Abstract Introduction Despite the results of epidemiological and psychometric studies reporting comparable levels of tobacco dependence among males and females, some clinical studies have detected disparities. Some smoking cessation studies based on clinical setting programs reported poorer outcomes among women than men. Methods This retrospective cohort study aimed to compare treatment success and retention between men and women on a smoking cessation program (n = 1,014) delivered at a CAPS-AD unit in Brazil. The psychological intervention lasted 6 weeks for each group of 15 patients. Each patient had to participate in weekly group cognitive-behavioral therapy (CBT) sessions and individual medical appointments during this period. These appointments were focused on the possibility of prescribing pharmacological treatment (i.e., nicotine replacement therapy, bupropion, or nortriptyline) as adjuvants to group therapy. Results The women had lower smoking severity at baseline, more clinical symptoms, and lower prevalence of alcohol and drug use disorders and were older than the men. Females had significantly higher levels of success (36.6% vs. 29.7%) and retention (51.6% vs. 41.4%) than males. Sensitivity analysis showed that female gender was significantly associated with both retention and success, among those without drug use disorders only. Conclusion Depending on the smoking cessation setting (i.e., low and middle-income countries and mental health and addiction care units), females can achieve similar and even higher quit rates than males. Previous drug use disorder was an important confounding variable in the gender outcomes analyses. Future studies should try to replicate these positive smoking cessation effects of CBT-based group therapy plus pharmacotherapy in women.

Resumo Objetivo É preocupante notar que os usuários sigam usando o narguilé, embora a literatura aponte que o seu uso cause danos irreversíveis à saúde. Esse estudo avaliou a percepção dos usuários de narguilé e a interferência do seu consumo sobre a saúde. Método Esse é um estudo qualitativo. Uma amostra intencional de usuários foi recrutada. Os participantes responderam a uma entrevista semiestruturada. Todas as entrevistas foram avaliadas pelo método de análise de conteúdo. Resultados A maioria dos discursos apontou que os entrevistados conhecem os malefícios à saúde advindos do uso de narguilé. Entretanto, os efeitos sobre a saúde mental raramente foram lembrados pelos entrevistados, embora muitos deles já estivessem em uso problemático de tabaco, álcool e ou de outras drogas. A percepção de controle sobre o uso, o poder reforçador dos efeitos e a ausência de experiências pessoais negativas com o narguilé são importantes motivadores para seguir o uso. Conclusão Campanhas educativas e medidas para a redução e o controle do uso devem ser encorajadas. qualitativo recrutada semiestruturada conteúdo Entretanto tabaco drogas encorajadas

Abstract Objective Although the scientific literature show that waterpipe tobacco smoking causes irreversible damage to health, users continue to use it. Method This study evaluates the users’ perceptions about the effect of this consumption on health. This is a qualitative study. A purposeful sample of current users was recruited. Participants were invited to undertake an in-depth semi-structured interview. The interviews were evaluated by content analysis method. Results Most speeches pointed out that the interviewees are aware of the harm to health from using waterpipe tobacco smoking. Although most interviewees were already developing a problematic use of tobacco, alcohol or other drugs, they rarely related waterpipe tobacco smoking with mental health consequences. The essential motivators for its continued use were the perception of control over waterpipe tobacco smoking use, the reinforcing tobacco effects, and the absence of negative health experiences in life. Conclusion Understand that educational campaigns and control measures should be encouraged. it recruited indepth depth semistructured semi structured interview method drugs consequences effects life encouraged

ABSTRACT BACKGROUND: There are still few studies on predictors of smoking cessation in Brazilian samples. Experimentation with tobacco during adolescence (ETA) may be one of the important predictors. OBJECTIVE: This study aimed, within the context of a treatment-seeking group of subjects, to test the hypothesis that ETA negatively affects the outcome of smoking cessation during adulthood. DESIGN AND SETTING: Retrospective (historic) cohort study conducted at a psychosocial care center in São Paulo, Brazil, between 2007 and 2010. METHODS: Data on sociodemographics, smoking and medical profiles were obtained through self-report questionnaires that were completed at the baseline and at any follow-up appointment. Logistic regression models were constructed to describe factors associated with the outcome of smoking cessation, measured according to the self-reported four-week success rate among 367 outpatient smokers. RESULTS: ETA was found to be associated with not quitting smoking through the treatment (odds ratio = 0.57; 95% confidence interval = 0.33-0.96; P < 0.05), even after adjustment for dependence level, sociodemographics, nicotine patch use and number of years of smoking. CONCLUSIONS: Early exposure to nicotine may lead to higher risk of continuing smoking after treatment, in adulthood.

