The effect of religiosity during childhood and adolescence on drug consumption patterns in adults addicted to crack cocaine

BACKGROUND

Although many studies suggest that religiosity is a protective factor against drug use, there is little information on its effect on drug consumption patterns of those who do use drugs.AimsWe aimed to examine if there is any relationship between religiosity during childhood and adolescence, and drug consumption in adult crack users.

METHOD

We performed a cross-sectional study of adults addicted to crack cocaine. Logistic regression analysis was used to estimate the odds ratio for the association between religious history in the age groups 8-11, 12-14 and 15-17 years and outcome variables.

RESULTS

From a total of 531 respondents, religious involvement during childhood and adolescence was correlated to less frequent onset of drug consumption before 18 years (odds ratio 0.95, 95% CI 0.92-0.98) and less craving (odds ratio 0.95, 95% CI 0.91-0.99), mainly between the ages of 15 and 17 years.

CONCLUSIONS

Religiosity provides some protection against drug consumption patterns in crack cocaine addicts.Declaration of interestNone.

Non-invasive brain stimulation for negative symptoms in schizophrenia: An updated systematic review and meta-analysis

BACKGROUND

Schizophrenia is a mental disorder with significant socioeconomic burden. Although current pharmacological treatments are effective for treating positive symptoms, medications have little-to-no effect in the treatment of negative symptoms.

OBJECTIVE

To assess the efficacy of non-invasive brain stimulation (NIBS) for negative symptoms in schizophrenia in randomized clinical trials (RCTs).

METHODS

A systematic review in Medline and Cochrane Library databases was performed up to May 31, 2017. The primary outcome was Hedges' g for continuous scores in a random-effects model. Heterogeneity was evaluated with the I² and χ² tests. Publication bias was assessed using Begg's funnel plot.

RESULTS

31 RCTs (n = 1272) were included, most with small-to-modest sample sizes. Both repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS) were superior to sham (Hedges' g = 0.19; 95% CI 0.07-0.32; and 0.5; 0.02-0.97, respectively). Only one study evaluated the use of transcutaneous auricular vagus nerve stimulation (taVNS). The funnel plot and Eggers test showed that the risk of publication bias was low. In relation to heterogeneity, we found an I² of 0% (p = 0.749) and 51.3% (0.055) for rTMS and tDCS, respectively.

CONCLUSION

Both rTMS and tDCS were superior to sham stimulation for ameliorating negative symptoms in schizophrenia. We found no considerable heterogeneity or publication bias in our analysis, corroborating the strength of our findings. Not enough studies on other NIBS techniques, such as taVNS, were found for an isolated analysis. Further RCTs with larger sample sizes are needed to clarify the specific impact of NIBS on negative symptoms in schizophrenia.

Pathways from witnessing parental violence during childhood to involvement in intimate partner violence in adult life: The roles of depression and substance use

INTRODUCTION AND AIMS

The aims of this study were to determine the prevalence of witnessing parental violence (WPV) during childhood and of current intimate partner violence (IPV) victimisation and aggression in a Brazilian sample, in order to verify pathways between WPV and involvement in IPV as an adult.

DESIGN AND METHODS

The mediating roles of substance use and depression were investigated. Data came from the Second Brazilian National Alcohol and Drugs Survey, a multi-cluster probabilistic household survey, which gathered information on the use of psychoactive substances, current depressive disorder, history of childhood direct and indirect exposure to domestic violence and IPV in a nationally representative sample. A subsample of 2120 individuals aged 14 years or older was analysed. Weighted prevalence rates, adjusted odds ratio and conditional path models were performed.

RESULTS

Being a victim of IPV was reported by 6% of the sample. Thus being, 4.1% reported being IPV perpetrators; these rates were 16.6% and 7.3%, respectively, among those who reported WPV (13%). WPV was associated with being a victim of IPV in adult life, but not with becoming a perpetrator, regardless of being a victim of physical violence during childhood. There was a direct effect of WPV on IPV mediated by depressive symptoms. Alcohol and cocaine consumption and age of drinking initiation mediated only when combined with depressive symptoms.

DISCUSSION AND CONCLUSIONS

Intergenerational transmission models of IPV through exposure during childhood can help to explain the high rates of domestic violence in Brazil. Our findings provide evidence to implement targeted prevention strategies where they are needed most: the victims of premature adverse experiences. [Madruga CS, Viana MC, Abdalla RR, Caetano R, Laranjeira R. Pathways from witnessing parental violence during childhood to involvement in intimate partner violence in adult life: The roles of depression and substance use. Drug Alcohol Rev 2017;36:107-114].

