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Substance dependence represents a pervasive global concern within the realm of public health. Presently, it is delineated as a persistent and recurrent neurological disorder stemming from drug-triggered neuroadaptations in the brain's reward circuitry. Despite the availability of various therapeutic modalities, there has been a steady escalation in the mortality rate attributed to drug overdoses. Substantial endeavors have been directed towards the exploration of innovative interventions aimed at mitigating cravings and drug-induced repetitive behaviors. Within this review, we encapsulate the most auspicious contemporary treatment methodologies, accentuating meta-analyses of efficacious pharmacological and non-pharmacological approaches: including gabapentin, topiramate, prazosin, physical exercise regimens, and cerebral stimulation techniques.

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INTRODUCTION: Currently, there is no scientific consensus on the concept of alcohol addiction recovery beyond substance use control. This conceptual issue challenges the implementation of therapeutic strategies and mental health policies that are unrestricted to symptomatic remission. Aiming to contribute to its definition, this study aimed to examine the recovery experience of individuals with alcohol addiction using dialectical phenomenological psychopathology (DPP) as a theoretical and methodological framework. METHODS: A dialectical phenomenological analysis was conducted through an examination of online interviews with eight Brazilian, São Paulo state citizens who were self-declared to be undergoing alcohol addiction recovery (or who declared that they had completely recovered). RESULTS: Participants' reports generated eight categories that were subdivided into two groups. The first group indicated experiential elements of recovery, such as changes in self-relation, changes in interpersonal relations, and changes in time relations, giving new meanings to suffering and alcohol use, and recovery as a continuous process. The second group referred to how the participants interpreted recovery according to their worldviews: as a spiritual experience, moral reformation, and mentality change. CONCLUSION: These categories can be understood through the lens of DPP as a process of change in the subjects' being in the world, characterized by the continued management of their existential imbalances in the dimensions of spatiality, temporality, selfhood, and intersubjectivity. The results are preliminary when it comes to conceptualizing recovery but may help future studies to develop recovery-oriented therapeutic strategies.

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O trabalho objetiva conhecer como profissionais de equipe multidisciplinar se utilizam do lazer para tratamento e (re)educação de pessoas com transtornos por uso de subtâncias psicoativas. Ocorreu estudo de caso, no Hotel Fazenda e Clínica X, onde participaram de entrevistas semiestruturadas trabalhadores de diversas especialidades. Artigos selecionados em quatro revistas de envergadura nacional estruturadas por universidades federais no Brasil ­ Licere (UFMG); RBEL(UFMG); Motrivivência (UFSC) e Movimento(UFRGS) ­ auxiliaram nas reflexões realizadas, além de autores clássicos que tratam de lazer, drogas e educação não formal. Restou evidenciado que o lazer ocupa função de destaque no tratamento da adicção de psicoativos porque viabiliza socialização e mudança positiva de comportamento das pessoas em tratamento; contribui ao autocuidado e controle da ansiedade dentre outros.

The objective of this work is to know how professionals from a multidisciplinary team use leisure for the treatment and (re)education of people with disorders due to the use of psychoactive substances. A case study took place at Hotel Fazenda and Clínica X, where workers from different specialties participated in semistructured interviews. Articles selected in four magazines of national scale structured by federal universities in Brazil ­ Licere (UFMG); RBEL(UFMG); Motrivivência (UFSC) and Movimento (UFRGS) ­ helped in the reflections carried out, in addition to classic authors who deal with leisure, drugs and non-formal education. It remained evident that leisure occupies a prominent role in the treatment of psychoactive addiction because it enables socialization and a positive change in the behavior of people undergoing treatment; contributes to self-care and anxiety control, among others.