Objective: To analyze the predictors of smoking cessation treatment outcomes in a sample with a high rate of medical and psychiatric disorders and addictions. Methods: Analysis of predictors of success of a 6-week treatment provided by an addiction care unit (CAPS-AD) to 367 smokers in Brazil from 2007 to 2010. Forty variables were collected at baseline. Success was defined as abstinence from smoking for a period of at least 14 consecutive days, including the last day of treatment. Twenty variables were selected for the logistic regression model. Results: The only condition correlated with successful treatment after logistic regression was smoking one's first cigarette 5 minutes or more after waking (beta = 1.85, 95% confidence interval [95%CI] = 1.11-3.10, p = 0.018). Subjects with hypertension and alcohol use disorders and those who were undergoing psychiatric treatment showed success rates comparable to or greater than the average success rate of the sample (34.2-44.4%). Conclusions: These findings support the importance of the variable time to first cigarette in treatment outcomes for a sample with a high rate of clinical and psychiatric disorders. Good success rates were observed for pharmacological treatment, which was combined with group therapy based on cognitive-behavioral concepts and integrated into ongoing treatment of other addictions and psychiatric disorders.

OBJETIVO: Comparar o uso de drogas entre os universitários e a população geral brasileira, assim como com os universitários norte-americanos, identificando possíveis diferenças de uso pela interferência da cultura. MÉTODOS: Para comparar o uso de drogas na vida entre as populações de interesse, foram utilizados os dados públicos de levantamentos estatísticos brasileiros realizados com universitários e a população geral, assim como levantamento estatístico norte-americano, por meio da comparação de intervalos de confiança (IC 95%). RESULTADOS: O uso de drogas na vida é mais frequente entre os estudantes norte-americanos, que relatam usar mais tabaco, tranquilizantes, maconha, ecstasy, alucinógenos, cocaína, crack e heroína que os universitários brasileiros. Em contrapartida, os universitários brasileiros relatam usar quase duas vezes mais inalantes do que os universitários norte-americanos. Esse padrão se repete ao se analisarem as diferenças intragênero. A isso se soma que os universitários brasileiros parecem envolver-se com mais frequência no uso de bebidas alcoólicas, maconha, tranquilizantes, inalantes, alucinógenos e anfetamínicos que seus pares da população geral brasileira. CONCLUSÕES: Conhecer as particularidades do uso de drogas entre os universitários é de suma importância para a detecção precoce desse consumo. Investimentos nesse segmento e diferenças de sexo devem ser contempladas nas políticas preventivas, assim como na elaboração de estratégias para a redução e o controle desse consumo, como programas de triagem e intervenção breve, uma vez que possuem a melhor relação custo-benefício.

OBJECTIVE: To compare drug use between college students and the general Brazilian population, as well as with American college students' drug use, identifying possible usage differences related to cultural interference. METHODS: To compare lifetime drug use between target populations, public data collected from statistical surveys conducted with Brazilian college students and the general population were used, as well as surveys conducted with American college students. The surveys' confidence intervals (95% CI) were subjects of comparison. RESULTS: Drug use is more frequent among American college students, who use more tobacco, tranquilizers, marijuana, ecstasy, hallucinogens, cocaine, crack cocaine and heroin than Brazilian college students. In contrast, Brazilian college students use nearly the double of inhalants than American college students. This pattern of use is repeated in the analysis of intra-gender differences. Add to this that Brazilian college students seem to engage more frequently in drinking alcoholic beverages and using marijuana, tranquilizers, inhalants, hallucinogens and amphetamines than their peers in the general Brazilian population. CONCLUSIONS: Knowing the particularities of drug use among college students is of paramount importance for the early detection of consumption. Investments in this segment and gender differences should be considered in preventive policies, as well as developing strategies of consumption reduction and control, such as screening programs and brief intervention, due to better cost-effectiveness.

