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�:Intervention for patients with psychoactive substance use disorders, starting from psychiatric emergency care: follow-up study after 30 and 90 days

Authors: Vitoria Mantoan PadilhaI,  Renata Cruz Soares de AzevedoII
Faculty of Medical Sciences (FCM) of the State University of Campinas (UNICAMP), Campinas, S�o Paulo, Brazil
Department of Medical Psychology - Faculty of Medical Sciences - State University of Campinas - UNICAMP - 13088-970, Campinas, S�o Paulo, Brazil

I - Psychiatrist, Department of Medical Psychology and Psychiatry, Faculty of Medical Sciences, State University of Campinas, Campinas, S�o Paulo, Brazil
 
II- Psychiatrist, Professor of the Department of Medical Psychology and Psychiatry, Faculty of Medical Sciences, State University of Campinas, Campinas, S�o Paulo, Brazil

Corresponding author: Vitoria Mantoan Padilha
Address: Avenida Professor Vicente Quirino, 405, Jaboticabal/SP
CEP: 14870-020,  Brazil
E-mail address:  HYPERLINK "mailto:vitpadilha@gmail.com" vitpadilha@gmail.com
Phone number: +55 16 3202-2440


Keywords: 
Emergency Psychiatric Services
Emergency Medical Services
Substance-Related Disorders
Follow-up studies



Introduction:

For the majority of the patients addicted to psychoactive substances (PAS), the Emergency Room (ER) is the only provider of medical care (Brubacher et al, 2008). International studies show prevalence of PAS abuse or dependence in approximately 20% of patients seeking the ER (Brubacher et al, 2008, Helmkamp et al, 2003, Hungerford et al, 2000, Hungerford et al, 2003) and 30% among those who are treated in the Psychiatric Emergency Unit (Larkin et al, 2005). The trend continues to increase in emergency admissions due to disorders related to PAS use, especially in relation to illicit substances: from 1995 to 2005 there was  an increase from 0.65% to 3.7% (Cherpitel & Ye, 2008). In 2007,    of all care performed   in the emergency room, 12.5% happened due to PAS use disorders, and 41% of these treatments resulted in hospitalization, rate 2.5 times greater than all other medical conditions (Owens et al , 2010). When seeking the emergency service, patients with PAS use disorders are probably more inclined to accept intervention. Thus, listening to the complaint, empathizing  with the difficulties of the patient and offering alternatives becomes indispensable to help treatment adherence (Claudino & Gon�alves, 2006). In a study conducted by Hungerford  and collaborators (2003), a large numbers of patients interviewed in the ER reported that they would not have been exposed to that information if they had not participated in the survey (43%). In the same study, 80.5% reported that the information about alcohol use were helpful, and 70.2% reported that the ER is a good place for this kind of information. 
Chafetz and collaborators (1962) were the first researchers to demonstrate the effectiveness of brief intervention in the ER, through the elaboration of a program, that approached alcoholic patients in the emergency room, empathetically: 65% of patients that were submitted to the program sought special treatment, compared with 5% in the control group. A systematic review of 37 studies point that brief intervention in the ER caused a reduction of morbidity and mortality in 12 studies (38%) and reduced levels of gamma-glutamyltransferase, lower blood pressure, fetal alcohol syndrome and trauma. It was also observed a reduction in alcohol use in 29 studies (90%) and fewer visits to the ER and hospitalizations in 4 studies (13%) (D'Onofrio & Degutis, 2002). 
However, some barriers have been identified by professionals when screening and counseling patients in the ER: lack of time (Hungerford et al, 2000, Jayaram & Triplett, 2008, Nordqvist et al, 2004, Segatto et al, 2007, Stange et al, 1998, Wallace, 2001), delay in treatment (Jayaram & Triplett, 2008); insufficient academic background of  the health care professionals that work at the ER regarding the approach of the problems caused by substance use (Barros et al, 2010, Havard et al, 2008, Segatto et al, 2007); fear of bothering the patients with a subject concerning PAS (Hungerford et al, 2000, Segatto et al, 2007), absence of the therapeutic relationship and precarious relationship with the team to which the patient will be referred (Barros et al, 2010, Jayaram & Triplett, 2008). 
It is known that the rate of drug abusers adhering to treatment is less than 50% (Carr et al, 2008). Studies have shown the barriers associated with low rates of treatment seeking and adherence of drug addicted patients in treatment (Xu et al, 2006). These barriers can be internal or external (Allen, 1994). Internal barriers include difficulty in recognizing the problem, fear of the reaction of others, stigma and ignorance about the treatment (Allen, 1995). The main external barriers are the delay in treatment, precarious availability of treatment and admission difficulty (Rapp et al, 2006). The delay in admission to treatment is associated with the increase of treatment dropout. Users that delay beginning treatment are more prone to health complications such as overdoses and exposure to sexually transmitted diseases (Carr et al, 2008).
The literature mentions several studies about intervention for patients with alcohol use disorders in the ER, with positive results (Aseltine, 2010, Babor & Higgins-Biddle, 2000, Brown et al, 2007, Daeppen et al, 2007, D'Onofrio & Degutis , 2002, Havard et al, 2008, Hungerford et al, 2000, Leontieva et al, 2009, Longabaugh et al, 2001, Pal et al, 2007, Rockett et al, 2003, Wright et al, 1998), but few studies have been made in this context with patients presenting substance use disorders related to other substances. Moreover, in most studies, the intervention occurs within the emergency room which while it is a suitable place, it also has its own difficulties in implementation, inherent to the ER context. The delay to treat these patients causes considerable aggravation of the condition, and, even considering the difficulties, the high demand of patients with PAS use disorders in the ERs makes these locations the key piece in the detection and early approach. It is necessary to expand the possibilities of offering treatment to people with PAS use disorders at a time when they are particularly receptive - emergency care - to adhere to a treatment for substance abuse/dependence. Considering the difficulties on how to the approach alcohol and other drugs abuse, an intervention model was proposed in which the patient is detected in the emergency care and invited to participate in a short term approach, aimed at facilitating their access and adherence to treatment . The objective of this study is to evaluate the intervention, starting from emergency care, by comparing patients with PAS use disorders who attended with those who did not attend the intervention, regarding the outcomes, reduction of PAS use and treatment seeking in 30 and 90 days, and analyze variables associated with the outcomes.

