Mindfulness adjunto ao tratamento ambulatorial de transtornos por uso de substâncias

• Ano de defesa: 2019
• Autor(a) principal: Machado, Mayra Pires Alves [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: Substance use disorders; Midfulness; Outpatients treatment; Transtorno por uso de substâncias; Mindfulness; Tratamento ambulatorial; Dependência química
• Link de acesso: https://sucupira.capes.gov.br/sucupira/public/consultas/coleta/trabalhoConclusao/viewTrabalhoConclusao.xhtml?popup=true&id_trabalho=7674177; https://repositorio.unifesp.br/handle/11600/58755

Substance use disorder (SUD) is a chronic condition that impacts on several spheres of life of the individual and society, which is accompanied by recurrent episodes of lapses and relapse. The Mindfulness-Based Relapse Prevention (MBRP) protocol is an innovative intervention in the United States with evidence of relapse prevention, but there’s a lack of Brazilian studies specially in treatment settings. The Centers for Psychosocial Alcohol and Drug Attention (CAPS ad) are the main Brazilian public ambulatory care services. Aim: to study the feasibility of the MBRP as a therapeutic intervention as na adjunct to outpatient public treatment for people with SUD, through indicators of acceptance and demand, implementation, integration and expansion. Methods: The objective was investigated through two studies. The first is a mixed method study in 8 CAPS ad in the city of São Paulo. The data were obtained through in-deep interviews, focus groups and field diary, with 140 users, 24 professionals, 7 managers and 4 specialists. Scales and questionnaires were also applied before and after the intervention. The second is a pilot of a randomized pragmatic controlled trial in 2 outpatient clinics linked to a higher education institution, with a 3-month follow-up. The qualitative data were submitted to content analyses, while the quantitative data were submitted to correspondence analysis and generalized linear models. Results: Study 1 indicated good acceptance and satisfaction with reports of benefits related to the promotion of mental health and reduction of reactivity, impacting consumption behavior. It was possible to apply the intervention, but challenges perceived by users indicates the need to adapt the format to an open and rolling group, especially in dealing with more vulnerable populations. Professionals were interested in integrating MBRP into CAPS ad, having demand and adapting to the infrastructure, culture and schedule of services. However, it is necessary to make teacher training more accessible. Study 2 provided evidence of the effectiveness of MBRP for important mental health conditions such as anxiety, depression and aggressive symptoms, but not for consumption behavior. Final considerations: The MBRP presented as a feasible intervention as an adjunct to the outpatient treatment in CAPS ad, but some adaptations are necessary. Future research should investigate changes in protocol format and teacher training, evaluate effectiveness and expansion for other treatment contexts or populations, as well as make cost-benefit analysis for its implementation in the public network.