Objective: To estimate the frequency of polydrug use (alcohol and illicit drugs) among college students and its associations with gender and age group. Methods: A nationwide sample of 12,544 college students was asked to complete a questionnaire on their use of drugs according to three time parameters (lifetime, past 12 months, and last 30 days). The co-use of drugs was investigated as concurrent polydrug use (CPU) and simultaneous polydrug use (SPU), a subcategory of CPU that involves the use of drugs at the same time or in close temporal proximity. Results: Almost 26% of college students reported having engaged in CPU in the past 12 months. Among these students, 37% had engaged in SPU. In the past 30 days, 17% college students had engaged in CPU. Among these, 35% had engaged in SPU. Marijuana was the illicit drug mostly frequently used with alcohol (either as CPU or SPU), especially among males. Among females, the most commonly reported combination was alcohol and prescribed medications. Conclusions: A high proportion of Brazilian college students may be engaging in polydrug use. College administrators should keep themselves informed to be able to identify such use and to develop educational interventions to prevent such behavior.

OBJECTIVE: To investigate the relationship between religiosity and drug use among Brazilian university students. METHODS: This manuscript is part of the "First Nationwide Survey on the Use of Alcohol, Tobacco and Other Drugs among College Students in the 27 Brazilian State Capitals". In this study, 12,595 university students were divided into two groups according to their attendance at religious services: frequent attenders (FR; 39.1%) and non-frequent attenders (NFR; 60.8%). Subsequently, we analyzed their responses to a structured, anonymous questionnaire on drug use and other behaviors. Individual multivariate logistic regression models tested the association between religiosity and drug use (alcohol, tobacco, marijuana and at least one illicit drug). RESULTS: Drug use over the last 30 days was higher among NFR students even after controlling for demographic variables. NFR students were more likely to use alcohol OR = 2.52; 95% CI: 2.08-3.06, tobacco (2.83; 2.09-3.83), marijuana (2.09; 1.39-3.11) and at least one illicit drug (1.42; 1.12-1.79) compared to FR students. CONCLUSION: Religiosity was found to be a strongly protective factor against drug use among Brazilian university students. However, more studies are needed to identify the mechanisms by which religiosity exerts this protective influence.

OBJETIVO: Avaliar a prevalência do uso de drogas entre universitários brasileiros, assim como sua relação com gênero e idade. MÉTODOS: Uma amostra nacional de 12.721 universitários que preecheram um questionário sobre o uso de drogas e outros comportamentos. Os critérios da escala Alcohol, Smoking and Substance Involvement Screening Test (ASSIST-WHO) avaliaram o uso de drogas de risco. Um modelo de regressão logística multivariada testou a associação entre a pontuação do ASSIST-WHO com o gênero, bem como a idade do universitário. O mesmo foi realizado para a medida de uso de drogas nos últimos 30 dias. RESULTADOS: Após o controle de outras variáveis sociodemográficas, acadêmicas e administrativas, os homens foram os mais prováveis de usar e se engajar no uso de risco de esteroides anabolizantes androgênicos, mais do que as mulheres, e para todas as faixas etárias. Por outro lado, mulheres > 34 anos foram mais prováveis de usar e se engajar no uso de risco de anfetaminas. CONCLUSÕES: Estes resultados são consistentes com o que tem sido descrito para a população geral brasileira. Portanto, eles deveriam ser considerados no desenvolvimento de estratégias de prevenção do uso de drogas, bem como para o reconhecimento precoce do abuso de drogas entre universitários.

