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Official websites use. Share sensitive information only on official, secure websites. E-mail: mariescobar hcpa. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. To evaluate the nutritional status of crack users and to analyze its correlation with drug use profiles. Cross-sectional study with crack users. A blood test to analyze hematocrit, hemoglobin, glucose, and lipid profiles was also performed. Crack use was determined through a standardized interview. Regarding hematological parameters, we found that hemoglobin and hematocrit levels were below normal for Considering normal parameters, a large part of the sample There were no significant correlations between drug profile and nutritional variables. This is a pioneering study that examines the nutritional status of crack users. Our results showed that most crack users present normal anthropometric findings and the prevalence of underweight is low. However, blood analysis showed changes and a specific type of malnutrition. Keywords: Crack cocaine, nutritional assessment, nutritional status, biochemical parameters. Crack cocaine crack , a smoked form of cocaine, is a highly addictive and powerful stimulant that became popular in the mids and has been used worldwide ever since. This increases the availability of these neurotransmitters in the synaptic cleft and causes intense feelings of pleasure. The clinical consequences and comorbidities of crack use have been well described in a number of studies, 8 - 12 but there is a gap in literature regarding the nutritional profile of crack users. Malnutrition in this population may be multifactorial and could involve lower caloric intake, abnormal metabolic and gastrointestinal functions, and even deleterious drug effects. Several studies have highlighted malnutrition and underweight in active multiple-drug users. This study focused on describing the previously-unknown nutritional profile of crack users, supporting early intervention based on scientific and personalized findings to aid clinical recovery. Our main hypothesis was that the severity of crack use may impair nutritional status. Due to the large number of crack users in Brazil and the increasing demand for health services, research is needed in this area. This study aimed to evaluate the nutritional status of crack users and analyze its correlation with drug use profiles. In addition, we compared the performance of different nutritional assessment methods, such as anthropometric and biochemical parameters blood tests. All patients met the criteria for crack addiction as described by the DSM Crack was required to be the drug of choice, but the use of other psychoactive substances was not an exclusion criterion. Subjects who presented symptoms compatible with dementia or psychosis or those who presented cognitive impairment that prevented comprehension of the study were excluded from the sample. These exclusion criteria were verified by a psychiatrist in a clinical interview, who used the standard recruitment center evaluation. This instrument includes questions about education, home appliances, housing characteristics, and access to public services to evaluate income level. Five classes are derived from these indicators: A points ; B points ; C points ; D points ; and E points. Class A is the most advantaged, while class E is the poorest. Crack use was determined through a standardized interview, using a questionnaire that included items related to the type, mode, and frequency of drug use. Severity of crack use was estimated by age of first use, years of use, and crack rocks used in the previous 30 days, as described in previous studies. The sum of these three variables was used to produce a crack use severity score, and the participants were categorized into a more severe or less severe group, which were divided by the median. Daily alcohol consumption in the last 30 days was also assessed. For the statistical analyses, we used World Health Organization WHO 32 parameters, whereby mL of beer or 30 mL of spirits correspond on average to 12 g of alcohol. We calculated the amount in grams of ethanol consumed daily. Data on the number of tobacco and marijuana cigarettes smoked in the last 30 days was also obtained in the clinical interview. The anthropometric evaluation was performed within 48 hours of admission. The test was administered according to manufacturer instructions, with patients having avoided exercise in the previous 12 hours, having fasted between 2 to 3 hours, and having their last urine elimination 30 minutes prior to the test. We used American Council on Exercise parameters to classify individuals based on body fat. Fasting blood samples were obtained for blood test analysis the morning after admission. We measured the hematocrit and hemoglobin levels using the reference values proposed by Hoffbrand, 35 and the glucose and lipid profiles were based on references established by the Brazilian Society of Cardiology. Since there were no significant differences between groups, all individuals were recruited for the sample. Data were collected after each individual was informed of the procedures and objectives and gave permission to participate by signing an informed consent form. The Kolmogorov-Smirnov method with Lilliefors significance correction was used to verify the normality of the variables. For the descriptive analysis, we used mean and standard deviation or median and interquartile range. Statistical analysis was processed in SPSS version Users were mostly Caucasian and came from poor socioeconomic backgrounds. Considering their BMI and BIA, few individuals were underweight or had low body fat; most were eutrophic, overweight, or obese. LDL cholesterol, total cholesterol, and glucose also presented alteration, but at lower percentages. HIV prevalence was Hematocrit and hemoglobin levels were measured using the reference values proposed by Hoffbrand 35 ; glucose and lipid profiles were based on references established by the Brazilian Society of Cardiology. Crack rocks consumed per day ranged from one to and the consumption period ranged from four months to 32 years. Sixty-six Ethanol consumption ranged from A total of A total of 50 individuals Among marijuana users, consumption