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How can I buy cocaine online in Bayamo

Abstract: Cuba implemented policies mandating social distancing on March 11, , which were still in place at the time of this study. During such periods of isolation, people with psychoactive substance-related disorders and other addictions may be tempted to reduce tension, stress, uncertainty and possible distress by increasing the use of substances or practices they have abused. This can mean relapses and setbacks for patients undergoing treatment. A multidisciplinary team of health professionals specializing in addiction at the Center for Academic Development in Drug Addiction, in Havana, Cuba, cares for people with these disorders and followed their evolution during the initial period of COVID social isolation. With the aim of characterizing strategies employed by patients undergoing treatment for substance abuse and addictions, we conducted a qualitative study from April through May , using a convenience sample of 37 patients all students who had been progressing towards recovery from addictive behaviors when face-to-face encounters were suspended due to COVID restrictions. Contact was maintained through information and communication technologies. The research used telepsychology and focused on understanding patient life experiences. Patients were interviewed using a semi-structured survey, which was then transcribed and coded thematically using a grounded-theory approach. Our findings suggest that despite the potential negative psychological impact of preventive social isolation during the COVID pandemic, individual coping mechanisms developed by these patients, aiming at improved self-control, allowed most to avoid setbacks that could have affected their recovery. Nevertheless, patients faced challenges to their recovery that were compounded by difficulties in specific situations, myths related to substances and addictive activities, and tendencies toward irrationality or lack of emotional control. Keywords: COVID, substance-related disorders, drug users, alcoholism, tobacco use disorder, psychophysiologic disorders, psychological adaptation, interview, qualitative research, psychological resilience, medical informatics, Cuba. Of particular relevance in this context is follow-up of international students who abuse drugs, referred to SC-CEDRO by the Student Orientation Units of their respective faculties when this abuse poses problems for students or their colleagues. The results of this study may be useful in developing preventive and therapeutic strategies in emergency situations applicable to persons with substance use disorders or addictions. The most frequent non-substance addictions include illicit gambling, technological addictions video games, internet, mobile phones, online games and social networking and somatic addictions compulsive physical exercise, compulsive sexual activity and eating disorders. Preventive social distancing in response to the COVID pandemic began in Cuba on March 11, ,\[8\] and was still in effect at the time of this report June International medical students stayed in their student residences and were given the option of voluntarily joining research teams working in nearby areas. Classes weekly sessions were held virtually. Only interns students in their sixth year of medical school continued their hospital work. Nevertheless, the service itself was maintained, turning to remote modes of operation that rely on information and communications technologies ICT. During the pandemic, SC-CEDRO has implemented use of telephone, email and social networks mainly WhatsApp \[13\] for therapy and monitoring of individuals requesting the service. These resources are recommended during conditions in which physical distancing is essential,\[12\] and have been useful in mitigating negative mental health impacts. During preventive social isolation, patients undergoing treatment for addiction may cohabitate with individuals who may try to avoid stress, tension and uncertainty through social use of alcohol or other drugs. This may favor an increase in consumption or relapse in patients faced with the challenge of organizing their daily lives in a context of pervasive stress and worry. WHO and PAHO have urged people not to adopt inappropriate response strategies to the pandemic, such as use of tobacco, alcohol or other drugs, since these can damage mental and physical well-being in the long term. Instead, they recommend people adopt strategies they had previously found helpful in managing stress and empowering them in the face of adverse situations. Current literature suggests that in crises caused by psychological emergencies, interventions should pay close attention to the use of psychoactive substances and other addictive behaviors. To characterize the psychological mechanisms adopted by SC-CEDRO patients in coping with the challenges posed by COVID restrictions, we carried out a qualitative study using a narrative framework aimed at understanding their life experiences during the initial period of preventive social isolation April—May We selected a convenience sample of 37 individuals Cuban and international students who had been in treatment as of January and thus had been involved in a routine therapeutic process for at least ten weeks, and who had also made partial progress toward rehabilitation. We developed a 7-question guide to facilitate open dialogue on how patients were coping psychologically with the restrictions imposed by COVID Questionnaire topics covered three fundamental areas: 1 behaviors relevant to recovery time management, therapeutic adherence and addictive temptations ; 2 psychological manifestations related to emotional experiences, understanding of the indicated measures and behavior in critical situations; and 3 efficacy in developing personal goals and coping mechanisms Table 2. Data collection Data were obtained through an interview conducted in Spanish with all patients. Since international students must be fluent in Spanish to access higher education in Cuba, it was not