OBJECTIVE: To assess the frequency of drug use among Brazilian college students and its relationship to gender and age. METHODS: A nationwide sample of 12,721 college students completed a questionnaire concerning the use of drugs and other behaviors. The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST-WHO) criteria were used to assess were used to assess hazardous drug use. A multivariate logistic regression model tested the associations of ASSIST-WHO scores with gender and age. The same analyses were carried out to measure drug use in the last 30 days. RESULTS: After controlling for other sociodemographic, academic and administrative variables, men were found to be more likely to use and engage in the hazardous use of anabolic androgenic steroids than women across all age ranges. Conversely, women older than 34 years of age were more likely to use and engage in the hazardous use of amphetamines. CONCLUSIONS: These findings are consistent with results that have been reported for the general Brazilian population. Therefore, these findings should be taken into consideration when developing strategies at the prevention of drug use and the early identification of drug abuse among college students.

OBJETIVO: Analisar a tendência do uso de drogas entre universitários entre 1996, 2001 e 2009. MÉTODOS: Estudo epidemiológico transversal com 9.974 universitários do município de São Paulo, SP, cuja amostra foi selecionada por estratificação e conglomerados. Adotou-se instrumento de pesquisa de autopreenchimento, anônimo, que caracterizou o uso de drogas por três medidas: uso na vida, nos últimos 12 meses e nos últimos 30 dias. Para comparação de frequências de uso de drogas entre as pesquisas, utilizou-se a metodologia de comparações múltiplas com correção de Bonferroni. RESULTADOS: Houve redução da frequência de estudantes que relataram consumo de drogas entre 1996 e 2009. Houve diminuição do uso de inalantes e aumento do uso de anfetamínicos em todas as medidas avaliadas [4,6% para 8,7% na vida, de 2,4% para 4,5% nos últimos 12 meses e de 1,9% a 3,3% nos últimos 30 dias]. Os alunos das Ciências Humanas relataram uso de drogas com maior frequência [48,6% na vida, 29,0% nos últimos 12 meses e 20,9% nos últimos 30 dias]. CONCLUSÕES: Entre os 13 anos de estudo, houve aumento de uso na vida de tabaco, alucinógenos, anfetaminas e tranquilizantes; além do aumento do uso de anfetaminas nos últimos 12 meses e diminuição do uso de álcool. Em relação aos últimos 30 dias, houve aumento do uso de anfetaminas.

OBJECTIVE: To analyze drug use trends among college students in 1996, 2001 and 2009. METHODS: A cross-sectional epidemiological study with a multistage stratified cluster sample with 9,974 college students was conducted in the city of São Paulo, southeastern Brazil. An anonymous self-administered questionnaire was used to collect information on drug use assessed in lifetime, the preceding 12 months and the preceding 30 days. The Bonferroni correction was used for multiple comparisons of drug use rates between surveys. RESULTS: There were changes in the lifetime use of tobacco and some other drugs (hallucinogens [6.1% to 8.8%], amphetamines [4.6% to 8.7%], and tranquilizers [5.7% to 8.2%]) from 1996 to 2009. Differences in the use of other drugs over the 12 months preceding the survey were also seen: reduced use of inhalants [9.0% to 4.8%] and increased use of amphetamines [2.4% to 4.8%]. There was a reduction in alcohol [72.9% to 62.1%], tobacco [21.3% to 17.2%] and marijuana [15.0% to 11.5%] use and an increase in amphetamine use [1.9% to 3.3%] in the preceeding 30 days. CONCLUSIONS: Over the 13-year study period, there was an increase in lifetime use of tobacco, hallucinogens, amphetamines, and tranquilizers. There was an increase in amphetamine use and a reduction in alcohol use during the preceding 12 months. There was an increase in amphetamine use during the preceding 30 days.

