Avaliação de eficácia do manejo de contingências no tratamento ambulatorial padrão para indivíduos com diagnóstico de dependência por crack

• Ano de defesa: 2016
• Autor(a) principal: Miguel, Andre de Queiroz Constantino [UNIFESP]
• Tipo de documento: Tese
• Tipo de acesso: Acesso aberto
• Idioma: por
• Instituição de defesa: Universidade Federal de São Paulo (UNIFESP)
• Palavras-chave em Português: Crack; Cocaine; Treatment; Contingency management; Cocaina; Tratamento ambulatorial; Manejo de contingências; Dependência química
• Link de acesso: https://sucupira.capes.gov.br/sucupira/public/consultas/coleta/trabalhoConclusao/viewTrabalhoConclusao.jsf?popup=true&id_trabalho=3625966; http://repositorio.unifesp.br/handle/11600/46565

Introduction: Crack dependence has become a severe public health problem in Brazil. It estimated that over one million Brazilians (0.8% of the population) have smoked crack in the last year, making Brazil world?s biggest market for crack use. Several clinical trials and meta-analyzes studies provide robust evidence that Contingency Management (CM) is the most effective psychosocial treatment regarding treatment retention, reduction of drug use and promotion of continuous abstinence. Despite all CM?s international echo this intervention has never been applied in Brazilian population nor has it ever been applied exclusively with crack dependent individuals. The objective of this thesis was to investigate the efficacy of Standard Treatment plus CM (STCM) in comparison to Standard Treatment Alone (STA) in the treatment of crack addiction in a Brazilian sample. For this porpoise four studies were conducted with the following objectives: Study 1: Review the theoretical and experimental principles behind CM interventions and present the results obtained by CM in clinical trials and metanalytical studies. Study 2: Evaluate the efficacy of CM on treatment adherence and retention, reduction of crack/cocaine use, and promotion of continuous abstinence for treatment seeking crack dependent individuals in Brazil. Study 3: Evaluate the efficacy of CM on reducing depressive symptoms among a Brazilian treatment seeking crack dependent population. We also present findings obtained in this trial not yet submitted for publication, regarding different forms of analyses for the primary outcomes, the impact of CM on anxiety symptoms, and pattern of crack us at 3 and 6-mounth follow-ups. Results: Study 1: CM is based on strong theoretical and experimental principles and present robust evidence of efficacy. Study 2: STCM is more effective than STA on treatment adherence and retention, reduction of crack/cocaine use, and promotion of continuous abstinence for treatment seeking crack dependent individuals in Brazil. Study 3: STCM was more effective than STA on reducing depressive symptoms among a Brazilian treatment seeking crack dependent population. Discussion: These findings provide evidence that CM is effective in promoting treatment adherence and retention, reducing crack/cocaine use as well as encouraging continuous crack/cocaine abstinence for treatment seeking crack dependent individuals in Brazil. These results also point to the efficacy of CM in promoting other therapeutic desirable outcomes such as the reduction of depressive symptoms.