Pessoas com transtorno por uso de substâncias e os tratamentos em comunidades terapêuticas e CAPS-AD: uma revisão de escopo

Abstract

Introduction: For a long period, the reality of Psychoactive substances abuse in Brazil was conducted predominantly, from a medical and psychiatric perspective, giving few spaces for psychological, political, and socio-economic perspectives. Brazilian psychiatric reform and the Brazilian anti-asylum struggle are important milestones toward the care and treatment of people with substance use disorders paradigm shift. Despite the emergence, a long time ago, of Therapeutic Communities and Psychosocial Care Centers for Alcohol and Drugs (CAPS-AD) as a resource for treatment of people with disorders related to substance use, there is a lack of understanding about the differences among these kinds of treatments and how it takes place. Background: A scoping review is required, due to a gap in the scientific literature related to differences and particularities of the treatments performed in Therapeutic Communities and CAPS AD in Brazil. General objective: Describe the scientific evidence about how treatments are offered both, in therapeutic communities and in CAPS AD, for people with disorders related to substance use. Specific objectives: Identify possible differences and similarities between the treatments offered in therapeutic communities and CAPS AD and understand how users perceive the experience of treatments in these different services Methodology: In order to recognize the evidence produced so far, a scoping review was carried out, which sought to bring a mapping of the literature in this field of interest. For the search, the databases BVS, Web of Sciences, Scielo, Portal CAPES, and PubMed were used. The terms 1 - “therapeutic community” and treatment; 2- “therapeutic community” and “user perception”; 3 - “therapeutic community” and definition; 4 - “CAPS AD” and treatment; 5 - "CAPS AD" and "user perception" e 6- “CAPS AD” and definition both in English and Portuguese were used for the literature search. For the review, it was included qualitative studies published in the period between 1986 and 2021, in Portuguese and English, from studies conducted in Brazil. To organize the studies, the Rayyan platform was used. The steps stated by the PRISMA Extension for Scoping Reviews were used for the methodological organization. Results: 1582 studies were found, of which 1573 were available and, after the peer decision and conflicts resolved (using the PICO strategy), a final number of 14 studies were included in the review, with regard to divergences and similarities in the two distincts modes of treatment, similar contents were observed, such as the logic of abstinence and prejudice towards users who are undergoing treatment, but there are also quite considerable differences, mainly in the way in which both treatments advocate care for people with substance use disorders, with treatment in freedom and the harm reduction strategy (CAPS-AD) as opposed to treatment in deprivation of liberty (CT). Conclusions: Was perceived a deficit of qualitative studies addressing the mental health of users of these services, in addition, a smaller number of studies carried out in TCs was found. Thus, it is important to consider the limitations in terms of achieving the objectives proposed here. However, it was possible to observe some divergences and confluences of the perceptions of the users treated in the different devices, making future studies necessary to effectively compare the perception of the users about these treatments.