Crack Cocaine: A Five-Year Follow-Up Study of Treated Patients

Abstract

Objectives: To follow-up a group of 131 crack cocaine users and examine drug use, treatment experience, employment status, involvement in crime and mortality at 2 and 5 years. Methods: Consecutive crack-dependent patients who were admitted to a detoxification unit in São Paulo between 1992 and 1994 were re-interviewed on two occasions: 1995–1996 and 1998–1999. Results: 5 years after treatment information was obtained on 124 (95%) of the original cohort. 39.7% (n = 52) of the patients reported having been abstinent from cocaine for at least the last year, and 21.4% (n = 28) had used the drug. Of those subjects not using cocaine at 2 years, 19 (62%) were still abstinent at 5 years. Twenty-three (17.6%) patients had died by the 5-year follow-up with homicide, due to firearms or other weapons, being the commonest cause (n = 13). The annual adjusted mortality rate for the sample was 24.92 deaths/1,000 individuals, the excess mortality rate was of 21.64 deaths/1,000 individuals, and the standardized mortality ratio was 7.60. A history of injecting drug use, unemployment at the time of the index admission and administrative discharge at the index admission were factors that contributed to the risk of dying over the next 5 years. Conclusions: There was a progressive movement towards abstinence over the follow-up period, and there was evidence that once abstinence had been achieved it was maintained. On the other hand, the mortality rate was extremely high and was higher among those who were still using crack at 2 years.

Evolução do consumo de crack em coorte com histórico de tratamento

“…Subjects were followed up two , fi ve (1998-99), and twelve (2005-06) years after discharge. 6,15,21 This convenience sample was obtained from the admissions registry of the detoxifi cation unit, and included patients consecutively admitted between May 1992 and December 1994. The criterion for inclusion was addiction to crack cocaine, diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV).…”

Childhood Trauma and Resilience: Vulnerabilities to Develop Crack/Cocaine Dependence

“…Although its prevalence is not high among other types of drug use -life use is around 4,2% -it has high potential to cause dependence, and its abuse is associated with a number of negative outcomes for the individual, families and community, including death due to violence and criminal behavior [6,7]. However, there is a group of patients that develop a more stable pattern of use and are somehow more resilient to the impairment caused by this substance [8].…”

Revisão sistemática sobre tratamentos psicológicos para problemas relacionados ao crack

“…Achados agrupados em tratamentos psicossociais e cuidados continuados sugerem que novos modelos de cuidados continuados são necessários para o tratamento de dependentes químicos, pois são mais aceitáveis para os pacientes e produzem melhores resultados [24][25] . Alternativas de apoio profissional e acesso ampliado aos serviços de saúde parecem efetivos na ampliação da ocorrência de resultados satisfatórios.…”

“…As equipes de saúde expandem seu olhar para informações relacionadas aos há-bitos de vida, e o acompanhamento do dia a dia permite encontrar elementos reforçadores da mudança de comportamento e otimizar soluções para questões frequentemente elencadas como facilitadoras ou determinantes de lapsos ou recaídas, como problemas ocupacionais, financeiros ou desentendimentos e frustrações inerentes à circulação e ao convívio em ambientes não protegidos. As principais limitações desses dois estudos [24][25] são o número reduzido de pacientes e o processo amostral, que em ambos foi de conveniência, sem randomização e com pessoas já vinculadas aos serviços base de cada estudo. A contribuição relevante, indicando que cuidados multiprofissionais, com modelos ampliados, chamados psicossociais, além de cuidados continuados, podem aumentar as chances de adesão e resposta positiva em termos de mudança de comportamento fica limitada pela impossibilidade de os dados serem extrapolados para usuários de crack em geral ou para grupos de usuários com características especí-ficas, como sexo, idade, renda e escolaridade, por exemplo.…”

“…Numa coorte com 131 usuários de crack que estiveram hospitalizados por 15 dias 25 , foi avaliada a abstinência dois e cinco anos após a alta. Durante a internação, os pacientes receberam tratamento individual e grupal de psicoterapia (não foi especificada a abordagem ou sua base teórica), terapia ocupacional e consultas psiquiátricas.…”