Abortion and sex-related conditions in substance-dependent Brazilian patients

Abortion is a very sensitive issue with relevance to public health; however few clinical or population-based studies have examined induced abortion among drug users. The study aims to evaluate the prevalence of induced abortion and sex-related conditions in an inpatient drug user sample. A cross-sectional design study was conducted in an inpatient addiction treatment unit in São Paulo, Brazil, with a sample of 616 patients, aged 18-75. Sociodemographic data, sexual behavior, and dependence severity were evaluated in relation to induced abortion. Approximately 27% of patients reported having a history of abortion (themselves in the case of women or partners in the case of men). The mean age was 34.6±10.9 years old, 34.9% diagnosed with severe alcohol dependence, 33% were diagnosed with severe levels of dependence on other drugs, 69.6% were diagnosed cocaine users (inhaled and smoked), and alcohol was the drug of choice for 30.4%. Chances of having a history of abortion is greater for women than for men with a odds ratio (OR = 2.9; 95%CI: 1.75-4.76), (OR = 1.7; 95%CI: 1.09-2.75) of no condom use; (OR = 2.0; 95%CI: 1.35-3.23) of history of STI and (OR = 3.2; 95%CI: 1.29-5.73) use of morning-after pill. Drug- and alcohol-dependent patients have high-risk behaviours of sporadic use or no-condom use which contribute to unplanned pregnancy and induced abortion, making this vulnerable population a group which deserves special attention in sexual health prevention programmes and health promotion efforts for the reduction of induced abortion.

Amphetamine-type stimulant use and conditional paths of consumption: data from the Second Brazilian National Alcohol and Drugs Survey

OBJECTIVE:

The aim of this study was to estimate nationally representative prevalence rates of amphetamine-type stimulant (ATS) use and to identify consumption-associated factors, proposing a conditional model of direct and indirect consumption paths.

METHOD:

Using data from the Second Brazilian National Alcohol and Drugs Survey, this cross-sectional study analyzed a subsample of 3,828 participants between 15 and 64 years old, gathering information on the use of psychoactive substances in a probabilistic sample of the Brazilian household population.

RESULTS:

Rates of lifetime and last-year ATS use were, respectively, 4.1 and 1.6%. Economically privileged individuals and users of other substances were more at risk for using ATS. The results suggest that higher education decreases the chances of ATS consumption. The conditional model showed that higher income increased ATS use, higher education lowered the odds of such an increase, and cocaine use cancelled that associative effect.

CONCLUSION:

Brazil presents high rates of ATS use. Prevention and treatment strategies should focus on the protective effect of higher education levels and should target polydrug use. Knowledge of ATS-associated factors and user profiles is the starting point for developing effective treatments and tailored prevention strategies.

Brazilian cross-cultural adaptation and validation of the List of Threatening Events Questionnaire (LTE-Q)

Objective:

To perform a construct validation of the List of Threatening Events Questionnaire (LTE-Q), as well as convergence validation by identifying its association with drug use in a sample of the Brazilian population.

Methods:

This is a secondary analysis of the Second Brazilian National Alcohol and Drugs Survey (II BNADS), which used a cross-cultural adaptation of the LTE-Q in a probabilistic sample of 4,607 participants aged 14 years and older. Latent class analysis was used to validate the latent trait adversity (which considered the number of events from the list of 12 item in the LTE experienced by the respondent in the previous year) and logistic regression was performed to find its association with binge drinking and cocaine use.

Results:

The confirmatory factor analysis returned a chi-square of 108.341, weighted root mean square residual (WRMR) of 1.240, confirmatory fit indices (CFI) of 0.970, Tucker-Lewis index (TLI) of 0.962, and root mean square error approximation (RMSEA) score of 1.000. LTE-Q convergence validation showed that the adversity latent trait increased the chances of binge drinking by 1.31 time and doubled the chances of previous year cocaine use (adjusted by sociodemographic variables).

Conclusion:

The use of the LTE-Q in Brazil should be encouraged in different research fields, including large epidemiological surveys, as it is also appropriate when time and budget are limited. The LTE-Q can be a useful tool in the development of targeted and more efficient prevention strategies.

