Background: The rapid diffusion of Novel Psychoactive Substances (NPS) constitutes an important challenge in terms of public health and a novelty in clinical settings, where these compounds may lead to erratic symptoms, unascertained effects and multi-intoxication scenarios, especially in emergency situations. The number of NPS available on the illicit drug market is astonishing: official reports suggest the appearance of a new drug every week. NPS may be enlisted in many different families such as synthetic phenethylamines, tryptamines, cathinones, piperazines, ketamine-like compounds, cannabimimetics and other plant-derived, medical products and derivatives. Therefore, healthcare services and professionals are often called to face this unknown 'galaxy' where NPS users seem to perceive traditional services 'unfitting' for their needs, requiring an attention which is quite different from known classic drug abusers. In this context, the Recreational Drugs European Network (ReDNet), a research project funded the European Commission and led by the University of Hertfordshire, aimed to explore the NPS galaxy and develop information tools for vulnerable individuals and professionals working with them. This initiative reported specific Technical Folders on new drugs and disseminated the collected information through innovative communication technologies (e.g. multimedia tools, social networking and mobile phone services) internationally. Aim and objectives: The aim of this work is to evaluate and contribute to expand the knowledge of health professionals on NPS. The key objectives are: 1) to assess the level of knowledge on NPS amongst a sample of Italian healthcare professionals; 2) to evaluate the effectiveness of dissemination tools developed by ReDNet, including an SMS-Email/mobile service (SMAIL); 3) to understand the clinical impact of NPS by providing four Technical Folders and collecting two clinical cases on NPS. Methodology: According to the objectives, the methodological approach has been articulated in the following three phases. Phase 1: investigating knowledge and preferred channels of information via an online survey among health professionals in Italy. This first Italian study on NPS awareness had been online from February to July 2011, recruiting participants from Departments of Addiction, Psychiatry and other services. Phase 2: evaluating the ReDNet initiative. An evaluation questionnaire was designed and disseminated online to assess the various resources provided by ReDNet project; it had been online from April to July 2013, targeting professionals registered to ReDNet services. This phase also investigated the SMAIL service, a mobile application that was the latest technological tool developed by ReDNet team. Phase 3: promoting evidence based work in clinical practice through the preparation of four Technical Folders and two case reports. Technical Folders followed the methodology optimised during the ReDNet experience, organising NPS data under specific headings, measured for the need of health professionals. Case reports were collected in a Dual Diagnosis Unit in Italy ('Casa di Cura Parco dei Tigli'); assessed patients revealed for the first time the use of NPS; clinical interviews were conducted to collect a full anamnesis while for the first time psychopathological characteristics were measured in NPS abusers, using a psychometric instrument (MMPI-2). Results: In Phase 1 Italian services, in particular interviewees (n=243) from Departments of Psychiatry and Addiction, showed a strong interest for the subject but a poor understanding of NPS: 26.7% of respondents did not know if their patients ever used NPS; at the same time they considered this phenomenon as very relevant to their profession (e.g. psychomotor agitation [75.7%], errors in the assessment [75.7%], management of the clients [72%]); in addition less of a quarter of them had reliable information on new substances. Interviewees also reported the need for easily accessible channels of information to expand their expertise in the field (including emails [70%] and dedicated websites [51.9%]). The ReDNet initiative (Phase 2) reached professionals (n=270) from European countries and various other regions; they appreciated the website above all (48.5%), which provided access to other information (in form of academic papers, news, technical folders, etc.). The integration of technological-based and classic educational resources was used to self-educate professionals (52.6%) and supply information for research (33.7%) with up-to-date and 3 reliable information; in the same Phase the SMAIL service was analysed in its first 557 searches: in the pilot period 122 professionals used SMS inquiries (95%), asking information on NPS while highlighting the increasing number of NPS available on the market. Technical folders (Phase 3) described two new phenethylamines (Bromo-dragonfly and 25I-NBOMe), a novel ethno drug (Kratom) and a new synthetic cathinone (alpha-PVP) whose severe effects were also described in one of the clinical cases. The first case report (Alice) involved a clubber who used mephedrone and other NPS with a severe worsening of her psychiatric disturbances; the second one (Marvin) described a patient who was referred by a psychiatric service and revealed himself as a 'psychonaut' with an intense abuse of alpha-PVP. Conclusions: The exploration of the NPS galaxy is a new challenge for healthcare professionals. In this study, Italian services seemed to be unprepared to face the emergency and requested rapid access to reliable information; the ReDNet project provided both technology-based and traditional resources to expand knowledge on NPS, making professionals more aware of emerging issues and helping especially clinicians working in the field (e.g. via SMAIL service and Technical Folders). Overall, it can be observed that effective information services on NPS targeted at professionals initiatives should include an online interface integrating up-to-date information, describing NPS through specific Technical Folders and disseminating scientific literature; the use of technological tools, including mobile applications, is an important strategy to support health professionals in their activity. Finally, more 'visual' guidelines, possibly in the form of a 'map' of these heterogeneous compounds, could be a useful framework to describe NPS to physicians and other professionals who are often unprepared and unconfident to face such an expanding galaxy.

