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Experiences of family members of drivers who violate the law against rinking and driving and its repercussions

Experiencias de familiares de conductores infractores de la ley seca y sus repercusiones

ABSTRACT

Objectives:

to understand the experiences of family members of drivers who violate the law against drinking and driving and the post-penal repercussions.

Methods:

a qualitative study, with family members of drivers who violated the law against drinking and driving who participated in the Projeto Justiça e Sobriedade no Trânsito de Maringá - PR (Traffic Justice and Sobriety Project in Maringá - PR). Data collection was carried through semi-structured interviews, analyzed through thematic analysis.

Results:

it was observed in the family members' reports: the suffering of families due to the consumption of alcohol and other drugs; the violation of the law against drinking and driving meaning turning point, with positive and negative changes in the family context; and the meanings of the Traffic Justice and Sobriety Project.

Final Considerations:

the law against drinking and driving penalties triggered unemployment and financial expenses, but the positive aspects were quitting alcohol use and/or not drinking and driving anymore. The Traffic Justice and Sobriety Project was informed as solidarity and a trigger for changing the offenders' behavior.

Descriptors:
Alcohol Intoxication; Family Relationships; Drive Under the Influence; Accidents, Traffic; Public Health Nursing

RESUMEN

Objetivos:

comprender las experiencias de los familiares de conductores infractores de la Ley seca y las repercusiones después de las sanciones

Métodos:

estudio cualitativo, realizado con familiares de conductores infractores de la Ley Seca participantes del Proyecto Justicia y Sobriedad en el Tráfico de la ciudad de Maringá, Paraná. La recolección de datos se llevó a cabo una entrevista semiestructurada, analizadas mediante análisis temático.

Resultados:

se observó en los relatos de los miembros de la familia: el sufrimiento de las familias por el consumo de alcohol y otras drogas; la violación de la Ley Seca que significa un punto de inflexión, con cambios positivos y negativos en el contexto familiar; y los significados del Proyecto Justicia y Sobriedad en el Tráfico.

Consideraciones Finales:

las penalidades de la Ley Seca provocaron desempleo y gastos financieros, pero hubo aspectos positivos como el cese del consumo de alcohol y/o el no conducir más en estado de embriaguez. El Proyecto Justicia y Sobriedad en el Tráfico es tenido como solidario y como detonante para cambiar el comportamiento de los infractores.

Descriptores:
Intoxicación Alcohólica; Relaciones Familiares; Conducir Bajo Influencia; Accidentes de Tránsito; Enfermería en Salud Pública

RESUMO

Objetivos:

compreender as vivências dos familiares de motoristas infratores da Lei Seca e as repercussões pós-penalidades.

Métodos:

estudo de cunho qualitativo, com membros da famílias de motoristas infratores da, Lei Seca participantes do Projeto Justiça e Sobriedade no Trânsito de Maringá - PR. A coleta de dados foi realizada por entrevista semiestruturada, analisadas mediante análise temática.

Resultados:

observou-se nos relatos dos familiares: o sofrimento das famílias pelo consumo de álcool e outras drogas; a infração da Lei Seca significando turning point, com mudanças positivas e negativas no contexto familiar; e os significados do Projeto Justiça e Sobriedade no Trânsito.

Considerações Finais:

as penalidades da Lei Seca desencadearam desempregos e gastos financeiros, mas os aspectos positivos foram a cessação do uso de álcool e/ou não dirigir mais embriagado. O Projeto Justiça e Sobriedade no Trânsito foi informado como solidário e um gatilho para mudança de comportamento dos infratores.

Descritores:
Intoxicação Alcoólica; Relações Familiares; Dirigir Sob a Influência; Acidentes de Trânsito; Enfermagem em Saúde Pública

INTRODUCTION

Harmful use of alcohol is responsible for approximately 3.3 million deaths every year, and 5.1% of the global disease burden is due to alcohol consumption(11 World Health Organization (WHO). Global status report on alcohol and health [Internet]. 2014 [cited 2017 Oct 14]. Available from: https://www.who.int/substance_abuse/activities/gsrah/en/
https://www.who.int/substance_abuse/acti...

2 Sanchez ZM. Binge drinking among young Brazilians and the promotion of alcoholic beverages: a Public Health concern. Epidemiol Serv Saude. 2017;26(1):195-8. doi: 10.5123/S1679-49742017000100020
https://doi.org/10.5123/S1679-4974201700...
-33 Garcia LP, Freiras LRS. Heavy drinking in Brazil: results from the 2013 National Health Survey. Epidemiol Serv Saúde. 2015;24(2):227-37. doi: 10.5123/S1679-49742015000200005
https://doi.org/10.5123/S1679-4974201500...
). Its implications are not restricted to the individual consumer, but it extends to all members of the family nucleus and society, with social and economic damage(44 Rane A, Church S, Bhatia U, Orford J, Velleman R, Nadkarni A. Psychosocial interventions for addiction-affected families in low and middle income countries: a systematic review. Addict Behav. 2017;74(1):1-8. doi: 10.1016/j.addbeh.2017.05.015
https://doi.org/10.1016/j.addbeh.2017.05...

5 Lopes APRT, Marcon SS, Decesaro MN. Abuso de bebida alcoólica e sua relação no contexto familiar. Estud Psicol. 2015;20(1):21-30. doi: 10.5935/1678-4669.20150004
https://doi.org/10.5935/1678-4669.201500...
-66 Mccann TV, Lubman DI. Stigma experience of families supporting an adultmember with substance misuse. Int J Mental Health Nurs. 2018;27(2):693-701. doi: 10.1111/inm.12355
https://doi.org/10.1111/inm.12355...
).

