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Max is a crack baseball player. Saturday mornings he walks with his sister, Lisa, to her dancing school on his way to the park for his weekly game. One morning Max is early, and Lisa's teacher invites him to join the class. Max stretches at the barre. He struggles for a split. And before he knows it, he's having fun! Young ballplayers and ballet dancers will share Max's delight when he discovers that dance class is a great way to warm up for a home run.---from the publisher
14-year-olds Erin Gemmell (200 FR) and William Hayon (100 FL) cracked the top 10 times in the 13-14 age group on day 3 of the NCSA AG Champs. 14 meet records were also broken along the way. Stock photo via Jack Spitser/Spitser Photography
Dependence on psychoactive substances has become a subject of both debate and research in our society and can be characterized as a prominent problem, growing constantly and on a global level.11 Capristrano FC, Ferreira ACZ, Silva TL, Kalinke LP, Maftum MA. Perfil sociodemográfico e clínico de dependentes químicos em tratamento: análise de prontuários. Esc Anna Nery. 2013;17:234-41. Research indicates that 22.8% of the Brazilian population have already taken some type of drug in their lives, 2.9% have used cocaine and 0.7% have used crack.22 Carlini EA, Galduróz JC, Noto AR, Carlini CM, Oliveira LG, Nappo SA, et al. II Levantamento domiciliar sobre o uso de drogas psicotrópicas no Brasil: estudo envolvendo as 108 maiores cidades do país, 2005. São Paulo: CEBRID/UNIFESP; 2007. In view of these proportions, it is essential to acquire knowledge and to map the variables around this disorder, as a source of support for development of new and more assertive actions for prevention and treatment of this disease.
Studies show that the main foci of the harm caused by abuse of cocaine and crack are as follows: social and occupational problems; physical, psychic and cognitive effects; and considerable reductions in quality of life.33 Oliveira LG, Nappo SA. [Characterization of the crack cocaine culture in the city of São Paulo: a controlled pattern of use]. Rev Saude Publica. 2008;42:664-71. Furthermore, these individuals have a tendency to become polydrug users - using several drugs concurrently - within which we highlight alcohol abuse.22 Carlini EA, Galduróz JC, Noto AR, Carlini CM, Oliveira LG, Nappo SA, et al. II Levantamento domiciliar sobre o uso de drogas psicotrópicas no Brasil: estudo envolvendo as 108 maiores cidades do país, 2005. São Paulo: CEBRID/UNIFESP; 2007.,44 Noto AR, Galduróz JC, Nappo SA, Fonseca AM, Carlini CMA, Moura YG, et al. Levantamento nacional sobre uso de drogas entre crianças e adolescentes em situação de rua nas 27 capitais brasileiras - 2003 [Internet]. 2003 [cited 2017 Jan 05]. cebrid.com.br/wp-content/uploads/2012/10/Levantamento-Nacional-sobre-o-Uso-de-Drogas-entre-Crian%C3%A7as-e-Adolescentes-em-Situa%C3%A7%C3%A3o-de-Rua-nas-27-Capitais-Brasileiras-2003.pdf This concurrency is thought to be related to users attempting to neutralize or relieve the symptoms of intoxication or the discomfort caused by abstinence.55 Gossop M, Manning V, Ridge, G. Concurrent use and order of use of cocaine and alcohol: behavioural differences between users of crack cocaine and cocaine powder. Addiction. 2006;101:1292-8. However, combined use of these substances creates a new drug, called cocaethylene, which has more potent effects.66 Scheffer, M, Pasa, GG, de Almeida RMM. Dependência de álcool, cocaína e crack e transtornos psiquiátricos. Psic Teor e Pesq. 2010;26:533-41.
