THE CONTRIBUTION OF ONLINE SOCIAL NETWORKS FOR DRUG ABUSE TREATMENT REFERRAL : A PILOT STUDY

The consumption of psychoactive drugs is growing in Brazil. The most frequently used psychoactive drugs are: alcohol, tobacco, marijuana, cocaine and crack. Currently, many drug users are unaware of the free treatment provided by the Brazilian National Healthcare System. This affects access to specialised healthcare centres by alcohol and drug users. Additionally, the number of individuals who have access to the Internet is also increasing. While in the recent past, most economic and interpersonal relationships required personal contact; now, they may occur within the virtual environment, in cyber environments called “social networks”. The Internet has been used as a good tool for social network building, as it allows open access to all. It has been seen as a technological advance to promote the possibility of early health interventions. In the face of growing use of psychoactive drugs in Brazil, combined to the increase trends in the access of social networks through the Internet, we proposed a pilot project, to develop a tool based on an online social network with the purpose of engaging with drug users for referral to healthcare in public facilities, according of the specificity of each case. We include as psychoactive drugs any substance capable of altering the behaviour, mood, and cognition of individuals. This study is a preliminary short report about the contribution of online social networks for drug abuse treatment as a support mechanism for psychoactive drug users. Its objectives are: developing the page in online social network to get a help take for free psychoactive drugs users and to present the results of its application. Thus, this is a preliminary access to the importance of an online social network.


Introduction
The consumption of psychoactive drugs is growing in Brazil.The most frequently used psychoactive drugs are: alcohol, tobacco, marijuana, cocaine and crack. 1 Currently, many drug users are unaware of the free treatment provided by the Brazilian National Healthcare System.][4] Additionally, the number of individuals who have access to the Internet is also increasing.While in the recent past, most economic and interpersonal relationships required personal contact; now, they may occur within the virtual environment, in cyber environments called "social networks". 5he Internet has been used as a good tool for social network building, as it allows open access to all. 6It has been seen as a technological advance to promote the possibility of early health interventions. 7In the face of growing use of psychoactive drugs in Brazil, combined to the increase trends in the access of social networks through the Internet, we proposed a pilot project, to develop a tool based on an online social network with the purpose of engaging with drug users for referral to healthcare in public facilities, according of the specificity of each case.We include as psychoactive drugs any substance capable of altering the behaviour, mood, and cognition of individuals. 1,3,4This study is a preliminary short report about the contribution of online social networks for drug abuse treatment as a support mechanism for psychoactive drug users.Its objectives are: developing the page in online social network to get a help take for free psychoactive drugs users and to present the results of its application.Thus, this is a preliminary access to the importance of an online social network.

Methods
This study is the first part of a larger project for the development of an online social tool to facilitate the referral of psychoactive drug users to care in psychosocial care units alcohol and drugs [Centros de Atenção Psicossocial Álcool e Drogas] (CAPS-ad) in Brazil.This is a descriptive study.The study population consisted of psychoactive drugs users from Rio de Janeiro City who have access to Internet and who sought help voluntarily by accessing the page Stay Free of Drugs (SFD) on Facebook. 8ata were collected in 2015, from July to September with participants completing an online form developed using Google ™ Application Forms © available on the SFD Abstract Background: The consumption of psychoactive drugs is growing in Brazil, as well as the access of social networks.This study is a preliminary short report about the contribution of online social networks for drug abuse treatment.The study aimed to evaluate the role of an online social network to engage psychoactive drug users in treatment.Methods: A descriptive study was undertaken from July to September 2015.The study population were psychoactive drugs users who accessed voluntarily the webpage "Stay Free of Drugs" (SFD) from the social network Facebook.Results: A total of 25 psychoactive drug users were enrolled in the study, and 16 (64%) accessed a healthcare centre seeking treatment.The average from the users' online contact to their visit to the healthcare centre was 8.4 days.Half of the participants were exclusive alcohol users and accessed the webpage at night (65%).Conclusions: The use of a social network showed a potential importance in referring drug users to treatment, also acting as health education strategy.Facebook ™ webpage.The page was controlled by researchers who stayed online in yours smartphones.Information about the City Zone of residence and the healthcare centre the user would like to attend to was collected via the webpage.Detailed information about the healthcare centres was available on the SFD webpage.
So that people have knowledge of the page SFD, the page was announced in other pages specific to the city of Rio de Janeiro in own social network.The data presented in this study refer to the test phase of the study that lasted one week in July.Descriptive statistics were used to summarise gender, type of drug, access time, City Zone of residence, healthcare centre of choice and experience at the first visit.