Materials and Methods

Prospective, descriptive and quantitative study, which detected patients with PAS use disorders treated at the Referenced Emergency Unit (REU) of the Hospital of the University of Campinas (UNICAMP-HC) from May 2010 to May of 2011. These patients received an invitation to participate in the intervention group (IG), which occurred within 7 days after the visit to the REU. A follow-up, evaluating whether there was a reduction in the consumption of PAS and treatment seeking after 30 and 90 days, was made by comparing patients who received and those who did not receive the intervention.

The study was divided into two phases:
Phase 1: description of the patients with disorders related to use of PAS attended at the REU Psychiatry in the period from May 2010 to May 2011;
�Phase 2: longitudinal follow-up of 30 and 90 days of patients with PAS use disorders, where patients who attended the intervention group (IG) with the absentees (NIG) were compared .

Subject
Inclusion criteria:
- Patients older than 18 years old with PAS use disorders of both genders, treated by the REU  Psychiatric Service during the period from May 2010 to May 2011, and who had a telephone number that would allow tracking in 30 and 90 days.
Exclusion criteria:
Patients who did not have any telephone number available to perform the tracking in phase 2.

Local 

Phase 1: The sociodemographic data were collected from medical records of patients attended by the Psychiatric service of the REU of HC-UNICAMP. The REU of HC-UNICAMP provides services of high complexity for the city of Campinas area, covering a population of about 5,000,000 inhabitants. The main objective of the REU is the specialized emergency and urgent care. The referral to the REU is done primarily through telephone contact by the Medical Emergency Rescue Service (SAMU) or the Regulatory Center of the Regional Health Directorate and its municipalities. Spontaneous demand patients are also attended and in this case, the criterion of seriousness is respected in order to determine the order of attendance. Prior to medical treatment, patients undergo a screening performed by the nursing teams, in which the patients with serious cases have priority in attendance. Only the cases attended by the Orthopedics or Psychiatric Department do not go through this screening and patients are attended directly by its specific specialty. The psychiatric care is done by doctors from the Medical Residency Program in Psychiatry, accompanied by medical students and supervised on site by a Psychiatrist, every day of the week, 24 hours a day.

Phase 2: All patients with disorders related to PAS use attended at the REU Psychiatry  received from the doctor who attended them, a printout inviting them to participate in the intervention group (IG) that took place within 7 days after the emergency treatment. Patients were also referred to public PAS disorder treatment services available, as the standard  routine of  the REU Psychiatric Department.
The intervention group  meeting (IG) took place weekly, as part of the PAS Outpatient Hospital  program (ASPA), HC-UNICAMP. Its main purpose was to act as a bridge between the medical services rendered by psychiatric care at the REU and the addiction treatment available in the public health care network, so that patients with PAS use disorders treated at the emergency rooms would seek treatment, instead of abandon it. During the intervention group sessions, the patients were evaluated by a psychiatrist who used a standardized medical questionnaire consisting of the patient�s medical and psychiatric anamnesis, information of the medical care offered by the REU, history of prescribed and over the counter medication, place where the patient was reffered to, if the patient was using prescribed medication and if the patient had sought treatment at the location to which he was referred by the REU staff. The cases were discussed with the ASPA faculty supervisor, to evaluate the presence of psychiatric comorbidities, adjust prescription drug when necessary and indicate the best type and place to obtain health care for each patient within the PAS use disorder services available at the medical network in the Campinas region. Every patient left the intervention group with an appointment, scheduled at the most suitable public health care service in relation to the severity of the patient�s conditions and proximity of the patient�s home, and with prescription drugs until the date of appointment. Patients were oriented about the negative consequences of PAS use and the importance of seek and adhere to treatment was reinforced. There was also an attempt to detect patients that were resistant to treatment. The care was based on an empathetic approach, respecting the principles of Motivational Interviewing (Miller & Rollnick, 2001). Depending on the demand of each week, patients were evaluated in group or individually, and when accompanied by family, every member was also oriented.

Instruments
Phase 1: Of all patients with PAS use disorders attended by a physician at the REU Psychiatry the following data were collected from medical records: name, registration number, sex, origin, age, marital status, ethnicity, education, profession, occupation, with whom the person lives, religion, reason for treatment at the REU, who referred the patient to the REU, diagnostic hypothesis, if medication was prescribed, if psychotropic medications were prescribed and which type of prescription, if mechanical restraint was necessary, referrals and prescription, pattern of PAS usage, diagnosis of PAS use, abuse or dependence, smoking, presence and type of psychiatric comorbidity, history of suicide attempts (SA),  legal problems history, previous visits to emergency services, hospitalization history, outpatient clinic treatment history, insertion in support groups, treatment in therapeutic communities, psychiatric hospitalizations and prior use of psychiatric medications for addiction treatment.
Phase 2: After 30 and 90 days, all patients with disorders related to PAS use, treated at the REU Psychiatry during this study period,were contacted by phone and an evaluation form, consisting of questions related to treatment seeking and change in PAS consumption pattern, was answered by them. It was asked if the patient was placed in any kind of treatment for PAS use disorder, if the patient had been hospitalized during that time, if the subject had returned to an emergency service, if the patient felt better, worse or the same, and if there were any changes in their PAS consumption pattern (if there was an increase, decrease or if the usage pattern did not change).

