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- ItemAcesso aberto (Open Access)Caracterização experimental do fenômeno de sensibilização comportamental imediata após administração única de diferentes drogas de abuso em camundongos(Universidade Federal de São Paulo (UNIFESP), 2009-06-24) Alvarez, Juliana do Nascimento [UNIFESP]; Frussa-Filho, Roberto [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)The behavioral sensitization phenomenon is characterized by a progressive and enduring enhancement of the locomotor stimulant effect of drugs of abuse following repeated treatment in rodents. This behavioral phenomenon seems to share the same neurobiological basis of drug dependence in humans and has been proposed as a pathophysiological animal model of drug dependence. Recently, we demonstrated an early-onset type of behavioral sensitization. Indeed, an “induction” injection of amphetamine potentiated the locomotor stimulant effect of a challenge injection of the drug, given some hours later. The aims of this Thesis were threefold: 1-) to behaviorally and neurochemically characterize the rapid-onset type of behavioral sensitization to amphetamine in mice, 2-) to verify if the rapid-onset type of behavioral sensitization would also occur to other drugs of abuse (cocaine, morphine and ethanol) and 3-) to investigate the possible development of rapid-onset cross-sensitization between amphetamine and cocaine, morphine or ethanol. Mice´s open-field locomotor activity was used as the experimental paradigm. We verified the development of the rapid-onset type of behavioral sensitization to amphetamine in the several behavioral parameters analyzed in the open-field (locomotion, rearing and immobility), by administering 2 injections of 2,5 mg/kg amphetamine, separated by a 4h interval. We demonstrated that this phenomenon was not a consequence of the stress induced by the priming injection of amphetamine and was not due to residual levels of the drug. Moreover, greater neuronal activation in the nucleus accumbens was observed in sensitized mice, in the absence of pré-synaptic neurochemical alterations in their striatum-accumbens, suggesting that postsynaptic adaptations may be involved. The rapid-onset behavioral sensitization also developed to cocaine and morphine, but not to ethanol. Finally, rapid-onset cross-sensitization occurred between amphetamine and the other drugs of abuse in a bidirectional way, except for ethanol. Within this aspect, cross-sensitization between amphetamine and ethanol only developed when amphetamine was administered during the induction of this phenomenon and ethanol in its expression. The present results may contribute to the comprehension of the mechanism involved in the binge pattern of drug abuse.
- ItemAcesso aberto (Open Access)Epidemiological methods for research with drug misusers: review of methods for studying prevalence and morbidity(Faculdade de Saúde Pública da Universidade de São Paulo, 1999-04-01) Dunn, John [UNIFESP]; Ferri, Cleusa Pinheiro [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Epidemiological studies of drug misusers have until recently relied on two main forms of sampling: probability and convenience. The former has been used when the aim was simply to estimate the prevalence of the condition and the latter when in depth studies of the characteristics, profiles and behaviour of drug users were required, but each method has its limitations. Probability samples become impracticable when the prevalence of the condition is very low, less than 0.5% for example, or when the condition being studied is a clandestine activity such as illicit drug use. When stratified random samples are used, it may be difficult to obtain a truly representative sample, depending on the quality of the information used to develop the stratification strategy. The main limitation of studies using convenience samples is that the results cannot be generalised to the whole population of drug users due to selection bias and a lack of information concerning the sampling frame. New methods have been developed which aim to overcome some of these difficulties, for example, social network analysis, snowball sampling, capture-recapture techniques, privileged access interviewer method and contact tracing. All these methods have been applied to the study of drug misuse. The various methods are described and examples of their use given, drawn from both the Brazilian and international drug misuse literature.
