Jogo Patológico e Dependência Química são transtornos psiquiátricos que apresentam relevante relação com avidez e estados afetivos. Inevitavelmente, a avaliação destes fenômenos nas dependências químicas sofre o viés da ação farmacológica da substância sobre o humor. Jogo Patológico vem sendo considerado uma dependência comportamental e um modelo promissor na investigação psicológica e contextual de fenômenos presentes nos diagnósticos de dependências. O estudo aprofundado da relação entre avidez e afetos em jogadores patológicos e a comparação dos mesmos com dependentes químicos contribuirá para melhor caracterização do Jogo Patológico e dos tratamentos relacionados / Pathological Gambling (PG) and Chemical Dependence (CD) are psychiatry disorders that have relevant relation with craving and affects. These phenomenons have been investigated in CD, however craving and affects among gamblers did not receive the same attention. Unavoidable, the study of these phenomenons on CD are under the substance related action influence. Craving and affects would be better understood on a disorder that shares the same addictions patterns without the presence of a psycho-active. PG has been described by literature as an addictive behavior. The parallels between Substance Disorders and PG are quite pronounced. PG as a promise model to comprehend the evolving process related to addiction. This investigation might enhance PG clinical characterization and treatment improvement

Submitted by Renata Lopes (renatasil82@gmail.com) on 2017-09-20T11:17:04Z No. of bitstreams: 1 pedrohenriqueantunesdacosta.pdf: 2575894 bytes, checksum: 3cb7ee6cfca37606a04d0c3af54f2eb3 (MD5) / Approved for entry into archive by Adriana Oliveira (adriana.oliveira@ufjf.edu.br) on 2017-09-22T15:10:33Z (GMT) No. of bitstreams: 1 pedrohenriqueantunesdacosta.pdf: 2575894 bytes, checksum: 3cb7ee6cfca37606a04d0c3af54f2eb3 (MD5) / Made available in DSpace on 2017-09-22T15:10:33Z (GMT). No. of bitstreams: 1 pedrohenriqueantunesdacosta.pdf: 2575894 bytes, checksum: 3cb7ee6cfca37606a04d0c3af54f2eb3 (MD5) Previous issue date: 2017-08-18 / Por meio da presente tese, objetivo o empreendimento de uma compreensão abrangente sobre as redes de atenção aos usuários de drogas no Brasil, entendendo seus fundamentos teórico-conceituais e marcos políticos, mas também como se conformam na prática. O trabalho encontra-se estruturado em três capítulos. O primeiro consiste numa tentativa de compreender e sinalizar possibilidades de abordagem às drogas na contemporaneidade brasileira. O segundo diz respeito à análise de conteúdo temática das atuais políticas e principais aparatos normativos-legais brasileiros sobre drogas, visando elucidar suas conceituações e caracterizações sobre as redes de atenção aos usuários de drogas, assim como algumas de suas categorias centrais, traçando possíveis contradições e potencialidades. Já o terceiro capítulo refere-se a um estudo empírico que avaliou a rede de atenção em sua concretude prática, no município de Juiz de Fora, Minas Gerais, tomando como proposta avaliativa a Análise de Redes Sociais. Foi constatada uma série de proximidades e distanciamentos entre as políticas e a rede na prática, bem como entraves no estabelecimento da integralidade e intersetorialidade e uma rede altamente centralizada no CAPSad. Observou-se também uma predominância no estabelecimento de relações de referência e contrarreferência de usuários, em detrimento da coordenação conjunta de casos e realização de programas em conjunto. Aponta-se para a necessidade de modificação da lógica de encaminhamentos, especialmente para os dispositivos especializados e de urgência/emergência, em direção ao cuidado compartilhado. Uma maior articulação entre os Sistemas Único de Saúde (SUS) e Assistência Social (SUAS) também é colocada, sobretudo na realização de programas e ações institucionais que vão para além do cuidado pontual. Conclui-se que as redes de atenção aos usuários de drogas são arranjos ainda recentes, abordando uma temática demasiadamente complexa e heterogênea, não se conformando, portanto, como estratégias prontas, estáticas, definitivas, mas que vão sendo moldadas ao longo do tempo. Nesse sentido, são necessárias algumas modificações advindas desde as políticas e aparatos normativos na área para que possam, posteriormente, reverberar positivamente na prática, possibilitando o fortalecimento