudo transversal de base populacional com adultos de 24 a 30 anos de idade residentes da zona urbana da cidade de Pelotas-RS. A seleção amostral foi realizada por conglomerados com múltiplos estágios. Foram coletados dados sócio-demográfico da amostra e o abuso ou dependência de substâncias foi avaliado através do Alcohol, Smoking and Substance Involvement Screening Test (ASSIST), bem como o ritmo biológico foi avaliado através da Biological Rhythm Interview of Assessment Neuropsychiatry (BRIAN). Foram avaliados 1241 sujeitos. As prevalências de transtornos por uso de substâncias na amostra foram as seguintes: álcool 14,1% (n=175), tabaco 30,8% (n=382), cannabis 10,5% (n=130), cocaína/crack 8,4% (n=104) e uso de outra substância psicoativas 9,2% (n=114). No modelo de ajuste por Regressão Linear, transtorno por uso de álcool foi capaz de predizer mudança no padrão de sono/social (p<0,001), atividade (p=0,024), alimentação (p=0,049) e ritmo global (p<0,001). Além disso, o transtorno por uso de outras substâncias psicoativas também foi capaz de predizer mudanças no padrão de sono/social (p<0,001), atividade (p<0,001), alimentação (p<0,001) e ritmo global (p<0,001). Nossos sugerem que os indivíduos com transtorno por uso de álcool e outras substâncias psicoativas apresentaram maiores alterações no padrão de sono/social, na atividade e no padrão alimentar, bem como, apresentaram maiores disrupturas na manutenção do ritmo biológico global.

O período da faculdade é relatado como fase de risco para uso problemático de álcool (UPA) e para transtorno mental comum (TMC). É importante avaliar a co-ocorrência entre UPA e TMC em estudantes de graduação considerando ser um tema pouco relatado na literatura. Este estudo transversal utilizou os instrumentos AUDIT e SRQ-20 para avaliação da prevalência de UPA e TMC e da co-ocorrência entre UPA e TMC em uma amostra de estudantes de graduação da área da saúde, com idade média de 22 anos e predominantemente feminina (65,6%). Também examinou a associação entre estas condições e a relação com a satisfação com aspectos da vida acadêmica. A prevalência de UPA foi de 23,5%, de TMC de 30,6% e de co-ocorrência de UPA e TMC de 7,3%. A média do escore total do AUDIT foi de 4,8 (DP=4,42) e do SRQ-20 de 4,0 (DP=4,0). Houve associação significante de TMC e de co-ocorrência entre UPA e TMC com a insatisfação com a carreira escolhida, insatisfação com o curso na faculdade e insatisfação com o desempenho como estudante. Não houve correlação entre UPA e TMC nesta amostra. A co-ocorrência entre UPA e TMC está presente em estudantes de graduação e as conseqüências são prejuízos para a saúde mental e insatisfação com as conquistas acadêmicas, o que, ocorrendo nesta fase importante da vida, poderá limitar o futuro destes adultos jovens. Os achados deste estudo referentes à ausência de associação entre UPA e TMC devem ser interpretados com cuidado quanto a sua generalização, considerando-se o caráter de estudo transversal de rastreamento em população de adultos jovens. / The study time at the university is reported as a risky phase for problematic use of alcohol (UPA) as well for common mental disorders (TMC). It is important to evaluate the topic of co-occurrence of UPA and TMC amongst university students considering that this topic has been scarcely mentioned in scientific papers. This cross-sectional study used the AUDIT and SRQ-20 screening instruments in order to assess the prevalence of UPA and TMC and the co-occurrence of UPA and TMC in a sample of university students of the health area, characterized by mean of age of 22 years and mostly female (65.6%). Also it examined the association between these conditions and their relationship with satisfaction regarding aspects of the academic life. The prevalence of UPA was of 23.5%, TMC of 30.6% and co-occurrence of UPA and TMC of 7.3%. The average total score of AUDIT was of 4.8 (SD=4.42) and the SRQ-20 of 4.0 (SD=4.0). Significant associations of TMC as well the co-occurrence between UPA and TMC have been found with: - dissatisfaction with the selected career, dissatisfaction with the academic program and dissatisfaction with the own performance as student. No correlation between UPA and TMC has been found in this sample. The co-occurrence of UPA and TMC is present amongst undergraduate students and its consequences are mental health problems and frustration with academic achievements which occurring in this important phase of life it can impair the future of these young people. The findings of this study shall be carefully interpreted concerning its generality, considering the type of the study being a cross-sectional screening study on a population of young adults.