This dissertation called "Influence of adult addictions and addictive behavior on children and adolescents" is divided into two parts: theoretical one and a practical one. In the theoretical part, there will be defined the addiction and the addictive behavior, after they will be put into the International Classification of Diseases and Related Health Problems. Then we will analyse concrete psychoactive substances that causes the addiction, types of addictive behavior, factors that encourage genesis of addiction and addictive behavior, influence of addictions and addictive behavior on children and adolescents. The last chapter of theoretical part occupies with possibilities of therapy of addiction and addictive behavior. The practical part proceeds from anonymous questionnaire survey that took place at an elementary school and at a high school. In the end there is a discussion about influence of adult addictions and addictive behavior on children and adolescents.

L’objectif de cette recherche est d’étudier, chez l’adolescent, les mécanismes psychopathologiques et psychologiques impliqués dans la co-occurrence de comportements antisociaux et de conduites de consommation et responsables de la « pathologisation » de la consommation de substances psychoactives, par l’adoption conjointe d’une approche centrée sur la personne et centrée sur les variables et la mise en place d’un dispositif d’étude multi-échantillons. Ainsi, cette recherche comporte trois volets : 1) une étude en milieu scolaire menée auprès de 1025 collégiens âgés de 12 ans à 16 ans, 2) une étude en milieu psychiatrique menée auprès de 168 adolescents suivis ou hospitalisés pour un trouble externalisé ou internalisé, âgés de 12 ans à 18 ans, et 3) une étude en addictologie menée auprès de 43 adolescents abuseurs/dépendants à une substance psychoactive, âgés de 12 ans à 18 ans. Un protocole d’évaluation pluri-source (adolescents, parents, enseignants) a permis d’évaluer les comportements antisociaux, les conduites de consommation, les conduites à risques, les troubles et symptômes externalisés et internalisés (et les antécédents de troubles), la personnalité, le stress perçu et les stratégies de coping de ces adolescents. Ce dispositif a permis de montrer que les adolescents les plus susceptibles d’associer ces deux comportements et d’adopter des conduites de consommation à risques présentent des difficultés à la fois relationnelles (faible coopération, trouble oppositionnel avec provocation, faible transcendance), émotionnelles (symptômes dépressifs, troubles internalisés, intolérance à la frustration, stress perçu dans le domaine scolaire ou dans la relation aux parents, stratégies d’adaptation dysfonctionnelles) et comportementales (forte recherche de nouveauté, comorbidité TDAH/TOP). La pathologisation des conduites de consommation relèvent d’enjeux similaires à l’adoption de conduites de consommation à risques. Néanmoins, le risque de pathologisation serait d’autant plus important que les enjeux émotionnels et relationnels relèvent de manifestations tempéramentales (faible dépendance à la récompense sociale). En termes de prévention des conduites de consommation à l’adolescence et de leur pathologisation, il paraît primordial de bien distinguer ces différents niveaux de vulnérabilité (psychopathologique, psychologique, tempéramentaux, adaptatif). / This work aims to study, among adolescents, the psychopathological and psychological mechanisms involved in the co-occurrence of antisocial behaviors and psychoactive substance use and in the “pathologizing” of psychoactive substance use through a person-centered and a variable-centered approach and based on a multi-sample plan. This research focus on: 1) 1 025 middle and high school students aged between 12 to 16 years old, 2) 168 inpatients and outpatients adolescents aged between 12 to 18 years old, and 3) 43 psychoactive substance abusers/dependent adolescents aged between 12 and 18 years. A multi-source assessment (adolescents, parents, teachers) was used to collect information about adolescents’ antisocial behaviors, psychoactive substance use, risk-taking behaviors, past and present externalized and internalized disorders and symptoms, personality, perceived stress and coping strategies. The results show that adolescents are most likely to associate antisocial behaviors and psychoactive substances use and to have a risky psychoactive substance use when they present both relational problems (low cooperation, oppositional defiant disorder, low transcendence), emotional difficulties (depressive symptoms, internalizing disorder, intolerance to frustration, perceived stress in school and in relationships with parents, dysfunctional coping strategies) and behavioral dysregulation (high novelty seeking, ADHD/ODD comorbidity). Mechanisms involved in the pathologizing of psychoactive substance use are similar to the adoption of risky psychoactive substance use. Nevertheless, the risk of pathologizing is all the more important when emotional and relational problems are temperamental expression (low social reward dependence). In terms of prevention of risky psychoactive substance use in adolescence and of its pathologizing, it seems important to distinguish between these different levels of vulnerability (psychopathological, psychological, temperamental, adaptative).