- ItemAcesso aberto (Open Access)Fatores associados a perfusão cerebral anormal em dependentes de cocaína(Associação Brasileira de Psiquiatria - ABP, 2001-03-01) Silveira, Dartiu Xavier da [UNIFESP]; Fernandes, Marcelo [UNIFESP]; Barbieri, Antonio [UNIFESP]; Labigalini, Eliseu [UNIFESP]; Silveira, Evelyn D [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)OBJECTIVE: To evaluate the relationship between the pattern of cocaine use and cerebral perfusion among cocaine addicts. METHOD: A sample of 30 cocaine addicts was studied using 99 m-Tc-HMPAO SPECT (single photon emission computed tomography with injection of 99 m-Tc-hexametilpropilenoamina-oxime). Their cerebral perfusion pattern was then compared with their pattern of cocaine use. RESULTS: Eighty percent of the sample presented some degree of impairment in brain perfusion, either focal or diffuse. There was no difference between sniffers and crack smokers regarding their perfusion patterns. No relationship could be established between the severity of SPECT abnormalities and the amount of drug consumption or period of abstinence. However, length of cocaine use did correlate with the severity of cerebral perfusion (Spearman correlation coefficient: r=0.45, p<0.05). CONCLUSION: This study documents the high frequency of cerebral functional impairment in cocaine addicts and establishes the relationship between length of cocaine exposure and severity of perfusion abnormalities.
- ItemAcesso aberto (Open Access)Freqüência de jogo patológico entre farmacodependentes em tratamento(Faculdade de Saúde Pública da Universidade de São Paulo, 2005-04-01) Carvalho, Simone Villas Boas de [UNIFESP]; Collakis, Silvia Teresa [UNIFESP]; Oliveira, Maria Paula Magalhães Tavares de; Silveira, Dartiu Xavier da [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Universidade de São Paulo (USP)OBJECTIVE: To investigate the frequency of pathological gambling among alcohol and other substance abusers who sought specialized treatment. METHODS: Seventy-four outpatients from three different substance abuse treatment services were interviewed. The South Oaks Gambling Screen (SOGS) scale was used for the diagnosis of pathological gambling. The diagnosis of alcohol and other substances abuse was established according to the DSM-IV criteria and the Short Alcohol Dependence Data (SADD) scale. The Portuguese version of the Self-Report Questionnaire (SRQ) scale was used to detect psychiatric symptoms and the Center for Epidemiological Studies Depression Scale (CES-D) for depressive symptoms. Average scores obtained from the application of these scales were compared using the Student t-test. RESULTS: All subjects met the criteria for drug abuse, 61.6% met the alcohol dependence criteria, 60.3% for cocaine/crack, and 34.2% for cannabis. According to the SOGS scale, the majority of drug addicts (70.3%) were classified as social gamblers, 10.8% as problem gamblers and 18.9% as pathological gamblers. Psychiatric and depression symptoms were found in the sample. Pathological gambling patients showed more depression symptoms than non-pathological gambling patients. CONCLUSIONS: A high frequency of pathological gambling was found among the drug addicts interviewed. It is emphasized the importance of investigating pathological gambling among patients under treatment of drug abuse and to include strategies for the treatment of this disorder.
- ItemAcesso aberto (Open Access)Razões para o não-uso de drogas ilícitas entre jovens em situação de risco(Faculdade de Saúde Pública da Universidade de São Paulo, 2005-08-01) Sanchez, Zila van der Meer [UNIFESP]; Oliveira, Lúcio Garcia de [UNIFESP]; Nappo, Solange Aparecida [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)OBJECTIVE: Although there are many studies on risk factors for drug use, little has been known about the reasons that prevent people away from drug use. The aim of this study was to identify the reasons that would prevent low-income youngsters against psychotropic drug experimentation and use, even when living in a drug dealing environment. METHODS: A qualitative study was carried out in an intentional sample selected according to a set of criteria. Sixty-two youngsters, aged between 16 and 24 years, from low-income families who have never used psychotropic drugs (32 subjects) or who were heavy drug users (30 subjects) were interviewed. Each interview lasted on average 110 minutes. RESULTS: Among non-users, access to information and a protective family structure were identified as major reasons from preventing youngster from drug use. Comprehensive information on the outcomes of drug use and affective bonds between parents and their children, assured by feelings of support and respect, seems to be important in helping them avoid drug use. The importance of these two factors as reasons to keep youngsters away from drugs is emphasized when their lack is mentioned and censured by drug users. CONCLUSIONS: The outlook of those who have never used drugs in their lifetime and their reasons should be considered in the development of drug prevention programs targeting low-income youngsters.
