REVIEW ARTICLE

 

Perception of the family regarding the treatment of drug users: integrative review^*

 

 

Cristiana Nelise de Paula Araujo^I; Clarissa Mendonça Corradi-Webster^II

^IUniversidade de São Paulo, Faculdade de Filosofia, Ciências e Letras de Ribeirão Preto (FFCLRP), Ribeirão Preto, SP, Brazil
^IIUniversidade de São Paulo, Faculdade de Filosofia, Ciências e Letras de Ribeirão Preto (FFCLRP), Ribeirão Preto, SP, Brazil

Corresponding Author

 

 

---

ABSTRACT

OBJECTIVE: to carry out an integrative review of national literature regarding the treatment of users of alcohol and other drugs from the perspective of their family members.
METHOD: an integrative review of the national literature was performed in the Virtual Health Library, and Portal of Periodicals of the Coordination of Improvement of Higher Level Personnel portals, Web of Science, The Cumulative Index to Nursing and Allied Health Literature, and PsycINFO databases. After analysis of the studies retrieved, 21 studies were selected.
RESULTS: the literature showed that outpatient services were recognized by family members as important for improving family relationships and the health conditions of the drug user. They also felt it was important to include the family members in the treatment to help drug users. However, studies demonstrated the difficulties of these services to fulfill the present requirements, barriers to treatment access, and lack of knowledge regarding these services, contributing to them seeking internments, including compulsory ones.
CONCLUSION: it is necessary to expand the outpatient services and provide support for the family members of drug users.

Descriptors: Family; Drug Abuse; Substance Abuse Treatment Centers; Treatment Outcome.

---

 

 

Introduction

Family involvement in the care for people that use alcohol and other drugs began to be understood in a different way due to the Psychiatric Reform (PR) movement. The family and the community were recognized as partners in caring for people who had received a psychiatric disorder diagnosis^(1-2), with the same being true for people who used alcohol and other drugs. The participation of the family in the treatment of these people began to be valued and stimulated by the health services and healthcare providers. Family members and users, together with the workers, began to play an active role in the transformations of the mental health field and in the PR, when they organized themselves as the anti-asylum movement⁽³⁾. Accordingly, the PR movement favored the promulgation of Law No. 10.216⁽⁴⁾, legislation that established the priority for treatment in outpatient services and the exceptional application of brief and motivated hospitalizations.

Aiming to strengthen community care, the Ministry of Health created the Psychosocial Care Network (Rede de Atenção Psicossocial - RAPS)⁽⁵⁾. This network is composed of the articulation of different primary health, specialized, urgent and emergency, transitory residential and hospital care services that must guarantee the health promotion, rehabilitation and social reintegration of the people who have received any mental disorder diagnosis⁽⁵⁾.

The Psychosocial Care Centers-alcohol and drugs (Centros de Atenção Psicossocial - CAPSad) are the main axis of articulation of this network for users of alcohol and other drugs and are composed of multidisciplinary teams that, in collaboration with the users and their families, aim to construct the individual therapeutic project, considering the needs and singularities of each person. The CAPSad are outpatient services that offer specialized daily care for those who use alcohol and other drugs, supported by the logic of harm reduction⁽⁵⁾. Harm reduction constitutes an alternative proposal to the emphasis on the internation of drug users, considering the establishment of abstinence as a goal that hinders access to health services⁽⁶⁾ for those who cannot or do not want to achieve this goal.

Within the RAPS, it is understood that family members should be seen as partners in the treatment of CAPSad users, considering the importance of actions that seek to guide and discuss the user's treatment with family members, as well as specific care actions required by the family members concerning the suffering and burden⁽⁷⁾. The family members of people who use alcohol and other drugs also need emotional care because they experience a variety of feelings such as anger, fear, worry and despair, which contribute to the development of physical and mental health problems⁽⁸⁾. In addition, many drug users do not seek treatment because they do not consider their drug use to be problematic, with the family members being the main actors involved in seeking treatment⁽⁹⁾.

However, in practice, the number of community services and their interventions are insufficient to meet the needs of the users and family members^(10-12). Family members are commonly included in outpatient services as mere informants for collecting information about the patient's symptomatic condition, having a passive role in the treatment and being often seen by the services as resistant to the proposed treatment⁽¹¹⁾.

Another challenge to the expansion and implementation of the RAPS is the difficulty of breaking with the historical logic of the financing of a system that provides internation places as the public policy in the field of alcohol and other drugs, an action that was mainly performed through the Federal Program "Crack, it is Possible to Win"⁽¹³⁾. In this context, the burden experienced by many family members when faced with the problem⁽¹⁴⁾, the lack of knowledge about the existence and lack of access to outpatient services, such as CAPSad⁽¹⁵⁾, are issues that may influence drug users seeking internation. Often, the family members are the main companions in situations of voluntary and involuntary hospitalization, and in most cases, it is the family members that requested the hospitalization⁽¹⁶⁾.