ranged from one to 15 cigarettes per day. The main correlations are presented in Table 4. There was no significant difference in the nutritional, biochemical, or drug use variables analyzed between the groups data not shown. This study provides new insights into the nutritional assessment of drug addicts. Regarding anthropometric parameters BMI and BIA , few individuals presented low weight and body fat, with most being normal weight, overweight, or obese. Although a number of studies have reported malnutrition and underweight in drug users, 13 , 14 , 16 - 21 our study found a low prevalence. Nevertheless, this does not exclude other specific deficiencies. The blood work revealed important alterations in a significant proportion of our sample, such as low levels of hemoglobin and hematocrit, which can be associated with protein-energy malnutrition and anemia. However, we found no significant correlations between crack use variables and any of the nutritional parameters we evaluated. One important bias is that the other studies involved multiple-drug users from other locations with different drug profiles, usage types and frequency, while ours included only crack cocaine users with associated alcohol and tobacco consumption. Since this is the first study to ever sample such a profile, we cannot compare it confidently with studies covering different types of drug users. There are data on overweight and obesity in recovering drug users, but not in current drug users. During abstinence, they may seek alternative ways of activating the brain reward system and the inhibition of dopamine reuptake, with one common outlet being overeating. Regarding hematological parameters, we found that hemoglobin and hematocrit levels were below normal in These decreased levels may indicate protein-energy malnutrition and anemia. In these cases, anemia may be associated with a diet poor in micronutrients, especially iron, as well as insufficient protein intake and clinical problems decreased hydrochloric acidproduction, decreased intrinsic factor secretion, intestinal perforations, bacterial or infectious diseases. Meanwhile, Ross et al. Compared to normal parameters, a large proportion of our sample LDL cholesterol 6. Tang et al. Our study also found low levels of HDL, which may be associated with a lack of social, economic, and physical activities. In a study on specific deficiencies in multiple-drug users, Nazrul Islam et al. The damage and consequences of crack use can lead to numerous specific nutritional deficiencies and may require further investigation. We found positive correlations between BMI, BIA, triglycerides, cholesterol, and glucose, which reinforces that body fat is associated with high serum lipid levels and glucose alterations. Changes in lipid and glucose profiles, alcohol consumption, and smoking are risk factors for the development of chronic diseases such as diabetes, dyslipidemias, hypertension, and metabolic syndrome. Considering that these individuals are at risk for cardiovascular problems due to drug use, the sum of these factors may increase the probability of disease and malnutrition. There was no significant correlation between severity of crack use and anthropometric or biochemical variables. Crack use has been reported to induce intestinal perforations, gastric ulcerations, retroperitoneal fibrosis, abdominal pain, nausea, mesenteric ischemia, and esophagitis, thus impairing absorption, digestion, and metabolism 9 and leading to malnourishment. As for cardiovascular consequences, cocaine can cause increased heart rate and blood pressure, endothelial dysfunction, arrhythmia, and atherosclerosis. This increases the duration of euphoric effects and is more cardiotoxic than consuming each drug separately. It has been well documented that smoking can cause numerous diseases, such as cancer, emphysema, and cardiovascular diseases. The nutritional effects of smoking include an increase in free radicals and a decrease in antioxidants. We found that users from classes D and E were mostly Caucasian, characterizing a low-income population with little access to education. HIV prevalence in this group is high Since crack use is associated with complex social issues, 43 these individuals could benefit from lifestyle intervention programs, which have had positive results in the obese, diabetics, and binge eaters. Moreover, we did not evaluate control subjects, which would have been important for comparison with the crack group. We also evaluated subjects seeking inpatient treatment who, therefore, do not represent the general population of crack-cocaine users. In fact, we are already developing a case-control trial protocol to better elucidate the nutritional profile of crack users and evaluate the influence of nutritional aspects on treatment prognosis. In summary, this was a pioneering study that examined the nutritional status of crack users. The BMI of most of them was within the normal, overweight, or obese range. However, their blood tests indicated alterations in hematocrit and hemoglobin levels and in glucose and lipid profiles. This shows that, although crack users are not necessarily underweight, they present other specific nutritional deficiencies that qualify them for a diagnosis of malnutrition. Furthermore, their condition may be associated with other issues that deserve attention, such as alcohol consumption and social problems. This study is the first step towards highlighting the importance of nutrition in the treatment of drug addiction for this marginalized population. We intend to follow these users and evaluate their changes in nutritional status during recovery, as well as food intake and food-related preferences during this period. As a library, NLM provides access to scientific literature. Braz J Psychiatry. Find articles by Mariana Escobar. Find articles by Juliana N Scherer. Find articles by Cassia M Soares. Find articles by Martine E Hagen. Find articles by Lisia von Diemen. Find articles by Flavio Pechansky. Received Jul 13; Accepted Oct 7; Collection date PMC Copyright notice. Open in a new tab. Similar articles. Add to Collections. Create a new collection. Add to an existing collection. Choose a collection Unable to load your collection due to an error Please try again. Add Cancel.
