USERS ' PERCEPTION ABOUT DRUGS IN THEIR LIVES

Drugs abuse has turned into a severe public health issue, due to its epidemiology as well as to the consequences of this abuse in the social environment, and its treatment is considered a challenge. The aim was to know how users perceive drugs. A qualitative, descriptive and exploratory research was undertaken. The data were produced through an interview with eight users of alcohol and other drugs, who were under treatment at a Therapeutic Community in a small city in the Northwest of Rio Grande do Sul, Brazil. For data analysis, thematic content analysis was applied. The results show that the users' search for drugs is related to their inability to cope with crises and frustrations; in addition, it can make them lose objects, values and their own family. In conclusion, it is important to develop this theme in nursing education with a view to humanized and effective care delivery. 1 RN, M.SC., Assistant Professor, Nursing Department, Universidade Federal de Pelotas (UFPEL), Pelotas-RS. Brazil. E-mail: r.gabatz@yahoo.com.br 2 RN, School of Nursing, Sociedade Educacional Três de Maio – SETREM, Três de Maio-RS. Brazil. E-mail: michelecapa@hotmail.com 3 RN, Ph.D., Adjunct Professor, Nursing Department and Graduate Nursing Program, Universidade Federal de Santa Maria (UFSM), Santa Maria-RS. Brazil. E-mail: martesm@ hotmail.com.br 4 RN, Ph.D., Adjunct Professor, Nursing Department and Graduate Nursing Program, Universidade Federal de Santa Maria (UFSM), Santa Maria-RS. Brazil. E-mail: stelamaris_padoin@hotmail.com 5 RN, Hospital Universitário de Santa Maria (HUSM), M.Sc. in Nursing, UFSM, Santa Maria-RS. Brazil. E-mail: adaoademirdasilva@yahoo.com.br 6 RN, M.Sc., Professor, School of Nursing, Sociedade Educacional Três de Maio, SETREM, Três de Maio-RS. Brazil. E-mail: jbrum@ciinet.com.br RESEARCH


INTRODUCTION
Drugs use is a universal and millenary practice among humans.It is presented in different peoples and diverse historical contexts.Drugs have always been part of humanity, whether for religious rituals, leisure or to gain readiness and energy like in ancient times, for cure or for therapeutic purposes.The link between drugs use and social problem is recent though.
The use of drugs is defined as the consumption of any substance capable of modifying and disorganizing the biological function of living organisms, resulting in physiological or behavioral changes 1 .For some time, only prohibited substances were considered, ignoring permitted substances like caffeine, alcohol, tobacco and medicines.Although a distinction exists between legal (permitted) and illegal (prohibited) substances, these distinctions vary according to the culture of each people 1 .
The consumption of legal or illegal psychoactive substances turned into a problem because of the range and expansion of its use, entailing important consequences for public health.According to the United Nations Organization, 0.6% of the world population, that is, about 26 million people, are addicted to illegal drugs.In addition, they kill 200,000 people each year.In South America, Brazil represents the largest market for opioids, with about 600 thousand users, which corresponds to 0.5% of the population between 12 and 65 years of age 2 .These figures entail a great economic and social impact, which has affected the Unified Health System (SUS) in terms of drugs consumption reduction as well as user rescue 3 .
The analysis of data on the cost of drugs use reveals the high cost of alcohol consumption.When considering data for 2001, in Brazil, 84,467 hospitalizations occurred due to alcohol-related problems, more than four times the number due to the use of other drugs.As the mean duration of hospitalization was 27.3 days, the annual cost of these hospitalizations for the SUS was more than 60 million reais 3 .
Through Law 11.343/06, the National Drugs Policy System (SISNAD) was created in Brazilian legislation, which is aimed at articulating health professionals' activities by integrating and coordinating prevention, promotion, treatment and social reintegration programs for users of alcohol and other drugs, as well as trafficking repression 4 .Although the treatment of alcohol and other drugs users has strongly evolved, through laws and the creation of treatment and rehabilitation centers, users are still seen as a danger to society.This conception has existed since ancient times, causing discrimination and hampering treatment and care for this epidemic.In this sense, the importance of research on the theme is highlighted, with a view to supporting better training programs for the professionals working at health services.Thus, acknowledging users and their characteristics and needs demands new strategies to have contact and bond with them and their relatives, with a view to designing and implementing multiple prevention, education, treatment and promotion programs, adapted to the different needs 3 .
Like all health professions, the target of Nursing is to preserve, conserve and maintain life, focusing on actions to keep the human body healthy.Nursing is solidary with patients, groups, families and communities, aiming for the mobilization and cooperation of all in order to conserve and maintain health.In that sense, it should be reminded that the family's participation is fundamental in care delivery to drugs users, as it can help to change behaviors and adopt a healthier lifestyle 5 .
One of the alternatives used to treat chemical addiction has been hospitalization in therapeutic communities (TC), which has demonstrated positive effects in terms of distancing the addicts from drugs use.Studies on the effectiveness of TC treatment indicate that, on average, between 30% and 35% of the people treated stopped using drugs around the world 6 .
Based on the above, the aim is to describe how users perceive drugs in their lives.

