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SMAD. Revista eletrônica saúde mental álcool e drogas

versão On-line ISSN 1806-6976

SMAD, Rev. Eletrônica Saúde Mental Álcool Drog. (Ed. port.) vol.17 no.4 Ribeirão Preto out./dez. 2021

http://dx.doi.org/10.11606/issn.1806-6976.smad.2021.155433 

ORIGINAL ARTICLE

 

Sociodemographic and chemical-dependency profile of users at a specialized Psychosocial Care Center

 

 

Gliciane Vasconcelos SantanaI; Joyce Lorena Santana SantosI; José Marcos de Jesus SantosII; Letícia de Jesus AlvesI; Andreia Freire de MenezesIII; Carla Kalline Alves Cartaxo FreitasIV

IUniversidade Federal de Sergipe, Campus Prof. Antônio Garcia Filho, Lagarto, SE, Brazil
IIUniversidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, PAHO/WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto, SP, Brazil
IIIUniversidade Federal de Sergipe, Departamento de Enfermagem, São Cristóvão, SE, Brazil
IVUniversidade Federal de Sergipe, Departamento de Enfermagem, Lagarto, SE, Brazil.

Corresponding author

 

 


ABSTRACT

OBJECTIVE:to identify the sociodemographic and chemical-dependency profile of users at a Psychosocial Care Center - Alcohol and Other Drugs.
METHOD: a retrospective and cross-sectional study carried out by referring to 360 medical records.
RESULTS: the majority of users were males (91.1%, n = 328), illiterate/Elementary School (70.8%, n = 255), without a partner (76.9%, n = 277), and lived in urban areas (63.3%, n = 228). Simultaneous use of multiple drugs was found in 43.5% (n = 157) and exclusive alcohol dependency in 40.4% (n = 146).
CONCLUSION: the predominance of single men with low schooling and dependency on multiple drugs and/or alcohol was found. This knowledge is relevant to evidence-based strategy proposals.

Descriptors: Health Profile; Drug Users; Street Drugs; Substance-Related Disorders.


 

 

Introduction

Drugs are psychoactive substances that can cause bodily, physiological and behavioral changes, as well as changes in the degree of awareness of their users, which vary according to the substances used and to intrinsic factors to the individual(1). Dependency on these substances is complex and has a multifactorial origin(2).

Drugs are known to cause severe health damage. Cannabis ativa (marijuana), for instance, can produce cognitive impairment and mental disorders, such as depression and suicidal behavior, in addition to cardiovascular and pulmonary diseases(3). There is also the possibility of more serious consequences, as the World Health Organization attributes more than 450,000 deaths per year to the use of these substances(4).

Worldwide, it is highlighted that disorders caused by alcohol use are the most prevalent, with an estimated number of 100.4 million cases in 2016. Next, marijuana (221 million) and opioid (26.8 million) dependency is observed(5). Dependency among males and females varies according to psychoactive substance type, region and socio-cultural aspects. In South America and elsewhere, there is a higher consumption of specific substances among men as compared to women(6-7).

In Brazil, it is noteworthy that the Psychosocial Care Centers for Alcohol and Other Drugs (CAPSad) are the main devices to embrace users who make harmful use of drugs. The purpose of these services is to promote social reintegration through access to work, leisure, the exercise of civil rights and the strengthening of family and community ties(8).

With this regard, it is pointed out that the problems arising from the use of psychoactive substances are also related to each individual's social, cultural and economic issues(9); therefore, it is essential to learn about one's characteristics in order to provide readjustment and/or propose strategies that are better directed to the social and clinical reality of such individuals. Furthermore, the present study is justified by the fact that it was conducted in a municipality in the state of Sergipe, in Northeastern Brazil, whose original scientific production on chemical dependency is incipient and superficial in relation to regional specificities.

In view of the above, the objective was to identify the sociodemographic and chemical-dependency profile of users at a CAPSad located in Northeastern Brazil.