Families of drug users, exposed to problematic situations, experience psychological suffering, which causes them to face daily challenges, such as guilt, depression, social abandonment, and anxiety. The suffering experience interferes with relationships and family life, causing tension by trying to resist the situation(55 Lopes APRT, Marcon SS, Decesaro MN. Abuso de bebida alcoólica e sua relação no contexto familiar. Estud Psicol. 2015;20(1):21-30. doi: 10.5935/1678-4669.20150004
https://doi.org/10.5935/1678-4669.201500...
,77 Orford J, Velleman R , Natera G, Templeton L, Copello A. Addiction in the family is a major but neglected contributor to the global burden of adult ill-health. Soc Sci Med. 2013;78:70-7. doi: 10.1016/j.socscimed.2012.11.036
https://doi.org/10.1016/j.socscimed.2012...

8 Sakiyama HMT, Padin MFR, Canfield M, Laranjeira R, Mitsuhiro SS. Family members affected by a relative's substance misuse looking for social support: who are they? Drug Alcohol Depend. 2014;1(147):276-9. doi: 10.1016/j.drugalcdep.2014.11.030
https://doi.org/10.1016/j.drugalcdep.201...
-99 Marcheti MA, Mandetta MA. Criança e adolescente com deficiência: Programa de Intervenção de Enfermagem com Família. Goiânia: AB Editora;2016.). A study on the repercussions of events related to alcoholism in the lives of these families, would assist in the understanding of this phenomenon, contributing to the prevention, users' treatment and rehabilitation, besides supporting response strategies focused on the family context(1010 Santana C J, Oliveira M LF. Effects of drug involvement on long-term users' family members. Rev Rene. 2017;18(5):671-678. doi: 10.15253/2175-6783.2017000500015
https://doi.org/10.15253/2175-6783.20170...
).

Among the several problems resulting from the harmful use of alcoholic beverages, traffic accidents fill a prominent position(1111 Malta DC, Berna RTI, Silva MMA, Claro RM, Silva Jr JB, Reis AAC. Consumption of alcoholic beverages, driving vehicles, a balance of dry law, Brazil 2007-2013. Rev Saúde Pública. 2014;48(4):692-696. doi:10.1590/S0034-8910.2014048005633
https://doi.org/10.1590/S0034-8910.20140...

12 Ribeiro LS. Consumo abusivo de álcool e envolvimento em acidentes de trânsito: resultados da Pesquisa Nacional de Saúde, Brasil, 2013 [Dissertação]. ICICT/Fiocruz;2017[cited 2020 Sep 15]. Available from: https://www.arca.fiocruz.br/bitstream/icict/24843/2/lucas_ribeiro_icict_mest_2017.pdf
https://www.arca.fiocruz.br/bitstream/ic...
-1313 World Health Organization (WHO). Strategies to reduce the harmful use of alcohol [Internet]. 2008 [cited 2020 Sep 15]. Available from: https://apps.who.int/iris/bitstream/handle/10665/44395/9789241599931_eng.pdf?sequence=1
https://apps.who.int/iris/bitstream/hand...
). According to the World Health Organization, due to its sedative-hypnotic characteristic, alcohol has a strong influence on traffic accidents, which is why it was considered an "accident factor", that is, it directly affects the skills of those who drive a motor vehicle(11 World Health Organization (WHO). Global status report on alcohol and health [Internet]. 2014 [cited 2017 Oct 14]. Available from: https://www.who.int/substance_abuse/activities/gsrah/en/
https://www.who.int/substance_abuse/acti...
,1212 Ribeiro LS. Consumo abusivo de álcool e envolvimento em acidentes de trânsito: resultados da Pesquisa Nacional de Saúde, Brasil, 2013 [Dissertação]. ICICT/Fiocruz;2017[cited 2020 Sep 15]. Available from: https://www.arca.fiocruz.br/bitstream/icict/24843/2/lucas_ribeiro_icict_mest_2017.pdf
https://www.arca.fiocruz.br/bitstream/ic...
-1313 World Health Organization (WHO). Strategies to reduce the harmful use of alcohol [Internet]. 2008 [cited 2020 Sep 15]. Available from: https://apps.who.int/iris/bitstream/handle/10665/44395/9789241599931_eng.pdf?sequence=1
https://apps.who.int/iris/bitstream/hand...
). Thus, studies point to a clear trend of increased risk for the occurrence of traffic accidents among drunk drivers(1414 Damacena GN, Malta DC, Boccoline CS. Alcohol abuse and involvement in traffic accidents in the Brazilian population, 2013. Cien Saude Colet. 2016;21(12):3777-86. doi: 10.1590/1413-812320152112.25692015
https://doi.org/10.1590/1413-81232015211...

15 Ladeira RM, Malta DC, Morais Neto OL, Montenegro MMS, Soares Filho AM, Vasconcelos CH, et al. Road traffic accidents: global burden of disease study, Brazil and federated units, 1990 and 2015. Rev Bras Epidemiol. 2017;20(1):157-70. doi: 10.1590/1980-5497201700050013
https://doi.org/10.1590/1980-54972017000...
-1616 Leonard EA, Buckley T, Curtis K. Impact of alcohol on outcomes in hospitalized major trauma patients: a literature review. Trauma Nurs. 2016;23(2):103-114. doi: 10.1097/JTN.0000000000000194
https://doi.org/10.1097/JTN.000000000000...
).

Brazil has taken actions to discourage the population from driving under the influence of alcohol or any other drugs, implementing federal legislation since the 1990s, which establishes blood alcohol surveillance and imposes penalties on drivers who drive under the influence of alcohol(1515 Ladeira RM, Malta DC, Morais Neto OL, Montenegro MMS, Soares Filho AM, Vasconcelos CH, et al. Road traffic accidents: global burden of disease study, Brazil and federated units, 1990 and 2015. Rev Bras Epidemiol. 2017;20(1):157-70. doi: 10.1590/1980-5497201700050013
https://doi.org/10.1590/1980-54972017000...
,1717 Presidência da República (BR). Lei n.11.705 de 20 de junho de 2008. Altera a Lei n. 9.503, de 23 de setembro de 1997, que 'institui o Código de Trânsito Brasileiro', e a Lei n. 9.294, de 15 de julho de 1996, que dispõe sobre as restrições ao uso e à propaganda de produtos fumígeros, bebidas alcoólicas, medicamentos, terapias e defensivos agrícolas, nos termos do § 4o do art. 220 da Constituição Federal [Internet]. Diário Oficial da União;2008 [cited 2017 Nov 05]. Jun 16. 16 de junho de 2008. Available from: http://www.planalto.gov.br/ccivil_03/_ato2007-2010/2008/lei/l11705.htm
http://www.planalto.gov.br/ccivil_03/_at...
).

