Estudo das habilidades de enfrentamento e da autoefic?cia para a abstin?ncia em dependentes de crack

• Main Author: Souza, M?rcia Cristina Henrique de
• Other Authors: Oliveira, Margareth da Silva
• Format: Others
• Language: Portuguese
• Published: Pontif?cia Universidade Cat?lica do Rio Grande do Sul 2015
• Subjects: PSICOLOGIA; PSICOLOGIA CL?NICA; TRANSTORNOS RELACIONADOS AO USO DE SUBST?NCIAS; COCA?NA - ASPECTOS PSICOL?GICOS; COCA?NA CRACK; CIENCIAS HUMANAS::PSICOLOGIA
• Online Access: http://tede2.pucrs.br/tede2/handle/tede/6340

Submitted by Setor de Tratamento da Informa??o - BC/PUCRS ([e-mail]) on 2015-10-05T19:00:43Z No. of bitstreams: 1 475522 - Texto Parcial.pdf: 295790 bytes, checksum: 894ee0af17c806ed31db4e4c3ef21479 (MD5) === Made available in DSpace on 2015-10-05T19:00:43Z (GMT). No. of bitstreams: 1 475522 - Texto Parcial.pdf: 295790 bytes, checksum: 894ee0af17c806ed31db4e4c3ef21479 (MD5) Previous issue date: 2015-03-06 === The advent of crack cocaine has become worrying in the eyes of society and public health. The Science has been interested in the study of the phenomenon and also in the development of treatment approaches. In this sense, it is important to identify and anticipate what would be possible risk situations and how confident they feel users to follow and avoid relapse. This dissertation aims to study the coping skills and self-efficacy for abstinence in crack cocaine users through four studies. The first is entitled "Coping Skills and Self-efficacy in Abstinence Crack cocaine: A Literature Review". This study reviewed the scientific publications of the last five years (2010-2014), indexed in PubMed, PsycInfo, Lilacs, Proquest and Web of Science. The descriptors were coping skills, self-efficacy, abstinence, relapse prevention, drug abuse and crack cocaine. The descriptors in the English language were surveyed coping skills, self-efficacy, abstinence, relapse prevention, drug abuse and crack cocaine. Few were found specific articles to crack cocaine: parenting styles and the influence on coping skills, craving and crack cocaine and coping resources in women. It was concluded that the time of abstinence, coupled with appropriate approaches and self-efficacy can help in the positive treatment outcome. The crack cocaine, with its own characteristics, leads to many losses, but the cognitive improvement is possible, given the time of abstinence. Studies on coping skills and self-efficacy are relevant in the crack cocaine of the abstinence of context, but still incipient. The second study, "Coping and Self-efficacy Skills for Abstinence in Dependent Crack Cocaine", evaluated the coping skills and self-efficacy in the context of the crack cocaine abstinence in 189 subjects. This is a quantitative, descriptive and correlational with cross-sectional design. The sample consists of women: 44.4% (n = 84) and men: 55.6% (n = 105), aged 19 to 59 years and up to 5 years of formal schooling. Chi-square tests of Pearson and Fisher exact tests were used, the Student t and Mann Whitney test for variables with asymmetric distribution and analysis of variance (Two way) - Post Hoc Sheffe. The level of significance is 5%. The average age is 31.7 years, 58.3% (n = 109) has primary and economic classification for Brazil demonstrated Criterion is the class "C" (49.02%). The resulting mean Mini-Mental State Examination (MMSE) is higher in males (26.8 ? 