Women users of crack: systematic review of Brazilian literature

Limberger, Jéssica; Nascimento, Raísa da Silva do; Schneider, Jaluza Aimèe; Andretta, Ilana

doi:10.1590/0047-2085000000107

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Table of contents

LITERATURE REVIEWS • J. bras. psiquiatr. 65 (1) • Jan-Mar 2016 • https://doi.org/10.1590/0047-2085000000107 linkcopy

Women users of crack: systematic review of Brazilian literature

Mulheres usuárias de crack: revisão sistemática da literatura brasileira

Authorship SCIMAGO INSTITUTIONS RANKINGS

Objective To present Brazilian’s empirical studies that address this issue between the period of 2004 to 2014.

Methods It is a Brazilian literature Systematic Review using the descriptors “crack cocaine” AND “women”, in the database Scopus, Lilacs, Medline and SciELO.

Results From the 785 articles found, 16 articles contemplated the inclusion criteria. It was evidenced that the use of crack by women is related to physical and sexual violence, provoking HIV risks in consequence of prostitution, and social prejudice.

Conclusion Given this reality, studies evaluating treatments in the Brazilian context are essential, according the specificities of women crack users.

Crack cocaine; women; substance-related disorders; drug use review

Authors and year	Delineation and instruments related to drug use	Participants	Main results
Orsi et al. (2004)¹⁵	Quantitative study, cross-sectional study. Structured interview, questionnaire about the use of cocaine and Cocaine Addiction Scale.	74 subjects of both sexes interned in specialized treatment for cocaine dependence in Porto Alegre/RS.	Throughout life, 55.4% of participants reported using crack. Among participants who used cocaine for longer, in its various forms, 87% were men and 12.8% were women. However, 80% of that used in larger quantities were women.
Correa et al. (2008)¹⁷	Quantitative study of epidemiological, descriptive and analytical character. Structured questionnaire.	75 female sex workers in bars and nightclubs, the city of Umuarama/PR.	Most sex workers (67.0%) were users of licit and illicit drugs, with higher consumption of tobacco (36.0%). Associations between STDs and the use of legal and illegal drugs were found.
Malta et al. (2008)¹⁸	Qualitative study, grounded theory. Focus groups and in-depth interviews were conducted.	26 female sex workers crack users in Foz do Iguaçu/PR.	Drug use is seen by participants as a way to deal with stressful situations, as experiences of physical and sexual violence. Risk factors for HIV, such as multiple partners and unprotected sex were identified by participants.
Nappo (2011)¹⁹	Qualitative study. Interviews.	75 women dependent of crack, in São Paulo/SP.	Prostitution was identified as a way of obtaining the crack. The population was identified as a risk group in the transmission of sexually transmitted diseases such as AIDS.
Tractenberg et al. (2013)²⁴	Quantitative study. SCID-I (Structured Clinical Interview for DSM Disorders) ASI-6.	99 women, aged between 18 and 52 years admitted to a detoxification unit of Porto Alegre/RS.	The results indicate an exposure rate of 86.9% among trauma dependent women of crack cocaine type. The PTSD rate was 15.1%. Among the types of reported events, the most frequent were: suffer aggression or physical abuse and be witness of violence.
Costa et al. (2012)²⁰	Quantitative, retrospective and cross-sectional study. Semi-structured interview.	85 pregnant women dependent of crack admitted for detoxification in a psychiatric inpatient unit in Porto Alegre/RS.	The beginning of crack use varied between 11 and 35 years. Most of the women had involvement with robbery, prison, exchange of sex for money/drugs, home abandonment and HIV.
Grassi-Oliveira et al. (2012)²⁸	Quantitative study. Socio-Demographic Data SCID I and Addiction Severity Scale.	23 women crack users in treatment.	The study identified the association between cortisol levels (from the hair evaluation) and stress exposure by 90 and 30 days before starting treatment.
