The speech evaluation as motivational instrument in the treatment of chemical dependency in
adolescents: a Brazilian experience.
Oliveira, C.C.C.*; Giusti, J.S.**; Scivoletto, S.***
* Graduate Student – University of São Paulo Medical School.
Speech therapist of the Adolescent and Drug Outpatient Unit of Child and Adolescence
Psychiatry Service of the Institute of Psychiatry - Hospital das Clínicas Medical School – University of
São Paulo, Brazil.
** MD in Psychiatry – University of São Paulo Medical School.
Psychiatrist of the Adolescent and Drug Outpatient Unit of Child and Adolescence Psychiatry
Service of the Institute of Psychiatry - Hospital das Clínicas Medical School – University of São Paulo,
Brazil.
***Ph.D. in Psychiatry – University of São Paulo Medical School.
Chief of the Adolescent and Drug Outpatient Unit of Child and Adolescence Psychiatry Service
of the Institute of Psychiatry - Hospital das Clínicas Medical School – University of São Paulo, Brazil.
Coordinator of the Interdisciplinary Group of Studies on Alcohol and Drugs of the Institute of
Psychiatry – Hospital das Clínicas Medical School – University of São Paulo, Brazil.
Drug use may jeopardize the communication process, from its access and planning to the
expression of oral language. In the treatment of adolescent drug users, the recognition of recoveries is
fundamental for increasing adherence to treatment’s strategies and motivating to keep up abstinence.
The study’s objective was to verify if the speech evaluation could improve the adherence to
treatment of Brazilian adolescent drug users.
METHODS: The sample was composed by 62 adolescents with mean age of 15,75 + 1.5 years, who
had used a mean of 3.75 + 1.5 different types of drugs during lifetime, that were admitted to outpatient
treatment for drug dependence. Half of them had their speech recorded in mini disc and analyzed it
together with a speech therapist. The first speech evaluation lasts about 40 min. After one week, the
patient had a "feedback" interview which lasts about 20 min. After that, the patients were stimulated to
abstain from drugs in order to repeat a second evaluation in 2 weeks. The same procedure was
repeated in the second evaluation. The 31 patients submitted to speech evaluation were the new cases
admitted from January to August 2005. To make the comparison, we selected the new cases
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consecutively admitted from end of 2000 until may/2001, respecting the proportion male/female of the
first group. The inclusion criteria for the treatment program were: aged 10 to 17, living in the Great São
Paulo, assigned the informed consent. Adolescents with diagnosis of mental retardation, schizophrenic
syndromes, according to the DSM-IV criteria or those who needed hospitalization were excluded from
the study. The first 4 weeks of the treatment program consisted of we called diagnosis procedure: 4
individual assessments with an adolescent psychiatrist (45 min each), 2 family interview made by a
family therapist (90 min each), KID-SADS evaluation (90-120 min), physical evaluation and laboratory
exams. After that, the treatment consisted of weekly individual therapy with psychiatrist (45 min each),
weekly family group orientation (90 min) and a monthly appointment for the patient and at least one
family member (60 min), in order to evaluate the outcomes. This program was absolutely the same for
both groups excepted for the speech evaluation which was performed at the first day of the patient at
the program. Comorbidity, permanence in treatment and duration of abstinence were between the two
groups.
RESULTS: All youths had a diagnostic of substance use dependence (SUD). Current psychiatric
diagnoses other than SUD was present in 32% of the total sample (43% of females and 29% of males,
p>0.05), without differences between the two groups. In the group with speech evaluation, 4 (13%) had
current diagnosis of major depression disorder (MDD), 1 (4%) conduct disorder (CD) and 6 (19.5%)
attention deficit and hyperactivity disorders (ADHD). In the group without speech evaluation, 10 (32%)
had MDD, 2 (6.5%) CD, and 3 (10%) ADHD. Major depression disorder was significantly more
frequently among females (p=0.005). Adolescents who were submitted to speech evaluation stayed
longer in treatment comparing to those who were not (30 ± 19.5 weeks vs. 13 ± 11.5 weeks, p=0,023,
respectively). Considering those who had used mainly marijuana during the year before the interview,
adolescents with speech evaluation were able to abstain from marijuana longer periods than those
without it (17 ± 14 weeks vs. 6 ± 7.5 weeks, p=0.01, respectively). No differences were found among
other drugs users.
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DISCUSSION: The clinical impression was that the speech recorded in mini disc and presented to the
patients could make it possible for them to recognize and reflect on the alterations objectively verified,
associating them to the use of drugs, particularly to marijuana. After that, the patients would be more
stimulated to abstain from drugs in order to repeat a second speech evaluation. In the cases that the
second evaluation had showed a significant improvement in the speech, the patient seemed to become
more motivated to come for appointments and to keep up abstinence. Besides that, some of them might
have an improvement on relationships obtained by the improvement of their speech and language.
These improvements might also be reflected on a better performance on social and scholastic
demands, increasing their motivation to keep adhered to treatment and to follow the treatment’s
orientations. However, we have to consider the study’s limitations: it was not a random study, which
might have some influence in the outcome. Also, it’s not known whether the group without speech
evaluation had some speech pathology or not. Attending the patients’ needs is one of the most
important points to consider when analyzing adherence to treatment.
Speech evaluation was an interesting resource for motivating the chemical dependent adolescents to
keep on treatment, especially those addicted to marijuana who usually are more resistant to the idea of
abstinence. Finding clinical and therapeutic resources to motivate the adolescent to treat himself/herself
is one of the biggest professional challenges for those who deal with adolescents.
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Mailing Address:
Sandra Scivoletto, M.D., Ph.D.
R. João Moura, 647 conj: 102
Zip code 05412-911
São Paulo-SP
BRAZIL
E-mail address: sscivole@uol.com.br
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