Labeling disorder--the relationship between conduct problems and drug use in adolescents

Correlates of binge drinking among Brazilian adolescents

Abstract Adolescence is a vulnerable period for risk-taking tendencies, including binge drinking. The aim of this study was to examined the prevalence of binge drinking and its association with factors related to the consumption of alcoholic beverages by best friend, familial factors, socioeconomic status and religiosity. A Census of 633 students from public and private schools in Diamantina-MG was conducted. Participants completed a self-administered questionnaire, the Alcohol Use Disorders Identification Test-C (AUDIT-C) and, another on the consumption of alcohol by family and friends. Surveys inquiring about socioeconomic conditions were sent to parents/guardians. Descriptive and bivariate analyzes were performed (p < 0.05). The log-binomial model was used to calculate PR and 95% CI. The prevalence of binge drinking was 23.1%. The average age of onset of alcohol consumption was 10,8 years. Binge drinking was more prevalent among adolescents whose best friend [OR = 4.72 (95% CI 2.78-8.03)] and brother [PR = 1.46 (95% CI 1.10-1.92)] drink alcohol. Religiosity [PR = 0.40 (95% CI 0.27-0.62)] appeared as a possible protective factor. Our findings indicate that peer effects are important determinants of drinking and could be utilized as a potential target for interventions to reduce alcohol consumption rates.

[Adolescent substance use and family problems]

This study aimed to evaluate the association between substance use (alcohol, tobacco, and illicit drugs) and family problems among 965 adolescents from 50 public schools in two cities in São Paulo State, Brazil, in 2007. The Drug Use Screening Inventory (DUSI) was used for data collection. Use of alcohol, tobacco, and illicit drugs was associated with a negative assessment of the family relationship, lack of monitoring/support, and psychoactive substance use by family members (p < 0.05). Adolescents that reported having used alcohol, tobacco, and illicit drugs had more family problems than those who did not consume any substance (p < 0.001). Adolescents that used alcohol and tobacco (p = 0.028) and illicit drugs (p < 0.001) reported having more family problems than those who used only alcohol. The results highlight the importance of awareness of alcohol and tobacco use by adolescents, since such use was associated with significant family impairments, similar to illicit drug use.

The impact of psychiatric diagnosis on treatment adherence and duration among victimized children and adolescents in São Paulo, Brazil

OBJECTIVE

Despite the high prevalence of substance abuse and mood disorders among victimized children and adolescents, few studies have investigated the association of these disorders with treatment adherence, represented by numbers of visits per month and treatment duration. We aimed to investigate the effects of substance abuse and mood disorders on treatment adherence and duration in a special program for victimized children in São Paulo, Brazil.

METHODS

A total of 351 participants were evaluated for psychiatric disorders and classified into one of five groups: mood disorders alone; substance abuse disorders alone; mood and substance abuse disorders; other psychiatric disorders; no psychiatric disorders. The associations between diagnostic classification and adherence to treatment and the duration of program participation were tested with logistic regression and survival analysis, respectively.

RESULTS

Children with mood disorders alone had the highest rate of adherence (79.5%); those with substance abuse disorders alone had the lowest (40%); and those with both disorders had an intermediate rate of adherence (50%). Those with other psychiatric disorders and no psychiatric disorders also had high rates of adherence (75.6% and 72.9%, respectively). Living with family significantly increased adherence for children with substance abuse disorders but decreased adherence for those with no psychiatric disorders. The diagnostic correlates of duration of participation were similar to those for adherence.

CONCLUSIONS

Mood and substance abuse disorders were strong predictive factors for treatment adherence and duration, albeit in opposite directions. Living with family seems to have a positive effect on treatment adherence for patients with substance abuse disorders. More effective treatment is needed for victimized substance-abusing youth.

Current challenges and future perspectives in the field of addiction psychiatry in Latin America

This paper provides a brief review of the addictions field in Latin America. Epidemiology, legal aspects, dual pathology, treatment, prevention and future directions are discussed. This increasing disease is one of the major contributors for mental health problems in the region. Efforts have been made in treatment and prevention but results and budgets are scarce. Dual pathology, new modalities such as injected heroin in countries such as Colombia, low coverage of programmes, training resources, research and publications are important challenges. The tendency to liberalize legal terms of use would require more effort for prevention and education. Based on relevant literature and a long and current experience in the area, the authors summarize this important theme.

Psychiatry and politics in Pelotas, Brazil: the equivocal quality of conduct disorder and related diagnoses

The world-wide emergence of categories for diagnosing mental health problems in children and youth such as conduct disorder is often attributed to the globalization of a highly biomedical form of psychiatry. In Brazil, a small group of therapists are resisting biomedicalization by keeping psychodynamic traditions alive and aiming to transform psychotherapy into a resource for politicized youth empowerment. Nevertheless, clinical practices demonstrate an increased use of biomedical diagnoses and therapeutic routines. On the basis of fieldwork with therapists and teachers, and a nine-year-long ethnography of young people, this article explores the localized effects of these potentially contradictory developments. Results show that the growth of biomedical practices alongside politicized therapeutic approaches is not indicative of underlying ambiguities but has, rather, emerged from the purposefully equivocal nature of Brazilian social, medical, and professional life. The article uses this Brazilian case study to critically debate theories of medicalization in the anthropology of psychiatry.