METHOD
A qualitative, descriptive and exploratory research was undertaken at a TC in a small city in the Northwest of Rio Grande do Sul, Brazil.This community attends to male adolescent and adult users, who mainly consume alcohol and other drugs, like marihuana, cocaine, crack and inhalants.The individuals analyzed had been hospitalized at least once.
The TC structure can house about 40 male patients.At the time of the field research, about 30 patients were under treatment.Monitors, who are also chemical addicts who went through the treatment and took other courses to become monitors, administer the service.Their work includes the supervision of activities, organization of routines, discipline and group coordination.The installations are new and organized.The daily activity routine is based on a fixed activity timetable.The patients are divided in groups and each has his function.To give an example, while one group takes care of the kitchen, the other is responsible for the garden or animals.
The data were produced through an individual interview with eight users of alcohol and other drugs, which was recorded.The participants were between 18 and 45 years of age, had been using drugs between four and 20 years and were interned at the institution in October 2010.The following inclusion criteria were considered: users interned in the community for at least 15 days, who had already gone through a relapse experience and who were lucid, oriented and coherent.

Users' perceptions of drugs
To preserve the users' anonymity, the letter 'P' (P1, P2, P3, P4...) was used to indicate the word participant, followed by a number that did not necessarily indicate the order of the interviews.The interviews were closed off when repeated information started to appear, considering the occurrence of data saturation 7 .
The interviews were transcribed for further analysis of the statements, with a view to thematic analysis 7 , involving three phases: pre-analysis, when the documents are selected for further exploration; exploration and coding of the material, and search for categories based on the reduction of the text to significant words and expressions 7 .Thus, the groups of meaning in the communication were highlighted, whose presence or frequency meant something for the analytic objective proposed.After treating the results, they were interpreted, underlining the theoretical dimensions suggested when reading the material 8 .
The research protocol received approval from the Ethics Committee for Research involving Human Beings at Universidade Federal de Santa Maria, Opinion 0237.0.243.000-10, and complies with the ethical guidelines for research involving human beings, according to National Health Council Resolution 196/96 9 .An Informed Consent Term was structured with two copies, which was read together with each participant who agreed to take part in the research.

DISCUSSION OF THE RESULTS
Based on the analysis of the interview discourse, themes and meanings were matched which resulted in the following thematic categories for this study: entry into the world of drugs and its consequences; search for rehabilitation and relapses.

Entry into the world of drugs and its consequences
The entry into the world of drugs is related to different factors, such as influence from friends, personal difficulties and as a facilitator of social relations.At the same time as drugs offer momentary satisfaction, they impose a range of consequences on their users 10 .In the statements, the participants' inability to deal with their frustrations were highlighted:

[...] I got into the world of drugs because I was unable to administer the crises, the friendships, the frustrations, the crises, I liked a person but it was unrequited, that made me seek refuge in drugs again, that sick love [...] addiction is complicated (P4).
This testimony shows that the search to use drugs was related to the inability to cope with affective and personal crises.In the same sense, in a research that involved relatives and friends of drugs users, 60% of the cases involve excess stress and frustrations, which cause crises that are risks factors for drugs use 11 .
From an individual-emotional perspective, the act of getting drugged can be analyzed as a narcissistic search for pleasure.The desire and pleasure the drug entails will substitute any other will or pleasure and its need is indicated by impulsiveness, aggressiveness and the urge to get satisfied.It is in this phase of pleasure that addiction is established 12 .
The possible reasons to start using drugs can be the emergence of an opportunity for the person to choose experimenting the drug, the power of transforming emotions the drug permits, group influence on consumption, attempts to minimize suffering and feelings like solitude, low self-esteem or lack of confidence 13 .Indiscriminate drugs use represents a complex phenomenon.In view of the daily difficulties the addicts find in drugs chemically effective means to overcome their weakness and, supposedly, to prevent the destabilization of their ego 13 .
Because my life sucked and I used drugs to hide from that, to get rid of the difficulties, the problems, who uses drugs seeks pleasure (P5).
In the above testimony, drugs use is justified as a refuge, the place to hide from problems and difficulties, full satisfaction, with the feeling of pleasure or satisfaction stimulating further use.Hence, drug addiction is a specific relation between a subject and an object.The latter has the power of pleasure, which the subject is unable to leave aside 14 .
The users' testimonies reveal the difficulty to contain their drugs use, as if the drugs mastered and manipulated them.

Users of alcohol and other drugs go through a process of difficulties to take distance from the substance, despite knowing the consequences of its use, and thus see the drug as a thing that manipulated them, also described in another study as an energy that seduces. The users' frequent drugs
Gabatz RIB, Johann M, Terra MG, Padoin SMM, Silva AA, Brum JL Users' perceptions of drugs use entails different material and affective losses 13 .Each day, the written and spoken media present cases of children who are chained at home by their parents so as not to use drugs or who steal objects to buy the drugs, but the losses are not just material.In all cases of drugs use, the family plays a preponderant role as a protection factor against drugs use, to prevent the start of consumption as well as to strengthen the prevention of relapse 15 .P8 indicates the different loses he experienced as a drugs user, mainly related to the emotional aspect:

[...] I lost a lot of things, such as values, family, people I loved [...] I did a lot of things until I almost died, [...] I took various hits in my life (P8).
The drugs strongly affect the users' lives, causing physical and mental losses.They are responsible for the loss of employment, material goods, the rupture of family bonds and harmful effects for health.Maintaining marital, parental and friendship relations is very difficult, as users tend to replace their relations with people by their relations with drugs 16 .

The search for rehabilitation and relapses
The search for treatment or rehabilitation is not an easy task.This route comes with many obstacles as, in most cases, after being interned, the individuals end up returning to the same midst where they started using, finding their former friendships and the drugs.The need for bonding and commitment between users and health services is highlighted, aiming to enhance their adherence to treatment 17 .
The users considered the drugs as a disease that needs great willpower and access to treatments in order to be overcome.

[...] I have this disease, for me, holding on is myself, it's gusto, willingness, willpower, always being ready (P1).
P1's testimony shows that the medical model identifies drugs use as a biological and genetic disease, which hence requires treatment and rehabilitation.This view contributes to maintain the users powerless and disjointed, making prevention and the reduction of damage resulting from drugs use more difficult 18 .On the opposite, clinical evidence exists about neurological and psychiatric changes deriving from chemical addiction, which contribute to the great difficulty to take distance from the drugs, as both the organic and psychological body depend on their stimulating effect 6 .
To stop using drugs, the participants indicated the need for awareness raising, behavioral changes and respect for the drugs:

[...] gaining awareness, that it's not just to quit using [...] giving up the drugs and the alcoholism, it's a change of attitudes, of behavior [...] it means changing completely (P1).
[...] the main thing is to cut off old friendship when you return to social life.[...] I can say that I won't use drugs anymore, but if that's not what I truly want inside of me, then the masks will fall when I get back out there (P4).
In the statements, it is observed that the attitude of change needs to emerge from the users.If not, if they do not agree with the change, it will not happen.In addition, P4's testimony reveals a certain degree of fear to return to the world outside the community, demanding a lot of strength to avoid relapse.When the users do not understand the need to change their attitude, rehabilitation does not take place, as they get back to doing the same things they did before the treatment.