Data analysis
Sample calculation: the sample calculation was obtained from the pilot study, with 90 days of data collection. Using the calculation of  Fleiss, with continuity correction, the numbers 109 in the IG group and the number 218 in the group NIG were obtained. To identify factors associated with outcomes univariate and multivariate Cox regression analysis was used with Stepwise process of selection of variables used. The significance level for statistical tests adopted was 5%.

Procedures
From May 2010 to May 2011, all patients with PAS use disorders attended at the REU Psychiatry, received a printed invitation through prior arrangement with the Psychiatry staff  at the REU, which was made available in the medical room, so that the physician (resident psychiatrist or assistant psychiatrist) could deliver to the patient at the end of the emergency care. In this printout, the outpatient clinic phone number was available and patients with alcohol and drug use disorders attended at the REU were invited to come back to the ASPA to participate in the intervention group. The printout was written as it follows: "INVITATION: You were attended at the Referenced Emergency Unit of  the HC-UNICAMP due to problems related to alcohol or other drugs. We invite you to attend the Psycoactive Substances Outpatient Clinic on the 2nd floor of the HC, at Thursday 4th at 7:30am to meet with Dr Vitoria. We count on your presence. See you there! "
The REU medical records of these patients were collected and photocopied by the researcher. From these records, sociodemographic data and telephone contact were aquired. We analyzed all the reasons described at the beginning of  the attendance and diagnostic hypotheses were defined by the doctor by the end of treatment. In the pilot phase groupings of reasons and diagnostic hypotheses were defined, thereby standardizing the collection to build the database. Defined as psychiatric complaints were symptoms other than PAS consumption, such as insomnia, anxiety, depression, or any other symptom of psychic order. Similarly, categories related to the source of referral, prescription medication and referral completion were standardized.

After 30 and 90 days from the treatment in the REU, all patients, including those who attended the intervention group (IG) and the absentees (NIG), were contacted through a phone call and questioned about seeking treatment and their PAS usage pattern. The contact was made with the patient, or a family member available at the moment, who could provide the necessary information.
The research project was approved by the Ethics Committee of the FCM-UNICAMP (number 269/2010).

Results
During the period from 25 May 2010 to 31 May 2011, there were 70,137 visits at the REU HC-UNICAMP, ie, 189 calls per day on average. Of these, 1835 (2.6%) were treated by Psychiatry, corresponding to 1465 patients, or 5 calls a day on average. Among these patients, 358 patients were treated due to PAS use related symptoms. Excluding those under 18 years old, 350 patients (23.8% of total serviced by Psychiatry) were studied.

There was an increasing tendency in the treatment of patients with symptoms related to PAS use during the study, when the 1st semester of this study data collection (n = 157 patients) with the 2nd half (n = 188 patients) (p = 0.05) are compared.

Among patients with PAS use disorders, 123 (35.1%) attended the intervention group (IG) and 227 (64.8%) did not attend (NIG). There was no patient refusal, regarding the terms of the informed consent.

Dropout rates (no contact following 30 and/or 90 days) were 10.5% (n = 13) in the IG and 37.4% (n = 85) in the NIG.

Table 1 shows the socio-demographic profile of patients in IG and NIG.

			INSERT TABLE 1 HERE


The rate of missing data varied from 4.8% for the age group to 46.8% for type of religion.
Table 2 presents the clinical data of patients from the IG and NIG, namely: Reason for treatment at the REU Psychiatry, diagnosis related to the use of PAS, smoking, presence of comorbidities, history of suicide attempts and  history of legal problems.

                                                   INSERT TABLE 2 HERE

Table 3 shows the outcomes of patients in groups IG and NIG in 30 and 90 days.
 
                                                   INSERT TABLE 3 HERE

 The analysis showed that the variables related to a greater use reduction in 30 days were those of  married/cohabiting (p = 0.0482), white (p = 0.0318) and brown (p = 0.0318). Having legal problems was associated with a smaller reduction in 30 days (p <0.0001).

The variable related to greater reduction in use in 90 days was to have college education (p= 0.0490). Variables related to lower rates of reduction of use in 90 days were: cocaine dependence (p = 0.0451), crack dependence (p = 0.0099), cannabis dependence (p = 0.0250), dependence of multiple PAS (p = 0.0324), psychiatric comorbidity (p = 0.0206), history of psychiatric hospitalization (p = 0.0313), history of suicide attempt (p = 0.0339) and smoking (p = 0,0372). The outcome,  if the patient was or was not hospitalized, in 30 and 90 days was significantly more associated with the diagnosis of multiple PAS dependence (30 days: p = 0.0379, 90 days: p = 0.0368).
Regarding multivariate analysis (Cox regression), the crack dependence had 1.66 times more chance to not reduce the PAS consumption in 90 days (p = 0.0412, 95% CI; 1020, 2702). In multivariate analysis, being part of the intervention group resulted in PAS use reduction in 90 days (risk 2424, 95% 1244, 4725, p = 0.0093).

Discussion
This study evaluated the results of an intervention, for patients with PAS use disorders that started from the emergency care, and was held within 7 days of the visit to the ER. The innovative model of intervention intended to act as a bridge between emergency services and medical care provided in the public hospital network of the Campinas region, aiming to be a facilitator in the patient�s access and motivation when seeking treatment, and pointed relevant results.