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Abstract Background Therapeutic properties of ibogaine in the treatment of addiction are attracting both clinicians and patients to its use. Since ibogaine is not an authorized medicine, the quality of these products is not always known, increasing the probability of adverse reactions. Objective This study collects different types of iboga-derived samples from treatment providers, vendors and online buyers to analyse their content. Methods Analysis of iboga products (n = 16) was performed using gas chromatography and mass spectrometry methods (GC/MS). Products included Iboga root bark, Total Alkaloids (TA), Purified Total Alkaloids (PTA HCl), ibogaine hydrochloride (ibogaine HCl) and one Voacanga africana root bark. Results The content of ibogaine was highly variable, ranging from 0.6% to 11.2% for products sold as iboga root bark, from 8.2% to 32.9% for products sold as TA, 73.7% for one sample sold as PTA and from 61.5% to 73.4% for products sold as ibogaine HCl. One sample did not show any iboga alkaloids. Other alkaloids and unknown substances were found in almost all samples. Discussion The purity of iboga products is highly variable. These results should be taken into consideration by suppliers and users, especially regarding correct dosing to avoid overdose, as well as potential interactions with other substances.

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Abstract Introduction The opioid epidemic is a severe problem in the world, especially in the United States, where prescription opioid overdose accounts for a quarter of drug overdose deaths. Objective To describe psychiatrists' prescription of opioid, benzodiazepine, and buprenorphine in the United States. Methods We conducted a retrospective cross-sectional study of the 2016 Medicare Part D claims data and analyzed psychiatrists' prescriptions of: 1) opioids; 2) benzodiazepines, whose concurrent prescription with opioids can cause overdose death; 3) buprenorphine, a partial opioid agonist for treating opioid addiction; 4) and naltrexone microsphere, a once-monthly injectable opioid antagonist to prevent relapse to opioid dependence. Prescribers with 11 or more claims were included in the analysis. Results In Medicare Part D in 2016, there were a total of 1,131,550 prescribers accounting for 1,480,972,766 total prescriptions and 78,145,305 opioid prescriptions, including 25,528 psychiatrists (2.6% of all prescribers) accounting for 44,684,504 total prescriptions (3.0% of all prescriptions) and 131,115 opioid prescriptions (0.2% of all opioid prescriptions). Psychiatrists accounted for 17.3% of benzodiazepine, 16.3% of buprenorphine, and 33.4% of naltrexone microsphere prescriptions. The opioid prescription rate of psychiatrists was much lower than that of all prescribers (0.3 vs 5.3%). The buprenorphine prescription rate of psychiatrists was much higher than that of all prescribers (2.3 vs. 0.1%). There was a substantial geographical variation across the United States. Conclusions The results show that, proportionally, psychiatrists have lower rates of opioid prescription and higher rates of benzodiazepine and buprenorphine prescription.

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La ayahuasca es una sustancia psicoactiva de origen amazónico, usada tradicionalmente con fines espirituales, médicos y religiosos. En la década de los ‘90 adquiere gran popularidad, tanto a través de las redes internacionales de espiritualidad y religiosidad, como en el denominado renacimiento de los estudios psicodélicos, donde se retoma la investigación y experimentación sobre los posibles usos clínicos de estas sustancias. El presente artículo tiene como objetivo la descripción y análisis de los procesos de cura de cuatro casos de adicciones tratados en el Instituto de Etnopsicología Amazónica Aplicada (IDEAA), un centro dedicado al tratamiento de adicciones, con pacientes españoles llevados al Amazonas de Brasil. El procedimiento ha implicado una metodología cualitativa del tipo biográfica, bajo una mirada interdisciplinaria que integra enfoques cognitivos y culturales. En los resultados, se describen el proceso de intervención utilizado en el centro y las narrativas biográficas de los casos estudiados. Se realiza una descripción de los distintos tipos de experiencias recurrentes durante los rituales de ayahuasca: revisiones biográficas, insights psicológicos, experiencias emocionales y/o trascendentales. Se analiza la importancia de la memoria de la experiencia, en tanto disparadora de nuevas reconfiguraciones en las narrativas biográficas de los sujetos, mostrándose la centralidad de dicha dinámica en el proceso terapéutico. Se analizan otros mecanismos específicos interviniendo en el proceso de cura de cada caso: psicosomáticos, simbólicos, de cognición social y psiconeuroinmunológicos. Se concluye sobre la relevancia terapéutica del contexto ritual, social y cultural, así como de las estrategias de integración de la memoria de la experiencia en las narrativas biográficas de los sujetos.

