RESUMO
Cuba implemented policies mandating social distancing on March 11, 2020, which were still in place at the time of this study. During such periods of isolation, people with psychoactive substance-related disorders and other addictions may be tempted to reduce tension, stress, uncertainty and possible distress by increasing the use of substances or practices they have abused. This can mean relapses and setbacks for patients undergoing treatment. A multidisciplinary team of health professionals specializing in addiction at the Center for Academic Development in Drug Addiction, in Havana, Cuba, cares for people with these disorders and followed their evolution during the initial period of COVID-19 social isolation. With the aim of characterizing strategies employed by patients undergoing treatment for substance abuse and addictions, we conducted a qualitative study from April 2020 through May 2020, using a convenience sample of 37 patients (all students) who had been progressing towards recovery from addictive behaviors when face-to-face encounters were suspended due to COVID-19 restrictions. Contact was maintained through information and communication technologies. The research used telepsychology and focused on understanding patient life experiences. Patients were interviewed using a semi-structured survey, which was then transcribed and coded thematically using a grounded-theory approach. We found that patients' ability to cope successfully with challenges presented by COVID-19 were influenced by: 1) the individual's own methods for maintaining self-control (commitment to studies, projects, and work with therapists) that aided them in their goals concerning abstinence; 2) difficulties faced in addressing specific events and situations (doubts, uncertainties, disagreements, isolation and time use); 3) perpetuation and revivification of myths related to substances and addictive activities (exacerbation of supposed benefits of tobacco, alcohol, marijuana, overuse of social networks); and 4) tendencies toward irrationality and lack of emotional control (fear, sadness, anger, constant worry and self-imposed demands). Our findings suggest that despite the potential negative psychological impact of preventive social isolation during the COVID-19 pandemic, individual coping mechanisms developed by these patients, aiming at improved self-control, allowed most to avoid setbacks that could have affected their recovery. Nevertheless, patients faced challenges to their recovery that were compounded by difficulties in specific situations, myths related to substances and addictive activities, and tendencies toward irrationality or lack of emotional control.
Assuntos
Adaptação Psicológica , Comportamento Aditivo/psicologia , COVID-19/psicologia , Transtornos Relacionados ao Uso de Substâncias/psicologia , Adulto , Comportamento Aditivo/epidemiologia , Comportamento Aditivo/reabilitação , COVID-19/epidemiologia , Cuba/epidemiologia , Feminino , Teoria Fundamentada , Humanos , Masculino , Pandemias , Pesquisa Qualitativa , SARS-CoV-2 , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/reabilitaçãoRESUMO
La Terapia Ocupacional, además de desempeñar un rol importante en la rehabilitación, constituye una herramienta indispensable para realizar acciones preventivas direccionadas al consumo de sustancias adictivas en la adolescencia, desde los centros comunitarios de salud mental. En el presente trabajo se destacan el valor de la comunidad como escenario para la intervención, la clasificación científica de las drogas teniendo en cuenta sus efectos sobre el sistema nervioso central, así como las acciones desde la actividad y las ocupaciones, lo cual mejora la calidad del servicio que se presta a ese grupo etario.
The Occupational Therapy, besides carrying out an important role in rehabilitation, constitutes an indispensable tool to achieve preventive actions addressed to the consumption of addictive substances in adolescence, from the mental health community centers. In this work, the value of the community as scenario for the intervention, as well as the scientific classification of drugs are highlighted keeping in mind its effects on the central nervous system, as well as in the actions from the activity and occupations, which improves the service quality to that age group.
Assuntos
Humanos , Masculino , Feminino , Adolescente , Comportamento Aditivo/prevenção & controle , Comportamento Aditivo/reabilitação , Transtornos Relacionados ao Uso de Substâncias/prevenção & controle , Terapia Ocupacional , ComunicaçãoRESUMO
In order to reconstruct the origin and development of neo-Pentecostal devices for the treatment of addictions in the City of Buenos Aires, Argentina, the article analytically puts into historical context the "therapeutic spiritualization" of addictive behavior undertaken by evangelical agents since the 1970s and explores the way in which the State and religious groups converge in the Recover Inclusion Program. Based on qualitative methodology and a sociological approach and carried out in 2015 and 2016, the study includes fourteen interviews with teachers, leaders and former users of the program, twelve interviews with state officials, participant observation in training courses and a corpus made up of documents related to both institutions. The emergent processes of political and religious institutionalization were analyzed according to three dimensions: a) charisma and its opposite, bureaucracy, b) the dynamic role of the second lines of leadership and c) the networked organization structures. It is concluded that points of convergence and analogies exist in the dynamics of evangelical and public institutionalization in addiction treatment.
