Estratégias utilizadas no tratamento de famílias com usuários de substâncias
DOI:
https://doi.org/10.24879/2015009002009Abstract
Este estudo teve por objetivo descrever as estratégias cognitivo-comportamentais mais utilizadas por pacientes usuários de substâncias (n=52) e seus familiares (n=75) para lidar com as situações de risco durante o tratamento. A intervenção baseou-se na psicoterapia cognitivo-comportamental, e foram analisadas estratégias de fuga e enfrentamento. A análise de conteúdo destacou o suporte familiar para auxiliar o paciente no redirecionamento de novos hábitos envolvidos com o uso de drogas. A inclusão de estratégias direcionadas aos familiares dos dependentes foi importante para o treino de habilidades de mudança de comportamentos desadaptativos envolvidos no consumo de substâncias. Esses achados também ajudam na elaboração de futuras intervenções destinadas aos dependentes de drogas e seus familiares como forma de aumentar a efetividade da intervenção.
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References
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Belles, S., Budde, A., Moesgen, D., & Klein, M.
(2011). Parental problem drinking predicts
implicit alcohol expectancy in adolescents and
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1091-1094. doi: http://dx.doi.org/10.1016/j.
addbeh.2011.06.007
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Social determinants of adolescent drinking; whatthey think, what they do and what I think and do.
Journal of Studies on Alcohol, 41(3), 215-241.
Brady, K. T., Gray, K. M., & Tolliver, B. K. (2011).
Cognitive enhancers in the treatment of substance
use disorders: clinical evidence. Pharmacology
Biochemistry & Behavior, 99(2), 285-294. doi:
http://dx.doi.org/10.1016/j.pbb.2011.04.017
da Silva, V. A., de Aguiar, A. S., Felix, F., Rebello,
G. P., Andrade, R. C., & Mattos, H. F.
(2003). Brazilian study on substance misuse in
adolescents: associated factors and adherence
to treatment. Revista Brasileira de Psiquiatria,
25(3), 133-138. doi: http://dx.doi.org/S1516-
44462003000300004
Dattilio, F M. (1998). Case studies in couple and
family therapy: Systemic and cognitive perspectives.
New York: Guilford Pres.
Dattilio, F. M. (2002). Homework assignments in
couple and family therapy. Journal of Clinical
Psychology, 58(5), 535-547. doi: http://dx.doi.
org/10.1002/jclp.10031
Dattilio, F. M., & Epstein, N. B. (2005). Introduction
to the special section: The role of cognitivebehavioral
interventions in couple and family
therapy. Journal of Marital and Family Therapy,
31(1), 7-13.
De Micheli, D., & Formigoni, M. L. (2004). Drug
use by Brazilian students: associations with
family, psychosocial, health, demographic and
behavioral characteristics. Addiction, 99(5), 570-
578. doi: http://dx.doi.org/10.1111/j.1360-
0443.2003.00671.x
Dhonnchadha, B. A., & Kantak, K. M. (2011).
Cognitive enhancers for facilitating drug
cue extinction: insights from animal models.
Pharmacology Biochemistry & Behavior, 99(2),
229-244. doi: http://dx.doi.org/10.1016/j.
pbb.2011.01.018
Donovan, D. M., Anton, R. F., Miller, W. R.,
Longabaugh, R., Hosking, J. D., & Youngblood,
M. (2008). Combined pharmacotherapies and
behavioral interventions for alcohol dependence
(The COMBINE Study): examination of
posttreatment drinking outcomes. Journal of
Studies on Alcohol and Drugs, 69(1), 5-13.