anglicky This thesis deals with one of the most important issues of our time. Trying to look for personality structure of individuals dependent on alcohol, psychoactive substances and pathological gamblers. Describes differences in personality structure between the user and the differences between men and women. It is divided into theoretical and practical part. The theoretical part is devoted to the present the accessible knowledge in the field of personality-dependent individuals. The empirical part of the work deals with a research carried out at the pavilions of addictions in a psychiatric hospital Prague Bohnice. In the empirical part of the research hypotheses and set goals that are subsequently evaluated. This thesis provides insight into the personality of addicted individuals and their own research conclusions are largely consistent with findings from the literature.

A família, ao longo de seu processo sócio-histórico, atravessou inúmeras crises e transformações, recriando-se conforme a época e o contexto local, adotando para tanto estilos diferenciados. Apesar das mudanças, a organização familiar continua sendo eixo de referência para procriação e socialização das novas gerações, bem como a base de apoio que o indivíduo dispõe no decorrer de seu processo de desenvolvimento psicossexual. Ao longo do ciclo vital, a família desempenha papéis diversificados e exerce funções específicas, sendo considerada a plataforma de sustentação e estruturação do psiquismo desde os primórdios da relação mãebebê. Nessa vertente, estudos têm apontado que a família constitui-se como um espaço fundamental de transmissão psíquica. Considerando-se esses pressupostos, a literatura sustenta que a organização familiar tem impacto decisivo no processo de saúde-doença do indivíduo, inclusive no que diz respeito ao uso abusivo de substâncias psicoativas na adolescência. Assim, torna-se imperioso dedicar atenção diferenciada à família, por meio de uma abordagem que leve em conta a história, estrutura e dinâmica dos relacionamentos familiares, bem como sua inserção no contexto social mais amplo. Frente a essa problemática, o presente estudo teve por objetivos compreender a dinâmica familiar de famílias que possuem filhos adolescentes envolvidos com o abuso de drogas, na perspectiva de suas mães, e compreender a história de vida familiar. O estudo utilizou enfoque qualitativo de pesquisa e os dados foram coletados por meio de um roteiro de entrevista semi-estruturado elaborado com base na modalidade história de vida temática. Participaram quatro mães de adolescentes usuários de substâncias psicoativas atendidas pelo Programa de Saúde da Família de um município do interior paulista. A coleta de dados foi realizada em encontros individuais, previamente agendados com as mães. As entrevistas foram audiogravadas e transcritas na íntegra e literalmente. Além disso, paralelamente a cada entrevista realizada, foi redigido um diário de campo. Após a digitação, as falas foram enumeradas para facilitar posterior localização no momento da categorização. A análise dos dados foi orientada visando à identificação dos temas que emergiram, individualmente, e posteriormente no conjunto de entrevistas, com a finalidade de construir categorias gerais. O corpus de pesquisa foi analisado à luz do referencial psicanalítico adotado para o presente estudo, fundamentado nos estudos de Berenstein, Eiguer e Kalina. Os resultados mostraram, em linhas gerais, o impacto da transmissão psíquica na história de vida familiar e sua contribuição na produção de sofrimento emocional, que culminou com o adoecimento não só do membro identificado, como também das famílias que vivenciavam o uso de substâncias psicoativas na adolescência. O relato das mães permitiu desvelar histórias de vida marcadas pela violência crônica, distanciamento afetivo e um padrão de abandono recorrente, que constituíram legados transmitidos intergeracionalmente, sem possibilidades de transformação. Compreender o adoecimento e seu significado na adolescência implica na compreensão da dinâmica familiar na qual o adolescente encontra-se inserido e na qual a herança psíquica é transmitida entre gerações. O estudo traz subsídios importantes para o planejamento de ações terapêuticas lastreadas na consideração do fenômeno do abuso de substâncias psicoativas como inseparável dos processos de subjetivação contemporâneos. / The family, along its socio-historical process, passed by crisis and changes, recreating itself according to time and local context, adopting for both distinctive styles. Despite these changes the organization family remains the axis of reference to procreation and socialization of the new generations, as well as the support base that the individual has in the course of his psychosexual development process. Throughout the life cycle, the family plays diverse roles and exercises specifics functions being considered the platform of support and structure of the psyche since the dawn of the relation mother-baby. In this case, studies have appointed the family like being a fundamental space of psychic transmission. Given these assumptions, the literature supports that this organization would have a decisive impact on the process of health and illness of the individuals, including about the abusive use of psychoactive substances in the adolescence. Thus, it is imperative to devote attention from the family, through an approach that takes into account the history, structure and dynamics of family relationships and their integration into the wider social context. Faced with