das redes de atenção aos usuários de drogas. / Within the present thesis, I aim to undertake a comprehensive understanding on care networks for drug users in Brazil, understanding their theoretical and conceptual fundamentals and policy frameworks, but also how they conform in practice. The work is structured in three chapters. In the first, we try to comprehend and point out approach possibilities to drugs in its Brazilian contemporary form. The second one is the thematic content analysis of Brazil’s current policies and main normative-legal apparatus on drugs, to elucidate their conceptualizations and characterizations of the care networks for drug users, as well as some of its core categories, tracing possible contradictions and potentials. The third chapter refers to an empirical study that evaluated the care network in their practical concreteness, specifically the network of Juiz de Fora, Minas Gerais state, using Social Network Analysis as the assessment strategy. A series of close aspects and differences between policies and the network in practice were found. Barriers were identified in establishing the premises of integrality and intersectionality, as well as a highly centralized network in CAPSad. There was also a predominance to establish referral and counter-referral, instead of joint coordination cases and implementation of programs together. It points out to the need for modification of this forwarding and referral logic, especially for specialized and emergency services, towards shared care. Greater coordination between health and social assistance sectors is also placed, especially in carrying out institutional programs and actions that go beyond the occasional care. We conclude that the care networks for drug users are still recent arrangements, addressing an overly complex and heterogeneous theme, not conforming, therefore, as ready, static, and final arrangements, but they are being molded over time. In this sense, it takes some modifications resulting from the policies and regulatory apparatus in the area so that they can subsequently reverberate positively in practice, enabling the strengthening of care network to drug users.

Orientador: Renata Cruz Soares de Azevedo / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-21T18:34:02Z (GMT). No. of bitstreams: 1 Padilha_VitoriaMantoan_M.pdf: 5585179 bytes, checksum: 8135afde8664df21e30065b191cc727b (MD5) Previous issue date: 2012 / Resumo: O consumo e a dependência de substâncias psicoativas (SPA) representam um importante fator de risco de morbi-mortalidade no mundo todo. A literatura internacional mostra que 20% dos pacientes que procuram as Unidades de Emergência (UE) são usuários ou dependentes de SPA. Para a maioria destes pacientes, a UE é o único provedor de cuidados médicos, o que mostra a importância de se aproveitar esse tipo de serviço para uma abordagem inicial e encaminhamento para tratamento. Objetivos: Descrever o perfil de pacientes com transtornos relacionados ao uso de SPA atendidos pela Psiquiatria em serviço de emergência, compará-los com o demais pacientes atendidos pela Psiquiatria e avaliar intervenção a partir do atendimento de emergência, comparando os pacientes que receberam com os que não receberam a intervenção, quanto aos desfechos redução do uso de SPA e busca de tratamento em 30 e 90 dias. Método: Estudo descritivo e quantitativo, que levantou dados de pacientes atendidos pela Psiquiatria na Unidade de Emergência Referenciada (UER) do HC-UNICAMP, detectou os pacientes atendidos com transtornos por uso de SPA e realizou seguimento longitudinal. Durante o período de maio de 2010 a maio de 2011, todos os pacientes atendidos pela psiquiatria na UER do HC-UNICAMP com transtornos por uso de SPA foram convidados a participar do grupo de intervenção (GI). Após 30 e 90 dias, todos os pacientes, os que compareceram e os que não compareceram ao grupo (GNI), foram avaliados quanto à redução do consumo de SPA e busca por tratamento. Resultados: Durante o período, 1.465 pacientes foram atendidos pela Psiquiatria da UER. Encontrou-se predomínio de mulheres (53,7%), idade média de 37 anos e brancos (79,6%). Os diagnósticos mais frequentes foram transtornos relacionados a SPA (23%) e transtornos depressivos (18,5%). Entre os pacientes com transtornos por uso de SPA, o perfil se constituiu de homens (79,1%), idade média de 34,9 anos, cor branca (78,6%), sem