Drug use by men admitted to a psychiatric hospital*

Objective: to assess risk related to drug use in men admitted to a psychiatric hospital and to identify associations with sociodemographic, socioeconomic variables, and risk conditions. Method: a cross-sectional study with the application of a screening test in 209 participants hospitalized for mental and behavioral disorders due to the use of psychoactive substances. Statistical analysis was performed using descriptive statistics and adjustment of a binary logistic regression model for moderate or high risk of drug use. The odds ratio measured the strength of association. Results: high use in life was observed, with alcohol and tobacco experimentation in adolescence. A high prevalence of related risk was observed for alcohol, tobacco, smoked and inhaled cocaine, and marijuana. Moderate and elevated risks were found for tobacco (22.5% and 62.5%, respectively), alcohol (13.5% and 73%), marijuana (16% and 32.5%), smoked cocaine (3% and 41%) and inhaled cocaine (9% and 19.5%). Conclusion: the results showed high use in life, with an age of early experimentation. Tobacco and alcohol are the main drugs used by hospitalized men.


Introduction
The Anti-Asylum Fight in Brazil resulted in the enactment of Law 10,216, of April 6 th , 2001 (1) , creating barriers to involuntary and compulsory hospitalizations, especially in nursing homes. In 2011, Psychosocial Care Networks (RAPS, its acronym in Portuguese) was created aimed at people suffering from crack, alcohol and other drugs, changing the approach of the user and the drug addict, who, before being criminalized, becomes a health disorder patient, and differentiated strategies for care and social reintegration must be adopted for these users or drug addicts (2) .
Hospital care for drug users and addicts has been gradually replaced by non-hospital care based on rehabilitation and social reintegration, through RAPS articulated to other health networks (3) . These advances were positive, but the comprehensive treatment of drug addicts is incipient and hampered by the low role of men in relation to health care, the social stigma of drug use and dependence, and the current assistance gap in Primary Care (4) . Such factors can lead to late demand for treatment, increasing the indicators of morbidity and mortality and costs to the health system (3) .
Disorders related to drug use are considered a public health problem, with severe personal and community consequences and high worldwide prevalence, contributing substantially to the overload (5) of public health and high economic costs by combating crime, losses, productivity, and health care costs.
Despite public policies aimed at this problem, patients have high variability in response to interventions and high rates of relapse (6)(7) .
Knowing the sociodemographic and clinical profiles problems related to use; concern on the part of people close to the user; impairment in performing expected tasks; unsuccessful attempts to cease or reduce use; feeling of compulsion; and injectable use. Each answer corresponds to a score, which ranges from zero to 8, and the sum is the risk score related to drug use (RRU), which can vary from zero to 39 (8)(9) .
For alcohol use, RRU scores in the range of zero to 10

Results
In the study period, there were 218 hospitalizations in the drug addicts' sector, and 209 men interviews were carried out, with the six losses of individuals who were experiencing abstinence syndrome or inability to sign the IC, and three refusals to participate in the research.
The data on the sociodemographic, socioeconomic, and risk conditions of the sample are shown in Table 1. It was also observed that 3 men (1.4%) reported having already used injectable cocaine, but experimentally, without, however, constant use (Table 2). The data related to the drug RRU are shown in   (Table 4).

Discussion
There were four main findings in this study: the sociodemographic profile; the experimentation age Known to be greater among men, the beginning of drug use is also earlier, associated to constant use.
Factors such as easy access, low cost and preference for drugs considered potent, are pointed out as contributing to this circumstance. This scenario results in difficulties for recovery, being a challenge for health professionals who will need to face the low adherence to the proposed treatments and the high rates of relapses (12)(13)(14) . Data on this fact are important to advocate health and deinstitutionalization policies for these men.
Drug experimentation during adolescence, that is, from 12 to 18 years old (15) , is virtually normative.
However, most individuals do not become dependent on drugs (12) . The vulnerabilities for the development of drug-related disorders are related to the age of experimentation, genetics, gender and psychiatric causes, such as depression, conduct disorders, Attention Deficit Hyperactivity Disorder (ADHD) -classified as intrinsic; extrinsic are access to drugs, the environment (family, school and community), companions, living with user parents, stress common to this development stage and physical or sexual abuse (12)(13)(14) . as heavy drinking (18) .
Alcohol intoxication and drug use lead the user to increase the probability of doing or getting involved in something potentially harmful (19) , such as drunk driving, violent behaviors, and crimes (20) , or negligent behavior (sexual, for example) (21) . About activities, they can increase the probability of accidents (22) , leading to an increased risk of injuries and traumas (17) .
The multiple drug use found in the sample corroborates the findings of other studies (23- 24) , in which a trend of multiple drug use as observed in hospitalized individuals for the treatment of alcoholism (23) . In those hospitalized for crack addiction, involvement with legal drugs was observed during adolescence (24) .
The assistance of drug users is affected by the media, resulting in speeches that simultaneously refuse police repression and the use of evident coercion apparatus, but are consistent with institutional devices that are not always evident of sanitary violence, such as the hospitalization of these users, accepted by liabilities recognition of the disarticulation of RAPS and the biomedical staff shared by professionals (25) .
The user is defined as non-volitive, dominated by the autonomous drug. Such practices corroborate the lack of assistance in Primary Care, legitimizing care gaps, filled by more humanized, but no less perverse, institutions that survive sustained through public funding, adjusting to the weaknesses in the implementation of psychiatric and health reform in Brazil (25) .
The fact that the data collection took place within one psychiatric institution can be considered as limitations of this study, which may distort the responses of the participants, unsettled about hospital discharge or even fearful of the theme regarding illegality and, ultimately, due to the stigma of the participants themselves.
However, this approach has strengths and brings as a contribution to the advancement of knowledge the possibility of highlighting the sociodemographic, socioeconomic profiles and risk conditions that influence the drug RRU, which can be used to support planning and policy-making prevention programs, harm reduction programs, as well as contributing to training primary care to assist these individuals.

Conclusion
There was a risk related to use at moderate and high scores for alcohol, tobacco, marijuana, crack, hallucinogens, amphetamines, inhalants, and opioids.
In the sample, it was observed that 1. not having a religion was associated with the risk related to use inhaled cocaine; involuntary hospitalization and having been hospitalized more than twice were associated with the risk related to the use of smoked cocaine, and not currently working was associated with the risk related to the use of hallucinogens.