Results
Twenty-five psychoactive drug users accessed the SFD page during the one week study period.Nineteen (76%) were women, three (12%) were men and three (12%) did not report their gender.Of the 25 initial users, 20 (80%) completed the research form, and 16 (64%) went to the healthcare centre expecting to begin their treatment.The average time spent by the users from the online contact to their visit to the healthcare centre was 8.4 days.
Most access to the webpage occurred at night (65%) with most users choosing to be seen at healthcare centres located in the North Zone of Rio de Janeiro (45%).Among the 16 users who visited CAPS-ad, when questioned about the type of drug consumed, 10 users (62.5%) reported using only alcohol; 12.5% (2 users) reported using other unidentified drugs; 1 user (6.3%) reported using only tobacco; 1 user (6.3% reported making the association of alcohol plus tobacco and 2 users (12.5%) reported making the association between alcohol, tobacco and other unidentified drugs.
Regarding the first visit to the healthcare centre, most of the drug users 13 users (81.2%) reported that they were not seen by a healthcare provider, but by an administrative officer instead.Thus, this group could not begin their treatment immediately, and a new date to get a consultation was scheduled.

Discussion
This is a preliminary short report about the contribution of online social networks for drug abuse treatment.In this sample, there was a prevalence of women.This is similar to other governmental healthcare programs, 9 which suggest that women are more concerned with issues related to their health and well-being than men.Gomes et al. suggest that men conceive public healthcare centres as facilities visited mainly by women, which is seen as a barrier to their access. 10cording to the State Office of Chemical Addiction Prevention, alcohol is the second most used psychoactive drug in the Rio de Janeiro State. 11In this study, alcohol was the most commonly drug used by our study subjects.The great impact of alcohol and tobacco sales on the Brazilian Gross Domestic Product makes it difficult to significantly reduce consumption of these commodities.Also, many young people associate use of alcohol and drugs to social acceptance, and they are the target demographics of marketing strategies of those industries. 4This is expressed by the results of the study, which showed a predominance of alcohol and tobacco users.
Today, the Internet and online social networks are important tools to information dissemination.Online social networks attract many people.The popularity of smartphones also contribute to the increase of its use, especially Facebook, which is the most accessed social network in Brazil. 12In our study, we observed that there is a possibility to use these media do help drug users finding treatment, since in a short period, with no marketing campaign, we had people accessing the SFD webpage on Facebook looking for information about treatment for themselves.
Taking that into account, most of the participants visited a healthcare care centre expecting to begin their treatment after accessing the SFD webpage; thus, the social network showed its potential importance in supporting drug users.Many of those who accessed the website did not have any knowledge about where they could receive treatment, or the fact that the Ministry of Health provides free treatment for drug users.Some limitations must be highlighted in the present study.First, we only included those who had access to Internet, so, very poor or homeless drug users probably did not enter study group.In addition, most of the participants accessed the webpage at night, but the researchers could only answer their request in the morning.Since the researcher's answer was not immediate, some potential participants might have been lost, and gave up starting their treatment.That could be solved with the implementation of automated tools such as Clinical Decision Support Systems (CDSS), but the global initiatives in this direction are incipient. 13In Brazil, the reference healthcare centres to treat patients with psychoactive drugs abuse disorders are the Psychosocial Care Centres for Alcohol and Drugs.According to the Ministry of Health's Mental Healthcare protocol, the healthcare provider should see the drug users in their first visit to the healthcare centre.This is suggested to favour treatment adherence and to improve rapport. 2,3,14However, in our study, most of drug users reported not having access to the healthcare provider in their first visit.This situation suggests there is some deficiency in the patient admission, which might jeopardise the continuity of treatment.Considering that those who seek healthcare to quit drug use change their mind frequently, the healthcare system should not miss the chance to start the treatment for those patients, thus avoiding loss of motivation and treatment withdrawal. 14

Conclusion
This preliminary study presents great potential, considering the results obtained in the test phase and suggests that online social networks can be used as an education mechanism for healthcare and for enrolling patients in various healthcare services.