this problem, this study aimed to understand the family dynamics of families with teenage children involved in drug abuse in the perspective of their mothers, and understand the history of family life. The study used qualitative approach to research and data were collected through a structured interview script semi-structured based in the modality life history theme. Participated four mothers of teenagers users of psychoactive substances attended by the Family Health Problem of a town in the countryside of São Paulo state. The collect of data was performed in individual meetings, previously scheduled with the mothers. The interviews were audio recorded and transcribed and literally. Moreover, in parallel to each interview, was written a diary. After typing, the lines were listed to facilitate subsequent location at the time of categorization. The analysis was guided in order to identify the themes that emerged, individually, and later in the interviews in order to build broad categories. The body of research has been examined in the light of psychoanalysis adopted for the present study, based on studies of Berenstein, Eiguer and Kalina. The results showed, in general, the impact of psychic transmission in the history of family life and their contribution to the production of emotional distress, which led to the illness of a member not only identified but also the families who experienced the use of psychoactive substances in adolescence. The report of the mothers allowed us to reveal stories of life marked by chronic violence, emotional distance and a pattern of neglect applicant, which were transmitted intergenerational legacy without the possibility of transformation. Understanding the disease and its significance in adolescence involves the understanding of family dynamics in which the adolescent is inserted and in which the psychic inheritance is passed between generations. The study provides important information for the planning of therapeutic actions backed into consideration the phenomenon of substance abuse as inseparable from the contemporary subjectivity.

Introdução: A precocidade da iniciação do uso de substâncias psicoativas (SPAs) por adolescentes é uma preocupação constante, visto que pode aumentar o risco de dependência futura, além de estar associada a uma série de comportamentos de risco, como acidentes, violência sexual e participação em gangues. Neste sentido, a literatura indica que a família pode atuar como fator de risco e/ou proteção e/ou prevenção da iniciação desse uso. Entretanto, especificidades dessa interação ainda necessitam estudos, especialmente na adolescência. Objetivo: Caracterizar a relação entre o perfil de consumo de SPAs, as dimensões da coparentalidade (cooperação, conflito e triangulação) e do conflito pais-filhos em problemas emocionais e de comportamento em adolescentes. Método: Estudo explicativo, de caráter quantitativo e de corte transversal. De uma amostra de N=126 adolescentes estudantes de escolas públicas com idade entre 12 e 18 anos incompletos. Utilizou-se na coleta de dados os seguintes instrumentos: Questionário sócio-biodemográfico, Escala de avaliação da coesão familiar (Faces III), Escala de Conflito Pais-filho (ECPF), Escala de Coparentalidade para Pais e Adolescentes (CI-PA), Inventário de Auto Avaliação de Jovens de 11 a 18 anos (YSR, Youth Self-Report) e o ASSIST (Alcohol, Smoking and Substance Involvement Screening Test). Os dados foram analisados por meio do programa estatístico SPSS, considerando o nível de significância de 5% (p≤0,05), através de análises descritivas e inferenciais. Resultados: Constatou-se que quase metade (49,2%) dos adolescentes pesquisados indicou já ter feito uso de álcool e 8,7% de tabaco. Constatou-se que o uso de álcool correlacionou-se a conflitos com a mãe relacionados a “sair a noite” (r=0,289; p<0,001). O uso de maconha correlacionou-se com conflito com o pai relacionado ao “uso de drogas” (r=0,582; p<0,001). Também observou-se que o uso de maconha pelo adolescente estava correlacionado a maior intensidade do conflito com pai, caracterizado por “discutir intensamente ou gritar” (r=0,538; p<0,001) e “bater ou atirar coisas um no outro” (r= 0,912; p<0,001). Os preditores mais robustos para o consumo de álcool pelos adolescentes foram as variáveis relacionadas ao pai. Observou-se que a cooperação coparental do pai foi negativa, sendo protetora para consumo de álcool. Enquanto a intensidade do conflito do adolescente com o pai e o conflito coparental do pai com a mãe revelaram-se positivos. Conclusão: Em conjunto, esses resultados sugerem que existe relação entre uso de SPAs e problemas familiares. Além disso, podem indicar que a família que exerce a coparentalidade com coerência tem função de proteção para problemas emocionais e de comportamentos em adolescentes, bem como do uso de SPAs. / Introduction: The early initiation of psychoactive substances (PAS) use by adolescents is a constant concern, since it increases the risk of future dependence, being also associated with several risk behaviors, such as accidents, sexual violence and gang involvement. In this sense, the literature indicates that the family can act as a protection and / or prevention factor from this early use. However, specificities of this interaction still require studies, especially in adolescence. Objective: To characterize the relationships among the consumption profile of PAS, the dimensions of coparenting (cooperation, conflict and triangulation) and parent-child conflict in psychological symptoms and emotional and behavioral