Para reconstruir el origen y desarrollo de los dispositivos neopentecostales dirigidos al tratamiento de adicciones en la Ciudad de Buenos Aires, Argentina, el artículo periodiza analíticamente los impulsos de "espiritualización terapéutica" de la conducta adictiva que emprenden los agentes evangélicos a partir de la década de 1970 y explora el modo en que el Estado y los grupos religiosos convergen en el Programa Recuperar Inclusión. Desde una metodología cualitativa y un enfoque sociológico entre 2015 y 2016, se realizaron catorce entrevistas a profesores, dirigentes y ex usuarios del programa, doce entrevistas a responsables estatales, observación participante en los cursos de formación y se conformó un corpus de documentos relativo a ambas instituciones. Los procesos emergentes de institucionalización política y religiosa se analizaron de acuerdo a tres dimensiones: a) el carisma y su par opuesto, la burocracia, b) al rol dinamizador de las segundas líneas y c) las estructuras de organización en red. Se concluye que existen encuentros y analogías entre las dinámicas de institucionalización evangélica y pública en el tratamiento de las adicciones.
Assuntos
Cristianismo , Terapias Espirituais , Transtornos Relacionados ao Uso de Substâncias/reabilitação , Argentina , Comportamento Aditivo/reabilitação , Humanos , Fatores Sociológicos , Saúde da População UrbanaRESUMO
RESUMEN Para reconstruir el origen y desarrollo de los dispositivos neopentecostales dirigidos al tratamiento de adicciones en la Ciudad de Buenos Aires, Argentina, el artículo periodiza analíticamente los impulsos de "espiritualización terapéutica" de la conducta adictiva que emprenden los agentes evangélicos a partir de la década de 1970 y explora el modo en que el Estado y los grupos religiosos convergen en el Programa Recuperar Inclusión. Desde una metodología cualitativa y un enfoque sociológico entre 2015 y 2016, se realizaron catorce entrevistas a profesores, dirigentes y ex usuarios del programa, doce entrevistas a responsables estatales, observación participante en los cursos de formación y se conformó un corpus de documentos relativo a ambas instituciones. Los procesos emergentes de institucionalización política y religiosa se analizaron de acuerdo a tres dimensiones: a) el carisma y su par opuesto, la burocracia, b) al rol dinamizador de las segundas líneas y c) las estructuras de organización en red. Se concluye que existen encuentros y analogías entre las dinámicas de institucionalización evangélica y pública en el tratamiento de las adicciones.
ABSTRACT In order to reconstruct the origin and development of neo-Pentecostal devices for the treatment of addictions in the City of Buenos Aires, Argentina, the article analytically puts into historical context the "therapeutic spiritualization" of addictive behavior undertaken by evangelical agents since the 1970s and explores the way in which the State and religious groups converge in the Recover Inclusion Program. Based on qualitative methodology and a sociological approach and carried out in 2015 and 2016, the study includes fourteen interviews with teachers, leaders and former users of the program, twelve interviews with state officials, participant observation in training courses and a corpus made up of documents related to both institutions. The emergent processes of political and religious institutionalization were analyzed according to three dimensions: a) charisma and its opposite, bureaucracy, b) the dynamic role of the second lines of leadership and c) the networked organization structures. It is concluded that points of convergence and analogies exist in the dynamics of evangelical and public institutionalization in addiction treatment.
Assuntos
Humanos , Cristianismo , Transtornos Relacionados ao Uso de Substâncias/reabilitação , Terapias Espirituais , Argentina , Saúde da População Urbana , Comportamento Aditivo/reabilitação , Fatores SociológicosRESUMO
Introducción: El consumo problemático de drogas representa uno de los problemas de salud más significativos a nivel mundial. La terapia ocupacional es uno de los actores sociales que promueve la participación en la comunidad, mediante la ocupación, contribuyendo a la justicia ocupacional. Sin embargo, se desconoce qué perspectivas y prioridades se están utilizando en la investigación de la terapia ocupacional, lo cual es clave para desarrollar una práctica reflexiva y crítica. Objetivo: Actualizar, identificar y sintetizar las prioridades y perspectivas en la producción científica existente relacionada al consumo de drogas y terapia ocupacional. Método: Se realizó una revisión de la literatura siguiendo el marco de referencia para Scoping Review desarrollado por Arksey y OMalley. Se buscó en las siguientes bases de datos electrónicas: CINAHL, Cochrane Library Plus, Dialnet, EMBASE, ISI Web of Science, OTseeker y Scopus. Se empleó el método descriptivo analítico y la triangulación de investigadores para realizar el análisis de los datos. Resultados: Del análisis de la literatura emergieron tres categorías: Contextualización, Prioridades de investigación relación entre el desempeño ocupacional y la calidad de vida, instrumentos de evaluación e intervenciones de terapia ocupacional y Miradas teóricas en la investigación (una mirada positivista: la neurociencia como sustento de la intervención; una mirada empoderadora: construyendo el camino hacia la inclusión, y una mirada sistémica: centrada en la familia como base de la intervención). Conclusión: Es preciso continuar investigando acerca de la problemática del consumo de drogas desde la terapia ocupacional, empleando una perspectiva crítica basada en la ciencia de la ocupación.