2.6). In Factor 6 (Escape and Evade) the Coping Strategies Inventory occurred in females, significant correlation with Factor 2 (Feeling Expression) of Anticipatory Coping Inventory for Abstinence (IDHEA) (r = -0.250; p = 0.022). There are significant and positive correlations, especially among the factors 1 and 2 of IDHEA (Assertiveness and Feeling Expression) with all the factors of Self-efficacy Scale for Abstinence (EAAD) including your total score. Among the coping strategies and self-efficacy for abstinence EAAD in women, no significant correlations, and in men there is a positive correlation between self-efficacy factor for EAAD abstinence and the factors of coping strategies (Self and Resolution problems). It was found that women are more vulnerable to the use of crack cocaine and use more the Coping Strategies. More confident men are more self-controlled and have greater availability to solve problems. There are few studies that correlate the constructs presented in this study. The third study, titled "Relationship between Coping and the Abstinence Time Dependent on Crack Cocaine", correlated the Coping Strategies and the time of abstinence in men and women with severe disorder in crack cocaine use in treatment. This is a quantitative, descriptive and correlational with cross-sectional design and the sample consisted of 189 subjects: 84 women (44.4%) and 105 men (55.6%). Participants aged 19 to 59 have at least 5 years of formal study. The average age of age of 31.7 (? 8.8) years, have low school level and family income between 1 and 2 minimum wages (68.8%). The comparison of categorical variables in both groups occurred by chi-square tests of Pearson and Fisher exact. The significance level of 5% was adopted. The withdrawal period of 60 days was observed in 64.0% (n = 121). In assessing the Coping Strategies average higher in females, were Factor 1 (Head) (Men: 1.4 ? 0.6 vs. Women: 1.6 ? 0.6; p = 0.05); Factor 4 (Social Support) (Men: 1.6 ? 0.7 vs. Female: 2.0 ? 0.7; p = 0.001); Factor 6 (Escape and Evade) (Men: 1.5 ? 0.7 vs. Women: 1.8 ? 0.7; p = 0.014); Factor 5 (Liability of Acceptance) (Men: 1.9 ? 0.7 vs. Women: 2.1 ? 0.6; p = 0.011); and Factor 8 (positive reappraisal) (Men: 1.6 ? 0.6 vs. Women: 2.0 ? 0.7; p <0.001). Strategies for Coping correlated to the time of abstinence and sex, had a single significant effect on Factor 5 (Liability of Acceptance) for interaction between sex and abstinence time (F1, 189 = 5.318, p = 0.022, power = 0.631 ). There was borderline significance in Factors 3 (Self) (F1, 189 = 4.064, p = 0.072, power = 0.631) and 4 (Social Support) (F1, 189 = 4.031, p = 0.072, power = 0.615). Was no effect for sex factor evidenced for Factors 1 (Head) (F1, 184 = 8.357, p = 0.004, power = 0.820); 3 (Self) (F1, 184 = 4.450, p = 0.036, power = 0.555); 4 Social Support (F1, 189 = 5.574, p = 0.001, power = 0.931); 6 (Escape and Evade) (F1, 184 =; p = 0.011, power = 0.724); and 8 (positive reappraisal) (F1, 184 = 5.611, p <0.001, power = 0.953). Women have higher scores on Coping, regardless of the length of abstinence. Women with up to 60 days of abstinence have higher Acceptance of Responsibility (Factor 5 / Coping), and over 60 days decreased the Self (Factor 3 / Coping). Men over 60 days of abstinence increased social support (Factor 4 / Coping) in the group with less than 60 days. Differences in Coping strategies found between men and women in each withdrawal time range were not representative in this study. The fourth and final study, "Coping Skills, Self-efficacy and Crack Cocaine the Abstinence Time for Women", aimed to outline a dependent crack cocaine profile in women admitted in Therapeutic Communities, correlated variables Anticipatory Coping, Self-efficacy, Coping Strategies and abstinence time. This is a quantitative, descriptive and correlational with cross-sectional design. The sample is composed of 84 women. The distribution normality was verified using the Kolmogorov-Smirnov test with Lillifors correction, the relationship of linearity between the instruments was estimated using Pearson correlation coefficient and the comparative analysis by Student's t test. Statistical decision criteria we adopted the significance level of 5%. The results were 31.6 (? 