A eficácia e a segurança do acamprosato foram avaliadas no tratamento ambulatorial de setenta e cinco pacientes do sexo masculino, com idade entre 18 e 59 anos, com diagnóstico de dependência de álcool pelo CID-10. O estudo foi controlado duplo-cego, com duração de 24 semanas. Transtornos clínicos e/ou psiquiátricos que necessitassem de internação, uso de medicação psiquiátrica, quadros psicóticos prévios independentes do consumo de álcool e hipersensibilidade ao acamprosato foram critérios de exclusão. Após um período de desintoxicação de uma semana, os pacientes foram divididos aleatoriamente em dois grupos: o primeiro grupo recebeu acamprosato (6 comprimidos de 333 mg por dia durante 12 semanas), e o segundo recebeu placebo (6 comprimidos por dia durante 12 semanas). Após as primeiras 12 semanas, os pacientes continuaram o tratamento por mais 12 semanas sem uso de medicação. Os grupos foram comparados quanto a sintomas depressivos, uso de álcool, efeitos colaterais das medicações, exames laboratoriais e tempo de abstinência contínuo. 25% dos pacientes que estavam recebendo acamprosato e 20% dos pacientes que estavam recebendo placebo foram excluídos do seguimento. Os pacientes que receberam acamprosato mostraram maior taxa de abstinência contínua no final das 24 semanas de tratamento quando comparados aos que receberam placebo (57% versus 25%, p = 0,014), e tiveram uma duração média de abstinência contínua de 18,8 semanas enquanto o grupo placebo teve uma duração média de abstinência contínua de 12 semanas (p = 0,003). Efeitos colaterais foram registrados. O acamprosato mostrou-se ser seguro e eficaz no tratamento de pacientes dependentes de álcool e na manutenção da abstinência durante 24 semanas. / The efficacy and security of acamprosate were evaluated in the treatment of 75 men, between 18 and 59 years of age, with diagnosis of alcohol dependence by ICD-10. It was a double-blind, placebo controlled study, 24 weeks long. Patients with disorders that should be treated in an inpatient setting, using psychiatric medications, relating previous psychoses without alcohol use and with hipersensibility to acamprosate were excluded. After a one-week detoxification period, the patients were randomily divided in two groups: the first group received acamprosate (6 tablets of 333 mg a day during 12 weeks) and the second group received placebo (6 tablets during 12 weeks). After the first 12 weeks, the patients continued the follow-up for 12 weeks more without medication. The groups were compared in terms of depressive symptoms, use of alcohol, side effects of medications and laboratory tests. 25% of patients who were receiving acamprosate dropped out, whereas 20% of the placebo-treated patients dropped out of the study. Patients who were receiving acamprosate showed significantly higher continuous abstinence rate within the 24 weeks of treatment compared with patients who were assigned to placebo treatment (57% versus 25%, p = 0,014), and they had significantly longer mean abstinence duration of 18,8 weeks versus 12 weeks abstinent (p = 0,003). Few side effects were related. Acamprosate proved to be safe and an effective aid in the treatment of alcohol dependent patients and in maintaining the abstinence of patients during 24 weeks.