Introduction: Drug abuse is one of the most complex global health issues. Occupational therapy is one of the socialactors that promotes community participation, using occupation as a means to contribute to occupational justice. However, it is unknown what theoretical perspectives are being used in occupational therapy research. This knowledge is essential for developing a critical and reflexive practice. Objective: This study aims to update, identify and synthesize the priorities and perspectives employed in the existing scientific literature of occupational therapy related with problematic use of drugs. Method: A scoping literature review based on the methods described by Arksey and OMalley (2005) was conducted. Literature was identified using the following electronic databases: CINAHL, Cochrane Library Plus, Dialnet, EMBASE, ISI Web of Science, OTseeker, and Scopus. To analyse the data, a descriptive-analytic method and triangulation were used. Results: The literature reviewed reveals information regarding three categories: Contextualization, Research Priorities the relationship between occupational performance and quality of life, assessment tools, occupational therapy intervention and Theoretical Research Perspectives (a positivist view: neuroscience as base for intervention, an empowering view: paving the way for inclusion, and a systemic view: family as base for intervention). Conclusion: Further research is needed regarding the role of occupational therapy in the field of problematic drug use using a critical perspective based on occupational science.
Assuntos
Humanos , Comportamento Aditivo/reabilitação , Terapia Ocupacional/métodos , Transtornos Relacionados ao Uso de Substâncias/psicologia , Transtornos Relacionados ao Uso de Substâncias/reabilitaçãoRESUMO
La Terapia Ocupacional es una disciplina cuyo marco conceptual, objetivos y métodos están bien establecidos. Uno de los ámbitos en los que interviene es el de la adicción. Sin embargo, los textos y artículos ocupacionales disponibles carecen, en muchos casos, de un marco explicativo propio, recurriendo con demasiada frecuencia a otros importados de disciplinas preponderantes. Ello lleva, por una parte, a una pobre producción científica y, por otra, a un rol secundario de nuestra disciplina en los programas terapéuticos. El presente trabajo recoge la propuesta de un marco explicativo de la adicción desde una perspectiva ocupacional. Algunos autores parten de considerar que la propia adicción es, en sí misma, una ocupación, en la medida en que proporciona un rol y una significación al propio adicto. Desde esta perspectiva, toman sentido ocupacional paradigmas experimentales recientes, como el del enriquecimiento ambiental, o conceptos como el de empoderamiento. La rehabilitación cognitiva funcional, ampliamente aplicada en clínica del daño cerebral, representa otro enfoque complementario en la clínica de la adicción. Existen instrumentos de evaluación propios que cuantifican o sistematizan las variables ocupacionales relevantes. La Terapia Ocupacional está en condiciones de asumir un rol propio, protagonista e irrenunciable en el tratamiento de la adicción.
Occupational Therapy is a discipline whose conceptual framework, objectives and methods are well established. Addiction is one of the areas in that is involved. However, the available occupational texts lacking in many cases its own explanatory framework, resorting too often to other imported from prevailing disciplines. This leads, on the one hand, to a poor scientific production and, on the other one, to a secondary role for our discipline in therapeutic programs. This paper presents a proposed explanatory framework of addiction from an occupational perspective. Some authors start considering that addiction is itself an occupation, to the extent that it provides a role and significance to the addict himself. From this perspective, it makes occupational sense some recent experimental paradigms, such as environmental enrichment, or concepts such as empowerment. The functional cognitive rehabilitation, widely applied in clinical of brain injury, represents another complementary approach to addiction clinic. There are own assessment instruments that measure or systematize the relevant occupational variables. Occupational Therapy is able to take its own role, main and indispensable prominence in the treatment of addiction.
