Padrão de interação familiar de usuário de substâncias psicoativas: estudo de caso

Abstract

The use of psychoactive substances generates negative impacts not only on the individual's life but also on families and the community. Family members are affected in different dimensions, such as psychological, emotional, financial, and social, and may experience domestic violence, family conflicts, and changes in interpersonal relationships. It is known that including the family in the care of a person with a mental disorder can reduce stressors, improve the individual's clinical condition, reduce relapses and hospitalizations, and increase adherence to treatment. The importance of intervention models widely used in family nursing practice is highlighted, including the Calgary Family Assessment and Intervention Model (CFAM/CFIM), the 15-minute interview; therapeutic conversations and circular questions; the Family Strengths-Oriented Therapeutic Conversation Intervention (FAM-SOTC); and Circular Pattern Diagrams (CPD). Thus, therapeutic conversations and circular questions in the systemic approach are strategic and relevant resources, as they provide family members with a space for communication and reflection on their interactions, as well as assisting nurses in assessing family interaction patterns. Furthermore, there is little evidence in the national and international literature on the use of these resources, especially in the context of mental health and, more specifically, alcohol and other drugs. This study aimed to analyze the interaction patterns among family members in the context of alcohol and other drugs, through therapeutic conversations and the use of circular questions. Specific objectives included: identifying circular communication patterns among family members; synthesizing the main interaction patterns from the circular pattern diagram of families experiencing the use of psychoactive substances; understanding thoughts (cognitive), feelings/affects, and behaviors from the perspective of family members in the process of circular communication; understanding the experiences of family members in the context of alcohol and other drugs incorporating circular questions; and analyzing the use of circular questions as a tool for understanding interaction patterns. The method consisted of qualitative research, a single case study, conducted with a family of a psychoactive substance user at a Psychosocial Care Center for Alcohol and Drugs (CAPS-AD) in a city in the interior of São Paulo state, with the presence of the mother-child subsystem (index case). Two interviews were conducted with the dyad, involving content on sociodemographic characterization, construction of a genogram and ecomap, interviews using therapeutic conversation, circular questions, and the elaboration of Circular Pattern Diagrams (CPD), theoretically grounded in the Calgary Family Assessment and Intervention Model. The data were analyzed using Reflexive Thematic Analysis (RTA). The results indicated a single-parent family configuration (single mother) and the presence of two children, one of whom was the index case. The ecomap showed a limited support network, with support consisting of a specialized community-based mental health service, religiosity (attachment to God), emotional support from the mother's brother, and a weak relationship with the other children. The Circular Pattern Diagrams addressed the presence of repetitive and maladaptive interaction patterns within the dyad, with negative circularity, permeated by restrictive beliefs, which generated emotional states of psychic suffering and dysfunctional behaviors, with episodes of physical violence stemming from psychotic episodes experienced by the older son, who cohabited the home. Three themes emerged: "belief involves illness," "the emergence of negative feelings," and "difficulties in intrafamilial communication." Regarding the theme of belief involving illness, it was understood that medication alleviated the crises, and the son's cognitive and behavioral slowness was not related to medication or the psychiatric diagnosis (schizophrenia). The children should take responsibility for their own choices, and the violence was related to the older son's hallucinations. The theme of the emergence of negative feelings addressed the mother's physical and emotional overload, feelings of disappointment, worry, and fear during the episodes of violence. The theme of intrafamilial communication difficulties revealed behaviors of apathy (son - index case) and aggressiveness (mother) in response to episodes of family violence; absence of effective communication and lack of dialogue; and proposals for behavioral changes to strengthen relational bonds. It is concluded that the use of therapeutic conversation and circular communication allowed for the identification and analysis of interactional patterns and the relational bonds, as well as the thoughts, feelings, and behaviors existing within the family dynamic. These strategies enabled the mother-child dyad to reflect on the functioning and dynamics of the family, promoting changes and strengthening coping strategies.