Accordingly, the need is emphasized for practices that increase the active participation of the people who use alcohol and other drugs and their families in the decision-making and in the course of the treatment in order to promote health and prevent iatrogenic treatments such as those based on social exclusion. It is therefore important to identify the scientific production to better comprehend how the family constructs meanings about the treatment and about the services that offer treatment for users of alcohol and other drugs, in order to analyze the contributions and difficulties observed in the consultations and how these meanings affect seeking treatment by the family and the users. Thus, this study aimed to perform an integrative review of the national literature regarding the treatment of users of alcohol and other drugs from the perspective of their family members.

 

Method

This was an integrative review study of the national literature. The integrative review allows the analysis and synthesis of the results regarding the topic of interest, as well as the observation of gaps in the field of study researched and the investigation of the need for new studies⁽¹⁷⁾.

The following question guided the review process: What does the national literature present regarding the treatment of users of alcohol and other drugs from studies in which the sample consisted of family members of these users?

Data collection was performed in February 2018. For the performance of the search, the portals used were: Virtual Health Library (VHL) and Portal of Periodicals of the Coordination of Improvement of Higher Level Personnel (Capes Periodical Portal), using the terms indexed in the Health Sciences Descriptors (DeCS). A multidisciplinary database (Web of Science), a health database (The Cumulative Index to Nursing and Allied Health Literature - CINAHL) and a psychology database (PsycINFO) were also consulted, using terms from the Medical Subject Headings (MeSH Terms). These databases were consulted in order to find studies published in different areas of knowledge. The following combination of descriptors indexed in DeCS and MeSH Terms was used: ("family") AND ("drug users" OR "substance-related disorders") AND ("mental health" OR "mental health services" OR "substance abuse treatment centers" OR "health services accessibility") NOT ("HIV"). The search strategy included searching for the keywords throughout the text, without the use of filters for the delimitation of the year of publication.

Having defined the search strategy, the selection of the literature was carried out, which involved the preliminary establishment of inclusion and exclusion criteria. Potentially eligible articles were those studies that had the use of alcohol and other drugs as the main theme; articles that investigated treatments for drug users or the health services for the treatment of drug users, in the Brazilian context; studies in which the sample investigated consisted of family members of drug users; and studies published in English, Spanish or Portuguese. Studies on other problems associated with drug use, such as comorbidities; empirical studies evaluating treatment outcomes for drug users; and books or letters to the editor were excluded from the study.

The selection of the studies was made through reading the titles and abstracts obtained and excluding duplicate articles and those that did not meet the previously defined inclusion criteria. Subsequently, 68 remaining studies were selected for reading in full, with a further 47 studies excluded that did not meet the inclusion and exclusion criteria and did not answer the guiding question of this review. Figure 1 presents the selection process of the studies, performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes (PRISMA) protocol⁽¹⁸⁾.

The analysis corpus was composed of 21 studies, which were re-read for the extraction of relevant information considering the guiding question of this study. In order to organize the collected data, the researchers developed an instrument that included the following information: title, authors, year of publication, periodical of publication, area of knowledge of the periodical, database, objective, methodology, place of data collection, results and conclusions.

 

Results

The 21 selected studies were published between 2004 and 2017, the majority of which were original articles, with only one being a master's thesis. It should be noted that in 10 articles the data collection was carried out in CAPS and/or CAPSad. Regarding the methodology, the majority of the studies used qualitative methodology (n = 13), with only three studies using quantitative methodology. In relation to the area of the journal of publication, the majority of the articles (n = 16) were published in nursing journals, with the other studies being published in different areas (psychology, psychiatry and interdisciplinary) (Figure 2).

The themes identified as central in the different studies reviewed were grouped into three main axes: Construction of care practices; Challenges of an incipient care network; Issues involved in the process of seeking treatment (Figure 3).

Construction of care practices

In the review, it was verified that the family members considered that the treatment for the drug users helped to improve the family relationships^(19-23,24). According to some studies, family members believed that CAPS and CAPSad have favorable conditions to promote improvements in the health conditions of their drug user relative^{(20-21,23-25)} and are useful in reducing the damage associated with drug use⁽²¹⁾.

Participation in groups for family members of drug users at CAPSad was also seen by the family members as important for exchanging experiences, helping to construct support networks and reconstruct family ties⁽²³⁾. From the guidelines received in the CAPSad, the family members began to understand and accept the health needs of the drug user and thus, to deal with the problem better^(20,22,26).