Background: Given the increasing number of military deployments in modern forces and the high individual and social costs of substance use disorders, the risk of substance use (alcohol, nicotine, illegal drugs) and substance use disorders (abuse, dependence) associated with deployment and deployment-related stressful experiences is an important area of research. Main questions in this area are: Are deployment and deployment-related stressful experiences associated with problematic substance use patterns and substance use disorders? Are there high-risk groups for deploymentrelated increases in substance use and the occurrence of substance use disorders? Do other mental disorders such as posttraumatic stress disorder play a role for the risk of substance use disorders? This dissertation thesis aims to contribute to these questions. The thesis is based on a research program in German military personnel deployed to Afghanistan. The program includes a crosssectional and a prospective-longitudinal study component. In the cross-sectional component, a random, stratified sample of 1483 was assessed twelve months after return from deployment. As a control group, 889 never deployed soldiers were also assessed. In the prospective-longitudinal component, another sample of 358 male soldiers was assessed directly before and twelve months following deployment. Information about substance use and substance use disorders was obtained using a standardized diagnostic interview. Deployment-related stressful experiences and other relevant variables were assessed with additional scales and questionnaires. Based on this study program, the following research questions were addressed: (1) Do deployed and never deployed soldiers differ regarding the prevalence of problematic substance use patterns (alcohol, nicotine, illegal drugs) and substance use disorders (alcohol, nicotine)? (2) How are soldiers with deployment-related changes in alcohol use characterized? (3) Are posttraumatic stress disorder symptoms related to the risk for substance use disorders (alcohol, nicotine)? (4) Are soldiers with prior mood and anxiety disorders at higher risk for the onset of substance use disorders (alcohol, nicotine) following deployment-related stressful experiences? Main results: Regarding these research questions, the following main results were observed: (1) Deployed and never deployed do not differ considerably regarding the prevalence of substance use and substance use disorders. (2) There was evidence for both deployment-related increases and decreases in alcohol use in specific subgroups. Compared to soldiers with a stable consumption, soldiers with increased alcohol use were characterized by lower ranks, less acceptance, less social support, more sleeping problems after deployment and more deployment-related negative cognitions. Soldiers with deployment-related decreases in alcohol use were characterized by fewer posttraumatic stress disorders symptoms prior deployment and less childhood emotional neglect. (3) Posttraumatic stress disorder symptoms were related to the risk for substance use disorders. These associations were partially attributable to other comorbid mental disorders. However, several posttraumatic stress disorder symptoms were related to substance use disorders above the contribution of comorbidity. (4) Specific constellations of prior mood and anxiety disorders and high degrees of certain deploymentrelated stressful experiences predicted the onset of alcohol use disorders. Conclusions: Based on these findings it can be concluded that German soldiers deployed to Afghanistan do not have an overall elevated risk for substance use and substance use disorders. However, several subgroups with a deployment-related increase in substance use and substance use disorders could be identified for specific substances. These subgroups include soldiers with low ranks, low social support and other mental disorders, of which several posttraumatic stress disorder symptoms might be particularly relevant. In addition, soldiers who experience mood and anxiety disorders prior to deployment as well as high degrees of specific deployment-related stressful experiences might be at higher risk for the onset of alcohol use disorders. It is also noteworthy that some soldiers show a deployment-related decrease in alcohol consumption. These findings might contribute to an improved identification of high-risk groups and suggest targets for possible interventions and preventive efforts. Because of some limitations, mainly regarding crosssectional designs and limited statistical power, some observed