OBJETIVO: Analizar la tendencia del uso de drogas entre universitarios en 1996, 2001 y 2009. MÉTODOS: estudio epidemiológico transversal con 9.974 universitarios del municipio de Sao Paulo, Sureste de Brasil, cuya muestra fue seleccionada por estratificación y conglomerados. Se adoptó instrumento de investigación de auto llenado, anónimo, que caracterizó el uso de drogas por tres medidas: uso en la vida, en los últimos 12 meses y en los últimos 30 días. Para comparar las frecuencias de uso de drogas entre las investigaciones, se utilizó la metodología de comparaciones múltiples con corrección de Bonferroni. RESULTADOS: Hubo reducción de la frecuencia de estudiantes que relataron consumo de drogas entre 1996 y 2009. Hubo disminución del uso de inhalantes y aumento en el uso de anfetamínicos en todas las medidas evaluadas [4,6% para 8,7% en la vida, de 2,4% para 4,5% en los últimos 12 meses y de 1,9% a 3,3% en los últimos 30 días]. Los alumnos de las Ciencias Humanas relataron uso de drogas con mayor frecuencia [48,6% en la vida, 29,0% en los últimos 12 meses y 20,9% en los últimos 30 días]. CONCLUSIONES: Entre los 13 años de estudio, hubo aumento de uso en la vida de cigarro, alucinógenos, anfetaminas y tranquilizantes; así como aumento en el uso de anfetaminas en los últimos 12 meses y disminución en el uso de alcohol. Con relación a los últimos 30 días, hubo aumento en el uso de anfetaminas.

OBJETIVO: Analisar a tendência do uso de drogas entre universitários entre 1996, 2001 e 2009. MÉTODOS: Estudo epidemiológico transversal com 9.974 universitários do município de São Paulo, SP, cuja amostra foi selecionada por estratificação e conglomerados. Adotou-se instrumento de pesquisa de autopreenchimento, anônimo, que caracterizou o uso de drogas por três medidas: uso na vida, nos últimos 12 meses e nos últimos 30 dias. Para comparação de frequências de uso de drogas entre as pesquisas, utilizou-se a metodologia de comparações múltiplas com correção de Bonferroni. RESULTADOS: Houve redução da frequência de estudantes que relataram consumo de drogas entre 1996 e 2009. Houve diminuição do uso de inalantes e aumento do uso de anfetamínicos em todas as medidas avaliadas [4,6% para 8,7% na vida, de 2,4% para 4,5% nos últimos 12 meses e de 1,9% a 3,3% nos últimos 30 dias]. Os alunos das Ciências Humanas relataram uso de drogas com maior frequência [48,6% na vida, 29,0% nos últimos 12 meses e 20,9% nos últimos 30 dias]. CONCLUSÕES: Entre os 13 anos de estudo, houve aumento de uso na vida de tabaco, alucinógenos, anfetaminas e tranquilizantes; além do aumento do uso de anfetaminas nos últimos 12 meses e diminuição do uso de álcool. Em relação aos últimos 30 dias, houve aumento do uso de anfetaminas.

OBJECTIVE: To analyze drug use trends among college students in 1996, 2001 and 2009. METHODS: A cross-sectional epidemiological study with a multistage stratified cluster sample with 9,974 college students was conducted in the city of São Paulo, southeastern Brazil. An anonymous self-administered questionnaire was used to collect information on drug use assessed in lifetime, the preceding 12 months and the preceding 30 days. The Bonferroni correction was used for multiple comparisons of drug use rates between surveys. RESULTS: There were changes in the lifetime use of tobacco and some other drugs (hallucinogens [6.1% to 8.8%], amphetamines [4.6% to 8.7%], and tranquilizers [5.7% to 8.2%]) from 1996 to 2009. Differences in the use of other drugs over the 12 months preceding the survey were also seen: reduced use of inhalants [9.0% to 4.8%] and increased use of amphetamines [2.4% to 4.8%]. There was a reduction in alcohol [72.9% to 62.1%], tobacco [21.3% to 17.2%] and marijuana [15.0% to 11.5%] use and an increase in amphetamine use [1.9% to 3.3%] in the preceeding 30 days. CONCLUSIONS: Over the 13-year study period, there was an increase in lifetime use of tobacco, hallucinogens, amphetamines, and tranquilizers. There was an increase in amphetamine use and a reduction in alcohol use during the preceding 12 months. There was an increase in amphetamine use during the preceding 30 days.