- ItemAcesso aberto (Open Access)Seqüência de drogas consumidas por usuários de crack e fatores interferentes(Faculdade de Saúde Pública da Universidade de São Paulo, 2002-08-01) Sanchez, Zila van der Meer [UNIFESP]; Nappo, Solange Aparecida [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)OBJECTIVE: To establish a progression on drug use and its intervening factors among crack users. METHODS: A qualitative methodology was applied for an in-depth investigation, taking into consideration the interviewees' viewpoint of the problem. Long interviews using a semi-structured questionnaire were conducted. A purposeful sampling was outlined to create a criterion sampling. For theoretical saturation, 31 crack users and former users were interviewed. RESULTS: Two distinct phases of drug use were identified. In the first phase there predominate licit drugs, mostly alcohol and tobacco, encouraged by the parents and friends and the users' need of self-assurance. An early age start and heavy use of one or both drugs are determinant for the progression to illicit drugs. Marijuana is the first drug used in the second phase, characterized by an active attitude towards drugs which are regarded as a source of satisfaction. DISCUSSION: The progression on drug use seems to be more associated to external decisions (e.g. peer pressure, drug dealers' encouragement, etc.) than to users' preference. Two different kinds of progression were identified: in younger users (<30 years old): tobacco and/or alcohol, marijuana, snorted cocaine, and crack; in older users (>30 years old): tobacco and/or alcohol, marijuana, intravenous medication, snorted cocaine, intravenous cocaine, and crack.
- ItemAcesso aberto (Open Access)Validação concorrente e confiabilidade da versão brasileira do ASSIST-WHO (Smoking and Alcohol Substance Involvement Screening Test) for Teenagers(Universidade Federal de São Paulo (UNIFESP), 2010-03-31) Carminatti, Vanessa de Jesus Patrick [UNIFESP]; Souza-Formigoni, Maria Lucia Oliveira de [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Justificativa: Dado o grande número de jovens que utilizam álcool e outras drogas, são necessários instrumentos de triagem para avaliar o uso destas substâncias e a presença de problemas associados, visando um planejamento adequado de estratégias de prevenção, intervenção ou tratamento. Objetivo: O objetivo deste estudo foi testar a validade concorrente e avaliar a consistência interna da versão em português falado no Brasil do instrumento ASSIST-WHO (Alcohol Smoking and Substance Involvement Screening Test), já utilizado em adultos, em uma amostra de adolescentes brasileiros. Método: Foram entrevistados 183 adolescentes, entre 11 e 19 anos de idade, sendo 90 não usuários ou usuários ocasionais de drogas e 93 que preencheram critérios para abuso ou dependência de drogas. Além do ASSIST, foram aplicados dois instrumentos o CIDI (Composite International Diagnostic Interview) e o TEEN-ASI (Addiction Severity Index - for teenagers), como referência (padrão-ouro). A sensibilidade, a especificidade e os valores preditivos positivo e negativo na triagem do uso abusivo/dependência foram calculados para cada droga. A consistência interna foi avaliada pelo alfa de Cronbach e o nível de concordância entre os instrumentos pelo índice Kappa. Resultados: A confiabilidade do instrumento foi considerada boa (alfa de Cronbach de 0,81 para tabaco, 0,78 para álcool, 0,82 para maconha e 0,83 para cocaína). Os níveis de concordância entre ASSIST-WHO com CIDI e ASSIST-WHO com TEEN-ASI, considerando os índices Kappa, variaram de satisfatórios (64% para álcool) à muito bons (93% para maconha). Os valores de sensibilidade variaram de 61% para álcool até 100% para tabaco, enquanto que os de especificidade variaram de 76% para tabaco a 99% para outras drogas. Conclusões: O desempenho do ASSIST-WHO como instrumento de rastreamento do uso de drogas em adolescentes atendeu aos padrões psicométricos considerados razoáveis podendo ser utilizado para detectar precocemente o uso de álcool, tabaco, maconha e cocaína/crack nessa população específica. Entretanto, sua sensibilidade para o uso de álcool foi relativamente baixa, sugerindo serem necessárias adaptações nos pontos de corte.