Regarding the socio-demographic profile, patients treated due to PAS use disorders were mostly men, with a mean age of 35 years old, which is compatible with the literature data (Brubacher et al, 2008, Curran et al, 2008, Owens et al, 2010, Rockett et al, 2003). The sociodemographic profile of patients who attended the intervention group (IG) and patients who did not attend (NIG) was similar, differing only in age (about 3 years older in the IG) and color (slight predominance of whites in the NIG). In the 3 months follow-up study with patients with alcohol problems (Leontieva et al, 2009), among the patients who completed follow-up there were more women, fewer married couples, fewer smokers and more schooling. In another study involving alcohol and drug users, among those who attended the follow-up,  there were a smaller number of  married patients and more unemployment (Blow et al, 2010). Such differences were not found in this study.

Regarding the clinical profile and history of previous treatments, we observed some particular characteristics among patients who attended the intervention group (IG) when compared with those who did not attend (NIG). As for the diagnosis, there were a predominance of patients with alcohol dependence in the IG, whereas in the NIG there were higher rates of crack dependence and cocaine abuse.  The IG showed lower rates of psychiatric comorbidities and legal problems when compared with the NIG. In relation to previous treatments, the history of psychiatric hospitalizations was higher in NIG. For other modalities of pretreatment, there were no differences between IG and NIG. These data suggest that patients who did not attend the intervention group (NIG) probably constituted a more severely ill group of patients than those who attended (IG). 
Regarding the reason for care, in the IG there were higher rates of abstinence syndrome than in the NIG group, probably due to the prevalence of alcohol-dependent subjects, whereas in NIG there were higher rates of psychiatric complaints, other than the use of PAS, intoxication and having been brought by the family, than in the IG. This difference reinforces the hypothesis that patients in the NIG possibly had more severe symptoms, and were more dependent on family, perhaps presenting a lower level of autonomy, than the IG patients. This finding indicates the need to create strategies targeted at this subgroup of patients, who probably require different intervention approaches.
Regarding the outcomes, there was a significant difference in the reduction of use of PAS after 30 days, which was maintained after 90 days among patients who attended the intervention group. A study conducted in England (Wright et al, 1998), which evaluated brief intervention conducted in the ER in 202 patients with alcohol use disorders, showed that the reduction of alcohol use after 6 months was statistically significant, with an average reduction of 43%. A 3 month follow-up study conducted in India with 90 patients (Pal et al, 2007) showed that there was a significant reduction in the severity of dependence and improvement of the quality of life in patients who received two sessions of brief intervention. An examination of 30 intervention studies in patients with alcohol-related problems treated in the ER (Havard et al, 2008) showed no significant subsequent reduction of alcohol use, but the rate of problems related to alcohol use had a significant decline (OR = 0,59).
In this study, patients who attended the intervention group had higher rates of treatment seeking after 30 and 90 days. A study evaluating the brief intervention as a technique to increase adherence to treatment for addiction (Carroll et al, 2006), showed that, after 30 days the rate of compliance was 84% in patients undergoing brief intervention and 75% in patients undergoing standard procedures, considering the patients with alcohol use disorders had consistent results after 90 days, which was not observed in users of other PAS. 
Hospitalization rates were lower in IG in 30 days and 90 days. A systematic review of 37 studies on brief intervention in the ER for patients with disorders related to alcohol consumption showed a reduction of hospitalization in 4 studies (D'Onofrio & Degutis, 2002).
In our study, the variables that were related to lower rates of reduction in use in 90 days were cocaine dependence, crack dependence, cannabis dependence, dependence of multiple PAS, psychiatric comorbidity, history of psychiatric hospitalization, history of suicide attempt and smoking. The outcome, if the patient was or was not hospitalized, in 30 and 90 days was significantly associated with diagnosis of multiple PAS dependence. These data indicate the need for inclusion of specific treatment models that address the needs of each subgroup
In the multivariate analysis, being dependent on crack had 1.66 times more chance to not reduce the consumption of PAS in 90 days. The crack is considered a drug with potentially severe effects when compared with other PAS. Crack users have twice the risk of dependence that users of inhaled cocaine users have, and even greater risk when the association of cocaine, cannabis and alcohol are present (Chen et al, 2004, Marques et al, 2012, Wagner et al, 2007). The mortality rate of this population is up to 7 times higher than the general population, mainly due to violent causes (Ribeiro et al, 2006). Crack users also have greater difficulty adhering to treatment (Ribeiro & Laranjeira, 2010). In a study conducted in New York (Kleinman et al, 1992), 42% of crack users who participated in the selection for the research did not attend the beggining of treatment. We believe that the strategy proposed in this study proved to be ineffective for this particular population.
In our study, the only outcome in which there was no difference between the two groups was the demand for emergency care in 30 to 90 days. In a study that evaluated patients with comorbidity psychiatric disorders and use of PAS for 4 years (Curran et al, 2008) the group of patients with a primary diagnosis of PAS use disorder had 2.5 visits to the ER, while patients with psychiatric comorbidity had 5.2 visits. It is possible that the follow-up time might have been insufficient to evaluate this outcome.
In this study, sociodemographic variables related to greater use reduction in 30 days were among the patients that were married/cohabiting, white and brown, and in 90 days the same variables were among the patients that had higher education, data also observed in another study (Leontieva et al, 2009). A study evaluating the presence of stable relationship as a protective factor among patients with cocaine and heroin use disorders, showed that among patients married / cohabiting, the reduction in use was higher throughout the study period (35 weeks) when compared with patients without a stable relationship (Heinz et al, 2009). A study conducted in the United States, which tried to group the patients attended in the ER according to the severity of their PAS use, showed an association between poor social functioning and higher level of severity of the PAS use disorder (Blow et al, 2011). In our study, having legal problems was associated with smaller reduction in use in 30 days. Previous study with patients attended at the ASPA and at CAPS-AD Campinas (Oliveira, 2010) showed that 40.4% of the population attended had a history of criminal behavior, the latter being significantly associated with dependence on multiple PAS, Antisocial Personality Disorder and history of solvents use.
It is important to point out some limitations of this study. The first one refers to the high rate of missing data, especially in the sociodemographic variables, probably considered less essential when compared to the clinical data, which is essential for decision making in the context of emergency. This difficulty has been pointed out in other studies conducted in emergency services (Avanzi, 2005, Breton et al, 2007, Lambert et al, 2003, Soares, 1995). Another limitation was the fact that there was no randomization of patients, being that the methodological choice was to offer the IG to all studied population.  Although this option can be justified ethically and has allowed a more naturalistic observation of the subpopulation who accepted the invitation to the IG, it indicates parsimony in the analysis of the results once users who did not attend the group (NIG) comprised a subgroup of greater severity, indicating that this strategy may not prove successful in patients other than those comprised in the GI. Another limitation was the rate of loss during follow-up, problem also observed in other studies (Brown et al, 2007, Hungerford et al, 2000, Leontieva, 2009, McKay et al, 2005, Monti et al, 1999, Rocket et al, 2003, Wright et al, 1998). This is attributed in part to the itinerant character of the population seeking emergency care, particularly among users of PAS (Aseltine, 2010). In a study conducted in England (Wright et al, 1998), the loss rate during follow-up reached 46.5%. In a study conducted in the United States (Hungerford et al, 2000), patients who completed the follow-up did not represent the total of the sample  (27.7%). In another study conducted in the USA (Aseltine, 2010), the total number of patients studied, 63% completed follow-up in 3 months, 52% completed in 6 months and only 38% finished the 12 months of the study. In a study conducted in the United States (Rockett et al, 2003), 79.5% completed the study, 15.6% refused and 4.9% partially participated.
Despite these limitations, the study showed consistent data regarding PAS use reduction and treatment seeking among patients who attended the intervention group. The fact that the intervention was done not exactly in the ER but in their own environment, in the specialized outpatient clinic, it became perfectly viable,  and it currently became part of the routine of both services. Some studies conducted in emergency services were performed with a specialized intervention team, which increases costs and considerably hinders its implementation in the routine (D'Onofrio & Degutis, 2002, Hungerford et al, 2003, Wright et al, 1998).
A study that examined which features of the brief intervention performed in the emergency service were decisive in following 3 months, showed that the referral making was the conduct most associated with the reduction of alcohol consumption, followed by the establishment of a goal during the brief intervention (Leontieva et al, 2009). However, surprisingly, only 2% of these patients were referred. Study that analyzed the PAS users treatment schedule after the care provided in the ER (Breton et al, 2007), showed that only 13% had an appointment scheduled at a specialized service facility in the following 14 days. In our study, patients were attended no later than 7 days after the emergency treatment, and a major concern in the intervention group was to ensure the monitoring of the patients. A study evaluating the relationship between the waiting time to start treatment and retention in treatment (Hoffman et al, 2011) showed an inverse relationship between the delay in the onset of treatment and retention: while 37.1% of patients treated within 30 days had treatment retention, measured as the attendence frequency in at least four sessions, among those treated in 10 days the retention ratio was 61.7%. Studies have shown the need to address PAS users, with primary clinical complaints, treated at the ER, regarding the follow-up in services specialized in PAS disorders and emphasizing emergency care as the crucial moment for this bridge to be made and that the scheduling facilitated (Blow et al, 2011, Fortney et al, 2010). 
It is noteworthy that in our study, even patients who did not attend the intervention group had significant reduction rates of PAS use in 30 and 90 days (39% and 47%, respectively), as well as the search for treatment in 30 and 90 days (41.5% and 49.1%, respectively). These data suggest that the emergency care itself constitutes a facilitating factor for behavior change, as shown in other studies data (Blow et al, 2011, Daeppen et al, 2007). It is questionable if the delivery of the printed invitation and/or telephone contact in the follow-up also contributed to these rates. Previous studies showed that fractional interventions have proved effective. A study evaluating the impact of brief intervention conducted in the ER after 3, 6 and 12 months follow-up showed that after 3 months there was a significant reduction in alcohol consumption, but this reduction was not maintained at 6 and 12 months, which made the authors suggest the use of partitioned interventions in multiple contacts (Aseltine, 2010). 
Positive results held after 90 days showed that the intervention group proposed in this study is effective and viable, and encourage the development of new research in this area, aiming at expanding the health care network to patients with PAS use disorders and better interconnection among the  available services, particularly including the emergency services. The increase of PAS use throughout the general population and the increased demand of this population in the emergency services show that urgent measures should be taken to improve the provision of treatment for these patients.