The family members also realized that their participation in the activities developed by CAPS and CAPSad was important to help their relative that makes problematic use of drugs^(21,26-27). Other studies showed that family members realized that the support provided by CAPSad helped them to face their feelings of helplessness and the lack of knowledge about everyday problems caused by drug use^(26,28), to elaborate feelings such as fear, anger and loneliness, and to develop more hope regarding the recovery of the drug user relative⁽²²⁾.

The institutions offering prevention and treatment interventions for drug users were described as a protective factor against illicit drug use⁽²⁹⁾. In addition, family members stated that the group for people who problematically use drugs in which the users participated, functioned as an intervention tool in their social networks, considering the potentialities of the groups identified in the interviews⁽³⁰⁾.

Similarly, family members and friends of drug users highlighted that the specialized hospital (93%), mutual aid groups (91%) and community therapies (85%) are useful spaces for recovery and creation of a care network for the user⁽³¹⁾. However, in another study the family members understood that the drug user would receive better treatment within the family than when interned in the hospital (73.68%)⁽¹⁹⁾.

Challenges of an incipient care network

Family members considered that national laws on illicit drugs make it difficult for users to receive treatment⁽³²⁾. The primary health network, as well as the network of legal and social care services, have been described by family members as insufficient referring to the care of drug users and their families⁽²³⁾. Although there is talk of changes in the field of mental health, family members pointed out that they did not perceive changes in practice, since hospitalization time and number of beds were reduced, however, not enough alternative health services were created to meet the needs of this population^{(19,23,31,33)}. Therefore, religious groups (52.8%) and general hospitals (47.2%) continued to be identified by relatives as the main institutions for the treatment of drug users in their community⁽³³⁾.

Family members highlighted limitations in the service practices, highlighting the lack of training of the professionals working in the Primary Health Units⁽²⁸⁾ and in the Family Health Program to act in the care of people who problematically use drugs and their family members⁽²³⁾. Many studies also presented suggestions from family members so that challenges present in the functioning of the CAPS and CAPSad could be overcome, such as improvements in the training of the professional and in the physical structure of the place⁽²⁵⁾, 24-hour functioning of the service^(23-25), expansion of therapeutic activities for users⁽²⁴⁾ and the development of activities for users to enter the labor market^(24-25).

Some of the studies highlighted limits in the practices of institutions that offered internation for drug users. According to the family members, there was concern about the possibility of abuse of the user during the internation (73.6%)⁽¹⁹⁾. Another challenge perceived by the family members was the devaluation of their participation in the treatment of the interned relative and the lack of guidance that should be provided by the professionals so that they could help the user⁽³⁴⁾.

Issues involved in the process of seeking treatments

According to some studies, families reported not having sought treatment for the drug user, sometimes because they believed that this problem was transient and would be resolved without help (40.6%), because they did not know where to look for help (29.7%), because the user did not allow family members to seek help or they waited until the user accepted help (12.7%)⁽³⁵⁾.

Regarding the type of help the family members sought for people that used drugs, they reported having sought health professionals such as psychologists, physicians and therapists (35.8%) and self help groups (33%)⁽³⁵⁾. The family members also believed that only psychiatrists could help people who received a psychiatric diagnosis (84.2%)⁽¹⁹⁾.

Some studies have shown that psychiatric hospitalization of the person who consumes alcohol and other drugs was seen as the main treatment option^{(19,27-28,31,36)}, because the family members did not know how to deal with problematic drug use⁽²⁸⁾ and experienced an intense burden^(27,36). The literature highlights issues that contribute to the readmission of people who use alcohol and other drugs, with the family members reporting the lack of continuity of treatment in outpatient services after hospital discharge^(19,37-38). The family members also understood that the user only seeks psychiatric hospitalization due to family pressure, court orders and the effort to obtain the place, consequently resulting in them abandoning the treatment⁽³⁸⁾.

Some studies presented the barriers perceived by the family members so that they and drug users could access services for the treatment of problematic drug use^(31,33,39). These include the high cost of the treatment, long waiting lists, the lack of specialized professionals, limited hours of operation of the services⁽³³⁾, client centered and negligent interventions, disregard for the legal principles that govern the care of the users of illicit drugs, especially in hospital emergency units⁽³²⁾ and the stigma in relation to the drug user^(32-33,39).

 

Discussion

It should be highlighted that the selected studies were carried out, mainly, with family members of people attended in CAPSad and CAPS. This issue seems to be related to the incentive of public policies to centralize these services within the organization of the mental health network, mainly between the years of 2002 and 2014, with a large number of studies on these services. In addition, these services had the integral care of the users and their families through community actions as their precepts, valuing studies that investigated the perception of the user and his/her family members⁽⁴⁰⁾.

There was only one study in which the participants were family members who attended mutual help groups for family members of people who problematically use drugs. However, many family members still seek these groups in the current context, because prior to the implementation of the substitutive services, such as CAPS, the treatment of drug users was mainly carried out by therapeutic communities and self and mutual help groups⁽⁶⁾.