Intimate partner violence trends in Brazil: data from two waves of the Brazilian National Alcohol and Drugs Survey

OBJECTIVE

To compare intimate partner violence (IPV) prevalence rates in 2006 and 2012 in a nationally representative household sample in Brazil. The associations between IPV and substance use were also investigated.

METHODS

IPV was assessed using the Conflict Tactic Scale-R in two waves (2006/2012) of the Brazilian Alcohol and Drugs Survey. Weighted prevalence rates and adjusted logistic regression models were calculated.

RESULTS

Prevalence rates of IPV victimization decreased significantly, especially among women (8.8 to 6.3%). The rates of IPV perpetration also decreased significantly (10.6 to 8.4% for the overall sample and 9.2 to 6.1% in men), as well as the rates of bidirectional violence (by individuals who were simultaneously victims and perpetrators of violence) (3.2 to 2.4% for the overall sample). Alcohol increased the likelihood of being a victim (odds ratio [OR] = 1.6) and perpetrator (OR = 2.4) of IPV. Use of illicit drugs increased up to 4.5 times the likelihood of being a perpetrator.

CONCLUSIONS

In spite of the significant reduction in most types of IPV between 2006 and 2012, violence perpetrated by women was not significantly reduced, and the current national rates are still high. Further, this study suggests that use of alcohol and other psychoactive drugs plays a major role in IPV. Prevention initiatives must take drug misuse into consideration.

Sexual Dysfunction and Sexual Behaviors in a Sample of Brazilian Male Substance Misusers

The aim of this study was to evaluate the potential relationship between self-reported sexual dysfunction, sexual behavior, and severity of addiction of drug users. A cross-sectional design study was conducted at an inpatient addiction treatment unit in Sao Paulo, Brazil, with a sample of 508 male drug users. Sociodemographic data, sexual behavior, and severity of dependence were evaluated.The prevalence of sexual dysfunction was 37.2% and premature ejaculation was 63.8%. Men with sexual dysfunction presented from moderate to severe level of alcohol, tobacco, and other drugs of dependence. The findings from this study are particularly relevant identifying those sociodemographic factors, severity of drug use, and sexual behavior are related to men who experience sexual dysfunction. Health promotion and motivational interventions on sexual health targeted to male drug users can contribute in reducing these at-risk behaviors. More interdisciplinary research is desirable in future in considering men’s sexual health.

Opinions about Alcohol Control Policies Among Brazilians: The First National Alcohol Survey

Several general-population alcohol surveys have been conducted in Brazil in the past 25 years, none using probability sampling methodology. This article focuses on the results of the first alcohol national survey in Brazil, particularly as it concerns support for six alcohol policies. A total of 2,346 interviews were conducted with adults aged 18 and older. The interviews, averaging 53 minutes in length, were conducted face to face in the respondent's home by trained interviewers using a standardized questionnaire, with an overall response rate of 66.4%.

Overall at least half of the respondents supported the six alcohol policies analyzed. Gender, intensity of alcohol consumption and age were the main variables associated with approval of the alcohol policies. The relatively high level of support for the alcohol policies suggests that there is room for developing new measures in the area in Brazil.

Assessment of Sexual Dysfunction Symptoms in Female Drug Users: Standardized vs. Unstandardized Methods

AIMS

The aim of this study is to evaluate whether there is a difference in the identified prevalence between the assessment of symptoms of sexual dysfunction in female drug users using a standardized scale and by means of a nonstandardized set of questions about sexual dysfunctions.

METHOD

A cross-sectional study was conducted with two groups of substance-dependent women using the Drug Abuse Screening Test, the Short Alcohol Dependence Data questionnaire, the Fagerström Test for Nicotine Dependence for the evaluation of the severity of dependence, and the Arizona Sexual Experience Scale.

FINDINGS

In both groups, the severity of dependence and the prevalence of symptoms of sexual dysfunctions in women were similar.

CONCLUSION

The use of standardized and nonstandardized instruments to assess sexual dysfunction symptoms is an essential resource for the provision of good-quality care to this clientele.

Discrepant trends in income, drinking, and alcohol problems in an emergent economy: Brazil 2006 to 2012

BACKGROUND

To examine the association between increases in income and self-reported alcohol consumption, binge drinking, and alcohol problems in 2006 and 2012 in Brazil.

