Abstract In much of the West, including Brazil, drug use has increased since social distancing began in response to the pandemic. Use of smoked and modified drugs, and their impacts on health, may contribute to aggravate the effects of the pandemic. However, studies on the relationship between use of smoked drugs and the new coronavirus are still scarce and have not received enough attention in global health recommendations. This paper aims to briefly review the relationship between use of smoked drugs and acute respiratory syndrome coronavirus 2 [SARS-CoV-2]. Recent studies also suggest that drug consumption increases the risk of contamination by SARS-CoV-2 and leads to worse prognosis, particularly consumption of drugs that affect lung function. Use of smoked drugs, especially tobacco, is strongly associated with lung diseases that are risk factors for contamination by SARS-CoV-2. It is essential to develop strategies based on specific characteristics of drug users and for mental health professionals to be included in strategic teams. It is also necessary to invest in information campaigns regarding risks and prevention of harm caused by smoked drugs as well as to design strategies that facilitate access to psychosocial treatment during the pandemic.

Objectives: To compare suicide rates observed in Brazil after the onset of the COVID-19 pandemic with the estimated rate based on suicide deaths between 2010 and 2020, and identify sociodemographic variables associated with this outcome. Methods: Ecological time-series study. Data were obtained from Brazilian Unified Health System Department of Information Technology (DATASUS), with the structural break of the data set in March 2020. The number of actual suicides observed and the number of expected suicides if there were no COVID-19 pandemic were analyzed through bayesian structural time series modeling. Results: The overall incidence of suicides in Brazil remained stable after the start of the COVID-19 pandemic compared to what would be expected. However, there was a significant increase in suicide deaths among women (6.9%) and older adult (9.1%). Analysis by macro-regions of the country showed significant increases in suicide deaths in the Center-West (7.4%), Northeast (5.7%), and Southeast (10%). Stratified analyses revealed differences according to age, sex, education, and skin color. Conclusions: Despite stability in the overall number of suicides, this phenomenon occurs heterogeneously among different population groups and regions of Brazil. Rates have increased in populations with a history of poor access to health, which may have been more severely impacted by the pandemic.

Objective: This study aimed to evaluate whether progression from first drug use to crack-cocaine use differs according to gender, and whether the report of sexual or physical violence impacts the time of progression. Methods: We interviewed 896 crack-cocaine users (548 men; 348 women) from addiction treatment units. Cox regression models evaluated the time of progression from first drug use to crack use. We analyzed gender differences according to the absence or presence of sexual or physical violence, also considering whether violence, when present, had occurred before or after the onset of crack use. Results: Women presented a faster progression to crack use regardless of exposure to sexual or physical violence (p < 0.05). Compared to unexposed men, there was a similar progression for men exposed to sexual or physical violence before the first use of crack (p = 0.167 and p = 0.393, respectively). In both genders, we observed a faster progression among individuals exposed to these types of violence after the onset of crack use (p < 0.01). Conclusions: We found a faster progression to crack use among women and among individuals exposed to sexual and physical violence after the onset of crack use. These results encourage differentiated treatment strategies, focused on gender and individual characteristics.

Abstract Introduction Changes in brain-derived neurotrophic factor (BDNF) have been linked to the neuroadaptative consequences of chronic alcohol use and associated with disease severity and prognosis. Few studies have evaluated the influence of drug withdrawal and clinical and sociodemographic data on BDNF levels in severe alcohol users. Objectives Our goals were (1) to evaluate variation in BDNF levels during alcohol withdrawal and, (2) to assess the influence of putative confounding factors on BDNF levels. Methods Our sample consists of 62 men with alcohol use disorder undergoing a detoxification process. Serum BDNF levels were measured using a commercial sandwich-ELISA kit, at two points: before and after the detoxification period. Results We found an increase in BDNF levels during alcohol withdrawal (25.4±9.6 at admission vs. 29.8±10.2 ng/ml at discharge; p < 0.001), even after controlling for potential confounders (positive family history, number of days between blood sample collections, and age) (Generalized Estimating Equation: coefficient = -4.37, 95% confidence interval [95%CI] -6.3; -2.4; p < 0.001). Moreover, individuals who had first-degree relative with alcohol dependence had smaller increases in BDNF levels than individuals with no family history (14.8 [95%CI -5.3; 35.6] vs. 35.3 [95%CI 15.4; 74.8]; p = 0.005). Conclusions In summary, variation in BDNF levels seems to be influenced by withdrawal in severe alcohol users. A positive family history of alcohol dependence could also be a factor that influences variation in this biomarker.