 

Method

This is a cross-sectional, quantitative, retrospective and descriptive study, using secondary data from a CAPSad in northeastern Brazil. Data collection took place between the months of August and December 2018 by referring to the medical records of active and inactive users at the institution.

According to the data provided by the health service's management, it was estimated that there were 600 records of active and inactive users in 2017. Based on this, the sample calculation was made, considering a 96% confidence level and a 4% sample error(10). A 15% safety margin was added to the calculated number, resulting in 360 evaluated participants.

Thus, after obtaining authorization from the CAPSad management, the researchers visited the service and grouped all the medical records in the active and inactive files available at the institution's Medical and Statistics Archive Service (SAME). Such records were then numbered (in pencil), and 360 of them, which were eligible for the study, were drawn, thus ensuring the selection of participants by simple random sampling.

Participants in the study were users who had already been ("inactive") or who were still being ("active") monitored at CAPSad João Rosendo dos Santos, located in Lagarto, Sergipe, Brazil. Exclusion criteria were users whose medical records had a significant lack of information. It is noteworthy that the studied CAPSad considers users to be "inactive" when they have not participated in the therapeutic activities offered by the institution for six or more months.

Data were collected using a form consisting of objective questions on sociodemographic conditions, psychological problems and characteristics of psychoactive substance use. Such collection instrument was created with the limitation of having only the variables existing in the institution's medical records.

For statistical analysis, the univariate and bivariate techniques were used to obtain the distribution of absolute and relative frequency values between the nominal and ordinal qualitative variables. The mean, standard deviation and the minimum and maximum values of the quantitative variables were also calculated. The package used was IBM® SPSS - Statistical Package for the Social Sciences 20.0 Mac (SPSS 20.0 Mac, SPSS Inc., Chicago, Illinois, USA).

This study was approved in July/2018 by the Research Ethics Committee of the Federal University of Sergipe, according to report no. 2.784.416 and CAAE no. 92400818.9.0000.5546. The researchers followed the guidelines and regulatory standards provided for in Resolution no. 466/2012 by the National Health Council, concerning research involving human beings.

 

Results

Three hundred and sixty CAPSad users participated in the study, of whom 177 were considered "active" and 183 "inactive" by the institution. The participants' mean age at their first admission to the service was 33.8 years (standard deviation: 12.5; minimum: 10; maximum: 73), and, at the time of the study, it was 37.2 years (standard deviation: 12.8; minimum: 10; maximum: 77). Adolescents corresponded to 4.4% (n = 16) of the sample, and more than half were aged > 35 years (56.4%; n = 203) (Table 1).

 

 

Most of the participants were males (91.1%; n = 328), illiterate or had only attended elementary school (70.8%; n = 255), lived without a partner (o) (76.9%; n = 277) and, among these (n = 277), almost all of them lived with a relative (99.6%; n = 276). As for their place of residence, 63.3% (n = 228) lived in an urban area, 31.9% (n = 115) in a rural area and 3.9% (n = 14) were homeless (Table 1).

The simultaneous use of multiple drugs was 43.5% (n = 157). The drugs most often taken as a single drug were alcohol (40.4%; n = 146), crack (6.9%; n = 25) and marijuana/Cannabis sativa (5.6%; n = 20), with a weekly frequency of use, especially six or seven days a week (Table 2).

 

 

Regarding the form of admittance to CAPSad, it was observed that 61.9% (n = 223) of the users sought the service spontaneously, and 34.7% (n = 125) were referred from other services in the municipality's mental health network (Table 2).

It is noteworthy that 26.4% (n = 57) of users had committed acts of violence against themselves, and 44.7% (n = 97) against another person (Table 3).

 

 

Discussion

The present study found a predominance of psychoactive substance use among adult males. Such finding corroborates a study conducted in southern Brazil(11) in which 74.8% of the chemically dependent individuals were males. Regarding age, it is believed that, although drug use initiation occurs in adolescence, the demand for health services, and especially for CAPSad, will generally occur later, when the biological and socioeconomic damages caused by the use of psychoactive substances become more evident to users and/or families.