Conclusions
The results of this study show that during 30 and 90 days, patients in the IG group had greater reduction in PAS use and sought more treatment than the patients in the NIG group. There was no difference in follow-up when seeking emergency care in both groups. Patients who attended the intervention group (IG) were older, had higher rates of alcohol dependence, lower rates of psychiatric comorbidities, fewer legal problems and fewer psychiatric hospitalization episodes than patients who did not attend the group (NIG). Being crack dependent was associated with an increased risk of not reducing the use of PAS in 90 days.


References 
Allen, K. (1994). Development of an instrument to identify barriers to treatment for addicted women, from their perspective. International Journal of Addictions. 29(4):429�44.
Allen, K. (1995). Barriers to treatment for addicted African-American women. Journal of the American Medical Association. 87:751�6.
Aseltine, R.H. (2010). The impact of screening, brief intervention and referral for treatment in Emergency Department patients� alcohol use: a 3-,6- and 12-month follow-up. Alcohol and Alcoholism. 45(6): 514-9.
Avanzi, M.P. & Silva, C.R.G. (2005). Most common diagnoses for adults in the emergency rooms of a university hospital. Rev Cienc Med (Campinas). 14(2):175-85.

Babor, T.F. & Higgins-Biddle, J.C. (2000). Alcohol screening and brief intervention: dissemination strategies for medical practice and public health. Addiction. 95(5), 677-86.