The law against drinking and driving was an important step towards the establishment of more effective policies to fight drinking and driving, as it imposes zero alcohol intake and attention on alcohol intake by drivers(1111 Malta DC, Berna RTI, Silva MMA, Claro RM, Silva Jr JB, Reis AAC. Consumption of alcoholic beverages, driving vehicles, a balance of dry law, Brazil 2007-2013. Rev Saúde Pública. 2014;48(4):692-696. doi:10.1590/S0034-8910.2014048005633
https://doi.org/10.1590/S0034-8910.20140...
,1717 Presidência da República (BR). Lei n.11.705 de 20 de junho de 2008. Altera a Lei n. 9.503, de 23 de setembro de 1997, que 'institui o Código de Trânsito Brasileiro', e a Lei n. 9.294, de 15 de julho de 1996, que dispõe sobre as restrições ao uso e à propaganda de produtos fumígeros, bebidas alcoólicas, medicamentos, terapias e defensivos agrícolas, nos termos do § 4o do art. 220 da Constituição Federal [Internet]. Diário Oficial da União;2008 [cited 2017 Nov 05]. Jun 16. 16 de junho de 2008. Available from: http://www.planalto.gov.br/ccivil_03/_ato2007-2010/2008/lei/l11705.htm
http://www.planalto.gov.br/ccivil_03/_at...
-1818 Presidência da República (BR). Lei nº 13.546, de 19 de dezembro de 2017. Altera dispositivos da Lei nº 9.503, de 23 de setembro de 1997 (Código de Trânsito Brasileiro), para dispor sobre crimes cometidos na direção de veículos automotores. Diário Oficial da União;2018 [cited 2020 Aug 27]. Seção 1. Available from: http://www.planalto.gov.br/ccivil_03/_Ato2015-2018/2017/Lei/L13546.htm
http://www.planalto.gov.br/ccivil_03/_A...
). According to this law, drivers under the influence of alcohol will get fines, suspension of the right to drive for 12 months and the vehicle's apprehension, with the risk of imprisonment if there is a traffic crime(1717 Presidência da República (BR). Lei n.11.705 de 20 de junho de 2008. Altera a Lei n. 9.503, de 23 de setembro de 1997, que 'institui o Código de Trânsito Brasileiro', e a Lei n. 9.294, de 15 de julho de 1996, que dispõe sobre as restrições ao uso e à propaganda de produtos fumígeros, bebidas alcoólicas, medicamentos, terapias e defensivos agrícolas, nos termos do § 4o do art. 220 da Constituição Federal [Internet]. Diário Oficial da União;2008 [cited 2017 Nov 05]. Jun 16. 16 de junho de 2008. Available from: http://www.planalto.gov.br/ccivil_03/_ato2007-2010/2008/lei/l11705.htm
http://www.planalto.gov.br/ccivil_03/_at...
-1818 Presidência da República (BR). Lei nº 13.546, de 19 de dezembro de 2017. Altera dispositivos da Lei nº 9.503, de 23 de setembro de 1997 (Código de Trânsito Brasileiro), para dispor sobre crimes cometidos na direção de veículos automotores. Diário Oficial da União;2018 [cited 2020 Aug 27]. Seção 1. Available from: http://www.planalto.gov.br/ccivil_03/_Ato2015-2018/2017/Lei/L13546.htm
http://www.planalto.gov.br/ccivil_03/_A...
).

The experience with the individual who violates the law against drinking and driving, whether it is an acute/binge user or a chronic user(22 Sanchez ZM. Binge drinking among young Brazilians and the promotion of alcoholic beverages: a Public Health concern. Epidemiol Serv Saude. 2017;26(1):195-8. doi: 10.5123/S1679-49742017000100020
https://doi.org/10.5123/S1679-4974201700...
), weakens family relationships(1919 Elvira IKS. Vivências e implicações das penalidades da lei seca para o infrator e suas famílias. [Dissertação] [Internet]. Universidade Estadual de Maringá. 2019 [cited 2020 Oct 20]. 114p. Available from: http://www.pse.uem.br/teses-e-dissertacoes/dissertacoes
http://www.pse.uem.br/teses-e-dissertaco...
-2020 Elvira IKS, Rocha BP, Oliveira MLF. Alcoolemia no trânsito: vivências das penalidades da lei seca no contexto familiar dos infratores. In Anais do II Congresso de Saúde Coletiva da UFPR [Internet];2020 jul. 27 - 31[cited 2020 Oct 20];Curitiba, PR: Biblioteca Digital de Eventos Científicos da UFPR. Available from: https://eventos.ufpr.br/csc/csc20/paper/view/4293
https://eventos.ufpr.br/csc/csc20/paper/...
), because risky attitudes generate traffic violence, consequently fatal victims and physical and emotional sequelae in survivors, affect the offender's family members, who share the consequences of these attitudes, whether financial, psychological or physical(55 Lopes APRT, Marcon SS, Decesaro MN. Abuso de bebida alcoólica e sua relação no contexto familiar. Estud Psicol. 2015;20(1):21-30. doi: 10.5935/1678-4669.20150004
https://doi.org/10.5935/1678-4669.201500...
,77 Orford J, Velleman R , Natera G, Templeton L, Copello A. Addiction in the family is a major but neglected contributor to the global burden of adult ill-health. Soc Sci Med. 2013;78:70-7. doi: 10.1016/j.socscimed.2012.11.036
https://doi.org/10.1016/j.socscimed.2012...
,2121 Maciel SC, Melo JR, Dias CC, Silva GL, Gouveia YB. Depressive symptoms in family members of drug-addicts. Psicol Teor Prat [Internet]. 2014 [cited 2018 Jun 04];16(2):18-28. Available from: http://pepsic.bvsalud.org/pdf/ptp/v16n2/02.pdf
http://pepsic.bvsalud.org/pdf/ptp/v16n2/...
-2222 Reis LM, Oliveira MLF. Social vulnerability in families living with long-term addictive behavior. Acta Paul Enferm. 2017;30(4):412-419. doi:10.1590/1982-0194201700061
https://doi.org/10.1590/1982-01942017000...
).

