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Preventing relapse in recovery from cocaine use disorder

Publicado em 17 maio 2019

Por Karina Toledo, da Agência FAPESP

Brazilian researchers combined cognitive dysfunction tests with an analysis of drug use patterns to identify patients at high risk of relapse after treatment 

A study conducted at the University of São Paulo (USP) in Brazil and described in an article published in the journal Drug and Alcohol Dependence may help healthcare workers identify patients who risk relapse after undergoing treatment for cocaine use disorder.

According to the authors, the findings reinforce the need to offer individualized treatment strategies for these cases, which are considered severe.

The principal investigator for the study was Paulo Jannuzzi Cunha, a professor at the University of São Paulo’s Medical School (FM-USP), with a postdoctoral research scholarship from São Paulo Research Foundation-FAPESP and support from the National Council for Scientific and Technological Development (CNPq).

For 30 days, the researchers monitored 68 patients admitted for treatment for cocaine dependence to the Psychiatry Institute of Hospital das Clínicas, FM-USP’s general and teaching hospital in São Paulo. All patients volunteered to participate in the study. They were contacted three months after discharge to verify their abstinence. All but 14 reported a relapse, defined as at least one episode of cocaine use during the period.

One of the goals of the study was to determine whether the 11 criteria for diagnosing chemical dependence established in the DSM-5 were also effective at predicting the response to treatment. DSM-5 is the latest edition of the Diagnostic and Statistical Manual of Mental Disorders, published by the American Psychiatric Association (APA) and considered the standard classification by mental health professionals in many parts of the world.

“Our hypothesis was that these criteria would not accurately predict relapse. However, after completing the study, we recognized that they may, in fact, be useful for predicting vulnerability to relapse,” Cunha told.

The DSM-5 criteria for diagnosing a substance use disorder include taking the drug in larger amounts and/or for longer periods than intended; craving, or a strong desire to use the drug; giving up social, occupational or recreational activities because of substance use; continued use despite having persistent social or interpersonal problems caused or exacerbated by the effects of the drug; tolerance (needing increasing amounts to achieve the desired effect); and withdrawal symptoms, among others.

According to the DSM-5 guidelines, a substance use disorder can be considered mild if two or three of the 11 criteria are met for a year, moderate if four or five are met for a year, or severe if six or more are met for a year.

“Our sample included only cases classified as severe. We observed a clear difference between patients who met six to eight criteria and those who met nine to 11. The relapse rate was significantly higher in the latter group,” said Danielle Ruiz Lima, first author of the article.

The results suggested that the three categories recommended by DSM-5 should be reviewed. “There seems to be an ‘ultra-severe’ group as …read more

Source:: Daily times