METHODS

Participants were interviewed as part of 2 multistage representative cluster samples of the Brazilian household population between November 2005 and April 2006 and between November 2011 and March 2012. The number of current drinkers during these 2 intervals (n = 1,379 and n = 1,907, respectively) comprised the sample analyzed. Four past-year outcome variables-standard drinks per week, binge drinking, presence of alcohol-related social/health problems, and DSM-5 alcohol use disorder (AUD)-were estimated across income, age, and gender groups. Regression models were estimated to evaluate these and other sociodemographic effects on drinking and problem outcomes and to test for possible wave by income interactions.

RESULTS

Response rates were 66.4% in 2006 and 77% in 2012. Income increases were seen in virtually all age-gender subgroups and were particularly pronounced for younger age groups and older women. Both genders reported increased drinks per week (men: 12.82, 2006; 15.78, 2012; p < 0.01; women: 4.89, 2006; 7.66, 2012; p < 0.001) and proportion binge drinking (men: 57%, 2006; 66%, 2012; p < 0.05; women: 39%, 2006; 48%, 2012; p < 0.05), although this was not seen in all gender and age groups. Social/health problem prevalence decreased among men (37%, 2006; 26%, 2012; p < 0.001) and remained the same among women (13%, 2006; 14%, 2012). DSM-5 AUD decreased among men (34%, 2006; 24%, 2012; p < 0.01) and remained stable among women (14%, 2006; 16%, 2012).

CONCLUSIONS

Brazilian economic development between 2006 and 2012 led to a rise in income in several gender and age groups. Although not always directly associated with an observed increase in alcohol consumption, the rise in income may have created a sense of optimism that inhibited a rise in alcohol-related problems.

Suicide among physicians in the state of São Paulo, Brazil, across one decade

OBJECTIVE

To describe mortality by suicide among physicians in the state of São Paulo, Brazil, between 2000 and 2009.

METHODS

Secondary analysis of government mortality data. The variable of interest was "underlying cause of death", specifically deaths classified by the ICD-10 as intentional self-harm (X60 to X84).

RESULTS

The analyses examined 2,297 declarations of death, among which suicide accounted for 50 cases, i.e., 1.7% of all causes of death. Women comprised 13.2% of the total sample and represented 24% of the death-by-suicide group, indicating an overrepresentation of women in the latter (p = 0.02). Deaths by suicide occurred on average 20 years earlier than deaths by other causes (46.8 ± 14.2 years and 68.1 ± 15.8 years, respectively; p = 0.001). There was a significant association between single and/or divorced status and suicide (p < 0.001). The average mortality rate during the study period was 4.2 deaths per 100,000 physicians registered with the Regional Board of Medicine of the State of São Paulo.

CONCLUSION

Deaths by suicide occurred 20 years earlier than deaths by other causes. Medical institutions should develop strategies for the prevention and early detection of mental disorders and occupational stressors that elevate the risk of suicide among physicians.

Family members affected by a relative's substance misuse looking for social support: who are they?

BACKGROUND

This study proposes to describe family members in the city of Sao Paulo who are seeking support in mutual self-help groups to deal with a substance misusing relative.

METHOD

Five hundred participants (one participant per family) completed a structured questionnaire collecting socio-demographic information, length of time taken to seek help, and where they sought help. Participants were recruited from the mutual self-help group 'Amor Exigente' in the city of Sao Paulo, Brazil.

RESULTS

Parents of substance misusers counted as the largest group of family members. It took an average time of 3.7 years for the family members to discover their relatives' substance misuse. 42% had then sought help immediately; it took an average of 2.6 years for the remaining 58% of the sample to seek some form of support. A belief that the substance misuse of their relatives was just a transient problem or that they could cope with the situation by themselves were among the most indicated reasons for delay in seeking help.

DISCUSSION

Findings stress the importance of implementing services that take into account the difficulties families have in finding help to deal with the substance misusing relative.