ocupação regular (65,3%) e provenientes de demanda espontânea (65,2%). Quando comparados com os demais pacientes atendidos pela Psiquiatria, os usuários de SPA eram mais jovens, receberam mais medicações na UE, porém menos psicofármacos e foram mais encaminhados para serviços especializados. Compareceram ao GI 123 pacientes (35,1%). A maioria desses pacientes era dependente de álcool (73,1%). Entre os pacientes que não compareceram ao grupo, a taxa de comorbidades psiquiátricas foi maior, assim como o histórico de internações psiquiátricas e taxas maiores de dependência de crack. No seguimento de 30 e 90 dias, a redução do uso de SPA foi significativamente maior entre os pacientes do GI, assim como a busca por tratamento em 30 dias e em 90 dias. Ser dependente de crack esteve associado ao aumento do risco de não reduzir o uso de SPA em 90 dias. Conclusão: O grupo de intervenção se mostrou instrumento terapêutico eficaz na redução do uso de SPA e busca por tratamento após 30 e 90 dias, principalmente para os pacientes com dependência a álcool e sem comorbidade psiquiátrica / Abstract: The use and addiction to psychoactive substances (PAS) represent an important risk factor for morbidity and mortality worldwide. The international literature shows that 20% of patients seeking Emergency Unit (EU) are addicted or users of PAS. For most of these patients, the EU is the only provider of medical care, which shows the importance of taking this opportunity to use this type of service for an initial approach and referral for specific treatments. Objectives: Describe the profile of patients with disorders related to psychoactive substances use attended by the Psychiatry Service in the Emergency Unit, and evaluate the intervention given, starting from the care provided by EU and comparing the patients who received intervention with those who did not, regarding the outcomes reduction of psychoactive substances use and treatment-seeking in 30 and 90 days. Methodology: A descriptive and quantitative study that collected data of all patients attended by the Psychiatric Emergency Unit at UNICAMP Clinical Hospital, due to PAS use disorders and conducted longitudinal studies. During this period the patients with PAS use disorders were invited to join the support group of the patients attended by the UER, Intervention Group (IG). After 30 and 90 days, all patients, who attended and those who did not attend the group (NIG), were evaluated regarding the reduction in psychoactive substance use and search for treatment. Results: During the study period, 1465 patients were seen by the EU Psychiatric. We found a predominance of women (53,7%), mean age 37 years and white (79,6%). The most common diagnoses were substance use disorders (23%) and depressive disorders (18,5%). Among the patients with psychoactive substance use disorder, the profile consisted of men (79.1%), averaging 34.9 years old, caucasian (78.6%), with no regular occupation (65.3%) and from spontaneous demand (65.2 %). When compared with other patients seen by psychiatry, users of PAS were younger, received more medications in the EU, but less psychoactive and were more referred for specialized services. 123 patients (35.1%) attended the IG. Most of these patients were alcohol dependent (73.1%). Among patients who did not attend the group (NIG), the rate of psychiatric comorbidity was higher, as well as the history of psychiatric hospitalizations, and higher rates of crack addiction. In the following 30 and 90 days, the reduction of PAS use was higher among patients who attended the IG at 30 and 90 days as well as the search for treatment in 30 days and 90 days. Crack addiction was associated with the increased risk of not reducing the use of psychoactive substances in 90 days. Conclusion: The intervention group presented itself as an effective therapeutic tool to reduce the use of psychoactive substances abuse and promote treatment-seeking after 30 and 90 days, especially for patients with alcohol dependence and without psychiatric comorbidity / Mestrado / Saude Mental / Mestre em Ciências Médicas