OBJETIVO: Analizar la tendencia del uso de drogas entre universitarios en 1996, 2001 y 2009. MÉTODOS: estudio epidemiológico transversal con 9.974 universitarios del municipio de Sao Paulo, Sureste de Brasil, cuya muestra fue seleccionada por estratificación y conglomerados. Se adoptó instrumento de investigación de auto llenado, anónimo, que caracterizó el uso de drogas por tres medidas: uso en la vida, en los últimos 12 meses y en los últimos 30 días. Para comparar las frecuencias de uso de drogas entre las investigaciones, se utilizó la metodología de comparaciones múltiples con corrección de Bonferroni. RESULTADOS: Hubo reducción de la frecuencia de estudiantes que relataron consumo de drogas entre 1996 y 2009. Hubo disminución del uso de inhalantes y aumento en el uso de anfetamínicos en todas las medidas evaluadas [4,6% para 8,7% en la vida, de 2,4% para 4,5% en los últimos 12 meses y de 1,9% a 3,3% en los últimos 30 días]. Los alumnos de las Ciencias Humanas relataron uso de drogas con mayor frecuencia [48,6% en la vida, 29,0% en los últimos 12 meses y 20,9% en los últimos 30 días]. CONCLUSIONES: Entre los 13 años de estudio, hubo aumento de uso en la vida de cigarro, alucinógenos, anfetaminas y tranquilizantes; así como aumento en el uso de anfetaminas en los últimos 12 meses y disminución en el uso de alcohol. Con relación a los últimos 30 días, hubo aumento en el uso de anfetaminas.

CONTEXTO: A prevalência do uso prescrito de metilfenidato (MPH) e correlatos ainda é pouco conhecida no Brasil. OBJETIVO: Estimar a prevalência do uso prescrito de MPH e correlatos em uma amostra populacional de universitários brasileiros. MÉTODOS: Doze mil setecentos e onze universitários foram solicitados a responder a um questionário sobre o uso de drogas. Em relação ao uso na vida de MPH, os universitários foram divididos em dois grupos: usuários de MPH (MPHU) e não usuários de MPH (MPHNU). Um modelo de regressão quasibinomial foi usado para avaliar a correlação desse uso com as demais variáveis. RESULTADOS: 0,9% dos universitários relataram ter feito uso de MPH na vida (MPHU). Ser da região Centro-Oeste (RP = 4,8; p < 0,01) e Sul (RP = 5,2; p < 0,05), morar em repúblicas (RP = 5,8; p < 0,001), já ter feito uso prescrito de anfetaminas (RP = 8,9; p < 0,001) e benzodiazepínicos (< 3 semanas: RP = 4,4; p < 0,001; ≥ 3 semanas: RP = 6,7; p < 0,001) e fazer uso recente e de risco de álcool (RP = 4,0; p < 0,05) foram variáveis associadas ao MPHU. CONCLUSÃO: A associação do uso de álcool e de outras drogas com o uso prescrito de MPH entre universitários sugere a importância da triagem do padrão do uso de álcool e de outras drogas entre estudantes com sintomas de transtorno de déficit de atenção e hiperatividade (TDAH).

BACKGROUND: The prevalence of prescribed use of methylphenidate (MPH) and its correlates are not well-known in Brazil. OBJECTIVE: To estimate the prevalence of prescribed use of MPH and its correlates in a sample of Brazilian college students. METHODS: Twelve-thousand seven hundred and eleven college students filled out a drug use questionnaire. They were divided into two groups based on the lifetime use of MPH: MPH users (MPHU) and MPH non-users (MPHNU). Quasi-binomial regression models were carried out in order to evaluate the correlation among MPHU and other variables. RESULTS: A lifetime use of MPH was reported from 0.9% of college students (MPHU). Being from the Midwest (PR = 4.8, p < 0.01) and South (PR = 5.2, p < 0.05), living in students housing (PR = 5.8, p < 0.001), prescribed use of amphetamines (PR = 8.9, p < 0.001) and benzodiazepines (< 3 weeks: PR = 4.4, p < 0.001; ≥ 3 weeks: PR = 6.7, p < 0.001), and harmful use of alcohol (PR = 4.0, p < 0.05) were correlated with MPHU. DISCUSSION: The association of alcohol and drug use with prescribed use of MPH among college students suggests the importance of screening drinking patterns and use of other drugs among students with ADHD symptoms.