necessary to carry out interviews in other languages. However, some students elected to write reflections in their native language, with the aim of clarifying comments made during their interviews. These reflections were taken into account during data analysis. The interviews were carried out through telepsychology, specifically video calls via WhatsApp. When a participant had difficulty accessing the internet, conventional telephone and email were utilized. The complementary use of voice, video and written communications via internet allowed patients and providers to overcome geographical or temporal barriers, and difficulties caused by limitations and time restrictions placed on transportation. In the interview, participants described their daily activities and responded to the questionnaire. Interviews were recorded, and duration varied from 21 to 45 minutes average 34 minutes. Data collection ended when no new themes emerged, suggesting that acceptable information saturation had been reached. Please elaborate. Data analysis Researchers who did not conduct interviews analyzed the data and constructed inclusive categories, querying each other to increase reliability of results. Each participant received information on study objectives and guarantees as to the confidentiality of their contributions. Patients were assured that their ability to participate in treatment would not be affected if they decided against participating in the study or if they abandoned the study at any point. All participants gave written consent. At that time, patients in this study were in the midst of treatment, the continuation of which during a period of physical distancing implied therapeutic challenges, as it was not possible to verify whether the skills students had been developing were proving useful or to change therapeutic modalities if or when necessary. The psychotherapy and self-help groups in which patients were enrolled had also been suspended and patients were left without direct therapeutic support. In this context, three professionals assumed tele-consulting roles and continued to interact with 65 of 83 patients Among the 37 study participants, those who consumed alcohol 22; Alcohol is easily accessible in Cuba as it is a legal and socially accepted substance. Illicit drug users were predominant in the category of polydrug use, while smoking and social addictions were rare. We developed a conceptual map of coping mechanisms employed by individuals with disorders related to psychoactive substance abuse or other addictions, demonstrating changes caused by implementation of preventive social distancing Figure 1. In this context, we identified the following factors as main influences on psychological coping strategies and their success: 1 personal methods for maintaining self-control; 2 difficulties in dealing with specific events and situations; 3 perpetuation of myths related to drugs and addictive activities; and 4 irrational tendencies or a lack of emotional control. Personal methods for maintaining self-control Of the 37 participants, 29 When initially received at SC-CEDRO, most patients were indulging in their addictions uncritically and had already faced various social and academic difficulties. The time they had been in treatment was insufficient to consolidate skills that would help guarantee abstinence and it was entirely foreseeable that relapses and setbacks would occur. However, the resources acquired in the initial stages of treatment appear to have been decisive for many patients in facilitating adequate coping with the challenges posed by the COVID pandemic. The study participants indicated that they made an effort to be consistent with the profession in which they are being trained medicine, nursing and related fields, dedicated to caring for and assisting people with health problems , consistent with their lifelong goals usually associated with completing their university studies and being able to practice as health professionals and respectful of commitments made with their therapists regarding abstinence and reintegration into active social life while exercising self-control and responsibility. Despite the success of most patients in avoiding recidivism, 8 of the 37 patients In these cases, we employed intensive tele-health assistance whenever possible and resumed face-to-face treatment as soon as circumstances allowed. In general, these eight cases were those who had not advanced as far in their treatment plans prior to the pandemic as the rest of their cohort, and those who experienced technical difficulties in accessing remote treatment. For example, one international participant stated that he had managed to control his temptation to drink alcohol by keeping in mind that he wanted to become a good doctor and parent. He wrote edited solely for grammar :. I want to be a good doctor not a drunk doctor and a good father in the future. During my nine months of sobriety, there were challenges, but I defeated them, and I feel good for quitting. Now I am able to see the things I was doing while I was drunk, and my life is no longer the same. Several participants recognized that despite their initial fear of contracting COVID, participating with other medical students in daily active case detection in vulnerable populations had given them a better understanding of the importance of prevention and the need to control their addictive behaviors in order to meet the demands placed on them as healthcare professionals during the pandemic and beyond. To this end, one participant said edited solely for grammar :. At first, I felt the stress building and I was surprised that the world had practically fallen apart overnight. It has also helped me participate as a student in the daily COVID case detection efforts in the community. Some participants said therapeutic relationships established with professionals caring for them had provided a source of inspiration, helping them control their desire to drink and avoid setbacks. Another international participant wrote:. I have not seen any change with my desire to drink during