problems in adolescents. Method: explanatory, quantitative and cross-sectional study. From a sample of N = 126 adolescent students from public schools aged between 12 and 18 incomplete years. The following instruments were used in the data collection: Socio-biodemographic questionnaire, Family Coevaluation Scale (Faces III), Parent-Child Conflict Scale (PCCS), Coparenting Inventory for Parent and Adolescents (CI-PA), Youth Self-Report (YSR) and ASSIST (Alcohol, Smoking and Substance Involvement Screening Test). Data were analyzed using the SPSS statistical program, considering the significance level of 5% (p≤0.05). Results: It was found that almost half (49.2%) of the adolescents surveyed indicated they had already used alcohol, while 8.7% had consumed tobacco. Alcohol use was correlated with conflicts with the mother over "go out at night" (r = 0.289, p <0.001). Marijuana use correlated with father-related conflict over "drug use" (r = 0.582, p <0.001). Adolescent marijuana use was also correlated with a higher intensity of conflict with the father, characterized by "loudly arguing or yelling" (r = 0.538, p <0.001) and "hitting or throwing things at each other" (r = 0.912, p <0.001). The most robust predictors of adolescent alcohol consumption are the variables related to the father. It was observed that father's coparenting is negative, being protective for alcohol consumption. While the intensity of the adolescent's conflict with the father and the coparental conflict between father and mother are positive. Conclusion: These results altogether suggest that there is a relationship between the use of PAS and family problems. They also may indicate that the family that exercises coparenting with coherence has the function of protecting adolescents from psychological and behaviors problems, as well as from the use of PAS.

Esta pesquisa teve como objetivo conhecer o perfil dos usuários de substâncias psicoativas do CAPS de Três Passos e refletir se as atividades ofertadas aos pacientes estavam compatíveis com as necessidades levantadas. Trata-se de um estudo transversal de natureza quantitativa, em que os dados foram coletados através de entrevistas individuais ao longo de 2 meses, cujos instrumentos de coleta de dados foram ficha sociodemográfica, ASSIST, ASI6 Light e Entrevista Diagnóstica do DSM-V. Verificou-se que dos 97 pacientes atendidos no CAPS, 24 eram usuários de substâncias psicoativas. A maioria era homens (79,2%), raça branca (95,8%), natural da própria cidade do estudo (62,5%), não-casados (37,5% solteiros e 25% separados/divorciados) e concentrados na faixa etária dos 41 a 50 anos (33%; Média= 44; Mediana = 41,75; Mínimo = 22; Máximo = 62). Uma minoria estava trabalhando (16,7%) e a metade recebia Auxílio Doença. A principal substância de abuso foi o álcool (66,66%), seguido por cocaína (29,2%). Houve relato de uso de drogas injetáveis (n = 2), mas não nos últimos 3 meses. Com base nos escores médios gerados pela ASI6 Light, as áreas de maior gravidade foram de problemas psiquiátricos (0,11; DP = 0,48), problemas médicos (0,04; DP = 0,48) e problemas relacionados ao álcool (-0,66; DP = 0,48). As áreas que menos pontuaram foram as de problemas com drogas (-1,81; DP = 1,68), problemas sociofamiliares ( -2,34; DP = 1,31) e problemas legais (-2,55, DP = 1,91). Na área de emprego/sustento um pouco mais da metade dos usuários (n=13, 54,17%) considera que não possuem renda suficiente para pagar as necessidades básicas. Em relação às atividades ofertadas no CAPS, a área da Psicologia concentra o maior número de consulta no período (40 consultas), o que vem de encontro as necessidades dos usuários que apresentaram escores altos na área de problemas psiquiátricos. Entretanto, os escores elevados de problemas médicos demonstraram a necessidade da ampliação da atuação de profissionais da área médica (25 consultas) e de enfermagem (6 consultas). Da mesma forma, o elevado número de Benefício/Auxílio Doença e a opinião dos sujeitos de pesquisa de que sua renda é insuficiente para o sustento indicam mais atenção ao aspecto social no planejamento do plano terapêutico. Em suma, a padronização de um instrumento que avalia múltiplas esferas da vida do paciente, como ASI6 Light, favorece uma avaliação mais complexa dos pacientes e o levantamento mais detalhado das suas necessidades, podendo contribuir para planos de tratamento mais concordantes com a situação atual dos pacientes. / This research´s objective was to know the profile of the people who use psychoactive substances at CAPS in Três Passos, RS and analize if the activities offered to the patients were in accordance to the necessities raised. It was a cross-sectional study with a quantitative nature, in which the data were collected through individual interviews during 2 months, whose instruments of data collection were socio-demographic record, ASSIST, ASI6 Light and DSM-V Diagnostic Interview. It was verified that of the 97 patients attended at CAPS, 24 were users of psychoactive substances. The majority were men (79.2%), caucasian (95.8%), born in Três Passos (62.5%), unmarried, (37.5% single and 25% separated /divorced) and concentrated in the age group of 41 to 50 years old (33%, median = 44, mean = 41,75 minimum = 22, maximum = 62). A few people were working (16.7%) and half received Sickness Aid. The main substance of abuse was alcohol (66.66%), followed by cocaine (29.2%). There were reports of injecting drugs use (n = 2), but not in the last 3 months. Based on the scores generated by ASI6 Light, the most serious areas were of