Sandra Pires, Domingos Duran

Instituto da Droga e da Toxicodependência, I.P.

CONTACTOS

RESUMO

Na presente investigação os autores propõem-se avaliar e comparar a prevalência e tipologia de maus tratos infantis numa amostra de 121 sujeitos toxicodependentes (61 homens e 60 mulheres) acompanhados em ambulatório no Centro das Taipas, bem como analisar a relação entre os maus tratos sofridos na infância e os padrões de consumo de substâncias psicoactivas, a serologia do HIV e os comportamentos de risco experimentados ao longo da vida. Os resultados evidenciam uma prevalência elevada de abusos físicos, sexuais e psicológicos na infância e adolescência dos indivíduos adictos e discriminam diferenças entre géneros, sugerindo uma maior incidência de abusos emocionais (rejeição e sobreprotecção maternas) e sexuais nas mulheres e de abusos físicos nos homens. Também indicam uma prevalência significativamente mais elevada de HIV+ e de comportamentos de tentativas de suicídio no grupo de mulheres adictas. Estes dados traduzem importantes implicações preventivas e terapêu­ticas, na intervenção clínica com toxicodependentes, salientando-se a importância de uma avaliação diagnóstica cuidada da história de maus tratos infantis dos indivíduos com problemáticas de toxicodependência no sentido do delineamento de abordagens terapêuticas específicas, de acordo com as necessidades identificadas.

Palavras-chave: Maus Tratos Infantis; Padrões de Consumo de Substâncias Psicoactivas; Serologia do HIV; Comportamentos de Risco.

Dans cette investigation, les auteurs proposent d’évaluer et de comparer la prévalence et les types de violence envers les enfants dans un échantillon de 121 sujets toxicomanes (61 hommes et 60 femmes), accompagnés en clinique externe au Centro das Taipas, et d’analyser la relation entre la violence subis dans l’enfance et les modèles de consommation de substances psychoactives, la sérologie du VIH et les comportements de risque pris tout au long de la vie. Les résultats montrent une forte prévalence des abus physiques, sexuelles et psychologiques dans l’enfance et l’adolescence des individus toxicomanes. Ils permettent de voir des différences entre les genres, avec une incidence plus grande de la violence psychologique (rejet, surprotection maternelle) et sexuelle chez les femmes, et des abus physiques chez les hommes. Ils indiquent aussi une prévalence significativement plus élevée du VIH+ et des tentatives de suicide dans le groupe des femmes toxicomanes. Ces données reflètent d’importantes implications préventives et thérapeutiques dans l’intervention clinique auprès des utilisateurs de drogue. Il faut souligner l’importance d’une évaluation rigoureuse du diagnostic et de l’histoire de maltraitance des personnes avec des problèmes de drogue, pour qu’il soit possible de concevoir des approches thérapeutiques spécifiques selon des besoins identifiés.

Mots-clé: Violence sur les Enfants; Modèles de Consommation de Subs­tances Psychoactives; Sérologie du VIH; Comportements de Risque.

ABSTRACT

In this study the authors propose to evaluate and compare the prevalence and types of child abuse in a sample of 121 subjects addicts (61 men and 60 women) followed up in outpatient clinic at Centro das Taipas, and analyze the relationship between the bad abuse suffered in childhood and patterns of consumption of psychoactive substances, serology of the HIV and risk behaviors experienced throughout life. The results show a high prevalence of physical, sexual and psychological factors in the childhood and adolescence of drug addicted individuals. They also show the differences between genders, suggesting a higher incidence of emotional abuse (maternal overprotection and rejection) and sexual abuse in women, and physical abuse in men. They also indicate a significantly higher prevalence of HIV+ and suicide attempts in the group of women addicts. These data reflect important preventive and therapeutic implications in clinical intervention with drug users, highlighting the importance of a careful diagnostic evaluation of the history of child abuse in individuals with problematic drug issues, so that is possible to design specific therapeutic approaches according to identified needs.