Knowing the consequences of the association of alcohol and motor vehicle driving in the family context(55 Lopes APRT, Marcon SS, Decesaro MN. Abuso de bebida alcoólica e sua relação no contexto familiar. Estud Psicol. 2015;20(1):21-30. doi: 10.5935/1678-4669.20150004
https://doi.org/10.5935/1678-4669.201500...
,2121 Maciel SC, Melo JR, Dias CC, Silva GL, Gouveia YB. Depressive symptoms in family members of drug-addicts. Psicol Teor Prat [Internet]. 2014 [cited 2018 Jun 04];16(2):18-28. Available from: http://pepsic.bvsalud.org/pdf/ptp/v16n2/02.pdf
http://pepsic.bvsalud.org/pdf/ptp/v16n2/...
), this study aims to answer the following concerns: How did the family experience the violation by alcohol abuse of a family member? What are the repercussions of the penalties resulting from the violation of the law against drinking and driving on the family?

OBJECTIVES

To understand the experiences of family members of drivers who violate the law against drinking and driving and the post-penal repercussions.

METHODS

Ethical aspects

The project was approved by the Research Ethics Committee Involving Human Beings of the State University of Maringá, meeting the ethical aspects according to Resolution 466/2012 of the National Health Council. The interviewed family members were identified by the letter F, followed by the ordinal number that respects the sequence of the interviews, assuring the participants' confidentiality.

Type of study

This is a descriptive, qualitative study, to understand the meaning of alcohol use and the violation of the law against drinking and driving in families of offenders, based on Minayo's technique of thematic analysis(2323 Minayo MC. O desafio do conhecimento: pesquisa qualitativa em saúde. 14. ed. São Paulo: Hucitec;2015.).

Study setting and data source

Participants were family members of drivers who violated the law against drinking and driving, and were part of the Traffic Justice and Sobriety Project in Maringá, Paraná, and were registered in the Poison Control Center database of the Hospital Universitário Regional de Maringá - CCI/HUM as intoxicated by alcohol and other drugs.

The Traffic Justice and Sobriety Project of the First Criminal Court of Maringá was implemented in 2016. It is an educational intersectoral project, based on Law 13281/2016, that carry out activities for the offending driver who was fined for drunk driving, as an alternative penalty of the provision of services in health centers(1919 Elvira IKS. Vivências e implicações das penalidades da lei seca para o infrator e suas famílias. [Dissertação] [Internet]. Universidade Estadual de Maringá. 2019 [cited 2020 Oct 20]. 114p. Available from: http://www.pse.uem.br/teses-e-dissertacoes/dissertacoes
http://www.pse.uem.br/teses-e-dissertaco...
,2424 Presidência da República (BR). Lei n. 13.281, de 04 de maio de 2016. Altera a Lei n. 9.503, de 23 de setembro de 1997 (Código de Trânsito Brasileiro), e a Lei n. 13.146, de 6 de julho de 2015[Internet]. Diário Oficial da União;2016 [cited 2019 Jan 27]. Maio 5. Seção 1. Available from: http://www.planalto.gov.br/ccivil_03/_ato2015-2018/2016/lei/l13281.htm
http://www.planalto.gov.br/ccivil_03/_at...
), aimed at contributing to the change the offender's behavior and with the decrease of reoffending of alcohol in traffic.

The Project's activities are carried out in four phases: court hearing; participation in a meeting/workshop, which addresses aspects of defensive driving, with a primary focus on drunk driving and information for helping in health services; provision of services to assist victims of accidents treated in the health services/hospitals involved in the Project, with a workload of 30 hours; and evaluation of the effectiveness on the activities performed.

The first study scenario was the CCI/HUM, for the selection of the epidemiological records of Toxicological Occurrence of Alcohol Intoxication and/or Other Drugs - OT/IA of the offending drivers, who are reported through the University Extension Project Toxicovigilância e Busca Ativa de Casos e Educação em Saúde (Toxicovigilance and Active Search of Cases and Health Education), filled in meetings/workshops of the Traffic Justice and Sobriety Project. Drivers were considered intoxicated if their alcohol intake was chacked by an alcohol meter or signs of intoxication.

The following inclusion criteria for the study were considered: drivers approached by the Military Police in cases of traffic accidents or traffic inspections of different types; participants of the Traffic Justice and Sobriety Project in 2017; and who lived in the city of Maringá - PR. Offending drivers with incomplete addresses were excluded from the CCI/HUM records.

After selection, the second scenario of the study was the home of the offender/family member, to conduct a semi-structured interview. The following inclusion criteria for family members were used: being 18 years of age or older; and living with the offending driver, playing the role of a supporter/caregiver in the life of this family member. Family members of offenders who had not completed the four phases established by the Traffic Justice and Sobriety Project were excluded.

A total of 115 records of offending drivers met the criteria for inclusion in the survey and 30 OT/IA records were randomly separated for access to families. Eight family members were interviewed effectively, using the theoretical saturation criterion for dimensioning the sample, supported by the saturation of the speeches and the research objective achieved(2525 Minayo MCS. Amostragem e saturação em pesquisa qualitativa: consensos e controvérsias. Revista Pesquisa Qualitativa [Internet]. 2017 [cited 2017 Jul 5];5(7):01-12. Available from: https://editora.sepq.org.br/index.php/rpq/article/view/82/59
https://editora.sepq.org.br/index.php/rp...
).

Data collection

Data collection was carried out from October to November 2018, using interviews through a semi-structured script, with sociodemographic questions of the offender and family members, problems related to drug use and about the violation. The interviews were conducted in full by the main author, recorded on audio and guided by the questions: Talk about what it is like for you to live with the use of alcohol in your family? What are the repercussions of the penalties of the law against drinking and driving in the life of the offending driver and his family's life?