La rencontre des patients addictés suscite fréquemment l’inquiétude. Celle-ci rend difficile l’exercice du soin, même spécialisé, et attaque ses conditions éthiques. Cette thèse se propose d’explorer l’expérience des professionnels de l’addictologie, dans la diversité de leurs approches et de leurs pratiques. Elle s’inscrit dans une épistémologie de la complexité et adopte une méthodologie complémentariste. Des discours socio-anthropologiques, philosophiques et psychanalytiques peuvent ainsi être mis en contact au profit d’une appréhension plurivoque de la problématique éthique et clinique de la relation de soin en addictologie. Dans un premier temps, nous avons exploré de manière qualitative l’expérience des soignants. L’étude « Éthique et Narrativité dans les Addictions » (EthNaA) nous a apporté de nombreuses données sur les sources et les effets de l’inquiétude dans le soin, ainsi que sur des voies de dégagement. Une lecture psychodynamique de ces résultats nous a permis d’extraire une première théorie de la relation de soin : dans la rencontre, soignant et patient se replient sur des positions narcissiques qui déterminent leurs représentations de l’autre et d’eux-mêmes, ainsi que leur modalités de lien ; alternativement monstres et héros, les acteurs s’agrippent et se rejettent dans un climat de défiance qui infiltre tous les espaces ; dans la douleur de cette expérience et dans la conscience des conséquences éthiques pour le patient, les professionnels cherchent des moyens de restaurer une confiance dans un soin de soi et une recherche de soutien à l’ « extérieur », sans toutefois pouvoir s’y engager. Dans un second temps, en tant qu’acteur de ce soin, il était nécessaire que nous présentions notre propre expérience, ainsi que des histoires cliniques, pour pouvoir prétendre soutenir un discours éthique. Cette expérience est très proche de celle des soignants d’EthNaA mais son exposé a permis de souligner l’ancrage intrapsychique des mouvements affectifs décrits précédemment. Cela nous a mis sur la voie d’une seconde théorie capable de soutenir des propositions de nature à restaurer le soin dans ses qualités éthiques et cliniques. La « relation inquiète » met en présence un patient souffrant dans une attente silencieuse, et un soignant désireux de s’investir mais vulnérable, en premier lieu du fait d’un affaiblissement de la fonction tierce en lui comme dans son cadre institutionnel. La relation de soin s’enferme alors dans une circularité qui évoque le cercle des attitudes de Jean-Paul Sartre, entre masochisme, haine, sadisme et amour. Cet amour, présent dans le discours des soignants, reste replié sur soi et défiant. Nous avons alors repris les idées des professionnels d’EthNaA et les avons complétées en proposant un souci de soi, resubjectivant et allié à un réinvestissement de la fonction tierce intériorisée. Cette nouvelle prise de position soignante, dans une affirmation du primat du tiers, doit permettre une reconnaissance de l’autre-patient comme sujet propre. Ce « jeu » entre les protagonistes doit s’inscrire dans une éthique simultanément exigeante et tolérante. La piste « amoureuse » ouverte par les soignants d’EthNaA peut alors rejoindre l’éthique de Vladimir Jankélévitch. La relation de soin entre deux sujets restaurés peut alors se relancer – portée par une nouvelle dialectique entre soin de soi et amour de l’autre, entre inquiétude saisissante et élancement, entre défiance et confiance – sur une trajectoire sinueuse et parfois chaotique, mais qui donne finalement au soin le dernier mot. / The encounter with addicted patients frequently arouses a feeling of disquiet. It renders the practice of care difficult, even in expert settings, and degrades its ethical conditions. The present work explores the experience of professionals from the field of addictions treatment taking account of the diversity of their approaches and practices. It is in line with an epistemology of the complexity and adopts a complémentariste methodology. In this way, sociological, philosophical and psychoanalytical theoretical corpus can be put in discussion in order to comprehend the complexity of the ethical and clinical questions emerging from the care relationship.In a first phase, we conducted a qualitative inquiry of the caregiver’s experience. The study “Éthique et Narrativité dans les Addictions” (EthNaA) provided us with numerous data on sources and effects of disquiet in the care setting, as well as on ways out. A psychodynamical reading of these results led us to a first theory of the care relationship: in the encounter, the caregiver and the patient both withdraw on narcissistic positions which determine how they depict one another