Fonseca, A. M., Galduroz, J. C., Tondowski, C. S.,
& Noto, A. R. (2009). Alcohol-related domestic
violence: a household survey in Brazil. Revista de
Saúde Pública, 43(5), 743-749. doi: http://dx.doi.
org/S0034-89102009005000049Galduroz, J. C., & Carlini, E. A. (2007). Use of
alcohol among the inhabitants of the 107 largest
cities in Brazil--2001. Brazilian Journal of Medical
and Biological Research, 40(3), 367-375. doi:
http://dx.doi.org/ S0100-879X2007000300012
Gueorguieva, R., Wu, R., Donovan, D., Rounsaville,
B. J., Couper, D., Krystal, J. H., & O’Malley, S.
S. (2010). Naltrexone and combined behavioral
intervention effects on trajectories of drinking
in the COMBINE study. Drug and Alcohol
Dependence, 107(2-3), 221-229. doi: http://
dx.doi.org/10.1016/j.drugalcdep.2009.10.017
Hides, L. M., Elkins, K. S., Scaffidi, A., Cotton, S.
M., Carroll, S., & Lubman, D. I. (2011). Does
the addition of integrated cognitive behaviour
therapy and motivational interviewing improve
the outcomes of standard care for young people
with comorbid depression and substance misuse?
Medical Journal of Australia, 195(3), S31-37. doi:
http://dx.doi.org/hid10903_fm
Horigian, V. E., Robbins, M. S., Dominguez, R.,
Ucha, J., & Rosa, C. L. (2010). Principles for
defining adverse events in behavioral intervention
research: lessons from a family-focused adolescent
drug abuse trial. Clinical Trials, 7(1), 58-68. doi:
http://dx.doi.org/10.1177/1740774509356575
Jones, S. H., Barrowclough, C., Allott, R., Day, C.,
Earnshaw, P., & Wilson, I. (2011). Integrated
motivational interviewing and cognitive-behavioural
therapy for bipolar disorder with comorbid substance
use. Clinical Psychology & Psychotherapy, 18(5), 426-
437. doi: http://dx.doi.org/10.1002/cpp.783
Landau, J, & Garret, J. (2006). Invitational
intervention: a step by step guide for clinicians
helping families engage resistant substance abuses in
treatment. New York: Haworth.
Liddle, H. A., Dakof, G. A., Turner, R. M.,
Henderson, C. E., & Greenbaum, P. E. (2008).
Treating adolescent drug abuse: a randomized trial
comparing multidimensional family therapy and
cognitive behavior therapy. Addiction, 103(10),
1660-1670. doi: http://dx.doi.org/10.1111/
j.1360-0443.2008.02274.x
Longabaugh, R., & Magill, M. (2011). Recent
advances in behavioral addiction treatments:
focusing on mechanisms of change. Current
Psychiatry Reports, 13(5), 382-389. doi: http://
dx.doi.org/10.1007/s11920-011-0220-4
Magill, M., & Ray, L. A. (2009). Cognitive-behavioral
treatment with adult alcohol and illicit drug users:a meta-analysis of randomized controlled trials.
Journal of Studies on Alcohol and Drugs, 70(4),
516-527.
McHugh, R. K., Hearon, B. A., & Otto, M. W.
(2010). Cognitive behavioral therapy for substance
use disorders. Psychiatric Clinics of North America,
33(3), 511-525. doi: http://dx.doi.org/10.1016/j.
psc.2010.04.012
Miller, W. R., & Brown, J. M. (1991). Self-regulation
as a conceptual basis for the prevention and
treatment of addictive behaviors. In: N. Heather,
W. R. Miller & J. Greeley (Eds.), Selfcontrol and
the addictive behaviours. Sydney: Pergamon Press
Australia.
Minayo, M. C. S. (1992). O desafio do conhecimento:
pesquisa qualitativa em saúde. São Paulo-Rio de
Janeiro. HUCITEC-ABRASCO.
Monti, P. M., Rohsenow, D. J., Swift, R. M.,
Gulliver, S. B., Colby, S. M., Mueller, T. I., ...