9.1) years as the average age and low education in 57.1% (n = 48). Until intern, 40.5% (n = 34) of participants worked and 48.9% (n = 41) were classified as class "C" by Criterion Brazil. The 60 days of abstinence period was 62.9% (n = 66) and mean number of days without the use of drugs is 181.6 (? 294.7) days. Regarding the use of other substances, there was the association of crack cocaine to other drugs (alcohol 23.8%, 17.9% marijuana, cocaine 44.0% The weighted average of the results found in the cognitive screening by Intelligence Scale. Wechsler Adult (WAIS) were. cubes 11.4 (? 3.0); Codes 9.1 (? 2.4) and Digits 11.4 (? 3.3) the average score in the Mini State Examination mental (MMSE) is 25.8 in the evaluation of self-efficacy (EAAD), the highest average score occurred in Factor 3 (trust not use crack cocaine front of concerns: 3.6 ? 1.1). And the lowest in Factor 2 (trust not use crack cocaine to see others using: 3.2 ? 1.3). In assessing the anticipatory coping strategies to abstinence from crack cocaine (IDHEA), the highest scores are the factors 1 (Assertiveness and planning for high-risk situations: 2.3 ? 0.8) and 2 (positive sense of expression for abstinence maintenance: 2.3 ? 0.6), and the lowest mean score was the factor 3 (emotional Self-Control in situations adverse: 2.0 ? 0.8). The mean scores in coping strategies ranged between 1.6 and 2.1 points, and the established maximum score is 3 points. The maximum occur in the Acceptance of Responsibility (Factor 5 / Coping) (2.1 ? 0.6), the Social Support (Factor 4 / Coping) (2.0 ? 0.7) and positive reappraisal (Factor 8 / Coping) (2.0 ? 0.7). The minimum scores occur in the Head (Factor 1 / Coping) (1.6 ? 0.6) and Self (Factor 3 / Coping) (1.6 ? 0.6). Regarding the correlation of the instruments Coping strategies and anticipatory coping (IDHEA), it was found that Factor 1 IDHEA (Assertiveness and planning for high-risk situations) estimated significant correlations, positive of low degree with the strategies Coping Social Support (Factor 4 / Coping) (r = 0.221; p = 0.043), Responsibility Acceptance (Factor 5 / Coping) (r = 0.258; p = 0.018), Resolution Problems (Factor 7 / Coping) (r = 0.269, p = 0.013) and positive reappraisal (Factor 8 / Coping) (r = 0.291; p = 0.007); pointing out that high scores on Factor 1 IDHEA (Assertiveness and planning for high-risk situations) show up also correlated with high scores on factors of coping strategies. The most significant correlations between coping and anticipatory coping strategies are in emotional self in adverse situations (Factor 3 / IDHEA) and Social Support (Factor 4 / Coping) (r = -0.294; p = 0.007), Responsibility Acceptance (Factor 5 / Coping) (r = -0.232; p = 0.034), Problem Resolution (Factor 7 / Coping) (r = -0.311; p = 0.004), and positive reappraisal (Factor 8 / Coping) (r = -0.375; p <0.001). The Coping strategies and self-efficacy for abstinence vary independently in females. The average in Factor 2 Coping (Pitch) (1.6 ? 0.6) of participants up to 60 days of abstinence was higher (p = 0.026). There was borderline significance (0.05 <p <0.10) in Factor 5 / Coping (Liability of Acceptance) (p = 0.056) suggesting that the group average up to 60 days of abstinence (2.3 ? 0.6) may be showing higher compared to the group over 60 days of abstinence (2.0 ? 