Barros, R.E.M., Tung, T.C. & Mari, J.J. (2010). Psychiatric emergency services and their relationships with the mental health network in Brazil. Revista Brasileira de Psiquiatria. 32 (Supl II), p.71-7.

Blow, F.C., Walton, M.A., Murray, R., Cunningham, R.M., Chermack, S.T., Barry, K.L., Ilgen, M.A. & Booth, B.M. (2010). Intervention attendance among Emergency Department patients with alcohol- and drug-use disorders. Journal of Studies on Alcohol and Drugs. 71(50):713-719. 
Blow, F.C., Walton, M.A., Barry, K.L., Murray, R.L., Cunningham, R.M., Lynn, S.M., Chermack, S.T. & Booth, B.M. (2011). Alcohol and drug use among patients presenting to an inner-city emergency department: a latent class analysis. Addict Behav. 36(8): 793-800.
Breton, A.R., Taira, D.A., Burns, E., O�Leary, J. & Chung, R.S. (2007). Follow-up services after an emergency department visit for substance abuse. Am J Manag Care. 13(9):497-505.
Brown, R.L., Saunders, L.A., Bobula, J.A., Mundt, M.P. & Koch, P.E. (2007). Randomized-controlled trial of a telephone and mail intervention for alcohol use disorders: three-month drinking outcomes. Alcohol Clin Exp Res. 31(8): 1372-9.
Brubacher, J.R., Mabie, A., Ngo, M., Abu-Laban, R.B., Buchanan, J., Shenton, T. & Purssell, R. (2008). Substance-related problems in patients visiting an urban Canadian emergency department. CJEM.10(3):198-204.
Carr, C.J.A., Xu, J., Redko, C., Lane, D.T., Rapp, R.C., Goris, J. et al. (2008) Individual and system influences on waiting time for substance abuse treatment. Journal of Substance Abuse Treatment. 34:192-201. 
Carroll, K.M., Ball, S.A., Nich, C., Martino, S., Frankforter, T.L., Farentinos, C. et al. (2006). Motivational interviewing to improve treatment engagement and outcome in individuals seeking treatment for substance abuse: a multisite effectiveness study. Drug Alcohol Depend. 81(3):301-12.
Chafetz, M.E., Blane, H.T., Abrams, H.S., Golner, J., Lacy, E., McCourt, W.F. et al. (1962) Establishing treatment relations with alcoholics. J Nerv Ment Dis. 134:395-409.
Cherpitel, C.J. & Ye, Y. (2008). Trends in alcohol- and drug-related ED and primary care visits: data from three U.S. National Surveys (1995-2005). Am J Drug Alcohol Abuse. 34(5): 576-83.
Chen, C.Y. & Anthony, J.C. (2004).  Epidemiological estimates of risk in the process of becoming dependent upon cocaine: cocaine hydrochloride powder versus crack cocaine. Psychopharmacology (Berl). 172:78-86.
Claudino, A.D. & Gon�alves E. (2006) Situations related to substance use in psychiatric emergency. In: Silveira DX, Moreira FG. Current Panorama of drugs and Drug Dependencies. S�o Paulo: Atheneu. p.192-5. 
Curran, G.M., Sullivan, G., Williams, K., Han, X., Allee, E. & Kotrla, K.J. (2008). The association of psychiatric comorbidity and use of the emergency department among persons with substance use disorders: an observational cohort study. BMC Emergency Medicine. 8:17. doi: 10.1186/1471-227X-8-17.
Daeppen, J.B., Gaume, J., Bady, P., Yersin, B., Calmes, J.M., Givel, J.C. et al. (2007). Brief alcohol intervention and alcohol assessment do not influence alcohol use in injured patients treated in the emergency department: a randomized controlled clinical trial. Addiction.102: 1224-33.
D�Onofrio, G. & Degutis, L.C. (2002) Preventive care in the emergency department:     screening and brief intervention for alcohol problems in the emergency department: a systematic review. Acad Emerg Med. 9(6): 627-38.
Havard, A., Shakeshaft, A. & Sanson-Fischer, R. (2008). Systematic review and meta-analyses of strategies targeting alcohol problems in emergency departments: interventions reduce alcohol-related injuries. Addiction. 103:368-76.

Heinz, A.J., Wu, J., Witkiewitz, K., Epstein, D.H. & Preston, K.L. (2009). Marriage and relationship closeness as predictors of cocaine and heroine use. Addict Behav. 34(3): 258-63.

Helmkamp, J.C., Hungerford, D.W., Williams, J.M., Manley, W.G., Furbee, P.M., Horn, K.A. et al. (2003)  Screening and brief intervention for alcohol problems among college students treated in a university hospital emergency department. J Am Coll Health. 52:7-16.
Hoffman KA, Ford JH, Tillotson CJ & Choi D, McCarty D. (2011). Days to treatment and early retention among patients in treatment for alcohol and drug disorders. Addict Behav. 36(6): 643-47.

Hungerford, D.W., Pollock, D.A. & Todd, K.H. (2000). Acceptability of emergency department-based screening and brief intervention for alcohol problems. Academic Emergency Medicine. 7(12): 1383-92.

Hungerford, D.W., Williams, J.M., Furbee, P.M., Manley, W.G., Helmkamp, J.C., Horn, K. et al. (2003). Feasibility of screening and intervention for alcohol problems among young adults in the ED. Am J Emerg Med. 21:14-22.

Jayaram, G. & Triplett, P. (2008). Quality improvement of psychiatric care: challenges of emergency psychiatry. Am J Psychiatry. 165(10):1256-60.

Kleinman, P.H., Kang, S.Y., Lipton, D.S., Woody, G.E., Kemp, J. & Millman, R.B. 1992). Retention of cocaine abusers in outpatient psychotherapy. Am J Drug Alcohol Abuse. 18(1): 29-43. 