αCaMKII controls the establishment of cocaine's reinforcing effects in mice and humans

Although addiction develops in a considerable number of regular cocaine users, molecular risk factors for cocaine dependence are still unknown. It was proposed that establishing drug use and memory formation might share molecular and anatomical pathways. Alpha-Ca(2+)/calmodulin-dependent protein kinase-II (αCaMKII) is a key mediator of learning and memory also involved in drug-related plasticity. The autophosphorylation of αCaMKII was shown to accelerate learning. Thus, we investigated the role of αCaMKII autophosphorylation in the time course of establishing cocaine use-related behavior in mice. We found that αCaMKII autophosphorylation-deficient αCaMKII(T286A) mice show delayed establishment of conditioned place preference, but no changes in acute behavioral activation, sensitization or conditioned hyperlocomotion to cocaine (20 mg kg(-1), intraperitoneal). In vivo microdialysis revealed that αCaMKII(T286A) mice have blunted dopamine (DA) and blocked serotonin (5-HT) responses in the nucleus accumbens (NAcc) and prefrontal cortex after acute cocaine administration (20 mg kg(-1), intraperitoneal), whereas noradrenaline responses were preserved. Under cocaine, the attenuated DA and 5-HT activation in αCaMKII(T286A) mice was followed by impaired c-Fos activation in the NAcc. To translate the rodent findings to human conditions, several CAMK2A gene polymorphisms were tested regarding their risk for a fast establishment of cocaine dependence in two independent samples of regular cocaine users from Brazil (n=688) and Switzerland (n=141). A meta-analysis across both samples confirmed that CAMK2A rs3776823 TT-allele carriers display a faster transition to severe cocaine use than C-allele carriers. Together, these data suggest that αCaMKII controls the speed for the establishment of cocaine's reinforcing effects.

Gambling onset and progression in a sample of at-risk gamblers from the general population

The goal of this study was to investigate gambling-related behavior, onset and progression in a sample of at-risk gamblers from the community. A national household survey was conducted in Brazil, covering individuals 14 years old or older. Subjects were screened for at-risk gambling, those testing positive answered a questionnaire about gambling progression, preferred games and DSM-IV pathological gambling criteria. Out of 3007 respondents, 118 were considered at-risk gamblers according to the Lie/Bet Questionnaire. According to the DSM-IV, 32.7% and 24.9% of those were considered problem and pathological gamblers, respectively. Early at-risk gamblers (onset prior to 20 years of age), were more likely to be male, to prefer non-commercially structured games, and to chase losses while gambling. Young pathological gamblers (under 35 years of age) progressed faster from regular to problem gambling (roughly 2 years) than mature pathological gamblers (12 years). Such findings had not been described before because previous reports focused mostly on clinical samples that lack young, male, early-onset gamblers. Gambling programs have not satisfactorily covered this segment of gamblers. Outreach strategies and early interventions should be provided to prevent these individuals from rapidly evolving into pathological gambling.

How smokers may react to cigarette taxes and price increases in Brazil: data from a national survey

BACKGROUND

Despite being the third largest tobacco producer in the world, Brazil has developed a comprehensive tobacco control policy that includes a broad restriction on both advertising and smoking in indoor public places, compulsory pictorial warning labels, and a menthol cigarette ban. However, tax and pricing policies have been developed slowly and only very recently were stronger measures implemented. This study investigated the expected responses of smokers to hypothetical price increases in Brazil.

METHODS

We analyzed smokers' responses to hypothetical future price increases according to sociodemographic characteristics and smoking conditions in a multistage sample of Brazilian current cigarette smokers aged≥14 years (n=500). Logistic regression analysis was used to examine the relationship between possible responses and different predictors.

RESULTS

In most subgroups investigated, smokers most frequently said they would react to a hypothetical price increase by taking up alternatives that might have a positive impact on health, i.e., they would "try to stop smoking" (52.3%) or "smoke fewer cigarettes" (46.8%). However, a considerable percentage responded that they would use alternatives that would reduce the effect of price increases, such as the same brand with lower cost (48.1%). After controlling for sex age group (14-19, 20-39, 40-59, and ≥60 years), schooling level (≥9 versus ≤9 years), number of cigarettes per day (>20 versus ≤20), and stage of change for smoking cessation (precontemplation, contemplation, and preparation), lower levels of dependence were positively associated with the response "I would try to stop smoking" (odds ratio [OR], 2.19). Young age was associated with "I would decrease the number of cigarettes" (OR, 3.44). A low schooling level was strongly associated with all responses.

CONCLUSIONS

Taxes and prices increases have great potential to stimulate cessation or reduction of cigarette consumption further among two important vulnerable populations of smokers in Brazil: young smokers and those of low educational level. The results from the present study also suggest that seeking illegal products may reduce the impact of increased taxes, but does not eliminate it.