Home visits were previously scheduled by telephone contact and access to families was through addresses recorded in the OT/IA forms. There was no prior contact with the participants, and training to conduct the interviews was carried out in research groups. The interviews were conducted in two meetings per family, with an average of 40 minutes each, and in three interviews, in addition to the participant and interviewer, another family member was present, according to the interviewee's request.

Data organization and analysis

For the analysis of the relative's interview, the interviews were listened to, respecting the period of not exceeding three days after the meeting. The responses to the triggering questions were transcribed in full, typed into a text document using Microsoft Office Word 10.0.

The results were analyzed using Minayo's thematic analysis technique(2323 Minayo MC. O desafio do conhecimento: pesquisa qualitativa em saúde. 14. ed. São Paulo: Hucitec;2015.), following the phases of pre-analysis, material exploration and treatment of results/inference/interpretation.

In the pre-analysis, an attempt is made to make a comprehensive reading of the selected material, exhaustively, reaching deeper levels, so the author is saturated with the material. In the second phase, the exploration of the selected material is carried out, the analysis itself, also called categorization, which comprises making the clippings of the texts in units of records and the classification and aggregation of information in thematic categories, aimed at identifying the nuclei of meanings(2323 Minayo MC. O desafio do conhecimento: pesquisa qualitativa em saúde. 14. ed. São Paulo: Hucitec;2015.). In the third stage of treatment of the results/inference/interpretation, we seek to highlight the information provided by the analysis, through simple quantification. Thus, the inference is made at an intermediate stage, between analytical treatment and interpretation. Finally, the results obtained are interpreted using the theoretical basis(2323 Minayo MC. O desafio do conhecimento: pesquisa qualitativa em saúde. 14. ed. São Paulo: Hucitec;2015.).

RESULTS

The offending drivers were men, half were single, with ages ranging from 23 to 53 years old and an average of 42.0 (SD±6.02) and 7.8 (SD±2.47) years of education. The time of alcohol use, reported by the offending drivers, was 19.2 (SD±6.66) years and two offenders used illicit drugs associated with alcoholic beverages. Regarding the violation, three drivers were fined by the Military Police in traffic inspections and five were involved in traffic accidents after drinking alcohol.

The family members interviewed were women: two mothers, two wives and four sisters. The age ranged from 22 to 61 years, with an average of 44.4 (SD±14.56) and education of 9.5 (SD±3.60) years.

The family members speeches were organized into three themes, emphasizing situations experienced by families and the consequences of the penalties of the law against drinking and driving: Family suffering from the use of alcohol and other drugs; Turning point: positive and negative changes arising from the violation in the life of the offending driver and the family; and Recognizing the importance of the Traffic Justice and Sobriety Project in the offender and families' lives.

Theme 1: Family suffering from the use of alcohol and other drugs

The daily problems from living with the user can cause disorders in the family environment, mainly due to fights and financial expenses to buy alcohol and other drugs. In some families, the user was the primary provider of the home. Furthermore, it was observed that living with a family member who uses alcohol and/or other drugs generates codependency in these families (Chart 1).

Whether living with occasional alcohol use or abuse, the families expressed the repercussion as always being negative. Family suffering is intense, influenced by the "high doses" ingested on weekends and by daily living with alcohol consumption (Chart 1).

Chart 1
Thematic categories and text fragments (speeches) that originated the theme 1, Maringa, Parana, Brazil, 2018

Chart 1 also shows that in addition to testimonies of suffering from alcohol use, the problem of the association of drinking and driving was reported in a meaningful way by families, causing suffering due to the feeling of fear with the possibility that their family member will suffer some physical trauma, sequelae and permanent disability, besides death from a traffic accident. Moreover, the fear concerning the relative, the interviewees expressed fear that their relative would drive under the influence of alcohol and cause some harm to other people, to other families, which they called "innocent people".

Theme 2: Turning point: positive and negative changes from the violation in the offending driver and the family's lives

The law against drinking and driving was understood and supported by families as an extremely important law, which must be complied with by the offenders, even though they experience difficulties in the family context caused by the charge. These difficulties can be seen, especially, by the driver's unemployment and the financial resources spent to pay fines and other administrative measures (Chart 2).

Chart 2
Thematic categories and textual fragments (speeches) that originated the theme 2, Maringa, Parana, Brazil, 2018

On the other hand, although the violation was a difficult process experienced by the family, the penalties of the law against drinking and driving were understood, by some family members, as an essential measure in the offending driver's process of awareness, influencing the cessation of alcohol use. Although some offenders persisted to drink alcohol, some families expressed a feeling of relief that the family member no longer took the risks of drunk driving (Chart 2).

Theme 3 - Recognizing the importance of the Traffic Justice and Sobriety Project for the offender and families' lives

The interviewees showed support for the Traffic Justice and Sobriety Project, understood by them not as a punishment, but as an educational awareness activity. It was recognized by families as an impacting project, directly influencing offending drivers to rethink the act of driving under the influence of alcohol (Chart 3).

Chart 3
Thematic categories and text fragments (speeches), that originated the theme 3, Maringa, Parana, Brazil, 2018

The families experienced, with their members, the process of participation in the Project and they reproduced the knowledge on this theme, since they mentioned their experiences with the family (Chart 3).

The Project influenced the decision-making for the psychosocial treatment of the offender, although relapses were reported sometime after the end of the activities in the health units. In this way, family members expressed the desire that the activities in the Project would be carried out with a workload over 40 hours, understanding the influence of this period on the offender's rehabilitation process (Chart 3).

