RESUMEN
BACKGROUND: Psychoactive substance use among pregnant women has reached alarmingly high rates. Our aim was to characterize the psychiatric and clinical profiles of pregnant crack users in Brazil. METHODS: This was a cross-sectional study of 24 pregnant crack users admitted to a referral hospital for psychiatric disorders in pregnant women, in Porto Alegre, Brazil, over three years. The following instruments were applied: a clinical-obstetric questionnaire; the condensed version of the Addiction Severity Index; a diagnostic interview for psychoactive substance use based on DSM-5; the Mini International Neuropsychiatric Interview for DSM-IV; and the Semi-Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID-II). RESULTS: Most patients had severe crack dependence and used other substances, such as tobacco, cannabis, and alcohol. The median duration of crack use was three years, ranging between three and 12 years. Most women subsisted from illegal or informal activities; a fifth had previously been arrested and often had relationship problems. Twenty percent had HIV (n = 5), and 37.5% (n = 9) had syphilis. Borderline personality disorder was the most prevalent mental condition (62.5%), followed by suicidal tendencies (45.8%), hypomanic episodes due to substance use (37.5%), and past major depressive episodes (33.3%). CONCLUSIONS: An alarmingly high prevalence of consumption of other drugs, psychiatric disorders, and difficult-to-treat personality disorders was observed in our study. Investigating the psychiatric profile of women who use substances is essential to minimize the impacts on the mother and child, optimize therapeutic approaches to comorbidities, and enable more effective relapse prevention.
RESUMEN
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.