A b s t r a c t Objective: The study accompanied 131 crack-cocaine users over a 5-year period, and examined mortality patterns, as well as the causes of death among them. Method: All patients admitted to a detoxification unit in Sao Paulo between 1992 and 1994 were interviewed during two follow-up periods: 1995-1996 and 1998-1999. Results: After 5 years, 124 patients were localized (95%). By the study endpoint (1999), 23 patients (17.6%) had died. Homicide was the most prevalent cause of death (n = 13). Almost one third of the deaths were due to the HIV infection, especially among those with a history of intravenous drug use. Less than 10% died from overdose. Conclusions: The study suggests that the mortality risk among crack cocaine users is greater than that seen in the general population, being homicide and AIDS the most common causes of death among such individuals.Keywords: Crack cocaine; Longitudinal studies; Mortality rate; Cause of death; Substance related disorders Resumo Objetivo: O estudo acompanhou, por cinco anos, um grupo de 131 usuários de crack e observou os padrões de mortalidade, bem como as causas mortis entre esses. Método: Todos os pacientes que se internaram em um serviço de desintoxicação, localizado no município de São Paulo, entre 1992-1994 foram entrevistados em duas ocasiões: 1995-1996 e 1998-1999. Resultados: Após cinco anos, 124 pacientes foram localizados (95%). Vinte e três pacientes (17,6%) haviam morrido ao final do quinto ano de seguimento, sendo os homicídios a causa mortis mais prevalente (n = 13). Quase um terço dos pacientes morreu devido à infecção pelo vírus da imunodeficiência adquirida (HIV), especialmente aqueles com antecedentes pessoais de uso de drogas endovenosas. Menos de 10% dos pacientes morreu de overdose. Conclusões: O estudo sugere que os usuários de crack têm maior risco de morte do que a população geral, sendo os homicídios e a AIDS as causas mais observadas.Descritores: Cocaína crack; Estudos longitudinais; Coeficiente de mortalidade; Causa da morte; Transtornos relacionados ao uso de substâncias

No abstract

OBJECTIVE:To analyze the evolution of drug use among treated crack cocaine users. METHODS:A cohort originally comprising 131 crack addicts admitted to a detoxifi cation unit in the city of São Paulo, Southeastern Brazil, between 1992 and 1994 were followed up on three occasions: 1995-96, 1998-99, and 2005-06. Variables investigated included demographical data, risky sexual behaviors, intake patterns for crack and other substances, incarceration, disappearance, and death. Statistical analysis was carried out using chi-square tests, multinomial logistic regression and Cox regression. RESULTS:Among the patients evaluated, 43 were crack-free (12 months or longer), 22 were users, 13 were imprisoned, two were missing, and 27 were deceased. Three groups with distinct post-discharge drug use patterns were identifi ed. Safe sexual behavior (condom use) was correlated with stable abstinence (p=0.001). Positive HIV test upon admission (p=0.046), use of snorted cocaine in the last year (p=0.001), and lifetime use of snorted cocaine (132 months or longer) (p=0.000) were associated with long term use of crack cocaine. History of intravenous cocaine use increased the probability of death at 12 years by 2.5 fold (p=0.031) (95%CI: 1.08; 5.79). CONCLUSIONS:Recurrence and persistence of crack use in the years following discharge refl ect new modalities of drug use. On the other hand, stable abstinence patterns provide evidence of the feasibility of recovery from crack addiction.

The purpose of this study was to follow-up 131 crack users and examine drug use, treatment experience, employment status, and mortality at 2, 5, and 12 years. Consecutive crack dependent patients were re-interviewed in 1995-1996, 1998-1999, and 2005-2006. Of those subjects not using cocaine at 2 years, 19 (63%) were still abstinent at 5 years. Almost half of the users were abstinent at the same period. The abstinent group was still the most prevalent at 12 years. Twenty-seven (20.6%) patients had died by the 12-year follow-up, with homicide being the most common cause (n = 16). After 2000, however, it declined sharply with only 2 deaths in 7 years. There was a progressive movement toward abstinence over the follow-up period, with the evidence that once abstinence had been achieved it was maintained. On the other hand, the mortality rate was extremely high and probably more related with socioeconomic factors instead of the drug use itself.

RESUMO. Trata-se de um trabalho de atendimento a crianças e adolescentes com queixas escolares, como, por exemplo, baixo rendimento e indisciplina em sala de aula. Parte-se da crítica à abordagem da Psicologia clínica tradicional, que exclui a escola da produção de tais queixas. Através de um processo breve e focal, que busca trabalhar com todos os envolvidos na rede de relações em que essas queixas se engendram, têm-se movimentado situações cristalizadas, despatologizado diversas crianças e famílias e evitado longos tratamentos psicoterápicos desnecessários.Palavras-chaves: fracasso escolar, saúde mental, psicologia escolar. AN APPROACH TO SCHOOL PROBLEMSABSTRACT. This work is concerned with children and adolescents with school problems such as poor academic performance or classroom misbehavior. It begins with a critique of the traditional psychological approach, which ignores the school's contribution to such problems. We propose instead a brief solution-focused intervention that includes everyone involved in the network of relationships in which the difficulties are embedded. Thus, we have been able to re-conceptualize the issues, to "de-pathologize" students and family members, and to avoid long and unnecessary psychotherapeutic treatments.