Rede assistencial para usuários de álcool e outras drogas: desenvolvimento de um modelo de planejamento baseado em necessidades

Abstract

Although they are scarce in the literature and still have not been developed in the Brazilian context, planning-models based on a population’s needs are fundamental in the implementation of services for users of alcohol and drugs. The objective of this present thesis was to construct a needs-based planning-model for a support network for alcohol and other drugs users among the general population in Brazil. The specific aims were: (1) To identify among the key components in São Paulo, which services should offer support for detoxification, outpatient support and residential support; (2) To understand the rationality of the argumentation of these key components throughout the process of identifying the services, clarifying the main topics of consensus; (3) To obtain estimates of the Needs of Services based on the risk and harm associated with the abuse of alcohol and other drugs among the general population of the São Paulo Metropolitan Area (SPMA); (4) To obtain estimates of the Potential Demand for the use of services for the population in need of these services due to the risks and harm associated with the abuse of the substance in the SPMA; (5) To develop a planning model based on the needs of the municipality of Osasco, aiming to estimate the ideal capacity required for the users of alcohol and other drugs to be attended annually in a network of services. These objectives were developed in three studies, with specific materials and methods. In the first study, which aimed to focus on objectives (1) and (2), was carried out in a workshop among 33 professionals and researchers in São Paulo, who were sub-divided into three groups, using the Nominal Group Technique (NGT). A content analysis, both structural and thematic was carried out, to evaluate the debate in the NGT groups. In the comparison of the results obtained among the three groups, the Centres for Psycho-Social Attention for Alcohol and other Drugs-Users (CAPS AD) of type III, were designated as synthesis-units, which cover all the various care possibilities. In the residential care component, shelter-units and social-welfare assistance were also indicated. In the detox and outpatient support units, a variety of services was indicated to offer care for substance-users. The characteristics of a support-model designed to be integrated and interdepartmental contributed to the identification of the heterogeneous natures of the services provided by the support-units for detoxing and outpatient support, which the discontinued use of asylums influencing the need for residential support. Considering the wide range of services involved, it is important to strengthen the role of Brazilian services regarding the care and specific practices that can be offered to users of alcohol and other drugs. In the second study, aimed at objectives (3) and (4), data from the sub-sample of 2,942 respondents from the São Paulo Megacity study was used, which evaluated mental-health issues in the SPMA. This sub-sample was organised in five hierarchical categories of severity regarding the risks and harms associated with alcohol and drug abuse, making it possible to obtain estimates for the Needs for Services, which brought together criteria for the evaluation of substance abuse, chronic health issues and the comorbidity of mental-health issues over the last 12 months. For the percentage of the population at risk and harmed, estimates for the Potential Demand for service-use over the last year were obtained. Regarding the needs of services, the results demonstrated that 86.5% of the population (category 1) have no problems with alcohol or drugs abuse; 8.9% (category 2) require secondary prevention strategies; 3.49% (categories 3, 4 and 5) had substance abuse related issues, among whom 1.29% (categories 4 and 5) require more intense, specialised support. Regarding Potential Demand, estimates of 7.2% (category 2), 25.5% (category 3) and 51.1% (category 4) were found, demonstrating the existence of large numbers of individuals who have substance-abuse issues, who do not realise that they need professional help and/or are neglected by the network of services. The third study, which aimed to focus on the fifth objective in this thesis, was carried out in the municipality of Osasco, where ten professionals who work at CAPS AD, took part in a Delphi panel answering the questionnaire which was elaborated for this present research, called Questionnaire for the Construction of Estimates for the Allocation of Users of Alcohol and other Drugs in the Psycho-social Care Network. Basic attention was estimated to be offered to 100% of the users, specialised psycho-social attention to 54%, with 19% of users requiring shelter at night in the CAPS AD III, emergency and immediate attention to 37%, psycho-social rehabilitation to 35%, hospital care to 20% and temporary residential to 4%. The findings favour the strengthening of the CAPS AD as well as the other units in the psycho-social care network, and do not favour the prioritization of the residential component.