Levandowski et al. (2013)²⁶	Quantitative study. SCID I.	104 women crack/cocaine users, with and without a history of child abuse in hospital treatment unit for detoxification.	All users increased plasma levels of leptin during the abstinence period. However, the concentrations were lower compared with the group of non-users. The crack users who report childhood maltreatment showed a significant reduction in plasma levels of adiponectin and resistin compared to the group with no history of abuse.
Viola et al. (2013)²⁵	Cross-sectional and comparative Study. Cocaine Selective Severity Assessment and ASI-6.	85 women crack/cocaine users, divided in two groups: with a history of physical neglect in childhood (n = 37) with no history of physical neglect in childhood (n = 48).	Women crack/cocaine users with a history of physical neglect in childhood had lower performance on tasks of executive function when compared to women with no history of physical neglect in childhood.
Francke et al. (2013)²³	Comparative quantitative study, with follow-up. SCID I.	80 women treated in specialized unit for chemical dependence.	The results show a correlation between women who have suffered neglect in childhood and with the lowest results in successful treatment for drug addiction.
Diehl, Silva e Laranjeira (2013)³¹	Quantitative study of cross-cutting nature. Questionnaire with the diagnosis criteria of the DSM-IV-TR.	105 women admitted to a specialized unit of treatment for disorders related to substance use in a tertiary psychiatric hospital in São Paulo/SP.	The crack was the drug of choice in 42.9% of participants, followed by 30% alcohol. The prevalence of sexual dysfunction symptoms was 34.2%. There was an association between symptoms of sexual dysfunction, low education and drug addiction.
Pedroso et al. (2013)¹²	Qualitative study. Semi-structured interview.	5 women and 9 men crack users, aged 20 and 30, interned to a psychiatric hospital in Porto Alegre/RS.	The study founded specificities on crack abuse by women: while men are involved with the crime for the drug, women wear prostitution, exposing themselves to risks. In treatment, difficulties have been encountered to access the internment, relapses and treatment dropout.
Romanini e Roso (2013)²¹	Qualitative study. Participant observation, field diary and focus groups.	16 participants of both sexes, users of a CAPSad, Santa Maria/RS.	Gender stereotypes are present among crack users, where the prostitution is seen as a “women’s thing” and the robbery is reported by men as a way to keep the drug.
Levandowski et al. (2014)²⁷	Quantitative, cross-sectional study. SCID-I, ASI-6, Cocaine Selective Severity Assessment and The Fagerstrom Test for Nicotine Dependence.	A total of 48 women crack users in a hospital ward in southern Brazil. Of these, 24 with a history of childhood maltreatment and 24 with no history of childhood maltreatment.	It was identified that the crack users participants with early stress due to maltreatment in childhood had higher levels of tumor necrosis factor (TNF) and lower levels of the weak inducer of apoptosis related to TNF than crack users without early stress. Also the positive relationship between TNF levels the severity of symptoms of craving and severity of maltreatment of children was identified.
Pinto et al. (2014)¹⁶	Transversal quantitative study. Medical records.	The study was conducted in São Paulo with a total of 598 women (the participants sought treatment center specializing in HIV/AIDS).	The article shows the profile of the survey participants in which most were white, single, almost half of the interviews has over 8 years of formal education, and 13% reported the use of crack/cocaine. The study concludes by pointing the relationship between drug use and sexually transmitted diseases such as AIDS and syphilis.
Viola et al. (2014)²²	Quantitative study, follow-up. ASI-6, Cocaine Selective Severity Assessment.	104 women crack users, with (CSA +) and without (CSA -) a history of child abuse sexual, and 20 controls, 18-55 years.	Plasma levels of GDNF in CSA group + increased during three weeks of detoxification. In contrast, those in the CSA group showed lower levels of GDNF and stable under the same conditions. During the initial abstinence, plasma levels of GDNF and NT4/5 were the only factors to show changes associated with a history of childhood sexual abuse.

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