psychiatric problems (0.11, SD = 0.48), medical problems (0.04, SD = 0.48) and problems related to alcohol ( -0.66, DP = 0.48). The areas that scored the least were those with drug problems (-1.81, SD = 1.68), socio-family problems (-2.34, SD = 1.31) and legal problems (-2.55, SD = 1.91). In the area of employment / support a little more than half of the users (n = 13, 54.17%) consider that they don´t have enough income to pay for the basic necessities. In relation to the activities offered at CAPS, the Psychology area concentrates the highest number of appointments in the period (40 visits), which meets the needs of users who presented high scores in the area of psychiatric problems. However, the high scores of medical problems showed the need of expanding the performance of medical professionals (25 appointments) and nursing (6 appointments). Likewise, the high number of Benefit / Sickness Aid and the opinion of the interviwed people that their income is not enough, indicate more attention needed to the social aspect in the planning of the therapeutic plan. In short, the standardization of an instrument that evaluates multiple spheres of the patient's life, such as ASI6 Light, enables a more complex evaluation of the patients and a more detailed survey of their needs, being able to contribute to better treatment plans according to the current situation of the patients.

Trata-se de um estudo quantitativo, descritivo, tipo estudo de caso. O objetivo foi analisar a organização da rede para o atendimento de usuários de drogas a partir de um Centro de Atenção Psicossocial – Álcool e Drogas. A pesquisa foi realizada em um município da Fronteira Oeste do Rio Grande do Sul, Brasil. A coleta de dados ocorreu no período de Agosto à Dezembro de 2017 e dividiu-se em dois estágios seguindo as orientações de Blanchet e James (2011). A análise dos dados foi organizada a partir da utilização de um programa chamado Ucinet que realiza a mensuração dos dados obtidos e permite uma análise visual através da representação gráfica da rede. O estudo norteia-se pelo referencial metodológico de Análise de Redes Sociais (ARS). Os resultados apontaram a existência de 37 atores envolvidos de forma direta ou indireta no cuidado aos usuários de drogas dentro do município. Verificou-se que grande parte das métricas apresentou valores mais elevados com relação ao encaminhamento e recebimento de usuários dentro do sistema, caracterizando a maior parte dos vínculos realizados entre os atores. Por outro lado, as métricas que se referem à coordenação de casos, programas conjuntos e consultorias, que representam o grau de interação entre os dispositivos, tiveram métricas bastante inferiores. Estes resultados demonstram a dificuldade por parte da rede em atuar de forma integrada e construir possibilidades de cuidado conjuntas. O Centro de Atenção Psicossocial – Álcool e Drogas e a Estratégia Saúde da Família são alguns dos principais serviços que encaminham e também recebem demandas relacionadas aos usuários de drogas. Frente a isso, defende-se a ideia de que o trabalho em rede deve ser pautado na horizontalidade, reservando-se o papel específico de cada um deles e da importância estratégica na condução ou participação nas ações de cuidado em saúde mental. Portanto, precisamos vislumbrar a rede com a ideia de descentralização e conectividade entre os atores. Neste escopo, é preciso pensar em formas de atuação conjunta que propiciem a construção de um sistema verdadeiramente integrado e de cooperação. / It is a quantitative study, descriptive case study. The objective was to analyze the organization of the network for the care of drug users from a Psychosocial Care Center - alcohol and drugs. The survey was in a municipality in the western border of Rio Grande do Sul, Brazil. Data collection took two stages following the guidelines of blanchet and James (2011) and occurred in the period from August to December 2017. The data analysis was organized from the use of a program called ucinet that performs the measurement of the data obtained and allows a visual analysis through the graphical representation of the network. The study was guided by the methodological framework of social network analysis (SNA). The results indicated the existence of 37 actors involved directly or indirectly in the care of drug users within the municipality. It was found that great part of the metrics presented higher values with respect to the forwarding and receipt of users within the system, characterizing the majority of bonds made between the actors. On the other hand, the metrics that relate to the coordination of cases, joint programs and consultancies, which represent the degree of interaction between devices, had much lower metrics. These results demonstrate the difficulty on the part of the network to act in an integrated manner and build opportunities for joint care. The Psychosocial Care Center - Drug and Alcohol and the Family Health Strategy are some of the main services that route and also receive demands related to drug users. Face it, defends the idea that within the network there should be no hierarchy or degree of importance among the services, because each of them has its role and has different characteristics, which are fundamental to the establishment and maintenance of networking. Therefore, we need to discern the network with the idea of decentralization and connectivity between the actors. In this scope, it is necessary to think in forms of joint action that is conducive to the construction of a truly integrated system and cooperation.