Key Words: Child Abuse; Patterns of Consumption of Psychoactive Substances; Serology of HIV; Risk Behaviors.

RESUMEN

En la presente investigación los autores se proponen evaluar y comparar la prevalencia y tipología de malos tratos infantiles en una muestra de 121 sujetos drogodependientes (61 hombres y 60 mujeres) acompañados en ambulatorio en el Centro das Taipas, bien como analizar la relación entre los malos tratos sufridos en la infancia y los patrones del consumo de sustancias psicoactivas, la serología del VIH y los comportamientos de riesgo experimentados durante la vida. Los resultados evidencian una prevalencia elevada de abusos físicos, sexuales y psicológicos en la infancia y adolescencia de los sujetos adictos y discriminan diferencias entre géneros, indicando una mayor incidencia de abusos emocionales (rechazo y sobrepro­tección maternos) y sexuales en las mujeres y de abusos físicos en los hombres. Indican también una prevalencia significativamente más elevada de VIH+ y de comportamientos de tentativas de suicidio en el grupo de mujeres adictas. Estos datos traducen importantes implicaciones preventivas y tera­péuticas en la intervención clínica con drogodependientes, se desta­cando la importancia de una evaluación diagnostica cuidada de la historia de malos tratos infantiles de los sujetos con problemáticas de drogodependencia en el sentido del delineamiento de abordajes tera­péuticas especificas de acuerdo con las necesidades identificadas.

Texto completo disponível apenas em PDF.

Full text only available in PDF format.

REFERÊNCIAS BIBLIOGRÁFICAS

Bergeret et al. (1983). Toxicomanie et dépressivité, 2e rencontre internationale de psychiatrie et épidémiologie, Genève, 17-19 mars.

Berry & Sellman (2001). “Childhood adversity in alcohol and drug dependent women presenting to outpatient tratment”. Drug and Alcohol Review. Vol 20 (4): pp. 361-367.

Beutel, M. (1999). “Substance abuse in the survivors of child sexual abuse: an epidemiological study. Psychoterapeut“. Vol 44 (5), pp. 313-319.

Bowlby, J. (1973). “Attachment and loss“. Vol II: Separation: anxitey and anger. NY: Basic Books.

Browne, R. et al. (2000). “Child abuse and the clinical course of drug misuse“. The British Journal of Psychiatry, 177: 469

Canavarro, M. C. (1999). Relações afectivas e Saúde Mental. Coimbra: Quarteto.

Canha, J. (2000). Criança maltratada. O papel de uma pessoa de referência na sua recuperação. Estudo prospectivo de 5 anos. Coimbra: Quarteto.

Carlson, V. et al. (1989). “Disorganized/Desoriented attachment relation­ships in maltreated infants“. Developmental Psychology, 25 (4): 531.

Charnaud, B. & Griffiths, V. (2000). “Drug dependence and child abuse”. The British Journal of Psychiatry, 177: 84.

Cohen, f. S.; Densen-Gerber, J. (1982). “A study of the relationship between child abuse and drug addition in 178 patients: premilinary results“. Child Abuse & Neglect, 6 (4): 383-387.

Conroy, E. et al. (2009). “Child maltreatment as a risk factor for opioid dependence: Comparison of family characteristics and type and severity of child maltreatment with a matched control group“. Child Abuse Neglect., 33 (6): 343-52. Epub 2009.

Doermer, W. & Lab, S. (1995). “Child Maltreatment“. In W. Doerner (Ed.), Victimology. Cincinnati: Anderson Publishing: 137-158.

Egeland, B. & Sroufe, A. (1981). “Development sequelae of maltreatment in infacy“. New directions for child development. 11: 77-92.

Figueiredo, B. et al. (2002). “Maus tratos na infância: trajectórias desenvolvimentais e intervenção psicológica na idade adulta“. In Violência e Vítimas de Crimes, Coimbra: Quarteto, I, pp. 163-210.