Low schooling was another commonly present characteristic among the participants. This result is in line with those of a study conducted in Maceió (AL) with 200 crack users, in which 61.5% had only elementary education(12). It is noteworthy that the level of education of chemically dependent individuals is an important factor to be considered when carrying out educational/therapeutic activities on drugs, since it is necessary to adjust the language used and the level of the theoretical approach applied to the subject to be addressed.

Regarding marital status, most of the evaluated users lived without a partner at the time of study. A similar result was found in an investigation on 123 chemically dependent individuals, in which only 19.5% were married or had a steady relationship(13). Such difficulty in initiating and/or maintaining a loving relationship is attributed to the conflicts that are generated from the use of psychoactive substances.

Most users lived with their relatives. Authors report that the family can be a protective as well as an aggravating factor in relation to drug use, since conflicting homes favor the experimentation of substances. Also, in cases where family conflict is a possible cause of dependency, this will make users' rehabilitation difficult(14). With this regard, the importance of trying to learn about individuals in their entirety during embracement, thus understanding their family contexts, the difficulties that they face in life and the possible factors triggering the use of psychoactive substances, from the perspective of users themselves, is reinforced.

Another finding was the high prevalence of spontaneous search for CAPSad by users, which, in turn, can be justified, among other factors, by the difficulties faced in the Health Care Network. This result is similar to that found in a study conducted with 369 CAPSad users in the Triângulo Mineiro Region, in which almost half of the participants also reported the spontaneous search for these health services(15). It is believed that the recognition of the mental health service by the city residents as well as the role played by users' families in this process may have had an influence, since these aspects may or may not encourage them to adopt such an initiative behavior to seek help/care.

As for the chemical dependency profile, it was observed that the simultaneous use of multiple drugs and the exclusive dependency on alcohol prevailed in the sample. The greater exclusive use of alcohol is explained because it is a legal and easily accessible drug, in addition to meeting economic interests as well as those of the mainstream media, which stimulate its consumption(16-17).

Exclusive crack dependence showed to be second in place in this study. It is pointed out that this is a substance with high power of physical and psychological degradation, which, in prolonged use, can lead to the impairment of quality of life in general(18). Authors suggest that the increase in the number of crack users is associated with the search for more potent effects and the low cost of the substance(19).

Marijuana and cocaine ranked third and fourth as an exclusive dependency among participants, respectively. This result differs from that indicated by a study carried out in Porto Alegre with 1,125 users, in which an inversion of these positions was obtained: cocaine (19.5%) and marijuana (14.4%)(20). However, it is noteworthy that the same authors showed simultaneous use of multiple drugs in 42% of the sample, this figure being similar to that found in the present study (43.5%).

It is known that Brazil is a country with a large number of violent deaths that are commonly related to drug use(21). With this regard, it was observed that almost half of the sample in the present study reported having already committed violence against another person. This may be associated with the age at which drug use begins, the frequency of use and the decision-making difficulty when under the influence of psychoactive substances and/or in a withdrawal crisis(22).

In this respect, it is noteworthy that, contrarily to possible daily observations, the purchase of these drugs does not necessarily result from thefts or violent acts against other people, but at the expense of resources from users' work itself or from the sale/pawning of their personal property or their family members'(23). Therefore, violence against other people emerges in this group as one of the possible consequences of the use of psychoactive substances, and not as the main form of obtaining drugs.

The limitations in this study are mainly related to the instrument used for data collection, since it was restricted to only the variables existing in the medical records of the CAPSad chosen for the investigation. This has made it impossible to further approach certain issues concerning the chemical dependency of the users being assessed.