Assuntos
Humanos , Comportamento Aditivo/terapia , Terapia Ocupacional , Transtornos Relacionados ao Uso de Substâncias/terapia , Comportamento Aditivo/reabilitação , Modelos Teóricos , Transtornos Relacionados ao Uso de Substâncias/reabilitaçãoRESUMO
Since the recognition of addiction as a mental illness, studies concerning treatment and therapeutic models have tended to focus on its psychiatric and psychological dimensions. The aim of this article is to highlight the centrality of the social dimension, not only as potential trigger of addictive behaviors and of stigma regarding these behaviors, but also as a variable that permeates diagnosis and treatment. The reflections are based on fieldwork carried out in rehabilitation centers for drug-consuming women in the border city of Tijuana, northwestern Mexico. The results show that the predominant therapeutic models in the city are based in and reproduce the traditional role of women. The social implications of this finding are analyzed, and it is suggested that these centers could be better utilized in the process of building a society with greater gender equality.
Assuntos
Comportamento Aditivo/reabilitação , Identidade de Gênero , Disparidades em Assistência à Saúde , Sexismo , Centros de Tratamento de Abuso de Substâncias/métodos , Transtornos Relacionados ao Uso de Substâncias/reabilitação , Comportamento Aditivo/diagnóstico , Comportamento Aditivo/psicologia , Feminino , Disparidades em Assistência à Saúde/ética , Humanos , México , Fatores Sexuais , Estigma Social , Centros de Tratamento de Abuso de Substâncias/ética , Transtornos Relacionados ao Uso de Substâncias/diagnóstico , Transtornos Relacionados ao Uso de Substâncias/psicologia , Direitos da MulherRESUMO
This qualitative study aimed to learn the conceptions and attitude tendencies of nurses from public district basic health units towards alcohol, alcoholism and alcohol addicts. The sample consisted of ten nurses from three institutions in a city located in São Paulo. Data were recorded and submitted to content thematic analysis. Subjects evidenced that these nurses are permissive towards moderate alcohol use, but reject alcoholism, conceiving it as a potentially fatal disease, and tend to associate it to personal will, indicating the influence of the moral concept on their conceptions and attitudes. The participating nurses' knowledge about the topics alcohol and alcoholism was also evidenced. Based on the results, the authors suggest training this group and preparing these professionals for the care, recognition and prevention of disorders related to alcohol use/abuse at these health centers.
Assuntos
Alcoolismo/enfermagem , Alcoolismo/reabilitação , Atitude do Pessoal de Saúde , Comportamento Aditivo/enfermagem , Comportamento Aditivo/reabilitação , Serviços Comunitários de Saúde Mental/organização & administração , Etanol , Relações Enfermeiro-Paciente , Brasil , Área Programática de Saúde , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
This qualitative study aimed to learn the conceptions and attitude tendencies of nurses from public district basic health units towards alcohol, alcoholism and alcohol addicts. The sample consisted of ten nurses from three institutions in a city located in São Paulo. Data were recorded and submitted to content thematic analysis. Subjects evidenced that these nurses are permissive towards moderate alcohol use, but reject alcoholism, conceiving it as a potentially fatal disease, and tend to associate it to personal will, indicating the influence of the moral concept on their conceptions and attitudes. The participating nurses' knowledge about the topics alcohol and alcoholism was also evidenced. Based on the results, the authors suggest training this group and preparing these professionals for the care, recognition and prevention of disorders related to alcohol use/abuse at these health centers.
Ese estudio cualitativo tiene el objetivo de conocer las concepciones y tendencias de actitud de enfermeros de servicios públicos de atención básica de salud, ante el alcohol, alcoholismo y el alcohólico. Participaron diez enfermeros de tres instituciones de una municipalidad del estado de São Paulo. Los datos fueron recolectados mediante registros autograbados y sometidos al análisis temático de contenido. Los temas que emergieron evidenciaron que los enfermeros son permisivos al uso moderado de alcohol, pero rechazan el alcoholismo, concibiéndolo como una enfermedad que puede ser fatal y tienden a asociarlo con la voluntad personal, indicando la influencia del concepto moral en sus concepciones y actitudes. También se evidenció el conocimiento de los enfermeros participantes sobre el alcohol y alcoholismo. Con base en los resultados, se sugiere la capacitación de ese grupo, preparándolo para la atención, el reconocimiento y la prevención de trastornos relacionados al uso/abuso de alcohol en esos centros de salud.