Historically, there has been a lack of State actions in relation to the care of people with disorders related to the consumption of alcohol and other drugs, which has led to the increase in the performance of judicial, philanthropic and religious institutions in relation to this problem⁽⁴¹⁾, with self and mutual help groups and therapeutic communities. These issues contributed to the Ministry of Health's acknowledgment of the State's neglect in including problems related to the use of alcohol and other drugs in public mental health policies⁽⁴⁰⁾. Since then, the need for the scientific community to develop studies on this topic with family members of drug users has increased, as, according to the Brazilian Psychiatric Reform, the family is seen as one of the protagonists in the construction of public mental health policies.

The need to involve different actors to achieve integral health care for people with problems arising from the use of drugs is recognized in the field of mental health. The involvement of the community, family members, professionals and services contributes to the construction of partnerships and social support networks that are co-responsible for the care to the user⁽⁴²⁾. Accordingly, some studies highlighted that family members understand the importance of their inclusion in the treatment of drug users.

The existence of conflicts between drug users and their relatives is common, mainly due to the control of the user's behavior exercised by the family to avoid relapses⁽⁴³⁾. The family members perceived the substitutive services as a space for dialogue between family members, users and professionals, helping to improve family relationships and deal better with the problematic drug use. By promoting meetings of family members of drug users experiencing the same situations, CAPSad makes it possible to accept difficult feelings and learn ways of dealing with daily life⁽²⁶⁾. Among the studies analyzed, the family members also highlighted that the outpatient treatments promoted the improvement of the health conditions of the user. Services such as CAPS and CAPSad are based on the harm reduction strategy that proposes the treatment of drug users without requiring abstinence, stimulating adherence to the treatment⁽⁶⁾.

However, several limits in the treatment of people with problematic drug use were described by their family members. Among them was the need to expand the practice of CAPS and CAPSad. Accordingly, the coexistence of outpatient services with the hospital-centered paradigm has implications for the construction of the psychosocial care network with an inability to fulfill the requirements^(44-45). Historically, psychiatric care was governed by the tensions between social classes of service users, the poor had access to public services and the more affluent had access to services of liberal medicine⁽⁴⁶⁾. This fact was observed in CAPS, where the majority of the population was from the "lower" classes, described as "SUS dependent", with the middle class people who sought CAPS doing this in a selective manner, seeking medical and psychological consultations and prescriptions for medications⁽⁴⁶⁾.

Another challenge highlighted by the family members was the difficulty to access the services that offer treatment for problems arising from the use of alcohol and other drugs, with the stigmatization of the user being highlighted as a barrier. It is understood that the stigmatization of drug users is often committed by healthcare providers, who find it difficult to recognize the use of drugs as a health problem and present a moral judgment about it⁽⁴⁷⁾. Thus, the training of these professionals constitutes a resource that helps to break with health practices based on stereotypes constructed about the user of drugs^(48-51).

Many studies have indicated situations that seem relevant for family members to continue to perceive internations as the best and only intervention options, including the family's lack of knowledge about where to seek treatment for drug users or other possibilities for treatment beyond internation, family burden in the care for the drug user, insufficient services and care network for drug users, disarticulation of the psychosocial care network and lack of training of the professionals working in the field of alcohol and other drugs. This situation was also discussed in the literature, highlighting that, according to legal professionals and regional health managers, family members requested compulsory internation due to the lack of health services and actions directed toward this population and their lack of knowledge about the public services offered⁽⁵²⁾. However, the continuity of treatment in substitutive services contributes to breaking the cycle of possible reinternations^(53-54).

 

Conclusion

The data from this literature review allowed the mapping of the scientific production on how family members perceived the treatment of drug users in the Brazilian context. The increase in scientific publications accompanied the inclusion of care for drug users and their families in mental health public policies.

The most studied research sites were CAPSad and CAPS, which were perceived by family members as spaces for fostering dialogue, contributing to the improvement of family relationships, improvement of the health of the user and reduction of the damage caused by drug use. The inclusion of the family member in the treatment was considered important, to alleviate their distress, to help them in the relationship with the familiar user and to enhance the resources of the family to support the treatment of the drug user.

Among the difficulties observed by family members in services and treatments for drug users, the inadequacy of outpatient services in the care of drug users and in the involvement of family members in the treatment of the user, with the need for the extension of these services, stand out. The existence of barriers for the user of drugs to access health services was also highlighted, this mainly being due to the stigmatization of the user by healthcare providers, making it difficult to welcome them and understand the contexts of consumption and sustaining coercive treatment practices. These difficulties, together with the lack of knowledge of places that provide support and treatment for drug users or outpatient services, contributed to family members seeking internation.