 

Conclusion

There was a predominance of single men, with low schooling, who lived in urban areas and showed dependency on multiple drugs and/or exclusively on alcohol. Regarding the exclusive use of psychoactive substances, it was noticed that, in addition to alcohol, other drugs also stood out: crack and marijuana. This knowledge is important for proposing therapeutic and harm-reduction actions in chemical dependency that are better directed to the reality of the subjects assessed.

In this context, it is intended to include, in the CAPSad investigated, a routine of health education actions concerning the biopsychosocial risks and implications associated with each of the psychoactive substances observed in order to foster collaboration from the respective users in their Singular Therapeutic Projects at the health care service in question.

It is also inferred that these users are prone to violence against themselves as well as against others due to the complexity involved in the phenomenon of violence among users of psychoactive substances. It is suggested that further studies should be conducted in order to better understand the reasons for that violence and the factors associated with such outcomes.

Thus, it is believed that the findings in the present study are relevant to the formulation and/or implementation of evidence-based harm-reduction/therapeutic strategies. It is essential, therefore, that health institutions specialize in order to better embrace these individuals, since their problems also affect family members as well as the community in which they live.

 

References

 

 

Corresponding author:
José Marcos de Jesus Santos
E-mail: jsmarcos@usp.br

Received: Mar 27th 2019
Accepted: Feb 4th 2021

 

 

Author's contribution: Study concept and design: Gliciane Vasconcelos Santana; Joyce Lorena Santana Santos; José Marcos de Jesus Santos; Andreia Freire de Menezes; Carla Kalline Alves Cartaxo Freitas.
Obtaining data: Gliciane Vasconcelos Santana; Joyce Lorena Santana Santos; José Marcos de Jesus Santos; Letícia de Jesus Alves. Data analysis and interpretation: José Marcos de Jesus Santos; Letícia de Jesus Alves; Andreia Freire de Menezes; Carla Kalline Alves Cartaxo Freitas. Statistical analysis: José Marcos de Jesus Santos.
Drafting the manuscript: Gliciane Vasconcelos Santana; Joyce Lorena Santana Santos; Letícia de Jesus Alves; Andreia Freire de Menezes; Carla Kalline Alves Cartaxo Freitas.
Critical review of the manuscript as to its relevant intellectual content: Gliciane Vasconcelos Santana; Joyce Lorena Santana Santos; José Marcos de Jesus Santos; Letícia de Jesus Alves; Andreia Freire de Menezes; Carla Kalline Alves Cartaxo Freitas.
All authors approved the final version of the text.
Conflict of interest: the authors have declared that there is no conflict of interest.

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Corresponding author:
José Marcos de Jesus Santos
E-mail: jsmarcos@usp.br

Received: Mar 27th 2019
Accepted: Feb 4th 2021

 

 

Author's contribution: Study concept and design: Gliciane Vasconcelos Santana; Joyce Lorena Santana Santos; José Marcos de Jesus Santos; Andreia Freire de Menezes; Carla Kalline Alves Cartaxo Freitas.
Obtaining data: Gliciane Vasconcelos Santana; Joyce Lorena Santana Santos; José Marcos de Jesus Santos; Letícia de Jesus Alves. Data analysis and interpretation: José Marcos de Jesus Santos; Letícia de Jesus Alves; Andreia Freire de Menezes; Carla Kalline Alves Cartaxo Freitas. Statistical analysis: José Marcos de Jesus Santos.
Drafting the manuscript: Gliciane Vasconcelos Santana; Joyce Lorena Santana Santos; Letícia de Jesus Alves; Andreia Freire de Menezes; Carla Kalline Alves Cartaxo Freitas.
Critical review of the manuscript as to its relevant intellectual content: Gliciane Vasconcelos Santana; Joyce Lorena Santana Santos; José Marcos de Jesus Santos; Letícia de Jesus Alves; Andreia Freire de Menezes; Carla Kalline Alves Cartaxo Freitas.
All authors approved the final version of the text.
Conflict of interest: the authors have declared that there is no conflict of interest.

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