Asher, M. K. (2001). Naltrexone and cue exposure
with coping and communication skills training
for alcoholics: treatment process and 1-year
outcomes. Alcoholism Clinical and Experimental
Research, 25(11), 1634-1647. doi: http://dx.doi.
org/10.1111/j.1530-0277.2001.tb02170.x
Noel, J. G., & Thomson, N. R. (2012). Children’s
alcohol cognitions prior to drinking onset:
Discrepant patterns from implicit and explicit
measures. Psychology of Addictive Behaviors, 26(3),
451-459. doi: http://dx.doi.org/10.1037/a0025531
Pinheiro, R. T., Pinheiro, K. A., Magalhães, P. V., Horta,
B. L., da Silva, R. A., Sousa, P. L., & Fleming, M.
(2006). Cocaine addiction and family dysfunction:
a case-control study in southern Brazil. Substance
Use & Misuse, 41(3), 307-316. doi: http://dx.doi.
org/10.1080/10826080500409167
Pinsky, I., Caetano, R., Muitsuhiro, S., & Laranjeira, R.
(2013). LENAD II – Consumo de Álcool no Brasil.
São Paulo: Universidade Federal de São Paulo.
Ray, G. T., Mertens, J. R., & Weisner, C. (2009).
Family members of people with alcohol or drug
dependence: health problems and medical cost
compared to family members of people with
diabetes and asthma. Addiction, 104(2), 203-
214. doi: http://dx.doi.org/10.1111/j.1360-
0443.2008.02447.x
Ribeiro, M. (2004). [Services organization for
the treatment of alcohol dependence]. Revista
Brasileira de Psiquiatria, 26 Suppl 1, S59-62. doi:
http://dx.doi.org/S1516-44462004000500015Robbins, M. S., Szapocznik, J., Horigian, V. E.,
Feaster, D. J., Puccinelli, M., Jacobs, P., ...
Brigham, G. (2009). Brief strategic family
therapy for adolescent drug abusers: a multi-site
effectiveness study. Contemporary Clinical Trials,
30(3), 269-278. doi: http://dx.doi.org/10.1016/j.
cct.2009.01.004
Schenker, M., & Minayo, M. C. (2004). [The
importance of family in drug abuse treatment:
a literature review]. Cadernos de Saúde Pública,
20(3), 649-659. doi: http://dx.doi.org/10.1590/
S0102-311X2004000300002
Schor, E. L. (1996). Adolescent alcohol use: social
determinants and the case for early familycentered
prevention. Family-focused prevention
of adolescent drinking. Bulletin of the New York
Academy of Medicine, 73(2), 335-356.
Smiths, J. E., & Meyers, R. J. (2004). Motivating
substance abusers to enter treatment: working with
family members. New York: Guilford.
Spirito, A., Sindelar-Manning, H., Colby, S. M.,
Barnett, N. P., Lewander, W., Rohsenow, D. J.,
& Monti, P. M. (2011). Individual and family
motivational interventions for alcohol-positive
adolescents treated in an emergency department:
results of a randomized clinical trial. Archives
of Pediatrics and Adolescent Medicine, 165(3),
269-274. doi: http://dx.doi.org/10.1001/
archpediatrics.2010.296
Stanton, M. D. & Todd, T. C. (Eds.). (1982).
The family therapy of drug abuse and addiction.
Guilford Press.
Szapocznik, J., & Williams, R. A. (2000). Brief Strategic
Family Therapy: twenty-five years of interplay
among theory, research and practice in adolescent
behavior problems and drug abuse. Clinical Child
and Family Psychology Review, 3(2), 117-134.
Watkins, K. E., Hunter, S. B., Hepner, K. A.,
Paddock, S. M., de la Cruz, E., Zhou, A. J., &
Gilmore, J. (2011). An effectiveness trial of group
cognitive behavioral therapy for patients with
persistent depressive symptoms in substance
abuse treatment. Archives of General Psychiatry,
68(6), 577-584. doi: http://dx.doi.org/10.1001/
archgenpsychiatry.2011.53
Webb, T. L., Sniehotta, F. F., & Michie, S. (2010).