Made available in DSpace on 2016-04-26T14:55:39Z (GMT). No. of bitstreams: 1 Vinicius Nascimento Francisco.pdf: 1026261 bytes, checksum: 20b5cb10d78c34bc1ff4bedf5bb989c1 (MD5) Previous issue date: 2015-09-11 / This study aims to analyze a particular course of action understood as a disease by the medical science and an offense to the structuring of processes ordered face-to-face interaction in everyday life. Alcoholism was selected for the theoretical and empirical object as the social experiences of members of self-help groups that acquired a social significance in recent decades: the "Alcoholics Anonymous" AA. The AA is a physical space that apprehends alcoholism as a matter related to the daily lives of men and women stigmatized as drunk. The AA members strive gradually in overlay alcoholism with a language related to the reorganization of their everyday lives. . In the first instance, we address the intrinsic relationship between the systemic world of science, its way to make sense to alcoholism (rational construction of the disease conception) and their acceptance of disability on other approaches to the problem of excessive alcohol consumption in social life. In a second step, we show the historical and political development of the United States and favorable social conditions for the emergence of a movement that understands alcoholism from the public discussion on the way to the common good of society. On a third occasion, we study the social experiences of AA members and the construction of belief in alcoholism within the group as a spring abnormality of disruption of the privacy of its visitors. We understand therefore that alcoholism for AA membership is a fact that hindered his performances in everyday social relations - and will continue blocking if nothing is done to understand the abnormality of those who constantly drink in everyday life. The work was based on qualitative methodologies such as case study, having been selected for the AA your research, semi-structured interviews with the group members, systematic observation of AA meetings and document analysis used by its frequenters / O presente trabalho analisa uma determinada maneira de agir, entendida como doença pela ciência médica, e uma ofensa à estruturação dos processos ordenados de interação face a face na vida cotidiana. Selecionou-se o alcoolismo para o estudo teórico e como objeto empírico as experiências sociais dos membros dos grupos de autoajuda que adquiriu uma importância social nas últimas décadas: os Alcoólicos Anônimos A.A. O A.A é um espaço físico que apreende o alcoolismo como uma questão relacionada ao cotidiano de homens e mulheres estigmatizados como bêbados. Os membros do A.A esforçam-se, gradativamente, em revestirem o alcoolismo com uma linguagem relacionada à reorganização de suas vidas cotidianas. Num primeiro instante, abordamos as intrínsecas relações entre o mundo sistêmico da ciência, sua forma em atribuir sentido ao alcoolismo (construção racional da concepção de doença) e sua incapacidade de aceitação diante de outras abordagens sobre o problema do consumo excessivo de álcool na vida social. Num segundo momento, mostramos o desenvolvimento histórico e político dos Estados Unidos e as condições sociais propícias para o surgimento de um movimento que compreende o alcoolismo, a partir da discussão pública em torno do caminho rumo ao bem comum da sociedade. Numa terceira ocasião, estudamos as experiências sociais dos membros do A.A e a construção da crença no alcoolismo dentro do grupo como uma anormalidade nascente da desestruturação da vida privada de seus frequentadores. Entendemos, pois, que o alcoolismo, para os membros do A.A, é um fato que obstruiu suas atuações nas relações sociais cotidianas e que continuará obstruindo, caso nada seja feito para se entender a anormalidade daqueles que bebem constantemente na vida cotidiana. O trabalho se apoiou em metodologias qualitativas como o Estudo de Caso, tendo sido selecionado o A.A para sua pesquisa, entrevistas semiestruturadas com os membros do grupo, observação sistemática das reuniões do A.A. e análise de documentos utilizados por seus frequentadores

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There is extensive literature available on the topic of recovery from alcohol abuse. The research focus of this study explores diverse ways in which the practice of faith and spirituality in any form have affected individuals’ recovery and wellness from a post-positivist perspective. The following question is addressed: How does faith and spirituality impact the recovery process and wellness of alcohol abusers? The study was conducted by interviewing volunteer members of three Alcoholics Anonymous mutual-help groups located in Southern California. Participants were asked 15 open ending questions interview. The study uses open and axial coding for analysis. The indirect variables (IV) for this study are faith and spirituality and the direct variables (DV) are recovery and wellness. Qualitative data has been analyzed using Nvivo data analysis software. Some of the themes that emerged from the interviews after coding were family history, willingness to recover, sense of hope, acquired coping skills, belonging to a healing community, and long-lasting sobriety. The analysis of the interviews and these themes showed a positive correlation between the practice of faith and spirituality and recovery and wellness among the pool of participants. Alcoholics with three or more years attending Alcoholics Anonymous meetings reported that they earned at least one year of sobriety through being willing to recover, having a sense of hope, the practice of new skills and spiritual tools, being consistent in attending the group meetings, and being at service of other alcoholics.

This dissertation investigates compulsory care of alcohol abusers in Sweden during the years 1940 to 1981. The purposes of the dissertation are twofold: in part to determine the concrete forms which care services for alcohol abusers took during the years focused on, in part to analyze what connections existed between the development of services and conceptions of the reasons for, consequences of and possible solutions to alcohol abuse. One point of departure is that the problem was defined with respect to the interests of influential social actors, and with respect to a very particular view of what a respectable life (free of social problems) was. Among the most influential actors involved in these social services, I argue for a focus not least on so-called “street-level bureaucrats”, with direct influence on the goals and methods of institutional care. The study is thus oriented towards mapping the development of problem definitions and formulation within the praxis of compulsory care in four institutionalized care establishments for alcohol abusers. This development is contrasted to broader trends of institutional and discursive development in the definition of alcohol abuse as a social problem. The legislation regulating compulsory care has constantly been founded upon assumptions of the social damage caused by alcohol abuse. At the level of concepts or discourse the consequences of causes for and solutions to alcohol abuse were initially defined in terms of individual morality, with definitions subsequently developing so as to depart from more medicalized terminology. Towards the end of the period the problem descriptions became focused on societal dysfunctions and reforms as the respective causes of and solutions to societally problematic alcohol abuse. At the level of treatment focused upon in the dissertation, societal explanations of alcohol problems departing from societal dysfunctions as causes thereof, and societal reforms as solutions, have never been fully integrated in care services praxis. This was not the case for the simple reason that these care activities, as such, were developed to deal with individuals rather than with society. Neither did a medicalized perspective come to dominate institutionalized care during the period studied – something which can be explained not least with the fact that the perspective’s expansion was not attended by development of medical treatment methods which were convincing with respect to results of use. On one hand, concretely practiced compulsory care thus long remained dominated by problem definitions departing from inmates’ gender-specific moral qualities. On the other hand, certain elements of a more resource-oriented and societal-reformist perspective can certainly be distinguished in the development of care services, albeit on the special terms associated with service implementation in the field. In conclusion, the historical development of care services for alcohol abusers shows that alcohol abuse need not necessarily, or primarily, be seen as a problem having to do with individuals’ relationship with alcohol. Other definitions of the problem have focused upon individuals’ relationship also to working life, the family, sexual morals, the gender order, or capitalist oppression. The problem has been seen as a workers’ and poverty problem, a problem of families and violence, a medical problem, or a symptom of societal problems. Causes have been sought in the character of individuals, the ways in which they have been raised or not raised, their spiritual life, their metabolism, their genetic material, their socioeconomic environment, gender and family situation. The proposed solutions have included everything from work, organized coffee breaks, medicines, psychotherapy and democracy to piece-rate wages, no wages, collective care, or solitary confinement. Alcohol itself has been a secondary factor in the problem definitions which have let themselves be attached – either via perceived links of cause or of effect – to more overarching social issues. / <p>Sammanfattning på engelska med titeln: The rehab : compulsory care of alcohol abusers in Sweden 1940-1981</p>