associations have to be interpreted with caution. Further prospective studies in high-risk populations or larger samples are necessary to replicate and extend the suggested findings. Moreover, the generalizability of findings to non-military samples and other types of stressful experiences should be investigated. These investigations might help to further reduce the prevalence of excessive substance use and substance use disorders.:Content Zusammenfassung 10 Summary 13 0 Preface 15 1 General introduction 16 1.1 Substance use and substance use disorders 16 1.2 Stressful experiences 23 1.3 Stressful experiences and substance use in deployed military personnel 28 2 Aims 34 3 Methods 36 3.1 Design 36 3.2 Sampling 37 3.3 Study instruments 38 4 Substance use and substance use disorders in recently deployed and never deployed soldiers 40 4.1 Abstract 40 4.2 Introduction 41 4.3 Methods 43 4.4 Results 47 4.5 Discussion 52 5 Predictors of changes in daily alcohol consumption in the aftermath of military deployment 57 5.1 Abstract 57 5.2 Introduction 58 5.3 Methods 60 5.4 Results 64 5.5 Discussion 68 6 Associations between lifetime PTSD symptoms and current substance use disorders using a five-factor model of PTSD 73 6.1 Abstract 73 6.2 Introduction 74 6.3 Methods 78 6.4 Results 80 6.5 Discussion 85 7 Stress exposure and the risk for the onset of alcohol use disorders and nicotine dependence: The role of prior internalizing disorders 89 7.1 Abstract 89 7.2 Introduction 90 7.3 Methods 92 7.4 Results 96 7.5 Discussion 103 7.6 Conclusions 105 8 General discussion 106 8.1 Summary of main findings 106 8.2 Discussion of main findings 109 8.3 Critical discussion of methodology 117 8.4 Practical implications 120 8.5 Directions for future research 122 9 Conclusion 125 10 References 126 11 Appendix 157 / Hintergrund: Das Risiko für den Konsum psychotroper Substanzen (Alkohol, Nikotin, illegale Drogen)und das Auftreten von Substanzstörungen (Missbrauch, Abhängigkeit) im Zusammenhang mit Belastungen in militärischen Einsätzen ist angesichts der Zunahme militärischer Einsätze sowie der hohen individuellen und sozialen Kosten von Substanzstörungen ein Forschungsthema von hoher Relevanz. Wichtige Fragen sind dabei: Stehen Auslandseinsätze generell im Zusammenhang mit problematischen Konsummustern und Substanzstörungen? Gibt es bestimmte Risikogruppen für Anstiege im Substanzkonsum und das Auftreten von Substanzstörungen? Welche Rolle spielen andere psychische Störungen, wie z.B. die posttraumatische Belastungsstörung (PTBS), für das Auftreten einer Substanzstörung? Diese Dissertationsschrift behandelt verschiedene Aspekte dieser Fragestellungen auf der Grundlage eines Forschungsprogramms zur psychischen Gesundheit bei in Afghanistan eingesetzten deutschen Soldaten. Das Programm umfasste eine querschnittliche und eine prospektiv-longitudinale Studie. In der Querschnittstudie wurde eine randomisierte, stratifizierte Stichprobe von 1483 Soldaten zwölf Monate nach Rückkehr aus einem Einsatz in Afghanistan untersucht. Als Kontrollgruppe wurden zudem 889 Soldaten untersucht, welche niemals im Einsatz waren. In der prospektiv-longitudinalen Studie wurde eine weitere Stichprobe von 358 männlichen Soldaten unmittelbar vor und zwölf Monate nach Einsatzrückkehr aus Afghanistan untersucht. Information zu Substanzkonsum und Substanzstörungen nach DSM-IV wurden mittels standardisierter diagnostischer Interviews erfasst. Einsatzbezogene belastende Ereignisse und andere relevante Variablen wurden mit zusätzlichen Skalen und Fragebögen erhoben. Auf Basis dieses Studienprogramms wurden unter anderem die folgenden Fragestellungen bearbeitet: (1) Unterscheiden sich Soldaten mit und ohne Auslandseinsatz hinsichtlich der Prävalenz von kritischen Konsummustern (Alkohol, Nikotin, illegale Drogen) und Substanzstörungen (Alkohol, Nikotin)? (2) Durch welche Merkmale sind Soldaten mit einsatzbezogenen Veränderungen im Alkoholkonsum gekennzeichnet? (3) Sind Symptome der PTBS mit dem Risiko für Substanzstörungen (Alkohol, Nikotin) assoziiert? (4) Haben Soldaten mit bereits vor dem Einsatz bestehenden Angst- und affektiven Störungen ein höheres Risiko für das Auftreten einer Substanzstörung (Alkohol, Nikotin) nach belastenden Einsatzereignissen? Hauptergebnisse: In Bezug auf diese Fragestellungen ergaben sich folgende Ergebnisse: (1) Soldaten mit und ohne Auslandseinsatz unterschieden sich kaum hinsichtlich der Prävalenz von Substanzkonsum und Substanzstörungen. (2) Allerdings ergaben sich Hinweise auf Zu-, wie auch Abnahmeeffekte im Alkoholkonsum in unterschiedlichen Subgruppen. Soldaten mit einem Anstieg im Alkoholkonsum