I started visited old places and, without knowing it, I was having relapses in my behavior [...] the same thing for my attitudes (P2).
The circumstances that most cause temptation to use drugs are related to the places where they consume drugs; going to parties with friends; observe someone using or enjoy drugs; feeling extremely anxious and stressed or frustrated because things go wrong 19 .
It was observed that, to permit rehabilitation, it is fundamental to acknowledge their impotence towards the drugs as, while the users image that they master them and "quit whenever they want", they will be unable to quit, as the power the drugs exert on the addicts is very strong 19 .
The self-sufficiency of thinking that I was able to with the drugs, with the alcohol, that that wouldn't affect me, the lack of respect for the drug, today I respect them, that I can't with any of them, that if I take one I'll take several, if I want it's easy, I just have to reach out my hand.Today I do the opposite, I reach out my hand, but to help the other, I am able to lie down on my pillow and rest [...] (P1).
Gabatz RIB, Johann M, Terra MG, Padoin SMM, Silva AA, Brum JL Users' perceptions of drugs [...] admitting the impotence against the drugs [...], but I didn't accept it, I believed that I could use other drugs, like alcohol for example, as I was interned because of problems with crack, I thought I could continue with other drugs, the manipulation of my mind to return to the drugs [...] (P5).
In these statements, the users demonstrate the need to admit their impotence towards the substances in order to be able to start and surrender to the treatment.For users to be able to conquer the obstacle of relapse, it is fundamental for them to gain awareness of their disease and the harm it causes 20 .In addition, one can also perceive that mutual help is fundamental to seek rehabilitation.As the study was undertaken at a TC, the premises adopted there permeate the testimonies.
In that sense, something that needs to be highlighted as positive in the TC is their opening to self-help groups, allowing the interns to share feelings and situations, besides knowing their fellow interns' experiences 6 .In view of the acknowledged importance of the family in chemical addicts' rehabilitation, the need to include families in treatment at the TC is evidenced, considering that, after months of treatment, they will return to their families, which need to be prepared to support their relatives 15 .This support to chemical addicts is not easy and acknowledging this difficulty can help to cope with the disease and restructure the family, which is generally upset because of the consequences of the drug addiction 15 .

FINAL CONSIDERATIONS
This study shows that the drugs users under treatment are able to perceive the drugs in their lives in a broad sense.Their perceptions about the harm the drugs cause are not sufficient to make them abandon these substances though.Although the family is an important point in prevention as well as in the reduction of relapse, the participants hardly mentioned it, which may indicate problems to relate with their relatives.
The search for rehabilitation is indicated as a personal struggle to keep distance from the drugs.Nevertheless, these actions are fragile when the families they are inserted in and related to are not taken into consideration.In this sense, in this study, the relation between the addicts, their families and social context was not addressed in further depth, revealing a gap for further studies on the theme.
Care delivery to addicts is not an easy task, in view of the stigmas and prejudices that exist.These interfere strongly in care, as some professionals do not perceive users as sick people yet.To change this reality, further training is needed, with a view to focusing efforts in a sole direction, towards a common good, in the near future.Hence, to consider high-quality care, health professionals need to be concerned with attending to users without prejudice, so as to increase the possibilities of treatment adherence.Good welcoming is fundamental for success.
This can constitute the base for the elaboration of care strategies for alcohol and other drugs users, as well as for the elaboration and implementation of a more focused care that addresses the users' needs, including the establishment of support groups, activities that help the users to perceive their addiction as harmful, and entertainment activities.It is also fundamental to include the family in care, as that is where the users return after their treatment.In that sense, attention is needed to the accompaniment of drugs users after they leave the therapeutic community, forwarding them to outpatient support where medical, psychological and social help is offered.
Based on the study results, the importance of studies with other approaches is highlighted, in view of the limitations of qualitative research.In addition, care delivery to drugs users should be emphatically addressed in nursing education, with a view to equipping these professional to deliver a more holistic, humanized and effective care.