Esse estudo qualitativo tem por objetivo conhecer as concepções e as tendências de atitudes de enfermeiros de Unidades de Atenção Básica Distritais de Saúde (UDBS) frente ao álcool, ao alcoolismo e ao alcoolista. Participaram dez enfermeiros de três UBDS de um município paulista. Os dados foram coletados por meio de registro auto-gravado e submetidos à análise temática de conteúdo. Os temas que emergiram evidenciaram que os enfermeiros são permissivos ao uso moderado do álcool, no entanto rejeitam o alcoolismo, concebendo-o como uma doença que pode ser fatal e tendem a associá-lo à vontade da pessoa, revelando a influência do conceito moral em suas concepções e atitudes. Também, evidenciou-se o conhecimento dos enfermeiros participantes sobre o álcool e alcoolismo. Com base nos resultados, recomenda-se a capacitação desse grupo no sentido de prepará-los para o atendimento, o reconhecimento e a prevenção de transtornos relacionados ao uso/abuso do álcool nesses centros de saúde.
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Alcoolismo/enfermagem , Alcoolismo/reabilitação , Atitude do Pessoal de Saúde , Comportamento Aditivo/enfermagem , Comportamento Aditivo/reabilitação , Serviços Comunitários de Saúde Mental/organização & administração , Etanol , Relações Enfermeiro-Paciente , Brasil , Área Programática de SaúdeRESUMO
BACKGROUND: Craving is a central phenomenon in addiction. Temperament factors are also important for pathologic gambling and other addictions. The aim of this study was to compare craving between pathologic gamblers (PG) and alcohol-dependent subjects (ADS), correlating craving with personality. METHODS: Forty-nine PG and 101 ADS willing to start treatment were recruited. A trained psychiatrist diagnosed them according to DSM-IV criteria. To be included in this study, subjects had to be abstinent for at least five days and no longer than 21 days. Alcoholics should have no significant physical withdrawal symptoms by the time of craving assessment. Subjects with current comorbidity with other addictions were excluded, except nicotine. ADS rated craving for alcohol and PG rated craving for gambling on the same questions, respectively. Both answered a semistructured interview, the Temperament and Character Inventory and the Beck Scales for anxiety and depression. RESULTS: Pathologic gamblers scored higher than ADS on craving measures (p<0.001) and novelty seeking (p=0.01). ADS scored higher in harm avoidance (p=0.01). Alcohol craving correlated positively with anxiety and novelty seeking and negatively with length of abstinence and persistence. Gambling craving correlated positively with depression and negatively with length of abstinence and reward dependence CONCLUSIONS: Pathologic gamblers experienced stronger cravings than did ADS. This may be a disturbing experience for PG and a potential cause for relapse. The higher scores on novelty seeking concur with previous studies that associate PG and impulsivity. ADS higher scores on harm avoidance suggest anxiety vulnerability. The positive relation between alcohol craving, anxiety, and harm avoidance suggests that ADS rely on alcohol to deal with a proclivity to negative emotions. The positive relation of gambling craving to depression and negative relation to reward dependence suggests that individuals who have a lesser susceptibility to experience positive emotions are the ones who most miss gambling when abstaining.
Assuntos
Alcoolismo/psicologia , Comportamento Aditivo/psicologia , Jogo de Azar/psicologia , Motivação , Temperamento , Adulto , Alcoolismo/reabilitação , Ansiedade/diagnóstico , Ansiedade/psicologia , Comportamento Aditivo/reabilitação , Depressão/diagnóstico , Depressão/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inventário de Personalidade , Psicometria , Recidiva , Fatores de Risco , Estatística como Assunto , Síndrome de Abstinência a Substâncias/psicologia , Síndrome de Abstinência a Substâncias/reabilitaçãoRESUMO
Se presenta el rol de la familia en la prevención, el tratamiento, la rehabilitación y el seguimiento de las adicciones. La familia constituye un subsistema en el Modelo Familiar de enfoque Ecológico del fenómeno adictivo que facilita, obstaculiza o hace inviable la intervención terapéutica. Así, en base a su experiencia clínica, el autor propone la prevención teniendo en cuenta factores protectores y de riesgo, planteando el tratamiento a través de la detección precoz del adicto encubierto; finalmente, proporciona pautas para la familia en el manejo terapéutico del miembro enfermo.
It considers the role of the family in the prevention, treatment and follow up psychoactive drug dependency. The family constitutes a subsystem in the Family Model of the Ecological Approach to drug dependency that facilities, blocks or limits the therapeutic interventions. Based upon his clinical experience, the author proposes a preventive approach taking in consideration the protective and risk factors; and treatment, through early detection of conceded cases finally, he offers family guidelines as to what should be for the management of its ill member.