Using theories of behaviour change to inform
interventions for addictive behaviours. Addiction,
105(11), 1879-1892. doi: http://dx.doi.
org/10.1111/j.1360-0443.2010.03028.x
dominance of one? Journal of Health Psychology,
10(1), 19-21; discussion 37-43. doi: http://dx.doi.
org/10.1177/1359105305048550
Bardin, L. (1995). Análise de conteúdo. Lisboa:
Edições 70.
Belles, S., Budde, A., Moesgen, D., & Klein, M.
(2011). Parental problem drinking predicts
implicit alcohol expectancy in adolescents and
young adults. Addictive Behaviors, 36(11),
1091-1094. doi: http://dx.doi.org/10.1016/j.
addbeh.2011.06.007
Biddle, B. J., Bank, B. J., & Marlin, M. M. (1980).
Social determinants of adolescent drinking; whatthey think, what they do and what I think and do.
Journal of Studies on Alcohol, 41(3), 215-241.
Brady, K. T., Gray, K. M., & Tolliver, B. K. (2011).
Cognitive enhancers in the treatment of substance
use disorders: clinical evidence. Pharmacology
Biochemistry & Behavior, 99(2), 285-294. doi:
http://dx.doi.org/10.1016/j.pbb.2011.04.017
da Silva, V. A., de Aguiar, A. S., Felix, F., Rebello,
G. P., Andrade, R. C., & Mattos, H. F.
(2003). Brazilian study on substance misuse in
adolescents: associated factors and adherence
to treatment. Revista Brasileira de Psiquiatria,
25(3), 133-138. doi: http://dx.doi.org/S1516-
44462003000300004
Dattilio, F M. (1998). Case studies in couple and
family therapy: Systemic and cognitive perspectives.
New York: Guilford Pres.
Dattilio, F. M. (2002). Homework assignments in
couple and family therapy. Journal of Clinical
Psychology, 58(5), 535-547. doi: http://dx.doi.
org/10.1002/jclp.10031
Dattilio, F. M., & Epstein, N. B. (2005). Introduction
to the special section: The role of cognitivebehavioral
interventions in couple and family
therapy. Journal of Marital and Family Therapy,
31(1), 7-13.
De Micheli, D., & Formigoni, M. L. (2004). Drug
use by Brazilian students: associations with
family, psychosocial, health, demographic and
behavioral characteristics. Addiction, 99(5), 570-
578. doi: http://dx.doi.org/10.1111/j.1360-
0443.2003.00671.x
Dhonnchadha, B. A., & Kantak, K. M. (2011).
Cognitive enhancers for facilitating drug
cue extinction: insights from animal models.
Pharmacology Biochemistry & Behavior, 99(2),
229-244. doi: http://dx.doi.org/10.1016/j.
pbb.2011.01.018
Donovan, D. M., Anton, R. F., Miller, W. R.,
Longabaugh, R., Hosking, J. D., & Youngblood,
M. (2008). Combined pharmacotherapies and
behavioral interventions for alcohol dependence
(The COMBINE Study): examination of
posttreatment drinking outcomes. Journal of
Studies on Alcohol and Drugs, 69(1), 5-13.
Fonseca, A. M., Galduroz, J. C., Tondowski, C. S.,
& Noto, A. R. (2009). Alcohol-related domestic
violence: a household survey in Brazil. Revista de
Saúde Pública, 43(5), 743-749. doi: http://dx.doi.
org/S0034-89102009005000049Galduroz, J. C., & Carlini, E. A. (2007). Use of
alcohol among the inhabitants of the 107 largest
cities in Brazil--2001. Brazilian Journal of Medical
and Biological Research, 40(3), 367-375. doi:
http://dx.doi.org/ S0100-879X2007000300012
Gueorguieva, R., Wu, R., Donovan, D., Rounsaville,
B. J., Couper, D., Krystal, J. H., & O’Malley, S.
S. (2010). Naltrexone and combined behavioral
intervention effects on trajectories of drinking
in the COMBINE study. Drug and Alcohol
Dependence, 107(2-3), 221-229. doi: http://
dx.doi.org/10.1016/j.drugalcdep.2009.10.017
Hides, L. M., Elkins, K. S., Scaffidi, A., Cotton, S.