The importance was emphasized of financial investments by the State in the expansion of the network of outpatient health services, in the dissemination of services available in the community and in the training of the healthcare providers. It is hoped that the results of this study also promote reflection among managers and professionals working in the area regarding public policies directed toward people who are problematic drug users. It is necessary for the services to offer support to the family members of drug users who are very burdened, through guidance and alleviation of their feelings.

A limitation of this study was the focus on the national literature, with a need for future literature review studies to also include the international literature. It is also suggested that studies are performed with family members who participate in self-help and mutual help groups for family members of drug users, aiming to understand their views on the treatments and services available to care for drug users.

 

Referências

1. Borba LO, Paes MR, Guimarães AN, Labronici LM, Maftum MA. A família e o portador de transtorno mental: dinâmica e sua relação familiar. Rev Esc Enferm USP. 2011;45(2):442-9. doi: http://dx.doi.org/10.1590/S0080-62342011000200020.         [ Links ]

2. Mielke FB, Kohlrausch E, Olschowsky A, Schneider JF. A inclusão da família na atenção psicossocial: uma reflexão. Rev Eletron Enferm. [Internet]. 2010;12(4):761-5. doi: http://dx.doi.org/10.5216/ree.v12i4.6812.         [ Links ]

3. Ministério da Saúde (BR). Lei Nº 10.216 de 6 de abril de 2001. Dispõe sobre a proteção e os direitos das pessoas portadoras de transtornos mentais e redireciona o modelo assistencial em saúde mental. Brasília, MS; 2001. [Acesso 3 mar 2018]. Disponível em: http://www.planalto.gov.br/ccivil_03/leis/leis_2001/l10216.htm.         [ Links ]

4. Ministério da Saúde (BR). Portaria Nº 3.088 de 23 de dezembro de 2011. Institui a Rede de Atenção Psicossocial para pessoas com sofrimento ou transtorno mental e com necessidades decorrentes do uso de crack, álcool e outras drogas, no âmbito do Sistema Único de Saúde (SUS). Brasília: MS; 2011. [Acesso 25 mar 2018]. Disponível em: http://bvsms.saude.gov.br/bvs/saudelegis/gm/2011/prt3088_23_12_2011_rep.htm>         [ Links ].

5. Alves VS. Modelos de atenção à saúde de usuários de álcool e outras drogas: discursos. Cad Saúde Pública. 2009;25(11):2309-19. doi: http://dx.doi.org/10.1590/S0102-311X2009001100002.         [ Links ]

6. Kantorski LP, Jardim VMR, Quevedo ALA. Assessment of the structure and process of psychosocial care centers of southern Brazil. Ciênc Cuid Saúde. 2013;12(4):728-35. doi: 10.4025/cienccuidsaude.v12i4.10867.         [ Links ]

7. Lima RAS, Amazonas MCL, Motta JAG. Incidência de stress e fontes estressoras em esposas de portadores da síndrome de dependência do álcool. Estud Psicol. 2007;24(4):431-9. doi: http://dx.doi.org/10.1590/S0103-166X2007000400003.         [ Links ]

8. Gabatz RIB, Schmidt AL, Terra MG, Padoin SMM, Silva AA, Lacchini AJB. Perception of crack users in relation to use and treatment. Rev Gaúcha Enferm. 2013;34(1):140-6. doi: http://dx.doi.org/10.1590/S1983-14472013000100018.         [ Links ]

9. Lougon M. Desinstitucionalização da assistência psiquiátrica: uma perspectiva crítica. Physis. [Internet]. 1993;3(2):137-64. doi: http://dx.doi.org/10.1590/S0103-73311993000200006.         [ Links ]

10. Colvero LA, Ide CAC, Rolim MA. Família e doença mental: a difícil convivência com a diferença. Rev Esc Enferm USP. 2004;38(2):197-205. doi: http://dx.doi.org/10.1590/S0080-62342004000200011.         [ Links ]

11. Cavalheri SC. Transformações do modelo assistencial em saúde mental e seu impacto na família. Rev Bras Enferm. 2010;63(1):51-7. doi: http://dx.doi.org/10.1590/S0034-71672010000100009.         [ Links ]

12. Brasil. Decreto Nº 7179, de 20 de maio de 2010. Institui Plano Integrado de Enfrentamento ao Crack e outras Drogas, cria o seu Comitê Gestor, e dá outras providências. Brasília: Diário Oficial da União; 2010. [Acesso 3 mar 2018]. Disponível em: http://www.planalto.gov.br/ccivil_03/_Ato2007-2010/2010/Decreto/D7179.htm.         [ Links ]

13. Tabeleão VP, Tomasi E, Quevedo LA. Sobrecarga de familiares de pessoas com transtorno psíquico: níveis e fatores associados. Rev Psiquiatr Clin. 2014;41(3):63-6. doi: 10.1590/0101-60830000000012.         [ Links ]