0.7). We conclude that self-efficacy is associated with proactive coping strategies, and see other people using drugs are considered the most critical factor. Women with emotional control can reframe experiences and seek social support. It is considered the need for further research into anticipatory coping skills and self-efficacy in women who use crack cocaine. This work may stimulate further studies on coping skills and self-efficacy in the crack cocaine of context. === O advento do crack tornou-se preocupante aos olhos da sociedade e da sa?de p?blica. A ci?ncia tem se interessado no estudo do fen?meno e tamb?m no desenvolvimento de abordagens de tratamento. Nesse sentido, torna-se relevante identificar e antecipar o que seriam poss?veis situa??es de risco e o qu?o confiantes sentem-se os usu?rios para seguir e evitar a reca?da. Esta disserta??o objetiva estudar as habilidades de enfrentamento e a autoefic?cia para a abstin?ncia em usu?rios de crack atrav?s de quatro estudos. O primeiro tem o t?tulo de ?Habilidades de Enfrentamento e Autoefic?cia na Abstin?ncia do Crack: uma Revis?o Bibliogr?fica?. Neste estudo foram revisadas as publica??es cient?ficas dos ?ltimos cinco anos (2010-2014), indexados nas bases de dados PubMed, PsycInfo, Lilacs, Proquest e Web of Science. Os descritores foram habilidades de enfrentamento, autoefic?cia, abstin?ncia, preven??o ? reca?da, abuso de drogas e crack. Foram pesquisados os descritores em l?ngua inglesa coping skills, self-efficacy, abstinence, relapse prevention, drug abuse and crack cocaine. Foram encontrados poucos artigos espec?ficos ao crack: estilos parentais e a influ?ncia nas habilidades de enfrentamento, craving e crack e recursos de enfrentamento em mulheres. Concluiu-se que o tempo de abstin?ncia, associado com abordagens adequadas e a autoefic?cia podem ajudar no desfecho do tratamento. O crack, com suas caracter?sticas pr?prias, causa diversos preju?zos, por?m a melhora cognitiva ? poss?vel levando-se em conta o tempo de abstin?ncia. Estudos sobre habilidades de enfrentamento e autoefic?cia s?o relevantes no contexto da abstin?ncia do crack, por?m ainda incipientes. O segundo estudo, ?Habilidades de Enfrentamento e Autoefic?cia para a Abstin?ncia em Dependentes de Crack?, avaliou as habilidades de enfrentamento e a autoefic?cia no contexto da abstin?ncia do crack em 189 sujeitos. Trata-se de um estudo quantitativo, descritivo e correlacional com delineamento transversal. A amostra ? constitu?da de mulheres: 44,4% (n=84) e homens: 55,6% (n=105), com idades entre 19 e 59 anos e com at? 5 anos de escolaridade formal. Foram utilizados os testes Qui-Quadrado de Pearson e Exato de Fisher, o t-Student e de Mann Whitney para as vari?veis com distribui??o assim?tricas e a an?lise de vari?ncia (Two way) ? Pos Hoc Sheffe. O n?vel de signific?ncia ? de 5%. A m?dia de idade ? 31,7 anos, 58,3% (n=109) tem ensino fundamental e a classifica??o econ?mica pelo Crit?rio Brasil demonstrada ? a classe ?C? (49,02%). A m?dia resultante do Mini Exame do Estado Mental (MEEM) ? mais elevada no sexo masculino (26,8?2,6). No Fator 6 (Fuga e Esquiva) do Invent?rio de Estrat?gias de Coping ocorreu, no sexo feminino, correla??o significativa com o Fator 2 (Express?o de Sentimento) do Invent?rio de Enfrentamento Antecipat?rio para a Abstin?ncia (IDHEAA) (r=-0,250; p=0,022). H? correla??es significativas e positivas, principalmente entre os Fatores 1 e 2 do IDHEAA (Assertividade e Express?o de Sentimento) com todos os fatores da Escala de Autoefic?cia para a Abstin?ncia (EAAD) incluindo seu escore total. Entre as estrat?gias de Coping e a autoefic?cia para a abstin?ncia (EAAD), no sexo feminino, n?o h? correla??es significativas, sendo que nos homens h? correla??o positiva entre os fatores da autoefic?cia para a abstin?ncia (EAAD) e os fatores das estrat?gias de Coping (Autocontrole e Resolu??o de Problemas). Conclui-se que as mulheres s?o mais vulner?veis ao uso de crack e usam mais as estrat?gias de Coping. Homens mais confiantes s?o mais autocontrolados e tem maior disponibilidade de resolver problemas. Faltam estudos que