Terapia de Aceitação e Compromisso e Uso de Drogas: Uma Revisão Sistemática

Maia, Mariana Fonseca Carvalho; Santos, Bruna Ferreira dos; Castro, Lorrainy Costa de; Vieira, Natália São Tiago; Silveira, Pollyanna Santos da

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Sumário

Psychology of Health • Paidéia (Ribeirão Preto) 31 • 2021 • https://doi.org/10.1590/1982-4327e3136 copiar

Terapia de Aceitação e Compromisso e Uso de Drogas: Uma Revisão Sistemática

Autoria SCIMAGO INSTITUTIONS RANKINGS

Resumo

O uso prejudicial de substâncias psicoativas tem sido considerado um dos maiores problemas de saúde pública. Diversas abordagens são utilizadas para o tratamento dos transtornos relacionados ao uso de substâncias diante dos desafios impostos. O presente estudo teve por objetivo identificar os trabalhos empíricos que utilizaram a ACT para o tratamento do uso de substâncias e seus respectivos resultados no que diz respeito à aceitação, viabilidade e redução da gravidade da dependência, bem como nos resultados relacionados às comorbidades e demais aspectos associados ao uso através de uma revisão sistemática da literatura acerca do tema, utilizando-se das recomendações do guia Preferred Report Items for Systematic Reviews and Meta-Analyses (PRISMA) e buscas nas bases Pubmed, APA PsycNET, SciELO, ScienceDirect, Web of Science, BVS e LILACS. Foram analisados 17 estudos, permitindo observar aumento da flexibilidade psicológica, atenuação das taxas de abandono do tratamento e redução do consumo de substâncias nas intervenções analisadas.