Active Brazilian crack cocaine users: nutritional, anthropometric, and drug use profiles
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Many studies correlate characteristics of family functioning and the development of drug addiction. This study sought to evaluate and compare the family environment styles of two groups of psychoactive substance users: 1 alcohol-only users and 2 crack-cocaine users. Three hundred and sixty-four users of alcohol, crack-cocaine, and other drugs, recruited from research centers in four Brazilian capitals participated in this study. A final model was obtained using a logistic regression analysis. All analyses were adjusted for partner, age, and psychiatric t -score. The post-hoc test revealed a difference of 1. No significant between-group differences were observed in the other subscales. However, categorical analyses of variables regarding family dynamic showed that crack users more often reported that sometimes people in their family hit each other These results suggest that families of crack-cocaine users are less cohesive than families of alcohol users. This type of family environment may affect treatment outcome, and should thus be adequately approached. Environmental factors, especially the family environment, are strongly associated with onset of substance use. Early childhood predictors of early substance use and substance use disorders: prospective study. Aust N Z J Psychiatry. Within the conceptual framework that integrates environment, behavior, social contexts, and individuals, these elements influence each other mutually by dynamic processes. Gifford E, Humphreys K. The psychological science of addiction. From a developmental perspective, substance use disorders SUDs arise from an interplay of genetic and environmental factors, both of which have family as a common entity. The impact of substance use disorders on families and children: from theory to practice. Soc Work Public Health. In this respect, aspects related to family structure and the dynamics of family life serve as both protective and risk factors for initiation and further development of problem drug use. JI, Jukic? Familial risk factors favoring drug addiction onset. J Psychoactive Drugs. Exploring resilience in families living with addiction. J Prim Health Car. Family ties of crack cocaine users cared for in a psychiatric emergency department. Rev Lat Am Enfermagem. Moos RH. Theory-based processes that promote the remission of substance use disorders. Clin Psychol Rev. Such an unstable environment lacks the resources needed to provide social support, hindering the ability of family members to form healthy and fulfilling relationships, thereby affecting the mental and physical health of all individuals. Structural and functional aspects of social support as predictors of mental and physical health trajectories: whitehall II cohort study. J Epidemiol Community Health. Conversely, family engagement in treatment has a direct impact on prognosis, as affection and support from the family may in turn improve treatment adherence and outcomes. Rev Med Chil. In Brazil, it is estimated that 28 million people live with someone who has an SUD. However, studies of families with SUDs are still scarce in the country. Some studies have reported impaired family functioning due to drug abuse by a family member. Vianna et al. Rev Saude Publica. Given the large number of people in Brazil affected by the SUD of a family member or peer, it is relevant to further examine the family environment of substance abusers and determine whether there are differences in family environment depending on the substance of abuse. Within this context, the present study aimed to examine and compare the family environment of alcohol users and crack-cocaine users. The participants were selected by convenience sampling at the four centers for inpatient and outpatient treatment for substance abuse. Study participants were adults with a history of recent alcohol or drug use who were recruited from psychiatric inpatient units or outpatient clinics specializing in the treatment of substance abuse. Limited exclusion criteria were used so as to enable the investigators to evaluate and differentiate substance-abusing patients at different stages of substance use and treatment. Exclusion criteria were: presence of severe psychiatric disorders with symptoms at the time of interview psychotic symptoms, severe cognitive deficits, altered state of consciousness, psychomotor agitation requiring restraint, severe withdrawal symptoms, or acute effects of substance use that would preclude interview; or refusal to participate in the study or to give consent. The ASI-6 is a fairly complete and relatively brief instrument designed to provide important information on several potential problem areas in substance-abusing patients, which are often related to substance abuse and addiction. It is widely used in both research and clinical practice not only in the United States but also in other countries to evaluate adult users of alcohol and other drugs. The FES consists of 10 subscales that measure the actual, ideal, and expected social environment of families. The 10 subscales measure three