CHARACTERIZATION OF THE CLIENTELE ATTENDED IN A PSYCHOSOCIAL CARE CENTER ALCOHOL AND DRUGS

This documentary and retrospective study aimed to analyze the profile of the clientele attended in the Psychosocial Care Center Alcohol and Other Drugs from Sobral, Ceará, Brazil in 2010, based on 300 records. Males predominated with 75% (n=225), with age ranging from 11 to 29 years old with 44.3% (n=133), single with 49% (n=147), and with elementary school 45.7% (n=137). The most commonly used drug among men was crack, 31.3% (n=94), and among women, tobacco, 12% (n=36). The losses associated with dependence, are mostly related to the family, with 31.3% (n=94). The highlight to crack requires changes in the care process implemented in institutions. One should remain alert to these new profiles related to chemical dependency, so that quality and integral care can be offered to this clientele. Descriptors: Mental Health; Drug Users; Mental Health Services.

Nobody in Brazil has ever proposed a psychiatric "revolution" or "liberation", however, it is possible to say that, over the years, with the theoretical and political transformations, the assumed identity of the mentally ill patient, presented by the psychiatric institution, was transformed into the identity of a mentally ill citizen, proposed by militants of mental health, which culminated in the development of the current Brazilian mental health policy. According to this policy, the producer of the dehumanization of the mentally ill is the insane asylum and the solution to this dehumanization is the expansion based on demographic data, on substitutive institutions, that is, on the new control devices that promote the inclusion of the insane person in the society (1) .
Starting from the Psychiatric Reform and the process of deinstitutionalization, one created the Psychosocial Care Centers (CAPS), which have the function of providing care to people with severe mental suffering without taking them away from society, preventing and reducing psychiatric hospitalizations and trying to rescue the patient's autonomy and development, aimed at the recovery and inclusion in the family and the society. CAPS are the main alternative for people who look for mental health care.
When considering the increased consumption of alcohol and other drugs in Brazil and the problems related to the abuse that end up causing many social grievances, there was a necessity of creating a care network focused on community care associated with health and social services, to carry out the users' social reintegration. Changes in the health needs of the population and the history of alcohol and other drugs have demanded new services (2) .
In this perspective, one created Psychosocial Care Centers -Alcohol and other Drugs (CAPS-AD) that are branches of the care network aiming to reorder the full attention to the user, promoting intersectoriality between the areas of health, justice, education, social welfare and development, facilitating the capillarity between services and social reinsertion, the ultimate goal of the treatment (3) .  (6) .
The referential framework for mental health services is a municipality located in the northern state of Ceará, Sobral, where after the death of a user in the local mental hospital for mistreatment and beatings, elicited public complaints and resulted in disqualification of this service. Therefore, one created the psychosocial care network, composed currently of the following services: General CAPS II, (which is specialized in treating people with severe and persistent mental disorders), CAPS AD (specialized in treating people with chemical dependency), one Therapeutic Residential Service, a unit of psychiatric hospitalization in a general hospital, an outpatient psychiatry ward, for regional coverage and units of the Family Health Strategy (7) . It is noteworthy that Sobral was the first municipality in Ceará create a CAPS-AD.
In this context, this study aimed to analyze the profile of the clientele attended by the CAPS-AD from in the city (8) . One identified the need to meet the users' sociodemographic profile, however the difficulty of obtaining data about the clientele remained until the time that this research was conducted.
Regarding the service, CAPS-AD is a community care service that aims at the reintegration of the addict.  (Table   1).   One also associated the substance of the main complaint of the clientele regarding their age (   other than their family group of origin (9) . These sociodemographic findings are similar to studies performed in other Brazilians states (3,10) . When compared to a similar study also conducted in Sobral, in the period from 2002 to 2006 (11) there is a relative similarity in the variables sex, age, marital status and education.

RESULTS
Low educational level is characterized an as important phenomenon since it can be a condition associated with income. The growing disinterest in studies among those who use drugs can be more attributed to the overriding need to get the substances than the need to work, which is common among poor students who need to help support their families. They end up quitting their studies.
When one analyzes the situation of the individuals in relation to the labor market, one finds out that 37.7% did not work or were unemployed, which can be considered as a further aggravating to the addiction. with studies showing that the population potentially exposed to crack is predominantly of males, aged below 25 years old and with low socioeconomic status. It is also significant the number of minors who already consume crack (12) .
It is important to highlight that in a previous study conducted in Sobral, alcohol appeared as users' substance of preference and had a pattern of daily consumption (11) . In the present study this substance is still the most consumed in the age group above 29 years old. However, in recent years, as it has been occurring throughout the country (13)(14)(15) , it was possible to show an exacerbated increase in the consumption of crack, which has been called the crack epidemic.
It is likely that a person becomes dependent on crack with one or two experiences. That drug causes addiction, social exclusion, aggression, family breakdown and stimulates crime (10) . The acquisition of crack is simple and fast, which makes its consumption easier and its consumption grow more and more, as the increasing availability and distribution of the drug are growing too, representing a significant public health problem. Regarding the female population (25.0%), tobacco was the primary substance of abuse (12.0%).
Studies in many countries have shown the increasing consumption of this substance in this population group in particular (16)(17) .
When there is a correlation with the age of the subjects, which has been primarily tobacco consumed in the population aged over 30 years old (18.0%), going to the analysis of the genre, this period is characterized by the maturity in a woman's life. Researches have shown that women smoke after negative life experiences. Also, the inclusion in the labor market and the increasing accumulation of responsibilities arising from double shifts are also determinant to this consumption, since tobacco use was associated with a greater sense of autonomy and achievement of their own place in society and also as an emotional escape mechanism (18)(19)(20) .
When analyzing the frequency of drug use among the study subjects, comparing with the results of a previous research (11) , there was a notable reference to the daily use of drugs (84.7%), which means that the severe drug addiction has existed in Sobral for years.
This reinforces the argument that the use of psychoactive substances in our society has reached worrying levels, constituting a public health problem, considering the morbidity and socioeconomic loss that the phenomenon represents (21) .
Regarding the harm associated with drug dependence, reference to problems in the family (31.3%) was recurrent in this study. The literature indicates that family problems and disagreements, frustration, emotional stress, lack of credibility and mistrust are feelings aroused in people who have had the experience of having a drug user in the family and when this happens, all the family gets sick (22) .