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      Relação entre o craving por tabaco e o craving por crack em pacientes internados para desintoxicação Translated title: Relationship between craving for tobacco and craving for crack in patients hospitalized for detoxification

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          Abstract

          OBJETIVO: Verificar se há relação entre aumento do craving por crack e aumento do craving por tabaco em pacientes internados para desintoxicação. MÉTODO: Ensaio clínico tipo quase-experimental de análise quantitativa. Amostra composta por 32 homens dependentes de cocaína (crack) e tabaco, em duas a três semanas de abstinência. Realizou-se intervenção em grupo, no qual, inicialmente, foram aplicados: CCQB (Cocaine Craving Questionnaire-Brief ), QSUB (Questionnaire of Smoking Urges-Brief ) e BAI (Inventário Beck de Ansiedade). Em seguida, foram aplicadas imagens relacionadas ao crack e reaplicados CCQB, QSUB e BAI. Após, foi realizada entrevista individual em que se aplicaram FSD (Ficha com Dados Sociodemográficos) e FTND (Fagerström Test for Nicotine Dependence). RESULTADOS: A partir da exposição de imagens relativas ao crack, houve aumento significativo do craving por crack, do craving por tabaco e dos sintomas de ansiedade, estando essas medidas correlacionadas positivamente entre si. CONCLUSÃO: Os resultados indicam uma associação significativa entre craving por crack e craving por tabaco, sugerindo que a abstinência de tabaco pode ajudar na eficácia do tratamento para dependência de crack.

          Translated abstract

          OBJECTIVE: Verify if there is a relationship between crack craving increase and tobacco craving increase in patients hospitalized for detoxification. METHOD: Quasi-experimental clinical trial using a quantitative analysis. Sample comprised 32 crack-cocaine and tobacco-dependent males, in 2 to 3 weeks of abstinence. A group intervention was conducted to which initially Cocaine Craving Questionnaire-Brief (CCQB), QSUB (Questionnaire of Smoking Urges-Brief) and BAI (Beck Anxiety Inventory) were applied. Next, crack related images were applied and CCQB, QSUB and BAI were reapplied. After that, an individual interview was conducted in which a form containing sociodemographic information and data related to the pattern of consumption of psychoactive substances (FSD) and Fagerström Test for Nicotine Dependence (FTND) were applied. RESULTS: Following the crack related images exposure, there was a significant increase of crack craving, tobacco craving and anxiety symptoms, being them positively correlated. CONCLUSION: Results show a significant association between crack craving and tobacco craving, suggesting that tobacco abstinence can help on effectiveness of cocaine dependence treatment.

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          The neural basis of drug craving: an incentive-sensitization theory of addiction.

          This paper presents a biopsychological theory of drug addiction, the 'Incentive-Sensitization Theory'. The theory addresses three fundamental questions. The first is: why do addicts crave drugs? That is, what is the psychological and neurobiological basis of drug craving? The second is: why does drug craving persist even after long periods of abstinence? The third is whether 'wanting' drugs (drug craving) is attributable to 'liking' drugs (to the subjective pleasurable effects of drugs)? The theory posits the following. (1) Addictive drugs share the ability to enhance mesotelencephalic dopamine neurotransmission. (2) One psychological function of this neural system is to attribute 'incentive salience' to the perception and mental representation of events associated with activation of the system. Incentive salience is a psychological process that transforms the perception of stimuli, imbuing them with salience, making them attractive, 'wanted', incentive stimuli. (3) In some individuals the repeated use of addictive drugs produces incremental neuroadaptations in this neural system, rendering it increasingly and perhaps permanently, hypersensitive ('sensitized') to drugs and drug-associated stimuli. The sensitization of dopamine systems is gated by associative learning, which causes excessive incentive salience to be attributed to the act of drug taking and to stimuli associated with drug taking. It is specifically the sensitization of incentive salience, therefore, that transforms ordinary 'wanting' into excessive drug craving. (4) It is further proposed that sensitization of the neural systems responsible for incentive salience ('for wanting') can occur independently of changes in neural systems that mediate the subjective pleasurable effects of drugs (drug 'liking') and of neural systems that mediate withdrawal. Thus, sensitization of incentive salience can produce addictive behavior (compulsive drug seeking and drug taking) even if the expectation of drug pleasure or the aversive properties of withdrawal are diminished and even in the face of strong disincentives, including the loss of reputation, job, home and family. We review evidence for this view of addiction and discuss its implications for understanding the psychology and neurobiology of addiction.
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            The role of dopamine in drug abuse viewed from the perspective of its role in motivation.

            Drugs of abuse share with conventional reinforcers the activation of specific neural pathways in the CNS that are the substrate of their motivational properties. Dopamine is recognized as the transmitter of one such neural pathway, being involved in at least three major aspects of motivation: modulation of motivational state, acquisition (incentive learning) and expression of incentive properties by motivational stimuli. Drugs of abuse of different pharmacological classes stimulate in the low dose range dopamine transmission particularly in the ventral striatum. Apart from psychostimulants, the evidence that stimulation of dopamine transmission by drugs of abuse provides the primary motivational stimulus for drug self-administration is either unconvincing or negative. However, stimulation of dopamine transmission is essential for the activational properties of drugs of abuse and might be instrumental for the acquisition of responding to drug-related incentive stimuli (incentive learning). Dopamine is involved in the induction and in the expression of behavioural sensitization by repeated exposure to various drugs of abuse. Sensitization to the dopamine-stimulant properties of specific drug classes leading to facilitation of incentive learning of drug-related stimuli might account for the strong control over behaviour exerted by these stimuli in the addiction state. Withdrawal from drugs of abuse results in a reduction in basal dopamine transmission in vivo and in reduced responding for conventional reinforcers. Although these changes are likely to be the expression of a state of dependence of the dopamine system their contribution to the motivational state of drug addiction is unclear.
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              Manual da versão em português das Escalas Beck

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                Author and article information

                Journal
                jbpsiq
                Jornal Brasileiro de Psiquiatria
                J. bras. psiquiatr.
                Instituto de Psiquiatria da Universidade Federal do Rio de Janeiro (Rio de Janeiro, RJ, Brazil )
                0047-2085
                1982-0208
                2011
                : 60
                : 1
                : 28-33
                Affiliations
                [01] orgnameUniversidade Federal do Rio Grande do Sul
                [02] orgnameEscola de Saúde Pública
                [03] orgnamePontifícia Universidade Católica do Rio Grande do Sul
                [04] orgnameHospital Psiquiátrico São Pedro
                Article
                S0047-20852011000100006 S0047-2085(11)06000106
                14816a05-6021-4eda-9744-4f11a41c04b4

                This work is licensed under a Creative Commons Attribution 4.0 International License.

                History
                : 06 December 2010
                : 27 January 2011
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 30, Pages: 6
                Product

                SciELO Brazil

                Categories
                Artigos originais

                tratamento,Cocaína (crack),tabaco,craving,Cocaine (crack),tobacco,treatment

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