this pandemic. I am happy with the progress I have made, and I would like to thank my psychotherapist for his professional support and understanding. Many of my fellow students really need someone of your caliber to deal with whatever habit they have developed during their studies in Cuba. These statements indicate that these participants managed to grow in the face of difficulties they encountered from changes in their personal lives as students and in the general social context. While they spent more time living at home or in the student residence with no face-to-face therapeutic support, they nevertheless were able to overcome stress-induced consumption temptations, retaining some of the progress achieved during their earlier face-to-face therapy sessions. They also adequately addressed challenges posed by the unexpected switch to remote therapy modalities. Such difficulties were experienced by 25 participants For example, some expressed doubt as to the need for some of the guidelines issued by health authorities. Although they accepted the necessity of hygienic measures and specialized care for infected patients, they questioned preventive social isolation and the suspension of face-to-face classes and alternative care activities such as psychotherapy and self-help groups. Other statements reflected participant uncertainty about the efficacy of COVID treatments, expressing critical views of some of the indicated therapies, opinions that relied on sources other than health authorities or healthcare providers. It was also evident that several participants were struggling with time management in their daily lives. They said that staying at home or in student residences forced them to give up their usual physical and recreational activities, and some students made little effort to resume these activities. Some participants referred to the emergence or re-emergence of family or group disagreements. This disruption is common within families of addicts and required negotiating complications like renewed consumption or other situations that are caused or aggravated by social isolation. This was a frequent comment among students whose families were either living abroad or in other Cuban provinces. Participants also described alterations in their sleep—wake cycles generated by the changing circumstances. This was especially evident among students who did not elect to participate in research activities, for whatever reason. Additionally, students expressed worry about the inaccessibility of other sources of complementary professional help, such as psychotherapy and self-help groups alcoholics anonymous, narcotics anonymous, etc. Perpetuation of myths related to drugs and addictive activities These were referred to in 19 participant interviews Such misconceptions increase the likelihood of succumbing to addictive temptations by attributing beneficial qualities to psychoactive substances and addictive behaviors—among these, greater ability to avoid adversity, generate enjoyment and strengthen sociability. The myths relayed in patient interviews referred mainly to use of tobacco, alcohol, marijuana and social networks. Myths about tobacco. This is a drug with considerable addictive power that can lead to addiction shortly after initiating use. The idea that tobacco is capable of generating peace or relaxation, much less that it conveys a sense of maturity or responsibility, has no basis in fact. Drugs that are smoked also produce damage to the respiratory tract, which can put users at a greater risk for developing severe forms of COVID Participants expressed misguided ideas about tobacco, even if they did not habitually use the drug. Others said smoking during isolation would generate peace and help them relax, and some of the younger participants thought that it might make them look more mature and responsible. A few mid-level students in the allied health professions commented that since the novel coronavirus cannot survive high temperatures, smoking drugs like tobacco and marijuana might contribute to its control. These myths, gathered from participant interviews, could contribute to setbacks and addiction relapses. Myths about alcohol. Alcohol is a depressant whose consumption in excess can generate or exacerbate problems in work and study, as well with family and other social relationships. Low alcohol concentration per drink does not lessen addictive potential, as any alcoholic beverage consumed in large quantities is capable of generating an addictive response. Most of the false notions about alcohol expressed in interviews came from participants in therapy for other addictive substances or activities, who believed that alcohol is not a drug and that its consumption helps relaxation. Some participants also stated that beer and wine are not capable of generating addiction, that they are healthy lifestyle choices and useful during social isolation. Some younger students expressed that since alcohol is being used to curtail transmission by using it to disinfect hands and surfaces, then its consumption can destroy the virus in the body. These myths, if acted upon, can result in difficulty controlling alcohol misuse and may even contribute to novel addictions. Myths about marijuana. Like tobacco, it can result in respiratory difficulties and can contribute to severe manifestations of COVID Some participants expressed beliefs that over-estimated the medicinal benefits of marijuana. Several stated that during preventive social isolation, people in higher education may benefit from marijuana, as its use stimulates learning abilities. A Latin American participant argued that the use of natural medicines containing marijuana is a common practice in his country and that it is beneficial for relieving tension and anxiety symptoms. Myths about social networks. Social media facilitates information sharing, but indiscriminate use can generate addiction and other problems. During disasters and emergencies such as the COVID pandemic, social media can become a source of confusion and stress if all information is assumed to be factual or