and themselves, as well as their ways of establishing mutual bounds; alternatively monsters and heroes, the protagonists grab onto each other and reject each other in a climate of distrust which infiltrates all the areas of the relationship; through the pain of this experience and the consciousness of the ethical consequences for the patient, the caregivers seek resources allowing them to restore a trust by taking care of themselves and looking for support from the “outside”, but they still seem unable to commit themselves in this move.In a second phase, as a professional enrolled in the care of addicted patients, it was necessary that we exhibit our own experience and clinical stories in order to support an ethical stand. Our experience is very similar to the caregiver’s in the study but its report allowed us to underline the intrapsychic integration of the emotional dynamics previously described. It opened the way of a second theory able to support innovative propositions likely to restore the care in its ethical and clinical qualities.The “disquiet relationship” brings a suffering patient in a silent expectation face to face with a caregiver, willing to get involved but vulnerable, in the first place because of the weakening of the function of the third position in the caregiver’s thought as well as in the institutional frame. The care relationship then locks itself in a circularity witch evokes the circle of attitudes described by Jean-Paul Sartre among masochism, hatred, sadism and love. This love, present in the caregiver’s discourses, remains withdrawn into itself and distrustful. We then started again from the caregiver’s ideas, completing them by introducing a care of the self able to restore the subjectivity of the agent through its combination with the reinvestment of the function of the third position in the caregiver’s thought. This new caring stand, through the assertion of the primacy of the third position, shall allow the acknowledgement of the patient as a subject. This “play” between protagonists shall place itself in an ethic simultaneously demanding and tolerant. The “amorous” track opened by the caregivers of the study can then rejoin the ethic of Vladimir Jankélévitch. The care relationship between two restored subjects can then make a fresh start – supported by a new dialectic between care of the self and love of the other, between piercing disquiet and anxious yearning, between distrust and trust – on a sinuous and sometimes chaotic trajectory, but which finally gives to the care the last word.

Submitted by Renata Lopes (renatasil82@gmail.com) on 2016-01-28T16:52:33Z No. of bitstreams: 1 pedrohenriqueantunesdacosta.pdf: 1974309 bytes, checksum: b45c82f4275121658a223104d5a2477c (MD5) / Approved for entry into archive by Adriana Oliveira (adriana.oliveira@ufjf.edu.br) on 2016-01-29T11:01:23Z (GMT) No. of bitstreams: 1 pedrohenriqueantunesdacosta.pdf: 1974309 bytes, checksum: b45c82f4275121658a223104d5a2477c (MD5) / Made available in DSpace on 2016-01-29T11:01:23Z (GMT). No. of bitstreams: 1 pedrohenriqueantunesdacosta.pdf: 1974309 bytes, checksum: b45c82f4275121658a223104d5a2477c (MD5) Previous issue date: 2014-06-18 / CAPES - Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Atualmente no Brasil, quando se aborda o cuidado aos usuários de drogas o termo rede rapidamente emerge à tona. Assim, é necessária uma maior compreensão sobre o que seriam as redes de atenção aos usuários de drogas, seus obstáculos e potencialidades, procurando entender os fatores que influenciam a forma como as políticas reverberam na realidade. Dessa forma, o presente estudo objetivou realizar um mapeamento e análise da rede de atenção aos usuários de drogas de Juiz de Fora, Minas Gerais, desenvolvendo método a ser utilizado em outros contextos nacionais e internacionais. O método foi desenvolvido através do contato com secretarias gestoras municipais, conselhos locais, coleta de informações em bases de dados ministeriais e amostragem bola de neve. Foram identificados 184 serviços assistenciais aos usuários de drogas. Apesar da heterogeneidade de dispositivos e abordagens, existe uma hegemonia de oferta de serviços não governamentais especializados na assistência aos usuários de drogas. Os seguintes pontos são destacados: necessidade de ampliação da rede de atenção básica; implantação de mais Centros de Atenção Psicossocial para álcool