correlacionem os construtos apresentados neste estudo. O terceiro estudo, intitulado como ?Rela??o entre Coping e o Tempo de Abstin?ncia em Dependentes de Crack?, correlacionou as estrat?gias de Coping e o tempo de abstin?ncia em homens e mulheres com transtorno grave pelo uso de crack, em tratamento. Trata-se de um estudo quantitativo, descritivo e correlacional, com delineamento transversal e a amostra foi composta por 189 sujeitos: 84 mulheres (44,4%) e 105 homens (55,6%). Os participantes com idades entre 19 a 59 anos apresentam, no m?nimo, 5 anos de estudo formal. A idade m?dia de idade ? de 31,7 (?8,8) anos, apresentam n?vel escolar baixo e renda familiar entre 1 e 2 sal?rios m?nimos (68,8%). A compara??o entre vari?veis categ?ricas nos dois grupos ocorreu pelos testes Qui-quadrado de Pearson e Exato de Fisher. Adotou-se o n?vel de signific?ncia de 5%. O tempo de abstin?ncia de at? 60 dias foi observado em 64,0% (n=121). Na avalia??o das estrat?gias de Coping as m?dias mais elevadas, no sexo feminino, foram Fator 1 (Confronto) (Masculino: 1,4?0,6 vs. Feminino: 1,6?0,6; p=0,05); Fator 4 (Suporte Social) (Masculino: 1,6?0,7 vs. Feminino: 2,0?0,7; p=0,001); Fator 6 (Fuga e Esquiva) (Masculino: 1,5?0,7 vs. Feminino: 1,8?0,7; p=0,014); Fator 5 (Aceita??o de Responsabilidade) (Masculino: 1,9?0,7 vs. Feminino: 2,1?0,6; p=0,011); e Fator 8 (Reavalia??o Positiva) (Masculino: 1,6?0,6 vs. Feminino: 2,0?0,7; p<0,001). As estrat?gias de Coping, correlacionadas ao tempo de abstin?ncia e ao sexo, teve um ?nico efeito significativo no Fator 5 (Aceita??o de Responsabilidade) para a intera??o entre sexo e tempo de abstin?ncia (F1, 189 = 5,318; p=0,022; poder=0,631). Houve signific?ncia lim?trofe nos Fatores 3 (Autocontrole) (F1, 189 = 4,064; p=0,072; poder=0,631) e 4 (Suporte Social) (F1, 189 = 4,031; p=0,072; poder=0,615). Houve efeito para o fator sexo evidenciado para os Fatores 1 (Confronto) (F1, 184 =8,357; p=0,004; poder=0,820); 3 (Autocontrole) (F1, 184 =4,450; p=0,036; poder=0,555); 4 Suporte Social (F1, 189 =5,574; p=0,001; poder=0,931); 6 (Fuga e Esquiva) (F1, 184 =; p=0,011; poder=0,724); e 8 (Reavalia??o Positiva) (F1, 184 =5,611; p<0,001; poder=0,953). Mulheres t?m escores mais elevados no Coping, independente do tempo de abstin?ncia. Mulheres com at? 60 dias de abstin?ncia apresentam maior Aceita??o de Responsabilidade (Fator 5/Coping) e, com mais de 60 dias, diminu?ram o Autocontrole (Fator 3/Coping). Homens com mais de 60 dias de abstin?ncia aumentaram o Suporte Social (Fator 4/Coping) em rela??o ao grupo com menos de 60 dias. Diferen?as nas estrat?gias de Coping detectadas entre homens e mulheres em cada faixa de tempo de abstin?ncia n?o se mostraram representativas neste estudo. O quarto e ?ltimo estudo, ?Habilidades de Enfrentamento, Autoefic?cia e Tempo de Abstin?ncia do Crack em Mulheres?, objetivou tra?ar um perfil de mulheres dependentes de crack internadas em Comunidades Terap?uticas, sendo correlacionados vari?veis como Enfrentamento Antecipat?rio, Autoefic?cia, Estrat?gias de Coping e o tempo de abstin?ncia. Trata-se de um estudo quantitativo, descritivo e correlacional, com delineamento transversal. A amostra est? constitu?da de 84 mulheres. A distribui??o de normalidade foi verificada pelo teste de Kolmogorov-Smirnov com corre??o de Lillifors, a rela??o de linearidade entre os instrumentos foi estimada atrav?s do coeficiente de correla??o de Pearson e a an?lise comparativa pelo teste t-Student. Para crit?rios de decis?o estat?stica adotou-se o n?vel de signific?ncia de 5%. Os resultados encontrados foram 31,6 (?9,1) anos como a m?dia de idade e escolaridade baixa em 57,1% (n=48). At? internarem, 40,5% (n=34) das participantes trabalhavam e 48,9% (n=41) foram classificadas como classe ?C? pelo Crit?rio Brasil. O