Ayahuasca is an Amazon psychoactive compound traditionally used for spiritual, religious, and medical purposes. In the 1990s the brew gains popularity, both through the transnational networks of religiosity/spirituality and the renaissance of psychedelic studies, where these kinds of substances are investigated for its possible clinical applications. The goal of the current article is to describe and analyze the therapeutic process of four cases from IDEAA, a center located in the Brazilian Amazon forest, dedicated to the treatment of addicts taken from Spain. An interdisciplinary perspective is proposed, combining cognitive and cultural insights from different fields (medical anthropology, cognitive science of religion, psychoneuroimmunology, qualitative sociology, cultural psychology). Ritual of ayahuasca will be considered as a way of producing a variety of experiences, and the memories of these experiences as ways of producing new biographic narratives. Biographic narratives are considered as a higher mental competence that includes functions related to self-knowledge, episodic memory, reflexivity, and psychosocial homeostasis. Under the appropriate set & setting, this process of narrative reconstruction helps the individual to cope with difficult situations, including addictions. The procedure used in this research consisted in a qualitative biographic methodology. The four cases described were treated in the period between 2000 and 2007. They started as poly drug users in the 1980s, at the end of the dictatorship period, when heroin made its entrance to Spain. The results describe the process of intervention used in the center, and the biographic narratives of each case. Most common types of experiences are mentioned: biographical revisions, psychological insights, emotional and transcendental experiences. Specific therapeutic mechanisms are also described. In the first case, a psychosomatic style of expression, where the subject describes strong embodied experiences of suffering his illnesses, and embodied expressions of coping with them. In the second case, a therapeutic process that includes the recognition of the former biographic narrative as a “lie”, and a symbolic way of producing new narratives of the self that spins around the presence of the jaguar. This animal acted as symbolic figure that triggered different meanings, useful for there covery of the patient. The third case is a subject who was involved in drug traffic, robberies, and violent activities. Experiences related to social cognition (e.g. empathy, shame, self-forgiveness) played a major role in his therapeutic process. Last, the narrative of a woman addicted to heroin is analyzed. Biographical remembrances and self-forgiveness played an importantrole, but also her symbolic experiences with the proximity of death, related to her medical conditions (addiction to heroin, hepatitis C, HIV). The case is also a good example of how the treatment had a positive psychoneuroimmunology impact in the HIV viral load of the patient. As we will analyze, the effect cannot be explained by ayahuasca itself (in fact, the scientific literature suggest a negative or neutral impact), but by the therapeutic strategy as a whole, with its various components. The article concludes addressing the importance of the “memory of the experience” of the ritual as catalyzer of new meanings in the biographic narratives of the patients. The new narratives can be considered assystem for self-regulation in the different, psychological, social, and cultural levels. Besides, it can also triggers different top-down psychoneuroimmunology and psychosomatic effects. The production of new narratives is related to what is usually called “integration”, and involves different psychological, social and cultural elements that are of great importance for a positive or negative therapeutic outcome.

