Research paper
Characteristics of clients using a community-based drug treatment service (‘CAPS-AD’) in Brazil: An exploratory study

https://doi.org/10.1016/j.drugpo.2016.01.020Get rights and content

Highlights

  • ‘CAPS-AD’ is a novel vehicle of community-based treatment for alcohol and drugs in Brazil.

  • We assessed a ‘snapshot sample’ of CAPS-AD clients in Brasilia (capital of Brazil).

  • Most clients were male, middle-aged, unemployed, with alcohol or crack-cocaine problems.

  • Half engaged in their first-ever treatment episode, suggesting effective reach by the CAPS-AD.

  • Concerns about care structures, logistics and staff attitudes may compromise client retention.

Abstract

Background

Substance use is common in Brazil. In order to improve availability of substance misuse care services, over 400 Psycho-Social Care Centres for Alcohol and Drugs (CAPS-AD) – providing community-based care – have been established following mental health care reform (2001). Information on CAPS-AD clients and outcomes is limited. The present study examined select characteristics of local CAPS-AD clients.

Methods

N = 143 adult CAPS-AD clients in Ceilândia (suburb of Brasília, Federal District) participated in a 1-week ‘snapshot’ assessment of service users (February 2015). Following consent, descriptive data were collected by a brief, anonymous interviewer-administered questionnaire that included socio-demographic, drug use, treatment history and needs/barriers information.

Results

Participants were predominantly male; middle-aged; unemployed; married; with middle-school education; primary problem drugs indicated were alcohol and cocaine/crack; half had prior treatment histories and indicated that treatment was externally motivated; 60% reported ways to improve treatment and possible reasons for treatment discontinuation; in multi-variate analyses, the latter was associated with employment and education status (both p < .05).

Conclusion

CAPS-AD services appear to have increased low-barrier substance misuse treatment availability in Brazil, as well as attract individuals new to the treatment system. Various potential barriers to continuing in treatment should be addressed and more research on CAPS-AD clients and outcomes is needed.

Introduction

The use of psychoactive substances is common in Brazil. The most commonly used substances (e.g., past year) in the general adult population include: alcohol (50%), tobacco (17–19%), cannabis (2–3%), cocaine/crack (1–2%), other stimulants (<1%) and prescription sedative (non-medical) use (2–6%) (Braga et al., 2005, Inter-American Drug Abuse Control Commission, 2011, Laranjeira et al., 2014). Substance use – similar to other jurisdictions – is common and frequently elevated among adolescent/young adult (e.g., student) populations (Andrade et al., 2010, Carlini et al., 2010). The prevalence of problematic use or use disorders are concerns only among subsets of users, for example for alcohol: 10–12%; tobacco: 10–17%; cannabis: 1.2%; cocaine/crack: 1%; prescription sedatives/stimulants: <0.5% (Bastos and Bertoni, 2013, Galduroz et al., 2005, Laranjeira et al., 2014).

The landscape of interventions and treatment services for substance misuse in Brazil includes a variety of components. Recently, these profiles have shifted in the context of policy reforms. Importantly, national mental health/substance use system reform efforts in Brazil (initiated federally in 2001) aimed for improved, more patient/need-oriented and accessible services within a context of marked socio-economic inequalities in the population, and major gaps in fiscal and professional care resources (Andreoli, Mello, Mello, & Kohn, 2007). These reforms have resulted in substantive decreases in the number of psychiatric (long-term) inpatient hospital beds (51,393 in 2002 to 32,681 in 2011) mostly replaced by (short-term) detoxification beds in general hospitals. Moreover, the government implemented 129 ‘Street Level Care’ programs (Consultório na Rua) as low-threshold primary health services primarily for homeless people with substance use/mental health issues; 58 community-based Harm Reduction Training Programs (Escolas de Redução de Danos) to promote health interventions with street drug users; and funded 7541 beds in 336 residential therapeutic community programs (Andreoli et al., 2007, Ribeiro et al., 2014).

Additionally, a novel landmark intervention – ‘Psycho-Social Care Centres’ (CAPS – Centro de Atenção Psicossocial) was implemented (Andreoli et al., 2007, Barros and Salles, 2011, Mateus et al., 2008). The principal objective of CAPS has been to implement community-based care services for mental health and substance misuse while facilitating de-institutionalization from psychiatric hospitals. CAPS services are free – i.e., covered by universal public health care in Brazil – and offer a continuum-of-care, delivered by multi-disciplinary professional teams focusing primarily on psycho-social and patient needs-oriented interventions within wider social/health service networks (Mateus et al., 2008). Since their introduction, the number of CAPS programs for mental health/substance misuse care across Brazil has increased from 295 (2001) to 2328 (2015); of these, 403 are “CAPS-AD” – i.e., specialized services for alcohol/drug problems specifically (Ministério da Saúde, 2015, Ribeiro et al., 2014). Despite these system reforms, major gaps in availability and access to substance misuse care/services persist in Brazil, particularly for marginalized substance users (Cruz et al., 2013, Gigliotti et al., 2014, Madruga et al., 2015).

Select studies focusing on CAPS-based treatment users and outcomes exist, however they primarily focus on mental health aspects (Mateus et al., 2008), including: service user profiles, challenges of treatment retention for complex (e.g. co-morbid) patients, medication adherence and therapeutic plan aspects (Braga et al., 2005, Souza et al., 2011). Limited studies, which have assessed CAPS-AD specifically, have highlighted: low treatment adherence of crack-cocaine users compared to other drug users (Schein & Prati, 2013); better treatment engagement by self-motivated clients, older patients and those with longer substance use histories (Monteiro et al., 2011, Peixoto et al., 2010); and lower likelihood of treatment seeking and treatment continuity by younger users (Vasters & Pillon, 2011). Major knowledge gaps remain regarding CAPS-AD service users’ characteristics as well as treatment courses and outcomes.

Section snippets

Methods

The present study sought to describe select key characteristics in the client population of a local CAPS-AD service in Brazil in order to better understand the CAPS-AD population and generate evidence for improved services and outcomes. The study focused on the following central features of CAPS-AD clients: (1) socio-demographics; (2) drug use; (3) treatment history and motivation; (4) potential treatment barriers/reasons for discontinuation; and (5) possible treatment improvements.

Results

(See Table 1) The majority of participants were male, middle-aged (30–49 years), married, and had a middle school education; about half were employed.

Alcohol or cocaine/crack were indicated as the primary drugs of use by the vast majority of the sample. CAPS-AD was the first drug treatment intervention for about half of the participants while the remainder had received prior treatment care in a variety (including residential/hospital, primary care, self-help) of settings. Approximately three

Discussion

The present study provided valuable insights on key characteristics of a ‘snapshot sample’ of users of CAPS-AD in Brasilia. First, the sample was primarily male, middle-aged, unemployed and with limited education; the principal drugs of use influencing treatment-seeking were alcohol and crack/cocaine. This profile of characteristics is similar to observations from other studies of CAPS client populations, including a predominance of middle-age, low-educated males (Moreira, Fernandes, Ribeiro, &

Acknowledgements

The authors acknowledge the CAPS-AD (Ceilandia) staff team and clients who facilitated and supported the execution of this study, as well as the undergraduate student interviewers from the Faculty of Ceilândia, University of Brasilia, who performed the data collection for the present study. Resource support making the present study possible came from the Center of Drugs and Associated Vulnerabilities, Faculty of Ceilândia, University of Brasilia, and the Open Society Foundation.
Conflict of

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