DISCUSSION

The II National Survey of Alcohol and Drugs estimated that 5.7% of the Brazilian population is dependent on alcohol and/or marijuana and/or cocaine, that is, in households composed of an average of four people, one is dependent, with more than eight million drug users and 30 million people living with a drug addict(2626 Laranjeira R, Sakiyama H, Padin MFR, Madruga CA, organizadores. Lenad família: Levantamento nacional de famílias dos dependentes químicos. São Paulo: Instituto Nacional de Ciência e Tecnologia para Políticas Públicas de Álcool e Outras Drogas (INPAD) [Internet]. 2013 [cited 2017 Nov 10]. Available from: https://inpad.org.br/_lenad-familia/
https://inpad.org.br/_lenad-familia/...
). These families experience fears and insecurities occurring from the dependence and risk behaviors assumed by their members(55 Lopes APRT, Marcon SS, Decesaro MN. Abuso de bebida alcoólica e sua relação no contexto familiar. Estud Psicol. 2015;20(1):21-30. doi: 10.5935/1678-4669.20150004
https://doi.org/10.5935/1678-4669.201500...
,66 Mccann TV, Lubman DI. Stigma experience of families supporting an adultmember with substance misuse. Int J Mental Health Nurs. 2018;27(2):693-701. doi: 10.1111/inm.12355
https://doi.org/10.1111/inm.12355...

7 Orford J, Velleman R , Natera G, Templeton L, Copello A. Addiction in the family is a major but neglected contributor to the global burden of adult ill-health. Soc Sci Med. 2013;78:70-7. doi: 10.1016/j.socscimed.2012.11.036
https://doi.org/10.1016/j.socscimed.2012...
-88 Sakiyama HMT, Padin MFR, Canfield M, Laranjeira R, Mitsuhiro SS. Family members affected by a relative's substance misuse looking for social support: who are they? Drug Alcohol Depend. 2014;1(147):276-9. doi: 10.1016/j.drugalcdep.2014.11.030
https://doi.org/10.1016/j.drugalcdep.201...
,2727 Antunes F, Oliveira MLF. The quotidian of family caregivers of alcohol users who required intensive care hospitalization. Cienc Cuid Saúde [Internet]. 2016 [cited 2019 Jan 03];15(1):3-10. Available from: http://periodicos.uem.br/ojs/index.php/CiencCuidSaude/article/view/25153/pdf_1
http://periodicos.uem.br/ojs/index.php/C...
-2828 Elvira IKS, Reis LV, Gavioli A, Marcon SS, Oliveira MLF. Esperança de famílias que convivem com comportamento aditivo por tempo prolongado. Rev Enferm C-Oeste Mineiro. 2019;9(2019):e3241. doi: 10.19175/recom.v9i0.3241
https://doi.org/10.19175/recom.v9i0.3241...
).

Relatives of drug users have significantly more chronic physical symptoms, complaints of mental suffering and greater psychosocial difficulties than the average population(2121 Maciel SC, Melo JR, Dias CC, Silva GL, Gouveia YB. Depressive symptoms in family members of drug-addicts. Psicol Teor Prat [Internet]. 2014 [cited 2018 Jun 04];16(2):18-28. Available from: http://pepsic.bvsalud.org/pdf/ptp/v16n2/02.pdf
http://pepsic.bvsalud.org/pdf/ptp/v16n2/...
,2727 Antunes F, Oliveira MLF. The quotidian of family caregivers of alcohol users who required intensive care hospitalization. Cienc Cuid Saúde [Internet]. 2016 [cited 2019 Jan 03];15(1):3-10. Available from: http://periodicos.uem.br/ojs/index.php/CiencCuidSaude/article/view/25153/pdf_1
http://periodicos.uem.br/ojs/index.php/C...
-2828 Elvira IKS, Reis LV, Gavioli A, Marcon SS, Oliveira MLF. Esperança de famílias que convivem com comportamento aditivo por tempo prolongado. Rev Enferm C-Oeste Mineiro. 2019;9(2019):e3241. doi: 10.19175/recom.v9i0.3241
https://doi.org/10.19175/recom.v9i0.3241...
). Those who suffer most from the negative impact caused by the abuse of alcoholic beverages or illicit substances are women, who are generally responsible for the users' treatment, as a large part of them share the role of "head" of the family and care for the user and the whole family(88 Sakiyama HMT, Padin MFR, Canfield M, Laranjeira R, Mitsuhiro SS. Family members affected by a relative's substance misuse looking for social support: who are they? Drug Alcohol Depend. 2014;1(147):276-9. doi: 10.1016/j.drugalcdep.2014.11.030
https://doi.org/10.1016/j.drugalcdep.201...
,2222 Reis LM, Oliveira MLF. Social vulnerability in families living with long-term addictive behavior. Acta Paul Enferm. 2017;30(4):412-419. doi:10.1590/1982-0194201700061
https://doi.org/10.1590/1982-01942017000...
).

The family members, in general, revealed their daily struggle and confrontation, both because of the direct contact with the user, and because of the feelings of uncertainty, shame, sadness and insecurity concerning the trajectory of their family members(55 Lopes APRT, Marcon SS, Decesaro MN. Abuso de bebida alcoólica e sua relação no contexto familiar. Estud Psicol. 2015;20(1):21-30. doi: 10.5935/1678-4669.20150004
https://doi.org/10.5935/1678-4669.201500...
,2121 Maciel SC, Melo JR, Dias CC, Silva GL, Gouveia YB. Depressive symptoms in family members of drug-addicts. Psicol Teor Prat [Internet]. 2014 [cited 2018 Jun 04];16(2):18-28. Available from: http://pepsic.bvsalud.org/pdf/ptp/v16n2/02.pdf
http://pepsic.bvsalud.org/pdf/ptp/v16n2/...
-2222 Reis LM, Oliveira MLF. Social vulnerability in families living with long-term addictive behavior. Acta Paul Enferm. 2017;30(4):412-419. doi:10.1590/1982-0194201700061
https://doi.org/10.1590/1982-01942017000...
,2828 Elvira IKS, Reis LV, Gavioli A, Marcon SS, Oliveira MLF. Esperança de famílias que convivem com comportamento aditivo por tempo prolongado. Rev Enferm C-Oeste Mineiro. 2019;9(2019):e3241. doi: 10.19175/recom.v9i0.3241
https://doi.org/10.19175/recom.v9i0.3241...
). Family conflicts, divorces and financial problems due to the money continuously spent to buy alcohol and unemployment are consequences of harmful alcohol consumption(55 Lopes APRT, Marcon SS, Decesaro MN. Abuso de bebida alcoólica e sua relação no contexto familiar. Estud Psicol. 2015;20(1):21-30. doi: 10.5935/1678-4669.20150004
https://doi.org/10.5935/1678-4669.201500...
,2121 Maciel SC, Melo JR, Dias CC, Silva GL, Gouveia YB. Depressive symptoms in family members of drug-addicts. Psicol Teor Prat [Internet]. 2014 [cited 2018 Jun 04];16(2):18-28. Available from: http://pepsic.bvsalud.org/pdf/ptp/v16n2/02.pdf
http://pepsic.bvsalud.org/pdf/ptp/v16n2/...
-2222 Reis LM, Oliveira MLF. Social vulnerability in families living with long-term addictive behavior. Acta Paul Enferm. 2017;30(4):412-419. doi:10.1590/1982-0194201700061
https://doi.org/10.1590/1982-01942017000...
). With all the problems happening and experienced by the family, the fear of accidents, aggression and the driver's death is greater than all of these(2929 Santos EL, Simon BS, Schimitd SMS, Machado BP. The reflections of living together with crack users in family relationships. J Nurs Health [Internet]. 2016 [cited 2017 Nov 10];1(1):4-16. Available from: https://periodicos.ufpel.edu.br/ojs2/index.php/enfermagem/article/view/5959
https://periodicos.ufpel.edu.br/ojs2/ind...
).