e drogas; expansão da rede atenção psicossocial; reestruturação da atenção a grupos populacionais, como população em situação de rua, mulheres, crianças e adolescentes; ampliação da rede de urgência e emergência; e maior distribuição/regionalização dos serviços, principalmente os governamentais especializados. São necessários novos estudos para as redes de atenção aos usuários de drogas no país, com pesquisas que também abarquem aspectos relacionais. / Currently in Brazil, when discussing care for drug users the term network quickly emerges. Therefore, a greater understanding of what would be the networks of care for drug users, their obstacles and potential, seeking to understand the factors that influence how policies reverberate in reality is needed. Thus, the present study aimed to map and analyze the network care for drug users in Juiz de Fora, Minas Gerais, developing method to be used in other national and international contexts. The method was developed through contact with local management secretaries, local councils, gathering information on Ministries’ data bases and snowball sampling. One hundred eighty four care services for drug users were identified. Despite the heterogeneity of services and approaches, there is hegemony of non-governmental specialized services in the assistance for drug users. The following points are highlighted: the need for expansion of primary health care; implantation of more Psychosocial Centers for alcohol and drugs; expansion of the network of psychosocial care; restructure of the attention to population groups such as people on the streets, women, children and adolescents; expansion of the emergency network care; and the better distribution/regionalization of services, mainly the governmental specialized for drug users. Further studies are needed for care networks to drug users in the country, with research that also encompass relational aspects.

Background: One in ten people in the U.S. are affected by a substance use disorder (SUD), roughly one third of whom are women. Rates of unintended pregnancy are higher in this population than in the general public. Little is understood about how women with SUD use prescription contraception and think about pregnancy. Methods: By analyzing Medicaid claims data and conducting qualitative interviews with women with SUD, this doctoral thesis seeks to: 1) compare any use of and consistent, continued coverage by prescription contraceptives between women with and without SUD; 2) determine the extent to which SUD is associated with pregnancy, abortion, and adverse feto-maternal outcomes in women who use prescription contraception; and 3) explore facilitators of and barriers to contraceptive utilization by women with SUD, using qualitative interviews. Results: Compared to women without SUD, women with SUD are less likely to use any prescription contraceptive, particularly long-acting reversible methods. Among women who do use long-acting methods, SUD is associated with less continued, consistent coverage by a prescription contraceptive. Among women who use contraception, SUD is also associated with increased odds of abortion. When interviewed, women with SUD report fatalistic attitudes towards pregnancy planning, and have difficulty conceptualizing how susceptibility to pregnancy may change over time. Women with SUD also report that pregnancy has substantial impact on their drug treatment prospects. Conclusions: This study is the first to examine contraceptive utilization by women with SUD who are enrolled in Medicaid or state-subsidized insurance. Our study may help to inform clinical practice and policy development to improve the reproductive health and wellbeing of women with SUD.

Although the problem of patients with dual diagnoses is not new, it has only been in the last few years that their unique and complex problems have begun to be addressed. This recognition coincides with society's concern regarding the magnitude of substance abuse problems in general. Currently, treatment consists of integrating concepts from substance abuse and mental health fields. This integration may improve the therapeutic outcome for these patients. As more experience is gained in this specialty, it is hoped that new treatment concepts will evolve that will more powerfully address the interactive aspect of substance abuse and psychiatric disorders.

No description available.

