Fatores associados à recidiva e abandono do tratamento de dependentes químicos: um estudo longitudinal em duas Comunidades Terapêuticas
Arquivos
Data
2019-03-29
Autores
Perrone, Pablo Andrés Kurlander
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Editor
Universidade Estadual Paulista (Unesp)
Resumo
Sendo a não adesão um dos maiores problemas relacionados com o tratamento da dependência química, a presente pesquisa, realizada com dois grupos de dependentes químicos em tratamento em duas Comunidades Terapêuticas (CTs) - uma masculina e outra feminina -, visa identificar os fatores que podem se associar ao maior tempo de permanência, ao abandono do tratamento e à qualidade de vida pós saída. Para isto foi realizado um estudo longitudinal nesses dois grupos. Como variáveis explanatórias foram consideradas as condições sociodemográficas, gravidade da dependência, condições de saúde física e mental, assim como os escores de instrumentos validados, no início e durante o tempo de permanência na CT, até o desfecho, sendo estes: inventário Beck para depressão, inventário de ansiedade, Escala de apoio social, avaliação de fissura de cocaína/crack, assim como a avaliação dos comportamentos, percepções e crenças dos dependentes em relação ao seu processo. O desfecho foi avaliado a partir do tempo de permanência, em dias, tomado como variável contínua, e como variáveis categóricas o abandono e a conclusão do tratamento, assim como o abandono precoce e o não precoce. Foi ainda avaliado o resultado pós tratamento através de um questionário de seguimento externo aplicado trimestralmente por 12 meses. Os resultados foram analisados pelo teste de qui-quadrado e pela regressão logística multivariada, buscando compreender, principalmente, quais fatores poderiam estar associados ao abandono do tratamento, com ênfase no abandono precoce – estabelecido como até 90 dias de permanência – assim como com a manutenção da qualidade de vida pós saída. Em relação ao abandono do tratamento, as variáveis que apresentaram associação estatística foram: maior tempo de consumo, estar trabalhando antes do ingresso na CT, estar amasiado/casado, maior escore de SDS cocaína, escore Moderado no CCQ-B e autorrelato de ansiedade. Na avaliação de saída a própria percepção de melhora, principalmente em relação à questões laborais e religiosas, foram as mais presentes no discurso de quem abandonou. No seguimento pós saída foram contatados 56,2% dos homens e 62,4% das mulheres e 70,0% das famílias dos homens e 67,1% das famílias das mulheres, sendo a mãe o familiar mais frequentemente contatado, e os que tiveram alta terapêutica tiveram maior taxa de contato em relação ao abandono precoce. Aqueles que se mantiveram em abstinência por 12 meses tiveram maior taxa de indicadores de qualidade de vida, e aqueles que tiveram alta terapêutica apresentaram 2,5 vezes mais chance de indicadores de qualidade de vida elevados, assim como também apresentaram maior chance em cada um dos seis indicadores de qualidade de vida presentes no questionário. Maior escolaridade, sexo feminino e estar utilizando medicação psicoativa no início do tratamento foram variáveis que também se associaram a maiores indicadores de qualidade de vida elevados 12 meses pós saída. Finalmente foi evidenciado que a conclusão do programa terapêutico e a manutenção da abstinência foram os principais fatores associados com a presença de indicadores de qualidade de vida elevados 12 meses pós saída.
Adherence to treatment is a major problem in the treatment of substance use disorders. Therefore, the aim of this study was to investigate the different factors that could be related to a longer stay in treatment, dropout rates and quality of life after treatment. It was conducted in two Therapeutic Communities (TCs), one for males and one for females. Explanatory variables were: sociodemographic characteristics, mental and physical health state, severity of dependence, depression, anxiety, social support, cocaine craving as well as behaviors during treatment, perceptions and beliefs of patients about the treatment. Outcome was measured as time in treatment (in days - continuous variable), and completion of treatment or drop-out (early or late - categorical variables). After discharge, patients were evaluated four times at three months intervals, along one year. Outcome variables were analyzed by the chi-square test and by multivariate logistic regression, aiming at identifying which variables were associated to dropout, particularly early drop-out, and to quality of life after treatment. Variable significantly associated to drop-out were: longer period of drug use, being employed before admission to the TC, being married or living with a partner, higher severity of cocaine and self-reported anxiety. The reasons more frequently reported for dropping-out was perception of well being, particularly in relation to work and religious issues. At the after treatment follow-up 56.2% of men and 62.4% of women, 70.0% of families of men and 67.1% of families of women were contacted; mother was the main family member contacted, and those who concluded treatment had higher tax of contact than early dropouts. Abstinents for 12 months scored higher scores in quality of life indicators, and those who completed treatment had 2,5 more chance of scoring high in quality of life indicators. Higher education, female gender and using psychoactive medication at the beginning of the treatment were associated with higher indicators of quality of life 12 months after treatment. In brief, completions of treatment and abstinence maintenance were the main factors related to higher indicators of quality of life 12 months after treatment.
Adherence to treatment is a major problem in the treatment of substance use disorders. Therefore, the aim of this study was to investigate the different factors that could be related to a longer stay in treatment, dropout rates and quality of life after treatment. It was conducted in two Therapeutic Communities (TCs), one for males and one for females. Explanatory variables were: sociodemographic characteristics, mental and physical health state, severity of dependence, depression, anxiety, social support, cocaine craving as well as behaviors during treatment, perceptions and beliefs of patients about the treatment. Outcome was measured as time in treatment (in days - continuous variable), and completion of treatment or drop-out (early or late - categorical variables). After discharge, patients were evaluated four times at three months intervals, along one year. Outcome variables were analyzed by the chi-square test and by multivariate logistic regression, aiming at identifying which variables were associated to dropout, particularly early drop-out, and to quality of life after treatment. Variable significantly associated to drop-out were: longer period of drug use, being employed before admission to the TC, being married or living with a partner, higher severity of cocaine and self-reported anxiety. The reasons more frequently reported for dropping-out was perception of well being, particularly in relation to work and religious issues. At the after treatment follow-up 56.2% of men and 62.4% of women, 70.0% of families of men and 67.1% of families of women were contacted; mother was the main family member contacted, and those who concluded treatment had higher tax of contact than early dropouts. Abstinents for 12 months scored higher scores in quality of life indicators, and those who completed treatment had 2,5 more chance of scoring high in quality of life indicators. Higher education, female gender and using psychoactive medication at the beginning of the treatment were associated with higher indicators of quality of life 12 months after treatment. In brief, completions of treatment and abstinence maintenance were the main factors related to higher indicators of quality of life 12 months after treatment.
Descrição
Palavras-chave
comunidade terapêutica, dependência química, tratamento, abandono do tratamento, qualidade de vida, therapeutic community, addiction, Treatment, adherence, dropout, quality of life