underlying dimensions: Relationship, Personal Growth or Achievement Orientation , and System Maintenance. The Relationship and System Maintenance dimensions basically reflect internal family functioning, while the Personal Growth dimension reflects the connections between the family and the larger social context. In the present study, we used the Real Form of the FES Form R , designed to assess the current environment, to describe the actual family environment at the time of assessment. The scale consists of 90 statements designed to measure the perceptions of each family member of their actual family environment, i. Respondents are asked to score each statement about their family environment as true or false. These instruments have been validated in Brazil by the authors of the respective publications. Rev Psiquiatr Rio Gd Sul. Multiple logistic regression analysis was performed to determine which variables affected substance use and family cohesion. Statistical analysis was performed in PASW version Ethical procedures were followed to ensure that the rights and well-being of participants were protected. Written informed consent was obtained from participants prior to their inclusion in the study. The main results are listed in Table 1. Alcohol-only users had a significantly higher mean age Table 2 shows the pattern of alcohol and drug use. For every 1-day increase in alcohol use variable unit , patients had a 4. For every 1-year and every 1-day increase in drug use variable unit , patients had, respectively, a 9. For every one-point increase in the Cohesion score, patients had a Table 3 shows the mean scores obtained by the two groups in each subscale evaluated. In addition, post-hoc analysis revealed a difference of 1. In all other subscales, there was no significant difference in mean scores between the two groups. The family characteristics of the two groups are shown in Table 4. This is one of the first studies to evaluate the family environment in a multicenter sample of adult substance users in Brazil. The main finding was that crack-cocaine users seeking treatment, regardless of the use of other psychoactive substances, have less family cohesion than alcohol-only users. Family cohesion refers to the ability of family members to provide support for one another. According to Cohen, 13 Cohen S. Social relationships and health. Am Psychol. Thus, this result suggests that crack-cocaine users were more likely to perceive their families as lacking adequate resources for social support. Although no definite conclusion is yet possible, we hypothesize that these families already had weak emotional attachments before the initiation of substance use, and that the chronic use of a highly addictive drug, such as crack cocaine, may have driven the family members further apart. The validation study of the FES for Portuguese has defined that the Cohesion subscale belongs to the Interpersonal Relationship dimension, which measures the degree of mutual help and support among family members. In that study, the authors reported a higher Cohesion score for Brazilian functional families as compared to families of five international studies and hypothesized that this might be due to cultural differences. Literature data suggest that an unstructured family environment is a risk factor for relapse in SUD and is associated with a greater severity of dependence. The establishment of healthy emotional bonds between parents and children, for example, based on responsibilities, limits, support and affection, is a protective factor against drug use. The present study showed that crack-cocaine users have poorer family functioning in relation to personal commitment and have weaker family ties than do alcohol-only users, which may contribute to low family cohesion and the choice of hard drugs, such as crack cocaine. Evidence shows that, in severe cases, interpersonal ties may be broken, leading to progressive isolation and marginalization of substance users. Santis et al. Rev Chil Neuro-psiquiatr. Moura et al. Crack-cocaine users also showed higher rates of occupational, family, and legal problems than other substance users, 17 Crack users show high rates of antisocial personality disorder, engagement in illegal activities and other psychosocial problems. Am J Addict. Given the importance of social support and the quality of social relationships for mental and physical health, this conflicting family atmosphere represents a risk factor for mental and clinical illness. Another important finding of the present study was a difference in psychiatric scores between the two groups, with crack-cocaine users showing higher scores for psychiatric disorders. Evidence shows that the family environment since childhood can be an important factor in the clinical manifestation and natural history of psychiatric diseases. Coming to terms with the terms of risk. Arch Gen Psychiatry. J Abnorm Child Psychol. The present study also showed a higher frequency of aggressive behavior in the families of crack-cocaine users. Our findings are consistent with those of a recent study reporting high rates of occupational, family, and legal problems in populations of crack and cocaine users when