Fatores que afetam a detecção do uso abusivo e dependência de álcool e a eficácia de uma intervenção breve
Arquivos
Data
2008
Autores
Vianna, Vânia Patrícia Teixeira 
Orientadores
Souza-Formigoni, Maria Lucia Oliveira de
Tipo
Tese de doutorado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
O uso abusivo de álcool tem sido um problema crescente, tanto em termos de saúde individual quanto coletiva. A detecção precoce do uso de risco de álcool seguida por intervenção breve, pode ser uma importante estratégia para evitar o agravamento dos problemas sociais, de saúde física e mental dos usuários. Objetivos: avaliar a eficácia de uma Intervenção Breve de sessão única, realizada em unidades de saúde, na redução do consumo ou de problemas associados ao uso de risco de bebidas alcoólicas; analisar a influência do nível inicial de problemas associados ao uso de álcool no resultado da intervenção; comparar as taxas de prevalência de usuários de risco de substâncias psicoativas detectadas por profissionais de saúde com as detectadas por pesquisadores, usando o instrumento ASSIST. Metodologia: os instrumentos de detecção e os procedimentos de intervenção breve foram aplicados por pesquisadores ou por profissionais de saúde, que receberam um treinamento padronizado na aplicação do ASSIST e da Intervenção Breve (IB). O instrumento de detecção foi aplicado a 4335 pacientes que foram atendidos nos serviços de saúde com queixas gerais de saúde. Os 208 pacientes que pontuaram no ASSIST na faixa de uso de risco para álcool (108 com pontuação baixa – entre 11 e 15 e 100 com pontuação alta – entre 16 e 26) foram aleatoriamente alocados ao grupo Controle (CONT N=106) ou ao grupo Intervenção Breve (IB N=102). Resultados: Considerando como indicador de resultado a pontuação no instrumento de triagem ASSIST, três meses após a avaliação inicial (seguimento), observou-se redução significativa em relação à pontuação inicial (basal) nos dois grupos. A chance de sucesso foi significativamente maior (odds ratio = 5,68, IC 95% 2,8 – 11,7) no grupo que recebeu Intervenção Breve do que no grupo controle. Por outro lado, a chance de sucesso foi significativamente menor (odds ratio = 0,39, IC 95% 0,19 – 0,81) para os pacientes com alto nível basal de pontuação no ASSIST do que para os pacientes com baixo nível inicial de pontuação. Foi detectada menor porcentagem de uso de risco de álcool nos pacientes de São Paulo/Diadema (6,8%), onde os profissionais de saúde aplicaram o ASSIST, do que em Curitiba (13,3%), onde os pesquisadores aplicaram o ASSIST. Por outro lado, detectou-se maior prevalência de uso sugestivo de dependência de álcool em SP (3,8%) do que em Curitiba (0,2%). Em relação à maconha também foi detectada menor prevalência de uso de risco em SP (1,6%) do que em Curitiba (4,9%), o mesmo ocorrendo em relação à cocaína (0,7% em SP e 1,5% em Curitiba). A prevalência de uso sugestivo de dependência foi semelhante (maconha: 0,5% em SP e Curitiba e cocaína: 0,4% em SP e 0,7% em Curitiba). Discussão: A intervenção breve de sessão única aplicada por profissionais de saúde (ou por pesquisadores) imediatamente após a detecção do uso de risco de álcool pelo instrumento ASSIST mostrou-se eficaz na redução de problemas associados ao uso de álcool, sendo o sucesso da intervenção maior em pacientes com menor comprometimento. É possível que as diferenças de detecção observadas sejam devidas à falta de aleatorização na aplicação do instrumento por parte de alguns profissionais de saúde de São Paulo, enquanto que os pesquisadores do Paraná o aplicaram de modo aleatório. Os resultados indicam ser possível a utilização destas técnicas em serviços de atenção primária à saúde após um breve treinamento dos profissionais de saúde..
