The aim of this study was to compare three groups of Brazilian psychoactive substance (PAS) abuse patients (crack cocaine users, cocaine snorters, and non-cocaine PAS users) in terms of psychiatric comorbidities and severity of psychosocial problems. A cross-sectional, multi-center study was conducted at five Brazilian research centers. A total of 738 current PAS abusers seeking specialized treatment (outpatient and inpatient clinics) were assessed using the sixth version of the Addiction Severity Index (ASI-6): 293 patients using crack cocaine were compared with 126 using powder cocaine and 319 using non-cocaine PAS (mostly alcohol and marijuana). Psychiatric comorbidities were assessed in a smaller sample (290 cases), originating from three of the centers, using the Mini International Neuropsychiatric Interview Plus (MINI-Plus). Crack and powder cocaine users were significantly younger than non-cocaine PAS users (31.1 ± 8.1 and 32.9 ± 8.8 vs. 42.4 ± 12, respectively; p < .001). Crack users presented a higher rate of antisocial personality disorder (25%) than powder cocaine (9%) and non-cocaine PAS users (9%), even when adjusted for confounding factors (Pr = 2.6; 95% CI 1.10-6.40). According to ASI-6 summary scores, crack users presented a significantly higher rate of occupational, family, and legal problems and reported more illegal and violent activities such as burglary and theft (23%) and threatening or assaulting (32%) than non-cocaine PAS users. Our findings, combined with the recent increase observed in the prevalence of crack use in Brazil, highlight the severity of psychiatric symptoms and psychosocial problems related to this powerful drug and corroborate the already suggested association between crack/cocaine, violence, and legal problems. Treatment programs for crack users should routinely consider the possibility of associated psychiatric comorbidities, such as antisocial personality disorder, which may affect treatment outcomes.

Objective: To assess the characteristics of alcohol and drug users who seek treatment at the Brazilian Unified Health System in Brazil. Method: A multicenter cross-sectional study involving five clinical and research centers located in four Brazilian state capitals was conducted with 740 in-and outpatients. The only exclusion criterion was the presence of neurological or severe psychiatric symptoms at the moment of the interview. The Addiction Severity Index (ASI-6) and the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) were used to assess the severity of substance use and the problems related. Results: There were significantly more men than women in the sample; mean age was 36 years. The drug most frequently used at all sites was alcohol (78%), followed by cocaine/crack (51%). Alcohol was the drug that most commonly motivated treatment seeking, at all centers. ASI-6 Summary Scores for Recent Functioning (SS-Rs) were quite similar among centers. SS-Rs were compared between users who had never received treatment for psychoactive substance abuse (n = 265, 36.1%) and those who had already been treated at one or more occasions (n = 470, 63.9%). This analysis revealed significant differences between the groups in the drug, psychiatric symptoms, legal, and family/ social problems areas (p < 0.05). Conclusion: Our findings confirm previous evidence suggesting that the management of patients seeking drug abuse treatment should take several different aspects into consideration, e.g., education, employment, and family relationships, which often appear as areas of concern for these individuals. Keywords: Substance abuse, treatment, multicenter, alcohol, drugs, public health. ResumoObjetivo: Avaliar as características dos usuários de álcool e drogas que procuram tratamento no Sistema Único de Saúde. Método: Estudo transversal multicêntrico envolvendo cinco centros clínicos/de pesquisa localizados em quatro capitais brasileiras foi realizado com 740 pacientes hospitalizados e ambulatoriais. O único critério de exclusão foi a presença de sintomas neurológicos ou psiquiátricos graves no momento da entrevista. A Escala de Gravidade de Dependência (Addiction Severity Index, ASI-6) e o teste ASSIST (Alcohol, Smoking and Substance Involvement Screening Test) foram utilizados para avaliar a severidade do uso de substância e problemas relacionados. Resultados: Houve significativamente mais homens do que mulheres na amostra; a idade média foi de 36 anos. A droga mais usada em todos os centros foi o álcool (78%), seguido de cocaína/ crack (51%). O álcool foi a droga que mais motivou procura por tratamento, em todos os centros. Os Escores Resumidos da ASI-6 para Funcionamento Recente (SS-Rs) foram bastante similares nos centros. SS-Rs foram comparados entre usuários que nunca haviam recebido tratamento para abuso de substâncias (n = 265, 36,1%) e aqueles que já haviam sido tratados uma ou mais vezes (n = 470, 63,9%). Foram observadas diferenças significativas entre os grupos nas áreas de droga, sintomas psiq...

The aim of this study was to evaluate the psychiatric comorbidities and different areas of life functioning in substance abusers with attention deficit hyperactivity disorder symptoms. A cross-sectional, multi-center study involving 285 adult substance abusers from outpatient and inpatient clinics was performed. The Adult ADHD Self-Report Scale, the sixth version of the Addiction Severity Index, and the Mini International Neuropsychiatry Interview were used for data collection. Individuals with comorbid attention deficit hyperactivity disorder and substance use disorders showed increased addiction severity when compared with individuals without attention deficit hyperactivity disorder (53.3 ± 7.3 vs. 48.4 ± 8.4, respectively). Our results suggest that comorbid attention deficit hyperactivity disorder and substance use disorders is associated with a more severe course of substance use and with social and psychiatric impairment.

INTRODUÇÃO: Antes de iniciar um tratamento para abuso de substâncias psicoativas (SPA), é primordial avaliar os prejuízos que estas acarretam na vida dos usuários. Considerando a complexidade dessa avaliação, o instrumento atualmente mais utilizado no mundo para a abordagem multidimensional de problemas relacionados ao abuso de SPA é a Escala de Gravidade de Dependência (Addiction Severity Index, ASI). OBJETIVO: Através da revisão da literatura sobre o tema, da apresentação de um caso clínico, de aspectos da ASI e da discussão de tópicos contemplados na avaliação de usuários de drogas, este trabalho tem como finalidade auxiliar o profissional de saúde a sistematizar a avaliação desses pacientes. MÉTODO: A revisão da literatura foi realizada nas bases de dados MEDLINE, LILACS e PsycINFO, utilizando os descritores assessment e evaluation, cruzados com o termo substance-related disorders dos Medical Subject Headings e subexpressões nele incluídas. RESULTADOS E CONCLUSÃO: Na literatura, há uma carência de artigos sobre o tema, e, no Brasil, ainda não existem instrumentos que se proponham a avaliar os usuários de drogas de forma tão ampla como a ASI. A utilização de uma escala com essas características pode ser útil para o sistema de saúde brasileiro, favorecendo a identificação precoce de problemas e propiciando melhora na qualidade da assistência prestada.