Lambert, M.T., Lepage, J.P. & Schmitt, A.L. (2003). Five-year outcomes following psychiatric consultation to a tertiary care emergency room. Am J Psychiatry. 160:1350-3.

Larkin, G.L., Claassen, C.A., Emond, J.A., Pelletier, A.J. & Camargo, C.A. (2005). Trends in U.S. emergency department visits for mental health conditions, 1992 to 2001. Psychiatr Serv. 56(6):671�7.

Leontieva. L., Kimberly, H.E., Helmkamp, J., Furbee, M., Jarrett, T. & Williams, J. (2009). Counselors�reflections on the administration of screening and brief intervention for alcohol problems in the emergency department and 3-month follow-up outcome. Journal of Critical Care. 24, 273-279.

Longabaugh, R., Woolard, R.F., Nirenberg, T.D., Minugh, A.P., Becker, B., Clifford, P.R. et al. (2001). Evaluating the effects of a brief motivational intervention for injury drinkers in the Emergency Department. J Stud Alcohol. 62:806-16.

Marques, A.C.P.R., Ribeiro, M., Laranjeira, R.R. & Andrada, N.C. (2012). Abuse and Dependency: Crack. Rev Assoc Med Bras. 58(2): 141-53.

McKay, J.R., Lynch, K.G., Shepard, D.S., Pettinati, H.M. (2005). The effectiveness of  telephone-based continuing care for alcohol and cocaine dependence: 24-month outcomes. Arch Gen Psychiatry. 62(2): 199-207.

Miller, W.R & Rollnick, S. (2001). Motivational interviewing: Preparing people to change addictive behaviors. Porto Alegre: Artmed.

Monti, P.M., Colby, S.M., Barnett, N.P., Spirito, A., Ronsenow, D.J., Myers, M., et al. (1999).  Brief intervention for harm reduction with alcohol-positive older adolescents in a hospital emergency department. Journal of Consulting and Clinical Psychology. 67(6): 989-94.

Nordqvist, C., Johansson, K. & Bendtsen, P. (2004). Routine screening for risky alcohol consumption at an emergency department using the AUDIT-C questionnaire. Drug Alcohol Depend. 74:71-5.


Oliveira KD. (2010). Sociodemographic pattern of consumption and criminal behavior in psychoactive substance users who started treatment
 [Dissertation � Master�s degree]. Campinas (SP): Campinas State University.

Owens, P.L., Wens, P.L., Mutter, R. & Stocks C. (2010) Mental health and substance abuse-related emergency department visits among adults, 2007. National Comorbidity Survey and National Comorbidity Survey Replication. Available from:
 HYPERLINK "http://www.hcup-us.ahrq.gov/reports/statbriefs/sb92.pdf" http://www.hcup-us.ahrq.gov/reports/statbriefs/sb92.pdf [Acessed in august 04 2012].

Pal, H.R., Yadav, D., Mehta, A.S. & Mohan, I. (2007). A comparison of brief intervention versus simple advice for alcohol use disorders in a North India Community-based sample followed for 3 months. Alcohol & Alcoholism. 42(4), p.328-332.
Rapp, R.C., Xu, J., Carr, C.A., Lane, D.T., Wang, J. & Carlson, R. (2006). Treatment barriers identified by substance abusers assessed at a centralized intake unit. Journal of Substance Abuse Treatment. 30:227-35.
Ribeiro, M., Dunn, J., Sesso, R., Dias, A.C. & Laranjeira, R. (2006). Causes of death among crack cocaine users. Rev Bras Psiquiatr. 28(3):196-202.
Ribeiro, M. & Laranjeira, R. (2010). Treatment Plan. In: Ribeiro, M. & Laranjeira, R. (org). The treatment of crack users. S�o Paulo: Casa Leitura M�dica, p. 19-42.
Rockett, I.R.H., Putnam, S.L., Jia, H. & Smith, G.S. (2003). Assessing substance abuse treatment need: a statewide hospital emergency department study. Ann Emerg Med. 43:802-13.
Segatto, M.L., Pinsky, I., Laranjeira, R., Rezende, F.F. & Vilela, T.R. (2007). Screening and brief intervention for alcoholic patients treated at emergency rooms: prospects and challenges. Cad. Sa�de P�blica. 23(8):1753-62. 
Soares E. (1995). Qualidade dos registros de atendimento em pronto-socorro. Rev Enf. 3(1):10-8. [Assistance register quality in emergency services]
Stange, K., Flocke, S. & Goodwin, M. (1998) Opportunistic preventive services delivery: are time limitations and patient satisfaction barriers. J Fam Pract. 46, 419-24.
Wagner, F.A. & Anthony, J.C. (2007). Male-female differences in the risk of progression from first use to dependence upon cannabis, cocaine and alcohol. Drug Alcohol Depend. 86:191-8.
Wallace, P. (2001). Patients with alcohol problems � simple questioning is the key to effective identification and management. Br J Gen Pract. 51:172-3.
Wright, S., Moran, L., Meyrick, M., O�Connor, R. & Touquet, R. (1998).  Intervention by an alcohol health worker in an accident and emergency department. Alcohol & Alcoholism. 33(6): 651-6.
Xu, J., Rapp, R.C., Carr, C.A., Lane, D.T., Wang, J. & Carlson, R.G. (2006). Factor analysis of treatment barriers identified by substance abusers following assessment at a centralized intake unit. Journal of Substance Abuse Treatment. 30(3):227-35.