objective. Spending inordinate blocks of time on social media, including online games, can also be harmful. Themes related to the indiscriminate use of social networks and techno-addictions in general emerged during analysis. These myths were described by patients currently undergoing treatment for addiction to chemical substances who had also engaged in excessive social media use during the pandemic, often searching for information about COVID in a compulsive manner. One participant stated that social networks are secure sources of information which only disseminate truthful news; another argued that in order to stay up-to-date regarding the pandemic, one must be aware of the rumors that are constantly generated about the SARS-CoV-2 virus. These notions can lead to indiscriminate acceptance of all manner of unsubstantiated claims made in social media, and to obsessive behaviors. In the case of social media addicts, myths prevailed regarding the habitual use of social networking activities, like the idea that regular participation in online games is a non-dangerous practice that makes social isolation more acceptable. Irrational tendencies and lack of emotional control Of the 37 participants, 16 They added that they often engaged in compulsive behaviors. Several participants referred to higher incidences of negative emotions like fear, sadness and anger. One participant commented that in their current circumstances, fear constitutes a frequent and unpleasant emotion, which led to feelings of immobilization, anxiety, panic and insecurity. The constant concerns surrounding not only the very real possibility of getting sick, but also the possibility of infecting family and friends, caused distress and led to feelings of melancholy and depression. Emotional dysregulation is common during rehabilitation and social integration processes, manifesting with greater intensity during critical or difficult situations. Some participants spoke of frequent and sometimes uncontrollable anger, which was sometimes linked to feelings of resentment toward others. Additionally, several participants from outside Cuba noted that they were very affected by not knowing the current situations of their relatives, which caused them serious worry, leading to a tendency towards feelings of immobilization while waiting for news. Many students described negative emotions associated with the belief that it is unacceptable to not be competent and successful in all circumstances one happens to encounter. However, most patients navigated these difficulties without experiencing setbacks in their recovery. How has the suspension of face-to-face psychotherapy activities affected your recovery process? How have you managed withdrawal symptoms, addictive temptations, and possible relapses and setbacks? Section 2 psychological manifestations—affective, cognitive and behavioral 4. How have you regulated emotional reactions associated with risk, worry and stress? How would you describe your behavior in situations resulting from preventive social isolation? Section 3 efficacy of personal coping mechanisms 7. Do you have personal coping mechanisms that allow you to overcome difficulties without losing self-control? Narrative designs are especially useful in social and health sciences, as they encompass attempts to understand the succession of facts, situations, phenomena, processes and events involving thoughts, feelings, emotions and interactions related by the people who experienced them. Their treatment prior to suspension of face-to-face therapy sessions contributed to these strategies, exposing and reinforcing the incongruities of consumption and other addictive practices with the process of their professional training and their lifelong goals. The above arguments and adherence to treatment, fostered in part by commitment to their therapists, facilitated consistent positive changes in many of the patients over a short time, which in turn contributed to effective psychological coping mechanisms, allowing them to face unexpected difficulties imposed by the pandemic without setbacks or relapses. During circumstances such as social isolation, the risks of initiating, continuing or re-initiating drug use can manifest in various ways. This depends largely on substance type or specific activities and how much treatment each individual patient has already undergone. Participants raised doubts about the need to stop academic activities and treatments not considered to be medical emergencies. If patients trust that complying with established guidelines will result in greater probabilities of success, they are more likely to adhere to those guidelines. The rational use of time has been proposed as a preventive measure against risky behaviors like drug and alcohol abuse, as has attempting to maintain routines as much as possible. Living together in limited space can generate or exacerbate disagreements among family members or cohabiting individuals. In this case, appropriate negotiations aimed at fostering an atmosphere of understanding that facilitates continued abstinence should be promoted. One guide for psychological management of confinement during the COVID crisis\[34\] insists these steps are essential to avoid or ameliorate symptoms of acute stress, exhaustion, irritability and insomnia. However, many patients also seek guidance for challenges arising from specific needs and conflicts through psychotherapy and self-help groups. Study participants referred to the potential negative impact of the suspension of these groups during this period. Tobacco and rum have traditionally been considered part of Cuban culture. Globally, the purported benefits of marijuana have been disseminated through media campaigns aimed at its legalization and decriminalization. Tobacco use generally leads to addiction. The false nature of these claims is especially true in the case of drugs that are smoked, like tobacco and marijuana, as COVID mainly affects the respiratory system. The harmful effects of cigarette smoking include a significant reduction in defenses and a progression