As chamadas club drugs compreendem um vasto grupo de substâncias frequentemente utilizadas em bares, festas e raves, com a finalidade de intensificar o contato social e a estimulação sensorial. Englobam desde substâncias sintéticas comumente conhecidas, como a anfetamina, a metanfetamina, o MDMA, até moléculas de surgimento mais recente, denominadas novas substâncias psicoativas. Isoladas ou associadas a outras drogas, é possível que sejam causa de morte per se, ou que predisponham o usuário a envolver-se em situações potencialmente fatais, sendo necessário que os órgãos de Perícia Criminal (Institutos Médico Legais e Institutos de Criminalística) estejam aptos a detectar e quantificar essas substâncias em amostras biológicas. O presente trabalho teve como objetivo desenvolver um método analítico para identificação e quantificação de club drugs em sangue total, utilizando cromatografia líquida acoplada a espectrometria de massas com analisador híbrido quadrupolotempo de voo (LC-QTOF). Após o desenvolvimento do método, este foi validado utilizando as diretrizes do guia de validação do Scientific Working Group for Forensic Toxicology (SWGTOX), sendo analisados de linearidade, limite de detecção, limite de quantificação, efeito matriz, precisão intradia, precisão interdia, exatidão e integridade de diluição, além de recuperação e eficiência do processo. O método desenvolvido compreendeu a determinação de MDA, MDMA, 2C-B, DOB, cetamina, mCPP, cocaína e cocaetileno. Amostras provenientes de casos reais de morte não natural, oriundas do Instituto Médico Legal Aristoclides Teixeira de Goiânia - GO foram analisadas pelo método desenvolvido. 56 casos foram selecionados, em sua maioria com histórico de morte por projétil de arma de fogo e acidente de transito. Das 56 amostras analisadas, 28,5% (n=16) foram positivas para cocaína e/ou cocaetileno. As demais substâncias pesquisadas não foram encontradas nas amostras. / Club drugs are a large group of substances consumed in pubs, parties and raves, aiming to intensify social contact and sensorial stimulation. The term comprises largely known substances such as amphetamine, methamphetamine, 3,4-methylenodioxymethamphetamine (MDMA), as well as so-called new psychoactive substances, which are synthetic drugs recently developed or recently introduced in drug market. Club drugs can be taken alone, combined with each other or, most frequently, with alcohol or other commonly abused drugs such as cocaine. In any of these situations, club drugs can possibly be the cause of death or potentialize the involvement of the user with crime and potentially fatal behavior. Thus, official organisms in charge of criminal investigation must be capable of identifying and quantifying these substances in biological samples. The present work aimed the development of an analytical method to identify and quantify club drugs in whole blood, using liquid chromatography - mass spectrometry with hybrid analyzer quadrupole - time of flight (LC-QTOF). After analytical development, the method was validated according to do Scientific Working Group for Forensic Toxicology (SWGTOX) guidelines, evaluating linearity, limit of detection, limit of quantification, matrix effect, precision, intermediate precision, bias and dilution integrity, besides recovery and process efficiency. The developed method comprised MDA, MDMA, 2C-B, DOB, ketamine, mCPP, cocaine and cocaethylene determination. Real samples related to non-natural deaths were collected at Institute of the Legal Medicine Aristoclides Teixeira, Goiânia, Goiás, Brazil, and analyzed by the developed method. 56 cases were selected, most of them related to fire gun injury and traffic events, 28,5% (n=16) of them being positive for cocaine and/or cocaethylene. None of the other drugs comprised in the analysis were detected in these samples.