tempo de abstin?ncia de at? 60 dias ocorreu em 62,9% (n=66) e a m?dia de dias sem o uso de drogas ? de 181,6 (?294,7) dias. Quanto ao uso de outras subst?ncias, observou-se a associa??o do crack a outras drogas (?lcool 23,8%; maconha 17,9%; coca?na 44,0%. Os resultados ponderados das m?dias encontradas no screening cognitivo atrav?s da Escala de Intelig?ncia Wechsler para Adultos (WAIS) foram: Cubos 11,4 (?3,0); C?digos 9,1 (?2,4) e D?gitos 11,4 (?3,3). O escore m?dio apresentado no Mini Exame do Estado Mental (MEEM) ? de 25,8. Na avalia??o da autoefic?cia (EAAD), a pontua??o m?dia mais elevada ocorreu no Fator 3 (Confian?a em n?o usar crack frente a preocupa??es: 3,6?1,1) e a menor no Fator 2 (Confian?a em n?o usar crack ao ver outras pessoas usando: 3,2?1,3). Na avalia??o das estrat?gias de enfrentamento antecipat?rias para a abstin?ncia do crack (IDHEAA), as pontua??es mais elevadas est?o nos Fatores 1 (Assertividade e planejamento para situa??es de alto risco: 2,3?0,8) e 2 (Express?o de sentimento positivo para manuten??o da abstin?ncia: 2,3?0,6), sendo que o menor escore m?dio foi no fator 3 (Autocontrole emocional em situa??es adversas: 2,0?0,8). As pontua??es m?dias nas estrat?gias de Coping oscilaram entre 1,6 e 2,1 pontos, sendo que a pontua??o m?xima estabelecida ? de 3 pontos. As m?ximas ocorrem na Aceita??o de Responsabilidade (Fator 5/Coping) (2,1?0,6), no Suporte Social (Fator 4/Coping) (2,0?0,7) e na Reavalia??o Positiva (Fator 8/Coping) (2,0?0,7). As m?nimas pontua??es ocorrem no Confronto (Fator 1/Coping) (1,6?0,6) e no Autocontrole (Fator 3/Coping) (1,6?0,6). Em rela??o ? correla??o dos instrumentos estrat?gias de Coping e enfrentamento antecipat?rio (IDHEAA), verificou-se que o Fator 1 do IDHEAA (Assertividade e planejamento para situa??es de alto risco) estimou correla??es significativas, positivas de grau fraco com as estrat?gias de Coping Suporte Social (Fator 4/Coping) (r=0,221; p=0,043), Aceita??o de Responsabilidade (Fator 5/Coping) (r=0,258; p=0,018), Resolu??o Problemas (Fator 7/Coping) (r=0,269; p=0,013) e Reavalia??o Positiva (Fator 8/Coping) (r=0,291; p=0,007); apontando que pontua??es elevadas no Fator 1 IDHEAA (Assertividade e planejamento para situa??es de alto risco) mostram-se correlacionadas a pontua??es tamb?m elevadas nos fatores das estrat?gias de Coping. As correla??es mais expressivas entre estrat?gias de Coping e enfrentamento antecipat?rio est?o no autocontrole emocional em situa??es adversas (Fator 3/IDHEAA) e no Suporte Social (Fator 4/Coping) (r=-0,294; p=0,007), Aceita??o de Responsabilidade (Fator 5/Coping) (r=-0,232; p=0,034), Resolu??o Problemas (Fator 7/Coping) (r=-0,311; p=0,004), e Reavalia??o Positiva (Fator 8/Coping) (r=-0,375; p<0,001). As estrat?gias de Coping e a autoefic?cia para a abstin?ncia variam de forma independente no sexo feminino. A m?dia no Fator 2 do Coping (Afastamento) (1,6?0,6) dos participantes com at? 60 dias de abstin?ncia foi mais alta (p=0,026). Houve signific?ncia lim?trofe (0,05<p<0,10) no Fator 5/Coping (Aceita??o de Responsabilidade) (p=0,056) sugerindo que a m?dia do grupo com at? 60 dias de abstin?ncia (2,3?0,6) pode estar se mostrando mais elevada, quando comparada ao grupo com mais de 60 dias de abstin?ncia (2,0?0,7). Conclui-se que a autoefic?cia est? associada ?s estrat?gias de enfrentamento antecipat?rias, sendo que ver outras pessoas usando drogas ? considerado o fator mais cr?tico. Mulheres com controle emocional conseguem resignificar viv?ncias e buscar apoio social. Considera-se a necessidade de novos estudos sobre habilidades de enfrentamento antecipat?rio e da autoefic?cia em mulheres usu?rias de crack. Esta disserta??o poder? estimular novos estudos sobre habilidades de enfrentamento e autoefic?cia no contexto do crack.