INTRODUÇÃO: A dependência química engloba alterações comportamentais, cognitivas e fisiológicas. A impulsividade está presente em muitos transtornos psiquiátricos. Sobre a impulsividade na dependência química de cocaína, os estudos existentes são relativamente novos. A Estimulação Magnética Transcraniana de repetição (EMTr) é um método capaz de neuromodular o cérebro. Este estudo avaliou os efeitos da EMTr sobre a impulsividade em dependentes de cocaína. MÉTODOS: Em um estudo randomizado, duplamente encoberto, 25 pacientes diagnosticados pelo DSM-IV-TR foram tratados com EMTr de alta frequência ativa (1250 pulsos/dia) ou EMTr placebo. O tratamento consistiu em 1 mês de aplicação de EMTr seguido de 2 meses em acompanhamento ambulatorial semanal em um grupo de prevenção de recaídas. Os pacientes foram avaliados antes do início do tratamento com EMTr (T0) e após o término das aplicações (T1), através dos instrumentos: The Shorter PROMIS Questionnaire, The Schalling Impulsivity Scale e The Leeds Dependence Questionnaire. RESULTADOS: 25 pacientes foram tratados e a análise dos dados demonstraram redução nos índices de impulsividade em ambos os grupos ao longo do tempo, porém, quando comparados entre si, os valores de interação não se mostraram significativos. CONCLUSÃO: Os efeitos da EMTr não diferiram em eficácia terapêutica na redução da impulsividade em dependentes de cocaína, com o efeito ativo correspondendo com o placebo / INTRODUCTION: Chemical addiction involves behavioral, cognitive and physiological alterations. Impulsivity is present in many psychiatric disorders. Studies about impulsivity and cocaine chemical addiction are relatively new. Transcranial Magnetic Stimulation (EMTr) is a method capable of neuromodulation the brain. This study evaluated the effects of EMTr over impulsivity in cocaine addicts. METHODS: This is a randomized doubly covert study with 25 patients diagnosed by the DSM-IV-TR who were treated with active high frequency EMTr (1250 pulses/day) or placebo. Treatment was consisted of one month of application of EMTr followed by 2 months of clinical follow-up in a relapse prevention group. Patients were evaluated before the treatment with EMTr (T0) and after the end of the applications (T1), through the instruments: The Shorter PROMIS Questionnaire, The Schalling Impulsivity Scale and The Leeds Dependence Questionnaire. RESULTS: 25 patients were treated and data analysis showed a reduction in the levels of impulsivity in both groups throughout the time. However, group comparisons did not show statistical differences. CONCLUSION: EMTr\'s effects did not differ in terms of therapeutical efficacy in the reduction of impulsivity in cocaine addicts

Made available in DSpace on 2011-05-04T12:36:25Z (GMT). No. of bitstreams: 0 Previous issue date: 2010 / Esta dissertação tem como objetivo compreender o processo de recuperação do uso indevido de drogas vivido por fiéis da igreja pentecostal Assembleia de Deus de uma comunidade popular da cidade do Rio de Janeiro. Fez-se uso do método qualitativo, por meio da utilização de entrevistas semi-estruturadas e observação participante, considerando a visão do fenômeno dos indivíduos que estão neste processo. Foram entrevistados em profundidade 10 participantes de igrejas Assembleia de Deus (AD) que buscaram o local por problemas relacionados ao uso indevido de drogas. Observou-se que a busca pelo tratamento religioso decorre do respeito que os sujeitos e a comunidade têm pelos fiéis da AD, do envolvimento dos familiares dos usuários de droga com a igreja a fim de conseguir ajuda para tirá-los desta situação, da busca ativa que a igreja faz dos mesmos para lhes propor um novo estilo de vida e da crise existencial decorrente da perda de controle sobre o uso da droga e de problemas relativos ao tráfico. Foi demonstrado que a igreja faz o trabalho de recuperação do uso indevido de drogas visando à cura das almas e não ao tratamento em si, como meio de transformar a sociedade pela transformação de seus indivíduos, um a um. Durante o processo de recuperação, o sujeito se identifica com outros significativos que lhes oferecem uma estrutura de plausibilidade para que possam aprender um novo modo de interpretar o mundo e de estar nele. O indivíduo afasta-se dos antigos companheiros de droga ou de tráfico e passa a redefinir sua biografia em termos de antes e depois da conversão. As dificuldades de