Palavras-chave:
drogas; terapia cognitiva; intervenção psicológica

Articles	Population (n)	Objectives	Instruments
Luoma, Kohlenberg, Hayes and Fletcher (2011Luoma, J. B., Kohlenberg, B. S., Hayes, S. C., & Fletcher, L. (2011). Slow and steady wins the race: A randomized clinical trial of acceptance and commitment therapy targeting shame in substance use disorders. Journal of Consulting and Clinical Psychology, 80(1), 43-53. doi:10.1037/a0026070 https://doi.org/10.1037/a0026070... )	Program participants (n = 133)	Assess ACT for reducing shame in substance users	ISS; TSR; TLFB; The General Health Questinnaire- 12; The Quality of Life Scale; The Multidimentional Scale of Perceveid Social Support.
Litvin, Kovacs, Hayes and Brandon (2012Litvin, E. B., Kovacs, M. A., Hayes, P. L., & Brandon, T. H. (2012). Responding to tobacco craving: Experimental test of acceptance versus suppression. Psychology of Addictive Behaviors, 26(4), 830-837. doi:10.1037/a0030351 https://doi.org/10.1037/a0030351... )	Adult smokers (n = 162)	Compare ACT to suppression technique	FTND; QSU-4; Single item urgency scale; Magnitude estimate of desire.
Villagrá Lanza & Gonzáles-Menéndez (2013Villagrá Lanza P., & González-Menéndez, A. (2013). Acceptance and commitment therapy for drug abuse in incarcerated women. Psicothema, 25(3), 307-312. doi:10.7334/psicothema2012.292 https://doi.org/10.7334/psicothema2012.2... )	Incarcerated women (n = 31)	Test the effectiveness of ACT in the treatment of substance use disorders	Interview ad hac; MINI International Neuropsychiatric Interview; ASI-6; Anxiety sensitivity index; AAQ-II; AU; Auto save.
Villagrá Lanza, Fernández García, Rodríguez Lamelas and González-Menéndez (2014Villagrá Lanza, P., Fernández García, P., Rodríguez Lamelas, F., & González-Menéndez, A. (2014). Acceptance and commitment therapy versus cognitive behavioral therapy in the treatment of substance use disorder with incarcerated women: Drug abuse treatments to incarcerated women. Journal of Clinical Psychology, 70(7), 644-657. doi:10.1002/jclp.22060 https://doi.org/10.1002/jclp.22060... )	Incarcerated women (n = 50)	Determine the differential efficacy of ACT and CBT in substance use disorders	ASI-6; MINI Internacional Neuropsychiatric Interview; ASI; AAQ-II; UA; Auto save.
Kelly et al. (2015Kelly, M. M., Sido, H., Forsyth, J. P., Ziedonis, D. M., Kalman, D., & Cooney, J. L. (2015). Acceptance and commitment therapy smoking cessation treatment for veterans with posttraumatic stress disorder: A pilot study. Journal of Dual Diagnosis , 11(1), 50-55. doi:10.1080/15504263.2014.992201 https://doi.org/10.1080/15504263.2014.99... )	Smokers undergoing drug treatment for bipolar disorder and smoking (n = 19)	Evaluation of the viability and acceptance of ACT-TP combined with nicotine patches	Structured clinical interview for the non-patient version of the DSM-IV; FTND; The scale of contemplation; CSQ-8; QSU-Brief; Self report.
Marín Romero (2015Marín Romero, B. (2015). Tratamiento mediante ACT en un caso de conductas adictivas con sintomatología prefrontal [Treatment by ACT in a case of addictive behaviors with prefrontal symptoms]. Apuntes de Psicología, 33(3), 117-126. Retrieved from https://idus.us.es/bitstream/handle/11441/85145/568-1288-1-SM.pdf?sequence=1&isAllowed=y https://idus.us.es/bitstream/handle/1144... )	Adult multi-drug user (n = 1)	ACT-based intervention in conjunction with neuropsychological rehabilitation to reduce substance use	AAQ-II; ISP; SCL-90-R Symptoms Inventory; MoCA; VinciDrog.
Thekiso et al. (2015Thekiso, T. B., Murphy, P., Milnes, J., Lambe, K., Curtin, A., & Farren, C. K. (2015). Acceptance and commitment therapy in the treatment of alcohol use disorder and comorbid affective disorder: A pilot matched control trial. Behavior Therapy , 46(6), 717-728. doi:10.1016/j.beth.2015.05.005 https://doi.org/10.1016/j.beth.2015.05.0... )	Hospital patients with comorbid affective disorder (n = 52)	Examine the effectiveness of ACT added to the usual treatment	TLFB; BDI; BAI; YMRS
Mak, Lee e Loke (2015Mak, Y. W., Lee, P. H., & Loke, A. Y. (2015). Predictors of participation in a telephone-based acceptance and commitment therapy for smoking cessation study. BMC Public Health, 15(1), 1288. doi:10.1186/s12889-015-2650-0 https://doi.org/10.1186/s12889-015-2650-... )	Smoking patients in Primary Care Centers (n = 420)	Explore factors related to participation in an ACT-based program	SF-12; FTND; ERQ
Heffner, McClure, Mull, Anthenelli e Bricker (2015Heffner, J. L., McClure, J. B., Mull, K. E., Anthenelli, R. M., & Bricker, J. B. (2015). Acceptance and commitment therapy and nicotine patch for smokers with bipolar disorder: Preliminary evaluation of in-person and telephone-delivered treatment. Bipolar Disorders, 17(5), 560-566. doi:10.1111/bdi.12300 https://doi.org/10.1111/bdi.12300... )	Group Health members daily smokers with bipolar disorder (n = 16)	Develop and test new smoking cessation intervention by combining ACT with the use of nicotine patches	Semi-structured assessment protocol for the genetics of alcoholism; YMRS; MADRS; MINI International Neuropsychiatric Interview; PHQ-9; ASRM
Jones et al. (2015Jones, H. A., Heffner, J. L., Mercer, L., Wyszynski, C. M., Vilardaga, R., & Bricker, J. B. (2015). Web-based acceptance and commitment therapy smoking cessation treatment for smokers with depressive symptoms. Journal of Dual Diagnosis, 11(1), 56-62. doi:10.1080/15504263.2014.992588 https://doi.org/10.1080/15504263.2014.99... )	General population of smokers (n = 94)	Compare the receptivity of treatment with ACT with a government program via web	Anxiety and Depression Detector; AIS-27; Satisfaction questionnaire.
Zeng et al. (2016Zeng, E. Y., Heffner, J. L., Copeland, W. K., Mull, K. E., & Bricker, J. B. (2016). Get with the program: Adherence to a smartphone app for smoking cessation. Addictive Behaviors, 63, 120-124. doi:10.1016/j.addbeh.2016.07.007 https://doi.org/10.1016/j.addbeh.2016.07... )	General population of smokers (n = 84)	Examine a smoking cessation app based in the ACT	AIS-27
Smallwood, Potter e Robin (2016Smallwood, R. F., Potter, J. S., & Robin, D. A. (2016). Neurophysiological mechanisms in acceptance and commitment therapy in opioid-addicted patients with chronic pain. Psychiatry Research: Neuroimaging, 250, 12-14. doi:10.1016/j.pscychresns.2016.03.001 https://doi.org/10.1016/j.pscychresns.20... )	Patients with chronic low back pain (n = 12)	Assess ACT in relation to pain and opioid dependence	AAQ-II; MAAS; RMDQ; Ten Point (0-9); SPM8.
Thurstone, Hull, Timmerman and Emrick (2017Thurstone, C., Hull, M., Timmerman, J., & Emrick, C. (2017). Development of a motivational interviewing/acceptance and commitment therapy model for adolescent substance use treatment. Journal of Contextual Behavioral Science, 6(4), 375-379. doi:10.1016/j.jcbs.2017.08.005 https://doi.org/10.1016/j.jcbs.2017.08.0... )	Adolescents in substance use treatment program (n = 41)	Intervention with Motivational Interview/ACT for the treatment of substance use, evaluating its viability	ORS; TLFB; SRS
Shorey et al. (2017Shorey, R. C., Elmquist, J., Gawrysiak, M. J., Strauss, C., Haynes, E., Anderson, S., & Stuart, G. L. (2017). A randomized controlled trial of a mindfulness and acceptance group therapy for residential substance use patients. Substance Use & Misuse, 52(11), 1400-1410. doi:10.1080/10826084.2017.1284232 https://doi.org/10.1080/10826084.2017.12... )	Residential substance use treatment program (n = 117)	Verify the effectiveness of Mindfulness and ACT-based interventions in relation to the usual treatment	PACS; FFMQ; AAQ-AS