towards chronic obstructive pulmonary disease, both risk factors for COVID WHO has warned that abuse of social media can lead to an increase in anxiety and anguish,\[16\] which was perceived in our interviews, whether or not participants were addicted to social media. Top Cuban health authorities appear daily in media briefings that address ongoing problems generated by the COVID pandemic, and government authorities provide timely public reports on decisions taken in the national pandemic working group, charged with systematic analysis of the ever-evolving situation. Lack of emotional control and tendencies toward irrationality were observed in some study participants who had to adapt to different sociocultural environments, most notably living with classmates in student residences while separated from their families. Emotional disorders are common in patients struggling with addiction and are compounded by critical situations like the pandemic. Such situations constitute mental health emergencies. SC-CEDRO teletherapy is framed around encouraging patients to plan their days well and exercise responsible coping mechanisms when faced with challenges. Psychological interventions are based on the acceptance that reality is independent of individual will, but individuals can adopt resources allowing them to effectively deal with changes in their situations. Controlling negative emotions does not constitute their denial, as they are normal in these kinds of situations. Even extremely negative reactions like anger and rage can be vehicles in achieving security, confidence and a sense of firmness. The proper management of these emotions can promote individual assertiveness and help prevent uncritical subjection to outside expectations. The importance of this study lies in the fact that at the time it was carried out, there was no research in Cuba that considered possible effects of situations generated by COVID on people with addictions. There was concern within the services that attend to these patients, since rehabilitation requires routine therapeutic monitoring for variable time periods, plus subsequent follow-up appointments. The health emergency posed by COVID prevented these therapies from continuing as planned, which could affect therapeutic adherence and recovery. The results of this study are useful in developing corrective strategies and preventive interventions applicable to this situation and other special circumstances related to disasters or other emergencies. The main study limitation was the application of a qualitative narrative design through telepsychology. This implied difficulties in obtaining data from visual observation and extra-verbal communication. Even after interviews were conducted, coded and interpreted by several researchers independently and then reconciled among all researchers, it was not possible to rule out alternative interpretations. Such a case would be less likely with the use of other resources or with face-to-face interviews. This study identified the characteristics of psychological coping mechanisms present before the COVID pandemic in a group of people with disorders related to psychoactive substances and other addictions. Our findings suggest that despite the negative effects of the pandemic, the personal goals and mechanisms for self-control developed by participants during prior therapeutic exchanges and subsequent treatment conducted through telepsychology allowed many patients to face new and unexpected difficulties without compromising their recovery. We also identified circumstances favoring potential relapse, including difficulties in addressing specific events and situations, perpetuation of myths related to drug use and other addictive activities, and a tendency toward irrationality and lack of emotional control. Havana: University of Medical Sciences of Havana; — III Encuesta nacional de factores de riesgo y actividades preventivas de enfermedades no transmisibles. Cuba — \[Internet\]. Periodo — Bol Trastor Adict. Currie Maza Y. Las adicciones comportamentales: una tormenta al acecho. Cuba confirma primeros tres casos importados de nuevo coronavirus. Radio Bayamo \[Internet\]. Vanguardia \[Internet\]. Gorry C. Am Psychologist \[Internet\]. The need for prevention and early intervention. Horiz Sanitario \[Internet\]. Pan American Health Organization \[Internet\]. Washington, D. National Health Commission of China. Roca Perara MA. Charmaz K. Constructing grounded theory. Los Angeles: Sage Publications, Inc. Temas de Salud. Fabelo-Roche JR. Adicciones \[Internet\]. Spanish, English. Marihuana: beneficios vs grandes riesgos. Reflexiones sobre las tendencias legalizadoras. Adhanom Ghebreyesus T, Ng A. Colectivo de autores. Adicciones: un grave problema en el mundo. J Epidemiol Community Health \[Internet\]. Aportes desde la evidencia inicial. Terapia Psicol \[Internet\]. Salud mental y Covid consejos para combatir el aislamiento por la pandemia; Mar 20 \[cited Apr 4\]; \[about 2 p. Alonso Maynar. M, Germer CK. Rev Psicoter \[Internet\]. The psychological impact of quarantine and how to reduce it: rapid review of the evidence. Lancet \[Internet\]. An Acad Ciencias Cuba \[Internet\]. Risk factors associated with acute respiratory distress syndrome and death in patients with Coronavirus disease pneumonia in Wuhan, China. Caro Mantilla MM. Medi-Sur \[Internet\]. La verdad oculta tras el Neknomination. Timely mental health care for the Novel Coronavirus outbreak is urgently needed. Lancet Psychiatry \[Internet\]. Duan L, Zhu G. Recomendaciones de la APA para manejar la ansiedad que suscitan las noticias sobre el Coronavirus \[Internet\]. Madrid: Infocop; Mar 3 \[cited Apr 21\]. MediSur \[Internet\]. Justo R. Fabelo-Roche fabelo infomed. Ana M. Another international participant wrote: I have not seen any change with my desire to drink during this pandemic. Table 1. Questions by section Section 1 time management, adherence to therapy and addictive temptations 1. Chinese Alonso Maynar Spanish Notas de autor fabelo infomed.

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