OBJECTIVE: To investigate drinking patterns and gender differences in alcohol-related problems in a Brazilian population, with an emphasis on the frequency of heavy drinking. METHODS: A cross-sectional study was conducted with a probability adult household sample (n = 1,464) in the city of São Paulo, Brazil. Alcohol intake and ICD-10 psychopathology diagnoses were assessed with the Composite International Diagnostic Interview 1.1. The analyses focused on the prevalence and determinants of 12-month nonheavy drinking, heavy episodic drinking (4-5 drinks per occasion), and heavy and frequent drinking (heavy drinking at least 3 times/week), as well as associated alcohol-related problems according to drinking patterns and gender. RESULTS: Nearly 22% (32.4% women, 8.7% men) of the subjects were lifetime abstainers, 60.3% were non-heavy drinkers, and 17.5% reported heavy drinking in a 12-month period (26.3% men, 10.9% women). Subjects with the highest frequency of heavy drinking reported the most problems. Among subjects who did not engage in heavy drinking, men reported more problems than did women. A gender convergence in the amount of problems was observed when considering heavy drinking patterns. Heavy and frequent drinkers were twice as likely as abstainers to present lifetime depressive disorders. Lifetime nicotine dependence was associated with all drinking patterns. Heavy and frequent drinking was not restricted to young ages. CONCLUSIONS: Heavy and frequent episodic drinking was strongly associated with problems in a community sample from the largest city in Latin America. Prevention policies should target this drinking pattern, independent of age or gender. These findings warrant continued research on risky drinking behavior, particularly among persistent heavy drinkers at the non-dependent level.

OBJETIVO: Transtornos por uso de substâncias são prevalentes em setores de emergência gerais e psiquiátricos, atingindo taxas de 28% das ocorrências em prontos-socorros gerais. Todavia, profissionais dos setores de emergência identificam menos que 50% dos casos de problemas relacionados ao álcool. Este artigo visa fornecer base fundamentada em evidências para o tratamento específico a pacientes que preencham os critérios diagnósticos de transtornos por uso de substâncias e que se apresentam ao pronto-socorro em quadros de intoxicação ou abstinência. MÉTODO: Uma revisão sobre o tema foi realizada na base de dados Medline, usando-se os descritores "intoxicação aguda", "abstinência", "álcool", "cocaína", "cannabis", "opioides", "inalantes" e "manejo", tendo o inglês como idioma. RESULTADOS E CONCLUSÃO: O cuidado de pessoas com transtornos por uso de substâncias deve conter: avaliação completa (médica geral e psiquiátrica), tratamento dos quadros diagnosticados (abstinência, intoxicação e quadros clínicos que caracterizem uma emergência), sensibilização do paciente para realizar tratamento, se for necessário, e elaboração de encaminhamento.

OBJECTIVE: Substance use disorders are prevalent in emergency departments in medical and psychiatric services, reaching rates of 28% of cases in medical emergency departments. However, professionals in the emergency department identify less than 50% of cases of alcohol-related problems. This article aims to provide evidence-based interventions for the specific treatment to patients who meet diagnostic criteria for substance use disorders and who present to emergency rooms during intoxication or abstinence. METHOD: A literature review was performed on Medline database, using the descriptors "acute intoxication", "withdrawal", "alcohol", "cocaine", "cannabis", "opioid", "inhalant", "management", using English as the language. RESULTS: AND CONCLUSION: The care of persons with substance use disorders should include: comprehensive assessment (medical and psychiatric), treatment of diagnosed disorders (withdrawal, intoxication and clinical features that characterize an emergency), awareness of the patient to carry out treatment if necessary and referral.