Aspect	Result
Method	Number of Publications / (%)
Type of design
Quantitative	12 / (85.71)
Qualitative/Quantitative	02 / (14.29)
Target Audience:
Population:
Teens of both sexes	01 / (7.14%)
Adults of both sexes	09 / (64.29%)
Women	02 / (14.29%)
Men	01 / (7.14%)
Elderly Men	01 / (7.14%)
Drugs evidenced
Alcohol	01 / (7.14%)
Tobacco	06 / (42,86%)
Opiates	01 / (7.14%)
Drugs in general	06 / (42,86%)
Comorbidities
Neuropsychological comorbidities	01 / (7.14%)
Depression	02 / (14.29%)
Bipolar Affective Disorder (BAD)	02 / (14.29%)
Posttraumatic Stress Disorder (PTSD)	01 / (7.14%)
Mental disorders in general	01 / (7.14%)
No disorder identified	07 / (50.00%)
Procedures
Individual	07 / (50.00%)
Grupal	07 / (50.00%)
Face-to-face mode	09 / (64.29%)
Distance mode	05 / (35.71%)
Via phone	03 / (21.42%)
Via web	01 / (7.14%)
Via smartphone app	01 / (7.14%)
Random distribution	09 / (64.29%)
Control group	08 / (57,12%)
Pre-test	12 / (85.71%)
Post-test	09 / (64.29%)
Main Results
Effectiveness of ACT in relation to the reduction of drug use	09 / (64.29%)
Increased acceptance and psychological flexibility	05 / (35.71%)
Effectiveness in reducing the desire to use substances and greater adherence to treatment	05 / (35.71%)
Increased confidence, motivation and reduction of comorbidities related to substance use	05 / (35.71%)
Reduction of comorbid symptoms	06 / (42,86%)
High receptivity, increased probability of adherence and the levels of acceptance based on the benefits of treatment	04 / (28.58%)

Universidade de São Paulo, Faculdade de Filosofia Ciências e Letras de Ribeirão Preto, Programa de Pós-Graduação em Psicologia Av.Bandeirantes 3900 - Monte Alegre, 14040-901 Ribeirão Preto - São Paulo - Brasil, Tel.: (55 16) 3315-3829 - Ribeirão Preto - SP - Brazil
E-mail: paideia@usp.br

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[1] Correspondence adress: Pollyanna Santos da Silveira. Universidade Católica de Petrópolis. Rua Benjamin Constant, 213 - Centro, Petrópolis-RJ, Brazil. CEP 25.610-130. E-mail: pollyanna.silveira@ucp.br