compared to non-cocaine psychoactive substance users. Other studies evaluating impulsivity and aggression in cocaine users have shown that, even without a diagnosis of antisocial personality disorder APD , cocaine users are more impulsive and aggressive than controls. Increased impulsivity in cocaine dependent subjects independent of antisocial personality disorder and aggression. Drug Alcohol Depend. Also worth noting are the long-term neurobiological and structural changes caused by crack-cocaine use, such as dysfunction of electrophysiological and metabolic activities in the prefrontal cortex. Volkow ND, Morales M. The brain on drugs: from reward to addiction. Functional problems in this brain region can result in higher levels of impulsivity, which may in turn reinforce rigid, inflexible, and less adaptive responses to real-life events. Childhood trauma, impulsivity, and executive functioning in crack cocaine users. Compr Psychiatry. This study has some limitations. First, not all Brazilian regions were included in our multicenter design, producing a sample that was not representative of the country as a whole. Second, the sample was limited to patients seeking treatment at specialized public facilities. Third, few women and few people facing legal problems were included in the study. Fourth, the research design did not include a control group, which prevented us from analyzing the family functioning of psychoactive substance users compared to families without substance-abusing members. Finally, due to the cross-sectional design of the study, it is not clear whether family cohesion problems occur as a cause or as a consequence of SUD. In this respect, we plan to conduct further studies involving all these populations to address this issue. In conclusion, our results suggest that crack-dependent patients, regardless of whether they use other substances, have less family cohesion than alcohol-dependent patients. While confirmation is needed, we hypothesize that these families already had weak bonds between family members, which may have contributed to initiation of drug use. Moreover, the chronic and long-term use of a hard drug, such as crack cocaine, may have further disengaged family members from the drug users. In practice, these family circumstances may have an impact on recovery outcomes in drug-dependent patients. It is therefore important to understand the family system of drug-dependent patients in order to provide adequate treatment that is tailored to individual family problems as a therapeutic resource to enhance recovery. Open menu Brazil. Brazilian Journal of Psychiatry. Open menu. Text EN Text English. Objective: Many studies correlate characteristics of family functioning and the development of drug addiction. Methods: Three hundred and sixty-four users of alcohol, crack-cocaine, and other drugs, recruited from research centers in four Brazilian capitals participated in this study. Conclusion: These results suggest that families of crack-cocaine users are less cohesive than families of alcohol users. Family; family relationships; cohesion; substance abuse; alcohol use; crack-cocaine use. Introduction Environmental factors, especially the family environment, are strongly associated with onset of substance use. Methods Study design This was a multicenter cross-sectional study. Participants and setting Study participants were adults with a history of recent alcohol or drug use who were recruited from psychiatric inpatient units or outpatient clinics specializing in the treatment of substance abuse. Instruments Addiction Severity Index, 6th version ASI-6 The ASI-6 is a fairly complete and relatively brief instrument designed to provide important information on several potential problem areas in substance-abusing patients, which are often related to substance abuse and addiction. Statistical analysis Multiple logistic regression analysis was performed to determine which variables affected substance use and family cohesion. Results Sociodemographic characteristics The main results are listed in Table 1. History Received 1 Sept Accepted 27 Mar This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Nino C. E-mail: ninomarchi gmail. Juliana N. Mayra P. Luciano S. Melina N. Maria L. Felix H. Disclosure The authors report no conflicts of interest. Tables 4. Variable presented as mean standard deviation and compared by the t -test for independent samples. Data presented as median quartile interval: 25th percentileth percentile. Cohesion 5. Data presented as mean standard deviation. We put a lot of effort in our activities at home 55 Stay informed of issues for this journal through your RSS reader. PDF English. Google Google Scholar. Crack-cocaine users have less family cohesion than alcohol users. If there are any disagreement in our family we try really hard to temper things in order to maintain peace.
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Active Brazilian crack cocaine users: nutritional, anthropometric, and drug use profiles
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Active Brazilian crack cocaine users: nutritional, anthropometric, and drug use profiles
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