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Objective: The harmful use of psychoactive substances represents one of today's largest public health problems. Yet, in spite of its global relevance, current treatment for substance use disorders (SUDs) is still not entirely successful. The purpose of this study was to investigate alternative treatments and conceptions from traditional Amazonian medicine adapted to SUDs. Methods: We conducted semi-structured interviews with 13 practicing experts at a well-established addiction treatment center in the Peruvian Amazon and performed qualitative content analysis on the collected data. Main categories were deductively defined and corresponding subcategories inductively developed. Results: Our findings revealed characteristic features and consequences, causes and antecedents, and treatment methods of SUDs as the main categories. Overall, concepts of disease etiology bore resemblance with contemporary biopsychosocial models of SUDs. The Amazonian therapeutic means however differed markedly from current Western ones. The main methods involved dietary retreats, healing ceremonies, and purging rituals. The integral application of Amazonian methods, as well as their traditional implementation according to prescribed ritual protocols, were emphasized by the experts as crucial for efficacy and safety of treatment delivery. Conclusion: We suggest further scientific attention to these therapies, including clinical studies, for which our results provide conceptual underpinnings. Findings from this research expand the cross-cultural understanding of SUDs and, in the long run, may enhance its treatment options.

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Mexico has experienced disproportionate drug-related harms given its role as a production and transit zone for illegal drugs destined primarily for the USA. In response, in 2009, the Mexican federal government passed legislation mandating pre-arrest diversion of drug-dependent individuals towards addiction treatment. However, this federal law was not specific about how the scale-up of the addiction treatment sector was to be operationalised. We therefore conducted in-depth qualitative interviews with key 'interactors' in fields affected by the federal legislation, including participants from the law enforcement, public health, addiction treatment, and governmental administration sectors. Among 19 participants from the municipal, state and federal levels were interviewed and multiple barriers to policy reform were identified. First, there is a lack of institutional expertise to implement the reform. Second, the operationalisation of the reform was not accompanied by a coordinated action plan. Third, the law is an unfunded mandate. Institutional barriers are likely hampering the implementation of Mexico's policy reform. Addressing the concerns expressed by interactors through the scale-up of services, the provision of increased training and education programmes for stakeholders and a coordinated action plan to operationalise the policy reform are likely needed to improve the policy reform process.

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BACKGROUND: Violence against women is a social and public health issue in Mexico. The aim of this article is to explore violence among an understudied group of women, who attended Mutual-Aid Residential Centers for Addiction Treatment and experienced stigma both as women and addicts. These centers are particular kind of addiction treatment services that stem from 12-step philosophy, but that have been found to manipulate said philosophy and exercise extreme forms of psychological and physical violence. METHODS: Thirteen semi-structured interviews were carried in 2014 and 2015 out with women who resided in at least one of these centers to understand their experiences of violence prior and during their rehabilitation process. The interview guide covered questions regarding substance use initiations, family violence and dynamics, and rehabilitation experiences. Qualitative data was analyzed using interpretative-phenomenological analysis. RESULTS: Two categories emerged: violence and substance use and abuse, and violence against women in recovery. Results show that all participants experienced violence in their family since childhood, particularly sexual and physical violence. As a result, participants experienced guilt, sadness and shame, which led them to contexts of consumption. Violence continued as they explored alcohol and drug use, even though women felt empowered. CONCLUSIONS: Treatment reproduced masculine violence constantly, but women felt that they were in a context that helped them understand their addiction. Even though women felt these centers played a crucial role in their recovery, women's particular needs and experiences are not considered in the treatment program.

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AIMS: In the context of a public health-oriented drug policy reform in Mexico, we assessed the spatial distribution of police encounters among people who inject drugs (PWID) in Tijuana, determined the association between these encounters and the location of addiction treatment centers and explored the association between police encounters and treatment access. DESIGN: Geographically weighted regression (GWR) and logistic regression analysis using prospective spatial data from a community-recruited cohort of PWID in Tijuana and official geographical arrest data from the Tijuana Municipal Police Department. SETTING: Tijuana, Mexico. PARTICIPANTS: A total of 608 participants (median age 37; 28.4% female) in the prospective Proyecto El Cuete cohort study recruited between January and December 2011. MEASUREMENTS: We compared the mean distance of police encounters and a randomly distributed set of events to treatment centers. GWR was undertaken to model the spatial relationship between police interactions and treatment centers. Logistic regression analysis was used to investigate factors associated with reporting police interactions. FINDINGS: During the study period, 27.5% of police encounters occurred within 500 m of treatment centers. The GWR model suggested spatial correlation between encounters and treatment centers (global R(2)  = 0.53). Reporting a need for addiction treatment was associated with reporting arrest and police assault [adjusted odds ratio = 2.74, 95% confidence interval (CI) = 1.25-6.02, P = 0.012]. CONCLUSIONS: A geospatial analysis suggests that, in Mexico, people who inject drugs are at greater risk of being a victim of police violence if they consider themselves in need of addiction treatment, and their interactions with police appear to be more frequent around treatment centers.