Objetivos: Essa tese apresentou dados de dois estudos pioneiros no país, considerando a avaliação de usuários de SPAs em tratamento e a associação entre marcadores de gravidade em usuários de crack. Método: Os dados são oriundos de dois estudos multicêntricos. Estudo 1: delineamento transversal. Foram avaliados adultos (>18 anos) em uso recente de álcool ou drogas (n=600), provenientes de locais públicos de tratamento (ambulatórios e internações). Os instrumentos aplicados foram: ASI6, WHOQOL-BREF e MINI. Estudo 2: delineamento longitudinal. Foram avaliados adultos (>18 anos) com diagnóstico de abuso ou dependência de crack (n=1100), provenientes de locais públicos de tratamento (ambulatórios e internações). Os instrumentos aplicados foram: ASI6, MINI, PCC e EGD. Resultados: No Artigo 1, os escores do ASI6 foram comparados entre usuários que nunca haviam recebido tratamento para uso de substâncias psicoativas (n=265, 36,1%) e aqueles que já haviam sido tratados em uma ou mais ocasiões (n=470, 63,9%). Essas análises revelaram diferenças significativas entre os grupos em relação ao uso de drogas, transtornos psiquiátricos, problemas legais e familiares/sociais (p0.05). No artigo 2, foi realizada uma análise de regressão entre os escores do ASI-6 e os domínios do WHOQOL-BREF, que foram examinados usando variáveis que apresentaram significância estatística na análise de correlação. Todos os problemas relacionados às diferentes áreas da vida apresentaram correlações negativas com os domínios de qualidade de vida. No artigo 3, foi desenvolvido um modelo de equações estruturais, que apresentou um bom ajuste. A gravidade do uso de crack mediou a relação entre transtorno de conduta e violência. A associação direta entre a gravidade do uso de crack e comportamento violento (=.67) foi mais baixa do que a associação entre a gravidade do uso de álcool e comportamento violento (=.68). O Transtorno de conduta afeta a gravidade do uso de crack (= .17), que impacta na violência, mediada pelo uso de álcool. Considerações finais: Em relação ao primeiro artigo apresentado, os achados evidenciam a complexidade presente no tratamento dos indivíduos com problemas relacionados ao uso nocivo de substâncias, mostrando variáveis que influenciam na gestão dos pacientes e no planejamento de intervenções. O segundo artigo verificou que a diminuição da qualidade de vida em pacientes alcoolistas não estava diretamente vinculada à gravidade do uso de álcool, mas sim a problemas comuns encontrados em amostras equivalentes, como questões médicas. O terceiro artigo desenvolveu um modelo de equações estruturais com o objetivo de explicar parte das associações entre trauma, gravidade do uso de crack, transtorno de conduta, outras comorbidades psiquiátricas, uso de álcool e violência, variável esta posta como desfecho. A associação direta entre a gravidade do uso de crack e comportamento violento foi menor do que entre a gravidade do uso de álcool e comportamento violento. O transtorno de conduta afetou a gravidade do uso de crack, variável esta que impacta na violência mediada pelo álcool. Espera-se que esses estudos contribuam para um planejamento de intervenções terapêuticas mais adequadas e para o desenvolvimento de estratégias de prevenção e políticas públicas que protejam esse indivíduo, contemplando os vários aspectos de sua vida. / Introduction: This thesis presented data from two pioneering studies in the country regarding the evaluation of substance users in treatment and the association between markers of severity in crack users. Objectives: The aims were to identify characteristics of drug users under treatment, with an emphasis on severity of problems, drug that motivated seeking treatment, and quality of life in alcoholics, as well the relations between traumatic events, psychiatric comorbidity, severity of crack use and violence in crack users. Method: Data were obtained from two multicenter studies. Study 1: cross-sectional design. Adults (> 18) of a public treatment system, with recent use of alcohol or drugs (n = 600) were evaluated. The instruments applied were: ASI6, WHOQOL e MINI. Study 2: longitudinal design. Adults (> 18) from a public treatment system, diagnosed with crack abuse or dependence (n = 1100) were evaluated. The instruments applied were: ASI6, MINI, PCC and EGD. Results: Paper 1: The SS-Rs were compared between users who had never received treatment for psychoactive substance abuse (n=265, 36.1%) and those who had already been treated for substance abuse in one or more occasions (n=470, 63.9%). This analysis revealed significant differences between the groups in the drug, psychiatric symptoms, legal, and family/social problems areas (p0.05). Paper 2: The regression analyses between the ASI-6 summary scores and the WHOQOL-BREF domains analyzed variables that presented statistical significance in the correlation analysis. All problems related to the different areas of life showed negative correlations with QoL domains. Paper 3: The path model corresponding to the study constructs indicated a good fit to the data. Severity of crack use mediated the relationship between conduct disorder and violence. The direct association between the severity of crack cocaine use and violent behavior (estimate =.67) was lower than the association between the severity of alcohol use and violent behavior (estimate =.68). Conduct disorder affects the severity of crack use (estimate = .17), which impacts violence mediated by alcohol. Conclusions: The findings highlight the complexity involved in the treatment for individuals with problems related to harmful substances use, showing variables that influence in interventions planning. We found that the decreased quality of life in alcoholics was not directly linked to the severity of alcohol use, but to the common problems found in similar samples, like medical issues. According to the structural equation model, conduct disorder affected the severity of crack use, which impacted violence mediated by alcohol. It is expected that these studies contribute to shape appropriate therapeutic interventions planning and the development of public policies and prevention strategies that protect individuals, considering the various aspects of life.