14. Fabris DR, Zanchetti I. La Comprensión de las Familias de Niños y Adolescentes Dependientes de Sustancias Psicoactivas, Atendidas en el Servicio de Psiquiatría del Hospital Universitario del Oeste de Paraná-Huop. Amauta. 2014; 24:175-89. [Acceso 25 mar 2018]. Disponible en: http://investigaciones.uniatlantico.edu.co/revistas/index.php/Amauta/article/view/1078.         [ Links ]

15. Oliveira MSN, Pinto FJM, Aguiar JB, Sampaio RMM, Medeiros CRB. Perfil sociodemográfico e clínico de pacientes em internações psiquiátricas voluntárias e involuntárias. Rev Bras Promoc Saúde. 2011;24(4):361-6. doi: http://dx.doi.org/10.5020/2094.         [ Links ]

16. Mendes KDS, Silveira RCCP, Galvão CM. Revisão integrativa: método de pesquisa para a incorporação de evidências na saúde e na enfermagem. Texto Contexto Enferm. 2008;17(4):758-64. doi: http://dx.doi.org/10.1590/S0104-07072008000400018.         [ Links ]

17. Osinaga VLM, Furegato ARF. Usuários de álcool e drogas opinam sobre o doente, a família e a assistência recebida nas instituições psiquiátricas. J Bras Psiquiatria. 2004;53(2):81-9. [Acesso 3 mar 2018]. Disponível em: https://www.researchgate.net/publication/283547812_Usuarios_de_alcool_e_drogas_opinam_sobre_o_doente_a_familia
_e_a_assistencia_recebida_nas_instituicoes_psiquiatricas.         [ Links ]

18. Azevedo DM, Miranda FAN. Práticas profissionais e tratamento ofertado nos CAPSad do município de Natal-RN: com a palavra a família. Esc Anna Nery. 2010;14(1):56-63. doi: http://dx.doi.org/10.1590/S1414-81452010000100009.         [ Links ]

19. Azevedo DM, Miranda FAN. Oficinas terapêuticas como instrumento de reabilitação psicossocial: percepção de familiares. Esc Anna Nery. 2011;15(2):339-45. doi: http://dx.doi.org/10.1590/S1414-81452011000200017.         [ Links ]

20. Braun LM, Dellazzana-Zanon LL, Halpern SC. A família do usuário de drogas no CAPS: um relato de experiência. Rev SPAGESP. 2014;15(2):122-44. [Acesso 10 mar 2018]. Disponível em: http://pepsic.bvsalud.org/scielo.php?script=sci_arttext&pid=S1677-29702014000200010.         [ Links ]

21. Costa LFP. Desafios de familiares envolvidos no processo de cuidar de dependentes químicos [dissertação]. João Pessoa (PB): Universidade Federal da Paraíba; 2015 120 p. [Acesso 10 fev 2018]. Disponível em: https://repositorio.ufpb.br/jspui/handle/tede/758>         [ Links ].

22. Bosque RM, Oliveira MAF, Silva NN, Claro HG, Fernandes, IFAL. Satisfação dos trabalhadores, usuários e familiares dos centros de atenção psicossocial em álcool e outras drogas. Rev Enferm UFPE on line. 2017;11(11):4598-606. doi: https://doi.org/10.5205/1981-8963-v11i11a231199 p4598-4606-2017.         [ Links ]

23. Alvarez SQ, Gomes GC, Oliveira AMN, Xavier DM. Grupo de apoio/suporte como estratégia de cuidado: importância para familiares de usuários de drogas. Rev Gaúcha Enferm. 2012;33(2):102-8. doi: http://dx.doi.org/10.1590/S1983-14472012000200015.         [ Links ]

24. Azevedo DM, Miranda FAN. A representação social de familiares nos centros de atenção psicossocial. Esc Anna Nery. 2011;15(2):354-60. doi: http://dx.doi.org/10.1590/S1414-81452011000200019.         [ Links ]

25. Nasi C, Oliveira GC, Lacchini AJB, Schneider JF, Pinho LB. Tecnologias de cuidado em saúde mental para o atendimento ao usuário de crack. Rev Gaúcha Enferm. 2015;36(1):92-7. doi: http://dx.doi.org/10.1590/1983-1447.2015.01.45934.         [ Links ]

26. Pandini A, D'artibale EF, Paiano M, Marcon SS. Rede de apoio social e família: convivendo com um familiar usuário de drogas. Ciênc Cuid Saúde. 2016;15(4):716-22. doi: http://dx.doi.org/10.4025/cienccuidsaude.v15i4.34602.         [ Links ]