waren im Vergleich zu Soldaten mit stabilem Konsum durch einen niedrigeren Dienstgrad, ein geringeres Ausmaß an Akzeptanz, weniger soziale Unterstützung, mehr Schlafprobleme nach Einsatzrückkehr sowie ein höheres Ausmaß an negativen einsatzbezogenen Bewertungen gekennzeichnet. Bei Soldaten mit einer einsatzbezogenen Reduktion im Alkoholkonsum fanden sich weniger PTBS-Symptome vor dem Einsatz sowie ein geringeres Ausmaß an emotionaler Vernachlässigung in der Kindheit. (3) Es gab Zusammenhänge zwischen PTBS-Symptomen und Substanzstörungen, die jedoch teilweise durch andere komorbide psychische Störungen erklärt werden konnten. Allerdings blieben einige PTBS-Symptome über andere komorbide Störungen hinaus mit Substanzstörungen assoziiert. (4) Bestimmte Konstellationen von bereits vor dem Einsatz bestehenden Angst- und affektiven Störungen sagten bei hohem Ausmaß an einigen einsatzbezogenen Belastungen das Auftreten einer Störung durch Alkoholkonsum vorher. Schlussfolgerungen: Auf Grundlage dieser Befunde lässt sich schlussfolgern, dass in Afghanistan eingesetzte Bundeswehrsoldaten kein generell erhöhtes Risiko für kritische Konsummuster und das Auftreten von Substanzstörungen aufweisen. Allerdings konnten Subgruppen identifiziert werden, die in Bezug auf bestimmte Substanzen ein erhöhtes Risiko für einen erheblichen Anstieg im Substanzkosum oder das Auftreten einer Substanzstörung haben. Dazu gehören unter anderem Soldaten mit niedrigen Dienstgrad, geringer sozialer Unterstützung und anderen psychischen Störungen, wobei bestimmte Symptome der posttraumatischen Belastungsstörung von besonderer Relevanz sein könnten. Zudem scheint das Risiko für Störungen durch Alkoholkonsum bei Soldaten erhöht, bei denen bereits vor dem Einsatz Angst- und affektive Störungen auftraten und die gleichzeitig ein hohes Ausmaß an bestimmten Einsatzbelastungen erleben. Bemerkenswert ist aber auch, dass einige Soldaten nach dem Einsatz eine erhebliche Reduktion des Alkoholkonsums aufweisen. Die Befunde könnten zu einer verbesserten Identifikation von Risikogruppen beitragen und Ansatzpunkte für mögliche Interventionen und präventive Maßnahmen liefern. Aufgrund einiger Limitationen, die vor allem querschnittliche Designs und eine eingeschränkte statistische Power betreffen, sollten einige der beobachteten Zusammenhänge vorsichtig interpretiert werden. Weitere prospektive Untersuchungen an größeren Stichproben sowie Hochrisikokohorten sind nötig, um die Befunde zu replizieren und zu erweitern. Weiter sollte die Übertragbarkeit der Befunde auf nichtmilitärische Stichproben unter Einbezug anderer Arten von belastenden Ereignissen untersucht werden. Diese Untersuchungen könnten langfristig zur Senkung von problematischen Substanzkonsum und Substanzstörungen beitragen.:Content Zusammenfassung 10 Summary 13 0 Preface 15 1 General introduction 16 1.1 Substance use and substance use disorders 16 1.2 Stressful experiences 23 1.3 Stressful experiences and substance use in deployed military personnel 28 2 Aims 34 3 Methods 36 3.1 Design 36 3.2 Sampling 37 3.3 Study instruments 38 4 Substance use and substance use disorders in recently deployed and never deployed soldiers 40 4.1 Abstract 40 4.2 Introduction 41 4.3 Methods 43 4.4 Results 47 4.5 Discussion 52 5 Predictors of changes in daily alcohol consumption in the aftermath of military deployment 57 5.1 Abstract 57 5.2 Introduction 58 5.3 Methods 60 5.4 Results 64 5.5 Discussion 68 6 Associations between lifetime PTSD symptoms and current substance use disorders using a five-factor model of PTSD 73 6.1 Abstract 73 6.2 Introduction 74 6.3 Methods 78 6.4 Results 80 6.5 Discussion 85 7 Stress exposure and the risk for the onset of alcohol use disorders and nicotine dependence: The role of prior internalizing disorders 89 7.1 Abstract 89 7.2 Introduction 90 7.3 Methods 92 7.4 Results 96 7.5 Discussion 103 7.6 Conclusions 105 8 General discussion 106 8.1 Summary of main findings 106 8.2 Discussion of main findings 109 8.3 Critical discussion of methodology 117 8.4 Practical implications 120 8.5 Directions for future research 122 9 Conclusion 125 10 References 126 11 Appendix 157