M., Carroll, S., & Lubman, D. I. (2011). Does
the addition of integrated cognitive behaviour
therapy and motivational interviewing improve
the outcomes of standard care for young people
with comorbid depression and substance misuse?
Medical Journal of Australia, 195(3), S31-37. doi:
http://dx.doi.org/hid10903_fm
Horigian, V. E., Robbins, M. S., Dominguez, R.,
Ucha, J., & Rosa, C. L. (2010). Principles for
defining adverse events in behavioral intervention
research: lessons from a family-focused adolescent
drug abuse trial. Clinical Trials, 7(1), 58-68. doi:
http://dx.doi.org/10.1177/1740774509356575
Jones, S. H., Barrowclough, C., Allott, R., Day, C.,
Earnshaw, P., & Wilson, I. (2011). Integrated
motivational interviewing and cognitive-behavioural
therapy for bipolar disorder with comorbid substance
use. Clinical Psychology & Psychotherapy, 18(5), 426-
437. doi: http://dx.doi.org/10.1002/cpp.783
Landau, J, & Garret, J. (2006). Invitational
intervention: a step by step guide for clinicians
helping families engage resistant substance abuses in
treatment. New York: Haworth.
Liddle, H. A., Dakof, G. A., Turner, R. M.,
Henderson, C. E., & Greenbaum, P. E. (2008).
Treating adolescent drug abuse: a randomized trial
comparing multidimensional family therapy and
cognitive behavior therapy. Addiction, 103(10),
1660-1670. doi: http://dx.doi.org/10.1111/
j.1360-0443.2008.02274.x
Longabaugh, R., & Magill, M. (2011). Recent
advances in behavioral addiction treatments:
focusing on mechanisms of change. Current
Psychiatry Reports, 13(5), 382-389. doi: http://
dx.doi.org/10.1007/s11920-011-0220-4
Magill, M., & Ray, L. A. (2009). Cognitive-behavioral
treatment with adult alcohol and illicit drug users:a meta-analysis of randomized controlled trials.
Journal of Studies on Alcohol and Drugs, 70(4),
516-527.
McHugh, R. K., Hearon, B. A., & Otto, M. W.
(2010). Cognitive behavioral therapy for substance
use disorders. Psychiatric Clinics of North America,
33(3), 511-525. doi: http://dx.doi.org/10.1016/j.
psc.2010.04.012
Miller, W. R., & Brown, J. M. (1991). Self-regulation
as a conceptual basis for the prevention and
treatment of addictive behaviors. In: N. Heather,
W. R. Miller & J. Greeley (Eds.), Selfcontrol and
the addictive behaviours. Sydney: Pergamon Press
Australia.
Minayo, M. C. S. (1992). O desafio do conhecimento:
pesquisa qualitativa em saúde. São Paulo-Rio de
Janeiro. HUCITEC-ABRASCO.
Monti, P. M., Rohsenow, D. J., Swift, R. M.,
Gulliver, S. B., Colby, S. M., Mueller, T. I., ...