27. Ventura CAA, Souza J, Hayashida M, Ferreira PS. Protective factors against involvement with illegal drugs: the perception of family members and significant others. Mental Health Subst Use. 2014;7(4):329-42. doi: https://doi.org/10.1080/17523281.2014.930504.         [ Links ]

28. Souza J, Kantorski LP, Vasters GP, Luis MAV. Rede social de usuários de álcool, sob tratamento, em um serviço de saúde mental. Rev. Latino-Am. Enfermagem. 2011;19(1):122-40. [Acesso 10 fev 2018]. Disponível em:<http://www.scielo.br/pdf/rlae/v19n1/pt_19.pdf.         [ Links ]

29. Loyola CMD, Brands B, Adlaf E, Giesbrecht N, Simich L, Wright MGM. Uso de drogas ilícitas e perspectivas críticas de familiares e pessoas próximas na cidade do Rio de Janeiro - Zona Norte, Brasil. Rev. Latino-Am. Enfermagem. 2009;17:817-23. doi: http://dx.doi.org/10.1590/S0104-11692009000700010.         [ Links ]

30. Silva J, Brands B, Adlaf E, Giesbrecht N, Simich L, Wright MGM. Familiares e pessoas conhecidas de usuários de drogas ilícitas: recorte de opiniões sobre leis e políticas públicas de uma comunidade da zona oeste do Rio de Janeiro, Brasil. Rev. Latino-Am. Enfermagem. 2009 Nov-Dez; 17(Esp.):803-929. doi: http://dx.doi.org/10.1590/S0104-11692009000700008.         [ Links ]

31. Silva J, Ventura CAA, Vargens OMC, Loyola CMD, Albarracín DGE, Diaz J, et al. Illicit drug use in seven Latin American countries: critical perspectives of families and familiars. Rev. Latino-Am. Enfermagem. 2009;17:763-9. doi: http://dx.doi.org/10.1590/S0104-11692009000700002.         [ Links ]

32. Brischiliari A, Rocha-Brischiliari SC, Marcon SS. Necessidades de cuidados de adolescentes usuários de drogas segundo seus familiares. Rev Enferm UERJ. 2016;24(3):1-7. doi: http://dx.doi.org/10.12957/reuerj.2016.6888.         [ Links ]

33. Sakiyama HMT, Padin MFR, Canfield M, Laranjeira R, Mitsuhiro SS. Family members affected by a relative's substance misuse looking for social support: who are they?. Drug Alcohol Depend. 2015;147:276-9. doi: 10.1016/j.drugalcdep.2014.11.030.         [ Links ]

34. Paula ML, Jorge MSB, Albuquerque RA, Queiroz LM. Usuário de crack em situações de tratamento: experiências, significados e sentidos. Saúde Soc. 2014;23(1):118-30. doi: http://dx.doi.org/10.1590/S0104-12902014000100009.         [ Links ]

35. Oliveira EB, Medonça JLS. Family member with chemical dependency and consequent burden suffered by the family: descriptive research. Online Braz J Nurs. [Internet]. 2012;11(1):14-24. doi: https://doi.org/10.5935/1676-4285.20120003.         [ Links ]

36. Ferreira ACZ, Capistrano FC, Souza EB, Borba LO, Kalinke LP, Maftum MA. Motivações de dependentes químicos para o tratamento: percepção de familiares. Rev Bras Enferm. 2015;68(3):474-81. doi: http://dx.doi.org/10.1590/0034-7167.2015680314i.         [ Links ]

37. Bard ND, Antunes B, Roos CM, Olschowsky A, Pinho LB. Estigma e preconceito: vivência dos usuários de crack. Rev. Latino-Am. Enfermagem. 2016;24(1):1-7. doi: http://dx.doi.org/10.1590/1518-8345.0852.2680.         [ Links ]

38. Ministério da Saúde (BR). Secretaria Executiva. Coordenação Nacional de DST/Aids. A Política do Ministério da Saúde para Atenção Integral a Usuários de Álcool e outras Drogas. Brasília: Ministério da Saúde; 2003. 60 p. [Acesso 25 mar 2018]. Discponível em: <http://portalarquivos2.saude.gov.br/images/pdf/2015/marco/10/A-Pol--tica-do-Minist--rio-da-Sa--de-para-Aten----o-Integral-ao-Usu--rio-de---lcool-e-Outras-Drogas--2003-.pdf>         [ Links ].

39. Ministério da Saúde (BR). Secretaria de Atenção à Saúde. DAPE. Coordenação Geral de Saúde Mental. Reforma psiquiátrica e política de saúde mental no Brasil. Documento apresentado à Conferência Regional de Reforma dos Serviços de Saúde Mental: 15 anos depois de Caracas. OPAS. Brasília, MS; 2005. 56 p. [Acesso 3 set 2018]. Disponível em: <http://bvsms.saude.gov.br/bvs/publicacoes/Relatorio15_anos_Caracas.pdf>         [ Links ].