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Fundamental elements of hegemonic masculinity such as power and violence are analyzed through characteristics of 12-step programs and philosophy immersed in Mutual-Aid Residential Centers for Addiction Treatment (CRAMAAs). CRAMAAs are a culturally specific form of substance abuse treatment in Mexico that are characterized by control and violence. Fifteen interviews were carried out with men of varied sociodemographic characteristics, and who resided in at least two of these centers. Results identify that power is expressed through drug abuse and leads them to subsequent biopsychosocial degradation. Residency in CRAMAAs is motivated by women, but men do not seek the residency and are usually admitted unwillingly. Power through violence is carried out inside CRAMAAs where men are victims of abuse. From a 12-step philosophy, this violence is believed to lead them to a path of recovery but instead produces feelings of anger and frustration. The implications of these centers on Mexican public health are discussed.

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La hipertensión arterial es un problema de salud pública a nivelmundial, una de sus causas radica en la baja adhesión altratamiento. Se desea conocer si existe asociación entre adherenciaterapéutica y apoyo familiar en personas hipertensas.Se realizó un estudio descriptivo, transversal, correlacionalaplicado a personas hipertensas de la consulta externa del InstitutoNacional de Cardiología Ignacio Chávez (INCICH). Seaplicaron los Instrumentos para medir el estilo de vida (IMEVID)(α = 0.81) y la Escala de Efectividad en el Funcionamiento Familiar(E-EFF), (α = 0 .83). El α del instrumento fue de 0.82.Se observó que la mayoría tienen más de 55 años, son casadosy padecen hipertensión arterial desde hace más de 30 años.Más de la tercera parte combina medicamentos, ejercicio y dietapara controlar su enfermedad, pero algunos utilizan sólomedicamentos. Asimismo, el 46.7% tiene un nivel socioeconó-mico bajo y el 33.3% sólo tienen primaria. El 73% de la poblacióntiene alta adherencia terapéutica y el 63.3% alto apoyo familiar.La r de Spearman obtenida para estas variables fue de0.643 (p = 0.000). No existe ninguna asociación entre las variablesdemográficas y la adherencia terapéutica. El apoyo familiares un factor importante para el éxito del tratamiento,destacando que ni las cuestiones económicas, edad, nivel académicoo estado civil actúan como limitantes para ello.

Hypertension is a public health problem worldwide, a causelies in the low adherence to treatment. You want to know ifthere is an association between therapeutic adherence and familysupport in hypertensive persons. We performed a descriptive,cross-correlation applied to hypertensive individualsin the outpatient LTD. IMEVID instruments wereapplied (α = 0.81) and E-EFF (α = 0 .83). The α instrumentwas 0.82. It was noted that most are over 55 years, are marriedand have high blood pressure for over 30 years. Morethan a third of combining medications, exercise and diet tocontrol their disease, but some use only medicines. Also,46.7% have a low socioeconomic level and 33.3% have onlyprimary education. 73% of the population has high adhesiontherapy and 63.3% high family support. Spearman’s r for thesevariables was obtained from 0,643 (p = 0.000). There is noassociation between demographic variables and therapeuticadherence. Family support is an important factor in treatmentsuccess, noting that neither the economic, age, educationallevel and marital status act as constraints for this.

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