Abstract The coronavirus disease (COVID-19) pandemic is one of the greatest contemporary challenges. Feelings of fear and uncertainty triggered by this pandemic have had noxious effects on people’s mental health. This seems to have increased during quarantine and there is evidence of an intensification of reward-directed behavior. Nevertheless, there are few studies dealing with pornography consumption during this period. The aim of this manuscript is to contextualize this phenomenon during the pandemic and suggest some clinical recommendations on the matter.

Abstract The COVID-19 pandemic is unquestionably impacting on the mental health of the population worldwide. Fear of contamination can both increase levels of stress in healthy individuals and intensify psychiatric symptoms in patients with pre-existing conditions, especially obsessive-compulsive disorder (OCD). During the COVID-19 pandemic, the imminent risk of contamination creates a logical need for self-surveillance and hygiene habits. However, this kind of information can have drastic implications for subjects with OCD, since cognitive distortions and compensatory strategies (cleansing rituals) are no longer irrational or oversized – rather, these ideas become legitimate and socially accepted, generating plausible validation for the intensification of compulsive cleaning rituals. Patients who presented remission of OCD symptoms would be more likely to have a relapse, and subclinical patients may scale up and ultimately be diagnosed with OCD due to the reinforcement of their habits, emotions and thoughts.

Resumo Objetivo: sabe-se que o consumo de álcool entre adolescentes tem se intensificado no contexto nacional e internacional e em função disso o presente estudo foi concebido para avaliar em que medida variáveis como características sociodemográficas, desempenho escolar, padrão de consumo e saúde emocional podem predizer a variável de interesse, consumo recente de álcool, definido como consumo de bebidas alcoólicas nos últimos 30 dias, entre adolescentes de escolas públicas da região metropolitana de Porto Alegre/Rio Grande do Sul-Brasil. Método: trata-se de um estudo transversal, com delineamento observacional-analítico, do qual participaram 124 escolares, 69 meninas e 55 meninos, com idades entre 11 e 18 anos. Todos foram acessados em sala de aula para responderem ao Questionário de Dados Sociodemográficos, Youth Self Report e Questionário sobre o uso de drogas. Resultados: as variáveis com maior impacto no consumo recente de álcool foram o total dos problemas de internalização, ansiedade/depressão e sexo feminino. Ter feito uso de álcool com 15 anos ou menos e reprovação escolar também foram capazes de predizer o uso de álcool. Conclusão: os dados confirmam a multidimensionalidade do fenômeno que deve ser considerada em campanhas de prevenção.

Abstract Objective: It is known that alcohol use has increased both nationally and internationally. The present study was designed to evaluate the extent to wich sociodemographic characteristics, school performance, pattern of consumption and emotional health can predict the variable of interest, recent alcohol use, defined as the consumption of alcoholic beverages in the past 30 days, among adolescents from public schools in the metropolitan region of Porto Alegre/Rio Grande do Sul-Brazil. Methods: This was an observational, analytical, cross-sectional study of 124 students, 70 girls and 54 boys, aged 11 to 18 years. Participants were assessed in the classroom and completed a sociodemographic questionnaire, the Youth Self Report, and a questionnaire on drug use. Results: The variable with the greatest impact on recent alcohol use was total internalizing problems, anxiety/depression, and female sex. First alcohol use at 15 years or younger as well as school failure were also able to predict alcohol use. Conclusion: the data confirm the multidimensionality of the phenomenon that should be considered in prevention campaigns.

Resumen Objetivo: se sabe que el consumo de alcohol entre adolescentes se ha intensificado en el contexto nacional e internacional. En función de ello el presente estudio fue concebido para evaluar en qué medida variables como las características socio-demográficas, el rendimiento escolar, patrón de consumo y la salud emocional pueden predecir la variable de interés, el consumo reciente de alcohol, definido como el consumo de bebidas alcohólicas en los últimos 30 días, entre adolescentes de escuelas públicas de la región metropolitana de Porto Alegre / Rio Grande do Sul-Brasil. Método: se trata de un estudio transversal, con delineamiento observacional-analítico, del cual participaron 124 escolares, 69 niñas y 55 niños, con edades entre 11 y 18 años. Todos fueron accedidos en el aula para responder al Cuestionario de Datos Sociodemográficos, Youth Self Report y Cuestionario sobre el uso de drogas. Resultados: las variables con mayor impacto en lo consumo reciente de alcohol fueron el total de los problemas de internalización, ansiedad/depresión y sexo femenino. Haber hecho uso de alcohol con 15 años o menos y reprobación escolar también fue capaces de predecir el uso de alcohol. Conclusión: los datos confirman lo fenómeno multidimensional que debe ser considerado en campañas de prevención.