40. Schneider JF, Roos CM, Olschowsky A, Pinho LB, Camatta MW, Wetzel C. Atendimento a usuários de drogas na perspectiva dos profissionais da estratégia saúde da família. Texto Contexto Enferm. 2013;22(3):654-61. doi: http://dx.doi.org/10.1590/S0104-07072013000300011.         [ Links ]

41. Moraes LMP, Braga VAB, Souza AMA, Oriá MOB. Expressão da codependência em familiares de dependentes químicos. Reme, Rev Min Enferm. 2009;13(1):34-42. doi: http://www.dx.doi.org/S1415-27622009000100005.         [ Links ]

42. Orr LC, Barbour RS, Elliott L. Carer involvement with drug services: a qualitative study. Health Expect. 2013;16(3):60-72. doi: 10.1111/hex.12033.         [ Links ]

43. Rinaldi DL, Bursztyn DC. O desafio da clínica na atenção psicossocial. Arq Bras Psicol. 2008;60(2):32-9. [Acesso 25 ago 2018]. Disponível em: <http://pepsic.bvsalud.org/scielo.php?script=sci_arttext&pid=S1809-52672008000200005&lng=pt>         [ Links ].

44. Rosa LCS, Campos RTO. Saúde mental e classe social: CAPS, um serviço de classe e interclasses. Serv Saude Soc. 2013;(114):311-31. doi: http://dx.doi.org/10.1590/S0101-66282013000200006.         [ Links ]

45. Ronzani TM, Furtado EF. Estigma social sobre o uso de álcool. J Bras Psiquiatr. 2010;59(4):326-32. doi: http://dx.doi.org/10.1590/S0047-20852010000400010.         [ Links ]

46. Corradi-Webster CM, Minto EC, Aquino FMC, Abade F, Yosetake LL, Gorayeb R, Laprega MR, Furtado EF. Capacitação de profissionais do programa de saúde da família em estratégias de diagnóstico e intervenções breves para o uso problemático de álcool. SMAD, Rev Eletrônica Saúde Mental Álcool Drog. 2005;1(1):1-10. doi: https://doi.org/10.11606/issn.1806-6976.v1i1p01-10.         [ Links ]

47. Ding L, Landon BE, Wilson IB, Wong MD, Shapiro MF, Cleary PD. Predictors and consequences of negative physician attitudes toward HIV-infected injection drug users. Arch Intern Med. 2005;165(6):618-23. doi: 10.1001/archinte.165.6.618.         [ Links ]

48. Howard V, Holmshaw J. Inpatient staff perceptions in providing care to individuals with co-occurring mental health problems and illicit substance use. J Psychiatr Ment Health Nurs. 2010;17(10):862-72. doi: 10.1111/j.1365-2850.2010.01620.x.         [ Links ]

49. May JA, Warltier DC, Pagel PS. Attitudes of anesthesiologists about addiction and its treatment: a survey of Illinois and Wisconsin members of the American Society of Anesthesiologists. J Clin Anesth. 2002;14(4):284-9. doi: https://doi.org/10.1016/S0952-8180(02)00359-8.         [ Links ]

50. Lima HA, Morais MLS, Rosa TEC, Feffermann M, Cortizo CT, Siqueira SR. Violência associada ao uso de álcool e outras drogas: olhares da Justiça e da Saúde. BIS, Bol. Inst. Saúde. 2013;14(3):329-34. [Acesso 3 mar 2018]. Disponível em: <http://periodicos.ses.sp.bvs.br/scielo.php?script=sci_arttext& pid=S1518-18122013000400011&lng=pt&nrm=iso>         [ Links ].

51. Campos R. Clínica: a palavra negada-sobre as práticas clínicas nos serviços substitutivos de saúde mental. Saúde Debate. [Internet]. 2001;25(58):98-111. [Acesso 15 set 2018]. Disponível em: <https://www.fcm.unicamp.br/fcm/sites/default/files/paganex/rosana2001clinicaapalavranegada.pdf>         [ Links ].

52. Oliveira EB Mendonça JLS. Dificuldades enfrentadas pela família no acolhimento do paciente com transtorno mental após a alta hospitalar. Rev Enferm UERJ. 2011;19(2):198-203. [Acesso 15 set 2018]. Disponível em: <http://www.facenf.uerj.br/v19n2/v19n2a05.pdf>         [ Links ]

 

 

Corresponding Author:
Cristiana Nelise de Paula Araujo
E-Mail: crisnelise@yahoo.com.br

Received: Dec 10^th 2018
Accepted: Feb 27^th 2019

 

 

* Supported by Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) and da Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), Brasil, grant # 2015/22929-7 e 2017/05171-9.