The Brazilian government invests in increasingly rigorous measures for those who take up the risk of drinking and driving(1414 Damacena GN, Malta DC, Boccoline CS. Alcohol abuse and involvement in traffic accidents in the Brazilian population, 2013. Cien Saude Colet. 2016;21(12):3777-86. doi: 10.1590/1413-812320152112.25692015
https://doi.org/10.1590/1413-81232015211...
). Violating traffic laws and taking over driving under the influence of alcohol is considered a very serious violation by the Código de Trânsito Brasileiro - CTB (Brazilian Traffic Code). And those fined for violating the law against drinking and driving are determined to pay 10 times the fine, that is, R$ 2934.70(1818 Presidência da República (BR). Lei nº 13.546, de 19 de dezembro de 2017. Altera dispositivos da Lei nº 9.503, de 23 de setembro de 1997 (Código de Trânsito Brasileiro), para dispor sobre crimes cometidos na direção de veículos automotores. Diário Oficial da União;2018 [cited 2020 Aug 27]. Seção 1. Available from: http://www.planalto.gov.br/ccivil_03/_Ato2015-2018/2017/Lei/L13546.htm
http://www.planalto.gov.br/ccivil_03/_A...
,2424 Presidência da República (BR). Lei n. 13.281, de 04 de maio de 2016. Altera a Lei n. 9.503, de 23 de setembro de 1997 (Código de Trânsito Brasileiro), e a Lei n. 13.146, de 6 de julho de 2015[Internet]. Diário Oficial da União;2016 [cited 2019 Jan 27]. Maio 5. Seção 1. Available from: http://www.planalto.gov.br/ccivil_03/_ato2015-2018/2016/lei/l13281.htm
http://www.planalto.gov.br/ccivil_03/_at...
).

Besides the financial cost of the fine, the offending driver commits a traffic crime when he is caught driving a vehicle with a concentration equal to or greater than six decigrams of alcohol per liter of blood or equal to or greater than 0.3 milligrams of alcohol per liter of alveolar air, or if signs of intoxication are detected. The vehicle is apprehended and the driver arrested, if there is no situation of killing or serious bodily injury, the driver can pay bail of up to one hundred minimum wages(1818 Presidência da República (BR). Lei nº 13.546, de 19 de dezembro de 2017. Altera dispositivos da Lei nº 9.503, de 23 de setembro de 1997 (Código de Trânsito Brasileiro), para dispor sobre crimes cometidos na direção de veículos automotores. Diário Oficial da União;2018 [cited 2020 Aug 27]. Seção 1. Available from: http://www.planalto.gov.br/ccivil_03/_Ato2015-2018/2017/Lei/L13546.htm
http://www.planalto.gov.br/ccivil_03/_A...
).

The families of the offending drivers, under study here, experienced the penalties of the law against drinking and driving in its negative and positive aspects. The measures of authoritarian are evidenced by families as a necessary attempt for the user to recognize, with greater significance, the consequences arising from drinking(2222 Reis LM, Oliveira MLF. Social vulnerability in families living with long-term addictive behavior. Acta Paul Enferm. 2017;30(4):412-419. doi:10.1590/1982-0194201700061
https://doi.org/10.1590/1982-01942017000...
).

The law was understood as a measure to save lives and prevent traffic accidents caused by the influence of alcohol in the direction of motor vehicles. The families supported the law, recognizing the forthcoming risk of damage to the individual and other families, since most of the charges of its members were for being involved in traffic accidents.

However, the penalties reflected in the family financial condition, considering that many drivers were the main providers. Families highlighted long-term financial consequences and unemployment after the violation, which had an impact on the families' lives, both in the financial aspect, as well as in professional and family achievement.

Furthermore, they indicated the law against drinking and driving as a turning point in their family members' consumption of alcoholic beverages. A turning point is a moment when the individual becomes aware of his actions from an impactful, joyful or painful event, and starts to try to stop using the drug(3030 Oliveira LG, Nappo SA. Characterization of the crack cocaine culture in the city of São Paulo: a controlled pattern of use. Rev. Saúde Pública. 2008;42(4):664-71. doi: 10.1590/S0034-89102008005000039
https://doi.org/10.1590/S0034-8910200800...
-3131 Marangoni SR, Oliveira MLF. Triggering factors for drug abuse in women. Texto Contexto Enferm. 2013;22(3):662-70. doi: 10.1590/S0104-07072013000300012
https://doi.org/10.1590/S0104-0707201300...
). The violation was the moment that increased the propensity or behaviors in a "transformation" of life change towards the cessation or decrease of damages from the drug use(3131 Marangoni SR, Oliveira MLF. Triggering factors for drug abuse in women. Texto Contexto Enferm. 2013;22(3):662-70. doi: 10.1590/S0104-07072013000300012
https://doi.org/10.1590/S0104-0707201300...
).