Since these people are more likely to develop psychiatric disorders than people who do not take drugs, studies have been conducted to determine the most prevalent psychiatric symptoms in drug users.77 Ribeiro M, Laranjeira R. Tratamento do usuário de crack. 2ª ed. Porto Alegre: Artmed; 2012.,88 Hess ARB, de Almeida RMM, Moraes AL. Comorbidades psiquiátricas em dependentes químicos em abstinência em ambiente protegido. Estud Psicol (Natal). 2012;17:171-8. Moreover, it is known that one third of the population that takes psychoactive substances exhibit psychiatric comorbidities.99 Associação Brasileira de Psiquiatria. Abuso e dependência de múltiplas drogas [Internet]. 2012 Oct 15 [cited 2014 Nov 17]. diretrizes.amb.org.br/_BibliotecaAntiga/abuso_e_depend%C3%AAncia_de_multiplas_drogas.pdf The most prevalent mental disorders are depression (47.8%) and anxiety (21.2%), irrespective of whether users are being treated for their dependence or not.1010 Watkins KE, Hunter SB, Wenzel SL, Tu W, Paddock SM, Griffin A, et al. Prevalence and characteristics of clients with co-occurring disorders in outpatient substance abuse treatment. Am J Drug Alcohol Abuse. 2004;30:749-64.,1111 Paim Kessler FH, Barbosa Terra M, Faller S, Ravy Stolf A, Carolina Peuker A, Benzano D, et al. Crack users show high rates of antisocial personality disorder, engagement in illegal activities and other psychosocial problems. Am J Addict. 2012;21:370-80. In the presence of comorbidity, the situation is aggravated because mental disorders make managing and treating these users even more difficult, leading to a less optimistic prognosis.1212 Hopwood CJ, Morey LC, Skodol AE, Sanislow CA, Grilo CM, Ansell EB, et al. Pathological personality traits among patients with absent, current, and remitted substance use disorders. Addict Behav. 2011;36:1087-90.,1313 Swendsen J, Conway KP, Degenhardt L, Glantz M, Jin R, Merikangas KR, et al. Mental disorders as risk factors for substance use, abuse and dependence: results from the 10-year follow-up of the National Comorbidity Survey. Addiction. 2010;105:1117-28.
This research was conducted as a cross-sectional study with the aim of verifying psychiatric symptoms and their correlations with quality of life in cocaine and crack users. The project was approved by the Ethics Committee at the Hospital de Clínicas de Porto Alegre (HCPA) under protocol number 14-0153, registered on Plataforma Brasil, and an informed consent form was used with all the subjects, in accordance with current rules on research involving human beings.1717 Brasil, Ministério da Saúde (MS), Conselho Nacional de Saúde. Resolução nº 466/12. 2012 [cited 2017 Jan 05].
The sample comprised 25 male individuals with dependence on cocaine and/or crack who had been discharged from inpatient substance dependence treatment in the Álvaro Alvim Unit (AAU) at the HCPA, a hospital in the south of Brazil, and were receiving outpatient treatment at this same unit. Subject selection was by convenience. Patients were excluded from the study if they were exclusively dependent on alcohol or could not answer the instruments, whether because of major cognitive impairment (clinically verifiable), dementia, or illiteracy.
The sample investigated in this study has the same sociodemographic profile described in previous literature - it is made up of single white men, with children, low educational level, and economic vulnerability.2525 Kessler F, Faller S, Souza-Formigoni MLO, Cruz MS, Brasiliano S, Stolf AR, et al. Avaliação multidimensional do usuário de drogas e a Escala de Gravidade de Dependência. Rev Psiquiatr Rio Gd Sul. 2010;32:48-56.,2626 Santos Cruz M, Andrade T, Bastos FI, Leal E, Bertoni N, Villar LM, et al. Key drug use, health and socio-economic characteristics of young crack users in two Brazilian cities. Int J Drug Policy. 2013;24:432-8. Its prevalence of single men diverges from the south Brazilian population, in which they equate to 44.2%,2727 Instituto Brasileiro de Geografia e Estatística (IBGE). Diretoria de pesquisas, coordenação de trabalho e rendimento, pesquisa nacional para amostra de domicílios [Internet]. 2013 [cited 2014 Nov 17]. ibge.gov.br/home/estatistica/populacao/trabalhoerendimento/pnad2013/ which is lower than the rate observed in this study. These data may be related to this population's difficulty sustaining relationships, because they tend to organize their lives around drug use.2525 Kessler F, Faller S, Souza-Formigoni MLO, Cruz MS, Brasiliano S, Stolf AR, et al. Avaliação multidimensional do usuário de drogas e a Escala de Gravidade de Dependência. Rev Psiquiatr Rio Gd Sul. 2010;32:48-56.,2828 Figlie N, Fontes A, Moraes E, Payá R. Filhos de dependentes químicos com fatores de risco bio-psicossociais: necessitam de um olhar especial? Rev Psiquiatr Clin. 2004;31:53-62.
The mean age of these subjects is older than is reported in the literature - most studies refer to young adults, while our sample includes mature adults.2929 Guimarães CF, Santos DVV dos, Freitas RC de, Araújo RB. Perfil do usuário de crack e fatores relacionados à criminalidade em unidade de internação para desintoxicação no Hospital Psiquiátrico São Pedro de Porto Alegre (RS). Rev Psiquiatr Rio Gd Sul. 2008;30:101-8. This may be attributable to the context of several attempts at abstinence and relapses (as reported by the sample) or, also, to long periods of uninterrupted use, followed by many losses and suffering, which is a trigger and an aid in motivation to adhere to treatment and maintain abstinence.3030 Lima LAA, Machado DG, Silva FJG Jr, Monteiro CFS. Estratégias utilizadas para o manejo do craving em usuários de crack: revisão integrativa da literatura. Rev Enf UFPI. 2013;2:90-5. 350c69d7ab