Asher, M. K. (2001). Naltrexone and cue exposure
with coping and communication skills training
for alcoholics: treatment process and 1-year
outcomes. Alcoholism Clinical and Experimental
Research, 25(11), 1634-1647. doi: http://dx.doi.
org/10.1111/j.1530-0277.2001.tb02170.x
Noel, J. G., & Thomson, N. R. (2012). Children’s
alcohol cognitions prior to drinking onset:
Discrepant patterns from implicit and explicit
measures. Psychology of Addictive Behaviors, 26(3),
451-459. doi: http://dx.doi.org/10.1037/a0025531
Pinheiro, R. T., Pinheiro, K. A., Magalhães, P. V., Horta,
B. L., da Silva, R. A., Sousa, P. L., & Fleming, M.
(2006). Cocaine addiction and family dysfunction:
a case-control study in southern Brazil. Substance
Use & Misuse, 41(3), 307-316. doi: http://dx.doi.
org/10.1080/10826080500409167
Pinsky, I., Caetano, R., Muitsuhiro, S., & Laranjeira, R.
(2013). LENAD II – Consumo de Álcool no Brasil.
São Paulo: Universidade Federal de São Paulo.
Ray, G. T., Mertens, J. R., & Weisner, C. (2009).
Family members of people with alcohol or drug
dependence: health problems and medical cost
compared to family members of people with
diabetes and asthma. Addiction, 104(2), 203-
214. doi: http://dx.doi.org/10.1111/j.1360-
0443.2008.02447.x
Ribeiro, M. (2004). [Services organization for
the treatment of alcohol dependence]. Revista
Brasileira de Psiquiatria, 26 Suppl 1, S59-62. doi:
http://dx.doi.org/S1516-44462004000500015Robbins, M. S., Szapocznik, J., Horigian, V. E.,
Feaster, D. J., Puccinelli, M., Jacobs, P., ...
Brigham, G. (2009). Brief strategic family
therapy for adolescent drug abusers: a multi-site
effectiveness study. Contemporary Clinical Trials,
30(3), 269-278. doi: http://dx.doi.org/10.1016/j.
cct.2009.01.004
Schenker, M., & Minayo, M. C. (2004). [The
importance of family in drug abuse treatment:
a literature review]. Cadernos de Saúde Pública,
20(3), 649-659. doi: http://dx.doi.org/10.1590/
S0102-311X2004000300002
Schor, E. L. (1996). Adolescent alcohol use: social
determinants and the case for early familycentered
prevention. Family-focused prevention
of adolescent drinking. Bulletin of the New York
Academy of Medicine, 73(2), 335-356.
Smiths, J. E., & Meyers, R. J. (2004). Motivating
substance abusers to enter treatment: working with
family members. New York: Guilford.
Spirito, A., Sindelar-Manning, H., Colby, S. M.,
Barnett, N. P., Lewander, W., Rohsenow, D. J.,
& Monti, P. M. (2011). Individual and family
motivational interventions for alcohol-positive
adolescents treated in an emergency department:
results of a randomized clinical trial. Archives
of Pediatrics and Adolescent Medicine, 165(3),
269-274. doi: http://dx.doi.org/10.1001/
archpediatrics.2010.296
Stanton, M. D. & Todd, T. C. (Eds.). (1982).
The family therapy of drug abuse and addiction.
Guilford Press.
Szapocznik, J., & Williams, R. A. (2000). Brief Strategic
Family Therapy: twenty-five years of interplay
among theory, research and practice in adolescent
behavior problems and drug abuse. Clinical Child
and Family Psychology Review, 3(2), 117-134.
Watkins, K. E., Hunter, S. B., Hepner, K. A.,
Paddock, S. M., de la Cruz, E., Zhou, A. J., &
Gilmore, J. (2011). An effectiveness trial of group
cognitive behavioral therapy for patients with
persistent depressive symptoms in substance
abuse treatment. Archives of General Psychiatry,
68(6), 577-584. doi: http://dx.doi.org/10.1001/
archgenpsychiatry.2011.53
Webb, T. L., Sniehotta, F. F., & Michie, S. (2010).
Using theories of behaviour change to inform
interventions for addictive behaviours. Addiction,
105(11), 1879-1892. doi: http://dx.doi.
org/10.1111/j.1360-0443.2010.03028.x