The purpose of this qualitative study was to determine from the treated students' perspective what teacher behaviors facilitate recovery and what teacher behaviors inhibit recovery. Study participants included 16 high school students who had completed treatment for alcohol and drug dependency in grades 9-12, and 112 teachers. Students and teachers were interviewed to better explain the phenomenon from their perspectives. Data gathered from student interviews, student journal recordings, observer notes, and teacher interviews were used as corroborating data. The constant comparative method was used to analyze data (Glaser & Strauss, 1967).Five major themes emerged from the data analysis explaining the effects of teacher behavior on students who had completed treatment for drug and alcohol dependency. The data were segmented into themes using a bi-polar structure. These themes were: (1) student performance; (2) student communication; (3) student relations: security; (4) student: affective; and, (5) authority: student behavior. These themes yielded student identified causal conditions, intervening conditions, and action/reaction strategies that either inhibited or facilitated recovery.The data showed students did not have neutral feelings; they had either negative or positive feelings about their personal interactions with teachers or their observations of teachers' interaction with other teachers and/or other students. Teacher behaviors which resulted in negative student behavior consequences in each of the five major theme categories were not helpful to students and inhibited their recovery. Teacher behaviors which resulted in positive student behavior consequences in each of the five major theme categories helped students and facilitated their recovery.

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CYP2D6 metabolizes a range of centrally acting drugs, neurotoxins, and endogenous neurochemicals. Higher levels of brain, but not liver, CYP2D6 have been identified in alcoholics and smokers, suggesting exposure to ethanol and/or nicotine may induce brain CYP2D6. We investigated the independent and combined effects of chronic ethanol self-administration and nicotine treatment on CYP2D expression. METHODS: Monkeys were randomized into 4 groups of 10/group consisting of a control group, ethanol-only group, nicotine-only group, and a combined ethanol and nicotine group; treatments occurred for 64 days. RESULTS: Exposure to chronic ethanol and nicotine induced CYP2D across various brain regions and cell types, particularly when both drugs were given in combination. No changes in protein levels were observed in liver or in CYP2D mRNA levels in liver and brain. CONCLUSIONS: Ethanol and nicotine increase brain CYP2D levels, which may affect CNS drug response, neurodegeneration and personality among those exposed to alcohol and/or nicotine.

CYP2D6 metabolizes a range of centrally acting drugs, neurotoxins, and endogenous neurochemicals. Higher levels of brain, but not liver, CYP2D6 have been identified in alcoholics and smokers, suggesting exposure to ethanol and/or nicotine may induce brain CYP2D6. We investigated the independent and combined effects of chronic ethanol self-administration and nicotine treatment on CYP2D expression. METHODS: Monkeys were randomized into 4 groups of 10/group consisting of a control group, ethanol-only group, nicotine-only group, and a combined ethanol and nicotine group; treatments occurred for 64 days. RESULTS: Exposure to chronic ethanol and nicotine induced CYP2D across various brain regions and cell types, particularly when both drugs were given in combination. No changes in protein levels were observed in liver or in CYP2D mRNA levels in liver and brain. CONCLUSIONS: Ethanol and nicotine increase brain CYP2D levels, which may affect CNS drug response, neurodegeneration and personality among those exposed to alcohol and/or nicotine.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2006. / Härtill 4 uppsatser.