Estigma internalizado em usuários de drogas: avaliação de processo de uma estratégia de redução de estigma internalizado baseada na Terapia de Aceitação e Compromisso

Abstract

Dependence on alcohol and other drugs is one of the health conditions most stigmatized by society. The moral discourse on drug use reinforces the stigmatization process, causing users to stop being seen in their entirety, being reduced to a diminished, discredited and, consequently, marginalized person. Some strategies to reduce stigma have been used in several contexts, being important ways to mitigate the damage caused by the internalization of stigma. In this sense, Acceptance and Commitment Therapy (ACT) has been identified as a satisfactory approach to reduce internalized stigma and, in the context of drug use, to reduce the severity of dependence and the comorbidities associated with the disorder by substance use. In view of the severity of the substance use disorder itself and the consequences of the internalization process of stigma in this condition, this dissertation was divided into two studies. Study I, which aimed to conduct a systematic review of the literature in this regard, based on the recommendations in the Preferred Report Items for Systematic Reviews and Meta-Analyzes (PRISMA) guide, focusing on national and international production on ACT and use disorder of substances. The search was carried out in the PubMed, PsycNET (APA), VHL, Web of Science, SciELO, LILACS and Science Direct databases with the descriptors “Substance-Related Disorders” and “Acceptance and Commitment Therapy”. The analyzed articles presented interventions based on ACT in group and individual contexts, in person or at distance, as an additive to conventional treatment for addiction to tobacco, alcohol and other drugs, in different contexts, with positive effects of using ACT being verified in these treatments in terms of reducing the severity of dependence, reducing internalized stigma and comorbid symptoms. Study II aimed to evaluate the application process of an ACT-based protocol, translated and adapted for the Brazilian context, for users of alcohol and other drugs inserted in the Psychosocial Care Center for Alcohol and other Drugs - CAPSad, the reliability of original protocol and preservation of its key components. The sample consisted of nine participants and six meetings were held to apply the protocol. The intervention was conducted by a pair of therapists trained in the technique and three observers who made the relevant records according to the observation script previously prepared. The sociodemographic questionnaire was used to characterize the sample, the ambivalence questionnaire in psychotherapy, the internalized stigma scale (ISMI) and the dependency severity scale (SDS) for the purpose of assessing the level of internalization of the stigma, the severity of the dependence, psychological flexibility and motivation of the participants, in order to complement the data on the achievement of the objectives foreseen with the intervention. Data analysis took place in two stages, first from the characterization of the sample and from the quantitative analysis of the results of the instruments used, and then through the analysis of the observation scripts supported by the Grounded Theory. The intervention maintained a high degree of fidelity to the original theoretical model, keeping its key components active according to the objectives of each session. The results of the studies allowed us to identify that ACT can be effective both for reducing stigma and for reducing the severity of dependence, as well as the feasibility of the protocol in the Brazilian context. Thus, it is stated the need for continuity of studies and the feasibility of an integral model that aims to innovate the treatments already used.