relacionamento dentro da igreja são apontadas como o maior fator de desmotivação para a permanência neste grupo. A conclusão do estudo é de que tanto a categoria pessoa como indivíduo são utilizadas no processo de recuperação. Como pessoa, o sujeito está subordinado à consciência coletiva da igreja que lhe dita as regras do modo correto de pensar, interpretar os textos sagrados e se comportar, além de dizer como a realidade se estrutura. Também passa a pertencer a uma rede de relações que lhe oferece um tratamento diferenciado, expresso especialmente pelo apoio social. Como indivíduo, ele é responsável por suas escolhas, desde o uso de drogas, como pela busca e adesão ao tratamento, a ele e pela recaída. Sua auto-estima é fortalecida pelo desenvolvimento de potencialidades e pelo respeito que adquire perante a comunidade. Sua individualidade se expressa na margem de manobra que tem em relação ao seu novo papel socialmente predefinido. O trabalho aponta a possibilidade de diálogo e colaboração entre a AD e os profissionais de saúde na questão das drogas, pois, embora a exigência de abstinência como único resultado possível do tratamento feita pela igreja divirja do paradigma de Redução de Danos adotado pela Política do Ministério da Saúde para a Atenção Integral a Usuários de Álcool e Outras Drogas, esta instituição tem contribuído na prevenção, recuperação e reinserção dos mesmos à sociedade, que são objetivos desta política. / This thesis aims to understand the recovery process of drug misuse experienced by followers of pentecostal church Assembleia de Deus (Assembly of God) in a popular community of Rio de Janeiro. We used the qualitative method, through the use of semistructured interviews and participant observation, considering the vision of the phenomenon of individuals who are in the process. Ten participating of Assembleia de Deus (AD) were interviewed in depth, they sought this place due to problems related to drug misuse. It was observed that the search for religious treatment stems from the respect the individuals and the community have for the followers of AD, the involvement of family members of drug addicts with the church to get help to get them out of this situation, the active search the church does for them to offer them a new life style and the existential crisis resulting from the loss of control over drug use and problems related to drug dealing. It has been shown that the church does the work of recovery from drug misuse in order to "cure souls" and not the treatment itself, as a means to transform society by transforming its individuals, "one by one." During the recovery process, the individual identifies with "significant others" that provide them with a structure of plausibility in order to learn a new way of interpreting the world and being in it. The individual gets away from old addicted friends or from drug dealing and begins to redefine their biography in terms of "before" and "after" the conversion. The difficulties of relationships within the church are identified as a major factor of lack of motivation for staying in this group. The conclusion of the study is that both the category person and individual are used in the recovery process. As a person, the individual is subordinate to the collective consciousness of the church that rules the right way to think, interpret the sacred texts and behave, besides saying how reality is structured. They also start to belong to a network of relationships that offers them a different treatment, expressed especially by social support. As an individual, they are responsible for their choices, from the use of drugs, to the quest for treatment, adherence to it and relapse. Their self-esteem is strengthened by the development of abilities and the respect they acquire in the community. Their individuality is expressed in the margin of maneuver it has in respect to their new role socially predetermined. The work shows the possibility of dialogue and collaboration between AD and the health professionals of drug issue, because although the requirement of abstinence as the only possible result of treatment made by the church diverges from the paradigm of Harm Reduction adopted by the Health Department Politic About Tottaly Attention With Alcohool and Other Drugs Users, this institution has contributed to the prevention, recovery and reintegration into society of those who are targets of this policy.