Table 1 � Sociodemographic profile of the groups IG and NIG

Variable GI (n=123)
N      %NIG (n=227)
N      %pGender (n=350)
   Female
   Male
17       13.8
    106        86.1
43       18.9
     184        81.0
0.2087Age (years) 37.434.40.0146Age Group (n=333)
   18-24 years old
   25-39 years old
   40-59 years old
   >60   years old
17      13.8
58      47.1
42      34.1
6       4.8
  40      19.0
103      49.0
  56      26.6
  7       3.3

0.2132From Campinas (n=349)97      78.8171      75.60.4990Marital Status (n=311)
   Single
   Married/cohabiting
   Separated/divorced
   Widow/ widower
52      42.9
50      41.3
17      14.0
2      1.6
89      46.8
72      37.8
27      14.2
2      1.0

0.7888Color (n=299)
   White
   Brown
   Black
   Asian
84       69.4
20       16.5
16       13.2
 1       0.8
145      81.4
18       10.1
        14        7.8
 1        0.5

0.0561Schooling (n=276)
   d" 8 years
   > 8 years
54       44.1
68       55.5
77       49.9
77       49.9
0.5098Occupation (n=287)
   Housewife
   No occupation/ unemployed
   Informal work
   Regular/ Constant Occupation
   Retired
   Leave of absence
2       1.6
  50      40.6
11      8.9
  38      30.8
11      8.9
11      8.9
 7       4.2
  62      37.8
  18      10.9
  49      29.8
13      7.9
15      9.1


0.8334With whom one lives (n=297)
   Alone
   Spouse
   Spouse + children
   Children
   Parents
   Other
       12       9.8
23      18.8
21      17.2
5      4.1
44      36.0
17      13.9
23      13.1
23      13.1
29      16.5
3      1.7
78      44.5
19      10.8


0.3533Religion (n=186)
   Catholic
   Evangelical
   Spiritist    
63      70.7
22      24.7
3      3.3 
53      54.6
40      41.2
3      3.0 

0.0540



Table 2- Clinical data of groups IG and NIG
VariableGI
(n=123)
N       % NIG
(n=227)
N       %
pReason to attendance  (n=326)
   Intoxication
   Abstinence
   Suicide attempt
   Psychiatric complaints
   Willingness to treat / hospitalize
   Clinical Complaints other/accidents   
   Complaints related to PAS use
   Brought by family
   Missing data
14      11.4
19      15.5
8      6.5
23      18.8
24      19.6
    11       9.0
20      16.3
3      2.4
1      0.8
32      15.6
  12       5.8
  11       5.3
 58       28.4
 49       24.0
  10       4.9
   19      9.3
13      6.3
  23      10.1


0.0062Diagnosis related to PAS use
   Alcohol dependence (n=339)
   Cocaine dependence (n=347)
   Crack dependence (n=345)
   Cannabis/ Marijuana dependence (n=342)
   Dependence on multiple PAS (n=348)
   Alcohol abuse (n=134)
   Cocaine abuse (n=195)
   Crack abuse (n=235)
   Cannabis/Marijuana abuse(n=262)
   Multiple PAS abuse (n=251)
90      73.1
50      40.6
27      21.9
24      19.6
30      24.5
12      35.2
6      8.2
3      3.1
7      7.2
2      2.1
118      53.8
101      45.0
 81       36.4
 52       23.6
 65       28.7
 40       40.0
 28       22.9
12      8.5
14      8.4
12      7.5
0.0005
0.4250
0.0053
0.3983
0.4046
0.6267
0.0087
0.0957
0.7150
0.0695Smoking  (n=142)75      65.267      69.70.4806Presence of Psychiatric Comorbidity
   Depression
   Psychotic manifestation
   Anxiety / panic disorder manifestation
   Personality disorder
   Mania and Hypomania episodes
   Other35      29.1
     11      8.5
14      10.9
4      3.1
5      3.9
1      0.7
0     0.092      44.6
24      18.7
42      32.8
7      5.4
   11     8.5
2      1.5
7      5.4


0.0057History of suicide attemps (n=256)50      41.653      38.90.6607Legal Issues (n=181)32      30.435      46.00.0322Emergency service care (n=205)80      70.875      81.50.0753Hospitalization (n=217)53      46.947      45.10.8006Ambulatory care(n=282)77      64.1106      65.40.8258Support group(n=243)30      25.628      22.20.5322Hospitalization in Therapeutic Community (n=283)31      25.848      29.40.5029Admission to Psychiatric Hospital (n=293)39      32.588      50.80.0018Use of psychotropic drugs (n=290)86      69.9128     76.6 0.1979

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�CJOJQJmH	sH	hH~�CJOJQJmH	sH	h�`FCJOJQJmH	sH	h8\�CJOJQJaJnHtH Descriptive analysis and comparisons of outcomes between the groups IG and NIG
VariableGI
(n=110)
N         %NIG
(n=142)
N        %pReduction of PAS use in 30 days (n=196)
Yes
No 
76      79.1
20      20.8
39      39.0
61      61.0
<0.0001Treatment seeking in 30 days
Yes 
No 
67      68.3
31      31.6
47      41.5
66      58.4
<0.0001Returned to the ER in 30 days (n=200)
Yes
No
24      25.5
70      74.4
29      27.3
77      72.6
0.7702Hospitalized in 30 days (n=209)
Yes 
No
9      9.4
86      90.5
41      35.9
73      64.0
<0.0001Reduction of PAS use in 90 dias (n=193)
Yes 
No 
75      82.4
16      17.5
48      47.0
54      52.9
<0.0001Treatment seeking in 90 dias (n=206)
Yes
No 
63      70.0
27      30.0
57      49.1
59      50.8
0.0026Returned to the ER in 90 days (n=194)
Yes
No
14      16.0
73      83.9
29      27.1
78      72.9
0.0663Hospitalized in 90 days (n=199)
Yes
No
9       10.2
79      89.7
34      30.6
77      69.3
0.0005


























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