Freeman, R. C. et al. (2002). “Early life sexual abuse as a risk factor for crack cocaine use in a sample of community-recruited women at risk for ilicit drug use“. Am J Drug Alcohol Abuse, 28 (1): 109-31.

Kilpatrick, D. G. et al. (1992). “Rape in America: a Report to the Nation“. Crime Victims`Research and Treatment Center. Charleston, SC.

Kingston, S. et al. (2009). “The relationship of sexual abuse, early initiation of substance use, and adolescent trauma to PTSD“. J Trauma Stress, 22 (1): 65-8.

Logan, J. E. et al. (2009). “Gender-specific mental and behavioural outcomes among psysically abused high-risk seventh-grade youths“. Public health Rep., 124 (2): 234-45.

McDougall, J. (2001). “L`économie psychique de l`addiction“. In Anorexie, addictions et fragilités narcissiques, Collection Petite Bibliothèque de Psychanalyse. Paris: PUf.

Marsden, J. et al. (2000). “Psychiatric symtoms among clients seeking treatment for drug dependence“. British Journal of Psychiatry, 176: 285-289.

Najavits, L. M. et al. (1997). “The link between substance abuse and postraumatic stress disorder in women: a research review“. American Journal on Addictions, 6 (4): 273-283.

Najavits, L. M. et al. (1998). “Cocaine dependence with and without PTSD among subjects in the National Institute on Drug Abuse Collaborative Cocaine Treatment Study“. American Jounal of Psychiatry. 155: 214-219.

Parillo, K. M. et al. (2001). “Association between early sexual abuse and adult HIV-risky sexual behaviors among community-recruited women“. Child Abuse & Neglect, 25 (3): 335-46.

Pires, S. (2005). “Maus tratos infantis: factor de risco na génese da toxicodependência. (Re)visão teórica“. Toxicodependências. 11 (1): 65-78.

Sansone, R. A. et al. (2009). “The prevalence of childhood trauma among those seeking buprenorfine treatment“. J Addcict Dis., 28 (1): 64-7.

Simpson, T. L.; Miller, W. R. (2002). “Concomitance between childhood sexual and physical abuse and substance use problems. A review“. Clinical-Psychology Review.

Sroufe, A. (1988). “The role of infant caregiver attachment in develop­ment“. In J. Belsky & T. Nezworski (Eds.). Clinical implications of attachment. 18-38. Hillsdale, NY: Lawrence Earlbaum Associates.

Steele, B. (1994). “Psychoanalysis and maltreatment of children“. Journal of American Psychoanalytic Association, 42 (4): 1001-1025.

Stoltz, J. A. et al. (2007). “Associations between childhood maltreatment and sex work in a cohort of drug-using youth“. Soc. Sci. Med., 65 (6): 1214-21.         [ Links ]

Sung-Yeon Kang et al. (2002). “Relationships between childhood abuse and neglect experience and HIV risk behaviors among methadone treatment drop-outs“. Child Abuse & Neglect, 26 (12): 1275-1289.

Swan, N. (1998). Exploring the role of the child abuse in later drug abuse. NIDA Notes, 13 (2).

Widom, C. S. et al. (1999). “Childhood victimization and drug abuse: a comparison of prospective and retrospective findings“. Journal of Consulting and Clinical Psychology. Vol 67 (6): 867-880.

Widom, C. S. et al. (2001). “Alcohol abuse as a risk factor for and con­sequence of child abuse“. Alcohol Research & Health, 25 (1): 52-57.

CONTACTOS:

SANDRA PIRES

Psicóloga.Instituto da Droga e da Toxicodependência, I.P.Centro das Taipas Av. do Brasil, 53 – Pavilhão 21-B, Lisboa sandra.b.pires@gmail.com

DOMINGOS DURAN

Psicólogo.Instituto da Droga e da Toxicodependência, I.P.Centro das Taipas Av. do Brasil, 53 – Pavilhão 21-B, Lisboa domingosduran@gmail.com