Introdução: Os CAPS constituem a principal estratégia do processo de reforma psiquiátrica, por serem instituições destinadas a acolher os pacientes com transtornos mentais, estimular sua integração social e familiar e apoiá-los em suas iniciativas de busca da autonomia. Por serem um serviço de saúde com pouco mais de uma década de existência, torna-se relevante a avaliação desses equipamentos com o intuído de melhorar a qualidade do tratamento ofertado. Objetivo: Descrever e analisar os Centros de Atenção Psicossocial de Álcool e outras Drogas do estado do Amapá. Metodologia: Trata-se de um estudo avaliativo, que utiliza de métodos quantitativos transversais, descritivos e exploratórios, realizados nos CAPSad do Estado do Amapá, constituídos no total, por dois serviços. A amostra do estudo constituiu-se de 32 trabalhadores, 60 usuários e 28 familiares. Para a coleta de dados foram aplicados; um questionário sócio demográfico e a Escala de Satisfação - SATIS-BR para todos os sujeitos; a Escala de Mudança Percebida - EMP para usuários e familiares e a Escala de Atitude Frente ao Álcool, Alcoolismo e Alcoolista - EAFAAA para os trabalhadores. Os dados foram processados de forma descritiva pelo Programa Statistical Package for Social Sciences (SPSS), versão 20,0 para Windows. Resultados: os CAPSad do Amapá seguem a maioria das normativas exigidas pelo Ministério da Saúde. Entretanto, o CAPSad de Santana ainda precisa ajustar alguns itens, como o número mínimo de profissionais exigidos, além da oferta de alimentação para os usuários, o que acaba por influenciar na oferta de mais oficinas e grupos terapêuticos. Apesar disso, foram obtidos bons níveis de satisfação global para usuários (3,98) e familiares (4,0) e nível de satisfação intermediário para os trabalhadores (3,55) em relação aos aspectos avaliados do serviço. Em relação à mudança percebida após o início do tratamento, tanto os usuários quanto familiares obtiveram índices elevados na EMP, sendo as médias de 2,68 e 2,63 respectivamente. Os resultados obtidos a partir da EAFAAA sugerem que os profissionais dos CAPSad apresentam atitudes positivas frente ao usuário de AOD, com o escore médio de 3,38. Conclusão: os resultados indicam que apesar das fragilidades encontradas nos CAPSad do Estado do Amapá, os mesmos conseguem cumprir com o seu papel acolhedor, capaz de fornecer acompanhamento clínico na busca pela reinserção social dos usuários. Entretanto, necessita-se de mais investimentos para esses serviços de saúde, o que trará mais qualidade ao serviço ofertado. / Introduction: The CAPS represent the main strategy in the process of psychiatric reformation, since they are institutions destined to receive patients with mental disorders, to stimulate their social and family integration, and to support them in their initiatives towards autonomy. Because they are a health service with a little more than a decade of existence, it becomes relevant to evaluate this equipment in order to improve the quality of the offered treatment. Objective: to describe and to analyze the Psychosocial Care Centers for Alcohol and Other Drugs (CAPS) of the state of Amapá. Methodology: This is an evaluative study, that utilizes cross-sectional quantitative, descriptive, and exploratory methods, performed at the CAPSad of the state of Amapá, constituted by two services in total. The sample of the study was composed by 32 workers, 60 users and 28 relatives. For data collection, the following were applied; a sociodemographic questionnaire and the Satisfaction Scale - SATIS-BR for all the subjects; the Perceived Change Scale - EMP for users and relatives, and the Scale of Attitude Towards Alcohol, Alcoholism and Alcoholic - EAFAAA for the workers. The data were processed in a descriptive manner by the Statistical Package for Social Sciences (SPSS) program, version 20,0 for Windows. Results: The CAPSad of Amapá follow most of the regulations demanded by the Ministry of Health. However, the CAPSad of Santana still needs to adjust some items, such as the minimum number of professionals required, besides the food supply for the users, what ends up influencing the offer of more workshops and therapeutic groups. Despite that, the research obtained good levels of global satisfaction for users (3,98) and relatives (4,0), and intermediate level of satisfaction for the workers (3,55) related to the evaluated aspects of the service. Regarding the perceived change after the treatment start, both users and relatives obtained high indexes on the EMP, where the averages were 2,68 and 2,63 respectively. The results obtained from the EAFAAA suggest that the CAPSad professionals present positive attitudes towards the user of AOD, with average score of 3,38. Conclusion: The results indicate that despite the weaknesses found in the CAPSad of the state of Amapá, they can fulfill their hospitable role, being capable of offering clinical monitoring in the pursuance of the social reintegration of the users. However, more investments for these health services are needed, which will bring more quality to the offered service.