Introducing care management to Brazil’s alcohol and substance use disorder population

Abstract

Brazil has a sizable alcohol and substance use disorder (ASUD) population, yet there are considerable gaps in treatment access and retention. ASUD, a chronic medical condition, is highly comorbid with medical and behavioral health disorders. This indicates a need for more targeted interventions in order to achieve health care integration (a major goal of Brazil's health care system). Care management -that is, the organization of patient care by an institution -is a viable strategy to engage individuals with ASUD who might benefit from treatment but are not aware of or do not use the available resources, as well as to help maintain patients in treatment. Care management is considered an essential supplement to the treatment of chronic disease. The objective of this article is to discuss the applicability of care management for the treatment of ASUD within the public health care system in Brazil. We describe models of care management that have been adopted internationally and identify the feasibility and advantages for its adoption in Brazil.

Sex-based differences in multidimensional clinical assessments of early-abstinence crack cocaine users

“…Primary care is intended to employ a multidisciplinary team and to work in the community and in basic health units, which are standard caring centers for the community. Primary care provides access to more complex levels of the health-care system [29].…”

“…Tertiary care in the SUS comprises high-complexity conditions, which are mostly addressed in general hospitals focused on intensive care. For drug addiction, tertiary care occurs in psychiatric inpatient facilities, such as those where this study took place, or specialized wards [29]. Some non-governmental initiatives also offer treatment in therapeutic communities, but protocols and practices are not standardized [29].…”

“…For drug addiction, tertiary care occurs in psychiatric inpatient facilities, such as those where this study took place, or specialized wards [29]. Some non-governmental initiatives also offer treatment in therapeutic communities, but protocols and practices are not standardized [29]. Common symptoms that indicate the consideration of hospitalization are acute intoxication, withdrawal symptoms, psychiatric comorbidities, suicide ideation, aggressive behavior and psychotic symptoms [30].…”

Hospitalization due to mental and behavioral disorders caused by use of alcohol and psychoactive substances among older adults and elderly people in Brazil: a cross-sectional study

“…psychiatric conditions, cardiovascular conditions and sexual dysfunctions, and have become a public health issue that potentially affects individuals’ lives, employment and family relationships. 15 , 16 One explanation for this the influence of cultural factors that normalize alcohol abuse and facilitate increasing alcohol consumption, as seen in Brazil. Another important explanation is that alcohol and substance abuse negatively affect family relationships.…”

Decrease in Alcohol Use Disorder Hospitalizations in Brazil: What Does It Mean?

“…4,5 These specialized outpatient mental health services targets people with severe disorders that require intensive care, and also works integrated with other health units, admitting users in an inter-sectoral perspective. 6 Consequently, at the same time a progressive reduction of psychiatric beds in SUS occurred. 7 Therefore, the change in mental health guidelines in the country may have a relevant influence on hospitalizations of patients with alcohol use disorders.…”