The abusive use of alcoholic beverages is a growing problem as regards individual and public health. The early detection of risk use of alcohol followed by brief intervention can be an important strategy in order to prevent the aggravation of physical and mental health conditions as well as of social problems. Objectives: To evaluate the efficacy of a single session of Brief Intervention, performed in primary health care services, in the reduction of alcohol consumption or related problems; to analyze the influence of the initial level of alcohol-related problems on the outcome of the intervention; to compare the incidence rates of psychoactive substances risk users detected by health professionals with those detected by researchers using the screening instrument ASSIST. Methodology: The screening instruments (ASSIST) and the Brief Intervention (BI) were administered by researchers of or health professionals who had previously attended a standardized training. The screening instrument was administered to 4335 patients, users of primary health care services. The 208 patients who scored in the ASSIST risk range regarding alcohol (108 with low ASSIST scores – between 11 and 15 and 100 with high ASSIST scores – between 16 and 26) were randomly allocated to the control group (CONT N=106) or to the BI group (BI N=102). Results: Considering the ASSIST score in the follow-up (3 months after the basal evaluation) as the outcome indicator, we observed a significant reduction regarding the initial scores in both groups. The odds of success were significantly higher (odds ratio = 5.68, CI 95% 2.8 – 11.7) in the BI group than in the control group. On the other hand, the odds of success were significantly lower (odds ratio = 0.39, CI 95% 0.19 – 0.81) in the group of patients with higher initial ASSIST scores. A lower percentage of alcohol risk users was detected in São Paulo/Diadema (where the health professionals administered the ASSIST) than in Curitiba/Palmas (where the researchers administered the ASSIST). A lower percentage of risk alcohol use was detected in the patients of São Paulo/Diadema (6.8%), where the health professionals applied the ASSIST, than in Curitiba (13.3%), where the researchers applied it. On the other hand, we detected a higher prevalence of use suggestive of alcohol dependence in SP (3.8%) than in Curitiba (0.2%). As regards marijuana, a lower prevalence of risk use was also detected in SP (1.6%) than in Curitiba (4.9%), and also as regards cocaine (0.7% in SP and 1.5% in Curitiba). The prevalence of use suggestive of dependence was similar (marijuana: 0.5% in SP and Curitiba, and cocaine: 0.4% in SP and 0.7% in Curitiba). Discussion: A single session of Brief Intervention administered by health professionals or researchers, immediately after the screening of alcohol risk use by the ASSIST was effective in the reduction of alcohol related problems, being the success higher in the patients with lower levels of problems. It is possible that the differences detected are due to the lack of randomization in the application of the instrument by some health professionals in São Paulo, since the researchers in Paraná applied it randomly. The results indicate that the use of a screening instrument and the administration of BI are feasible in primary health care services after a short training of the health professionals.
The abusive use of alcoholic beverages is a growing problem as regards individual and public health. The early detection of risk use of alcohol followed by brief intervention can be an important strategy in order to prevent the aggravation of physical and mental health conditions as well as of social problems. Objectives: To evaluate the efficacy of a single session of Brief Intervention, performed in primary health care services, in the reduction of alcohol consumption or related problems; to analyze the influence of the initial level of alcohol-related problems on the outcome of the intervention; to compare the incidence rates of psychoactive substances risk users detected by health professionals with those detected by researchers using the screening instrument ASSIST. Methodology: The screening instruments (ASSIST) and the Brief Intervention (BI) were administered by researchers of or health professionals who had previously attended a standardized training. The screening instrument was administered to 4335 patients, users of primary health care services. The 208 patients who scored in the ASSIST risk range regarding alcohol (108 with low ASSIST scores – between 11 and 15 and 100 with high ASSIST scores – between 16 and 26) were randomly allocated to the control group (CONT N=106) or to the BI group (BI N=102). Results: Considering the ASSIST score in the follow-up (3 months after the basal evaluation) as the outcome indicator, we observed a significant reduction regarding the initial scores in both groups. The odds of success were significantly higher (odds ratio = 5.68, CI 95% 2.8 – 11.7) in the BI group than in the control group. On the other hand, the odds of success were significantly lower (odds ratio = 0.39, CI 95% 0.19 – 0.81) in the group of patients with higher initial ASSIST scores. A lower percentage of alcohol risk users was detected in São Paulo/Diadema (where the health professionals administered the ASSIST) than in Curitiba/Palmas (where the researchers administered the ASSIST). A lower percentage of risk alcohol use was detected in the patients of São Paulo/Diadema (6.8%), where the health professionals applied the ASSIST, than in Curitiba (13.3%), where the researchers applied it. On the other hand, we detected a higher prevalence of use suggestive of alcohol dependence in SP (3.8%) than in Curitiba (0.2%). As regards marijuana, a lower prevalence of risk use was also detected in SP (1.6%) than in Curitiba (4.9%), and also as regards cocaine (0.7% in SP and 1.5% in Curitiba). The prevalence of use suggestive of dependence was similar (marijuana: 0.5% in SP and Curitiba, and cocaine: 0.4% in SP and 0.7% in Curitiba). Discussion: A single session of Brief Intervention administered by health professionals or researchers, immediately after the screening of alcohol risk use by the ASSIST was effective in the reduction of alcohol related problems, being the success higher in the patients with lower levels of problems. It is possible that the differences detected are due to the lack of randomization in the application of the instrument by some health professionals in São Paulo, since the researchers in Paraná applied it randomly. The results indicate that the use of a screening instrument and the administration of BI are feasible in primary health care services after a short training of the health professionals.
Descrição
Citação
VIANNA, Vânia Patrícia Teixeira. Fatores que afetam a detecção do uso abusivo e dependência de álcool e a eficácia de uma intervenção breve. 2008. 108 f. Tese (Doutorado) - Escola Paulista de Medicina, Universidade Federal de São Paulo. São Paulo, 2008.