Resumo Introdução O vírus da hepatite C (HCV) está relacionado com graves patologias hepáticas, como a cirrose e o carcinoma hepatocelular, causando mais de meio milhão de mortes todos os anos, o que reflete um problema de saúde mundial. Sabe-se que usuários de drogas injetáveis possuem alta prevalência de infecção pelo HCV, sendo por isso considerados um dos maiores grupos de risco. Usuários de cocaína parecem ter maior risco de contrair o vírus do que usuários de outras drogas, e diversas hipóteses para essa associação estão sendo estudadas. Objetivo Revisar evidências de associação da infecção pelo HCV em usuários de cocaína, considerando a relevância das diferentes formas de administração da droga e comportamentos de risco. Métodos Esta foi uma revisão narrativa realizada nos principais bancos de dados científicos. Resultados e conclusão As evidências atuais sugerem que o uso de cocaína pode estar associado com a infecção por HCV devido às especificidades do padrão de consumo da droga, mesmo naqueles indivíduos que não fazem uso de drogas injetáveis, além de outros comportamentos de risco, como tatuagens e sexo desprotegido. Usuários de cocaína injetável parecem estar mais suscetíveis à contaminação do que usuários de cocaína não injetável. Entretanto, há a possibilidade de infecção devido ao compartilhamento de outros equipamentos de uso além das seringas (cachimbos, por exemplo). Além disso, prejuízos do sistema imune causados pela cocaína também parecem estar associados com a suscetibilidade de infecção pelo HCV, além da manutenção e piora dos sintomas da doença.

Abstract Introduction Hepatitis C virus (HCV) infection is related with several liver diseases such as cirrhosis and hepatocellular carcinomas, leading to more than 0.5 million deaths every year and to a great global burden. It is known that injection drug users show a high prevalence of HCV infection, being considered a risk group for this disease. Cocaine users seem to be in greater risk than other drug users, and several hypotheses for this association are being studied. Aim To review data on HCV infection in cocaine users, taking into consideration the relevance of the different routes of drug administration and other risk behaviors. Methods This was a narrative review performed in the main scientific databases. Results and conclusion Data suggest that cocaine use could be associated with HCV infection due to the specificities of cocaine consumption pattern, even in those subjects who do not inject drugs, in addition to other risky behaviors, such as tattooing and unprotected sex. Injectable cocaine users seem to be more susceptible to contamination than users who do not inject drugs. However, evidence is pointing to the possibility of infection by sharing drug paraphernalia other than syringes. Moreover, specific immune system impairments caused by cocaine use are also being linked with HCV infection susceptibility, persistence and increased pathological effects.

OBJECTIVES:To evaluate family problems among crack/cocaine users compared with alcohol and other substance users.METHODS:A cross-sectional multi-center study selected 741 current adult substance users from outpatient and inpatient Brazilian specialized clinics. Subjects were evaluated with the sixth version of the Addiction Severity Index, and 293 crack users were compared with 126 cocaine snorters and 322 alcohol and other drug users.RESULTS:Cocaine users showed more family problems when compared with other drug users, with no significant difference between routes of administration. These problems included arguing (crack 66.5%, powder cocaine 63.3%, other drugs 50.3%, p= 0.004), having trouble getting along with partners (61.5%×64.6%×48.7%, p= 0.013), and the need for additional childcare services in order to attend treatment (13.3%×10.3%×5.1%, p= 0.002). Additionally, the majority of crack/cocaine users had spent time with relatives in the last month (84.6%×86.5%×76.6%, p= 0.011).CONCLUSIONS:Brazilian treatment programs should enhance family treatment strategies, and childcare services need to be included.