The turning points are not only the cessation of consumption, but the tendency of individuals to move from the compulsive phase of drug use to controlled patterns(3030 Oliveira LG, Nappo SA. Characterization of the crack cocaine culture in the city of São Paulo: a controlled pattern of use. Rev. Saúde Pública. 2008;42(4):664-71. doi: 10.1590/S0034-89102008005000039
https://doi.org/10.1590/S0034-8910200800...
). However, relapses may happen if failure trying to achieve established goals and not taking over life more consciously occur(3131 Marangoni SR, Oliveira MLF. Triggering factors for drug abuse in women. Texto Contexto Enferm. 2013;22(3):662-70. doi: 10.1590/S0104-07072013000300012
https://doi.org/10.1590/S0104-0707201300...
).

After cessation of alcohol use, that is, alcohol abstinence, the recurrence rates decrease when the individual is aware of his dependence, determined and committed to changing behavior and have a new lifestyle(3131 Marangoni SR, Oliveira MLF. Triggering factors for drug abuse in women. Texto Contexto Enferm. 2013;22(3):662-70. doi: 10.1590/S0104-07072013000300012
https://doi.org/10.1590/S0104-0707201300...
).

Family members acknowledged that harm reduction actions, such as not drinking and driving, although the family member persisted to drink alcohol, should be encouraged, as it reduces stress and suffering in the family. Harm reduction strategies, which aim to identify the presence of a problem, stimulate behavior change and propose strategies for this change to happen(3232 Lima MJ, Oliveira LC, Silva HR, Pereira KR, Nascimento EDS, Costa RG, et al. Intervenção de redução de danos causados por drogas lícitas ilícitas a um individuo em situação de rua. Rev Extendere [Internet]. 2017 [cited 2019 Jan 02];5(1):67-78. Available from: http://periodicos.uern.br/index.php/extendere/article/view/2575/1406
http://periodicos.uern.br/index.php/exte...
), have been progressively incorporated into Brazilian drug legislation. Thus, in the last two decades, health policies have recognized the care gap provided to users of alcohol and other drugs that were carried out only in cessation programs(3232 Lima MJ, Oliveira LC, Silva HR, Pereira KR, Nascimento EDS, Costa RG, et al. Intervenção de redução de danos causados por drogas lícitas ilícitas a um individuo em situação de rua. Rev Extendere [Internet]. 2017 [cited 2019 Jan 02];5(1):67-78. Available from: http://periodicos.uern.br/index.php/extendere/article/view/2575/1406
http://periodicos.uern.br/index.php/exte...
-3333 Machado LV, Boarini ML. Políticas sobre drogas no Brasil: a estratégia de redução de danos. Psicol Cienc Prof. 2013;33(3):580-95. doi: 10.1590/S1414-98932013000300006
https://doi.org/10.1590/S1414-9893201300...
).

The Traffic Justice and Sobriety Project was understood as a harm reduction strategy for families and brought to the home experiences lived by offenders in health units, allowing families to perceive the impact of project activities on the offender, directly influencing awareness of the damage caused by driving under the influence of alcohol.

The desire for the Project to have a longer workload, seems to indicate that families also recognize it as a space for rehabilitation and shows that these families need educational actions and less stricto sensu punitive, so that their families cease the use of alcohol and/or other drugs and adopt healthy lifestyle habits.

In this perspective, more partnerships are required between public health networks with national traffic agencies, in raising awareness among drivers and others involved in traffic. Public health networks are closely related to fighting violence in traffic, since harmful alcohol consumption is an important public health problem. Working to promote the health of drug users is closely related to the well-being of their families.

Study limitations

Although the analysis presented here refers to data that identify only a small part of the problems associated with alcohol intake and driving, the study shows the consequences associated with this practice related to the penalties of the law against drinking and driving, which significantly affect the lives of families living with offending drivers.

As this is a study with families of traffic violators, who participated in a specific local project, we observed limited literature for further comparisons and discussions. However, the originality of the study stands out, which may support other research in diverse contexts.

Contributions to the field of nursing, health, or public policy

The impact of risky behavior by users of alcohol and other drugs is closely related to nursing actions, recognizing the role of caring through direct contact to the patient and his family. Thus, different learning scenarios make it possible to exercise clinical judgment in their training, by linking teaching and service, to establish relationships in the different settings of the individual, family, and society.

Studying the repercussions of the law against drinking and driving in the family context allows contributing to a better understanding of the problems related to alcohol and driving, besides being able to provide subsidies for the establishment of specific policies and campaigns, highlighting the importance of the link between awareness, prevention and inspection.

FINAL CONSIDERATIONS

This study highlights the repercussions of the law against drinking and driving penalties in the family environment, reported by families, in their positive and negative aspects. Participants reveal the suffering of families and drivers who violate the law against drinking and driving due to the daily problems caused by drinking, in which we highlight fights, financial problems, prison and fear of death.

The law against drinking and driving penalties was negatively impacted by financial expenses and unemployment after the offense. However, it was also positively recognized as a turning point in the lives of these families, mainly concerning the cessation and/or harm reduction from alcohol use. Family members also reported the meaning of the Traffic Justice and Sobriety Project in their lives, as a harm reduction strategy in terms of not driving under the influence of alcohol.

This study allows reflection on the importance of the family in the process of coping with risky behaviors involving alcohol and driving, and highlights that just punitive laws are important to establish rules on human behavior in traffic, educational projects activities are crucial in making drivers aware of compliance with the law.

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Edited by

EDITOR IN CHIEF: Antonio José de Almeida Filho
ASSOCIATE EDITOR: Mitzy Reichembach

Publication Dates

  • Publication in this collection
    22 Feb 2021
  • Date of issue
    2021

History

  • Received
    19 Sept 2019
  • Accepted
    05 Oct 2020
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