Analisar a estrutura fatorial e a escala de medida dos critérios de dependência do DSM-IV adaptado para açúcar a fim de verificar se as características estruturais são aplicaveis para dependência de açúcar. O questionário foi aplicado numa amostra de 500 pessoas (67% mulheres; média idade: 38 anos; 43% de clínicas obesidade; 63% IMC normal). A análise fatorial exploratória determinou a estrutura fatorial e unidimensionalidade; a análise de Rasch, a unidimensionalidade e distribuição dos itens. O modelo com melhor ajuste era unidimensional. Todos os itens apresentaram ajustes adequados na análise de Rasch com confiabilidade de 0,99, infit entre 0,86 a 1,14 e outfit entre 0,71 e 1,20. Os itens de dependência do MINI Plus adaptados para açúcar apresentaram boas propriedades psicométricas, sugerindo que os critérios do DSM-IV contribuem na verificação do constructo dependência de açúcar.

This study aimed to analyze the factorial structure and the scale of measurement of the items for dependence of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) adapted for sugar consumption in order to verify if the structural characteristics can be applied to sugar dependence. The questionnaire was applied to a sample of 500 subjects in Brazil (67% female; mean age: 38 y.o.; 43% from weight control clinics; 63% with normal BMI). An exploratory factor analysis was performed to determine the factorial structure and unidimensionality; and, a Rasch model analysis, to verify unidimensionality and items distribution. The model with best fit is unidimensional. All items had good fit to the Rasch model with a reliability of .99, infit between .86 and 1.14 and outfit from .71 to 1.20. The items of MINI Plus adapted for sugar dependence presented good psychometric properties, suggesting that the dependence criteria of DSM-IV support the verification of the construct for sugar addiction.

OBJETIVO: Estudos têm demonstrado sinais de lesão cerebral causadas por diferentes mecanismos em usuários de cocaína. A enolase sérica neurônio-específica e a proteína S100B são consideradas marcadores bioquímicos específicos de lesão neuronal e glial. Este estudo objetivou comparar os níveis sangüíneos de S100B e enolase sérica neurônio-específica em usuários crônicos de cocaína e em voluntários que não usam cocaína ou outras drogas ilícitas. MÉTODO: Vinte sujeitos dependentes de cocaína, mas não dependentes de álcool, maconha ou outra droga, e 20 sujeitos controles não usuários de drogas foram recrutados. Os sujeitos foram selecionados por amostragem consecutiva e não-probabilística e os níveis de enolase neurônio-específica e S100B foram determinados por ensaio de luminescência. RESULTADOS: Os usuários de cocaína tiveram escores significativamente maior que os controles em todas as dimensões psiquiátricas do SCL-90 e apresentaram prejuízos cognitivos no subteste cubos do WAIS e no span de palavras. Os níveis de S100B foram em média 0,09 ± 0,04 µg/l nos usuários de cocaína e 0,08 ± 0,04 µg/l nos controles. Os níveis de enolase neurônio-específica foram em média 9,7 ± 3,5 ng/l nos usuários e 8,3 ± 2,6 ng/l nos controles. CONCLUSÃO: Neste primeiro estudo utilizando esses marcadores específicos de lesão cerebral em usuários de cocaína, os níveis séricos de S100B e enolase específica do neurônio não foram significativamente diferentes entre dependentes de cocaína e controles.

OBJECTIVE: Studies have shown signs of brain damage caused by different mechanisms in cocaine users. The serum neuron specific enolase and S100B protein are considered specific biochemical markers of neuronal and glial cell injury. This study aimed at comparing blood levels of S100B and NSE in chronic cocaine users and in volunteers who did not use cocaine or other illicit drugs. METHOD: Twenty subjects dependent on cocaine but not on alcohol or marijuana, and 20 non-substance using controls were recruited. Subjects were selected by consecutive and non-probabilistic sampling. Neuron specific enolase and S100B levels were determined by luminescence assay. RESULTS: Cocaine users had significantly higher scores than controls in all psychiatric dimensions of the SCL-90 and had cognitive deficits in the subtest cubes of WAIS and the word span. Mean serum S100B level was 0.09 ± 0.04 µg/l among cocaine users and 0.08 ± 0.04 µg/l among controls. Mean serum neuron specific enolase level was 9.7 ± 3.5 ng/l among cocaine users and 8.3 ± 2.6 ng/l among controls. CONCLUSIONS: In this first study using these specific brain damage markers in cocaine users, serum levels of S100B and neuron specific enolase were not statistically different between cocaine dependent subjects and controls.