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Background : Responses to problem substance use have largely focused on illicit drugs, but reports on rising prescription drug misuse worldwide raise questions about their combined use with alcohol and potential consequences. The current study assessed prevalence of alcohol in conjunction with nonmedical opioid and benzodiazepine use across a nationally representative sample of adults in Brazil. Methods: Cross-sectional data on prevalence were estimated from the 2015 Brazilian Household Survey on Substance Use. We estimated past month nonmedical use of benzodiazepines and alcohol and past month nonmedical use of opioids and alcohol among adults who reported any past-year alcohol use. Zero-inflated Poisson models assessed independent correlates of alcohol and nonmedical opioid use, and alcohol and nonmedical benzodiazepine use. Results: Among adults who reported past year alcohol use, 0.4% ( N  = 257,051) reported past month alcohol and non-medical benzodiazepine use, and 0.5% ( N  = 337,333) reported past month alcohol and non-medical opioid use. Factors independently associated with co-use of alcohol and benzodiazepines included having depression (adjusted prevalence ratio (aPR):4.61 (95%CI 1.76-12.08)), anxiety (aPR:4.21 (95%CI 1.59-11.16)) and tobacco use (aPR: 5.48 (95%CI 2.26-13.27)). Factors associated with past-month alcohol and opioid use included having experienced physical or a threat of violence (aPR: 4.59 (95%CI 1.89-11.14)), and tobacco use (aPR:2.81(95%CI:1.29-6.12)). Conclusions: Co-use of prescription drugs with alcohol remains relatively rare among Brazilians, but findings point to a unique profile of persons at risk. Results of this study are important in light of changing dynamics and international markets of prescription drugs and the need for more research on use of these substances on a global scale.

Background: Reproducibility in Science is challenging and may be hard to achieve in alcohol research. Previous general population surveys in Brazil have estimated the prevalence of alcohol dependence to be around 10%. We aim to estimate alcohol use and dependence using different methods and definitions., Methods: The 3 rd Brazilian Household Survey on Substance Use (BHSU-3) was a nationwide, probability sample survey that interviewed 16,273 individuals. DSM-IV-TR criteria were used to determine alcohol dependence. In the BHSU-2 (covering only Brazil's 108 largest municipalities), alcohol dependence was defined as fulfilling 2/6 DSM-III criteria. Using the BHSU-3 data, alcohol use was estimated at: [1] the national level, [2] BHSU-2 municipalities, taking into consideration the sample design, and [3] BHSU-2 municipalities, ignoring the sample design. Alcohol dependence was calculated using: BHSU-3 and BHSU-2 definitions, two denominators ([A] population and [B] 12-month drinkers), and [1], [2], [3]., Results: Lifetime alcohol use ranged from 66.4% (95%CI:64.8-68.0 [1]) to 70.1% ([95%CI:69.1-71.0], [3]). The estimated population presenting with alcohol dependence ranged from N = 2.3 million (BHSU-3 definition, [1]) to N = 4.3 million (BHSU-2 definition, [1]). In the first case, the prevalence among the general population [A] and drinkers [B] was 1.5% (95%CI:1.2-1.8) and 3.5% (95%CI:2.8-4.2), respectively. In second case, prevalence was 2.8% (95%CI:2.4-3.3, [A]) and 6.6% (95%CI:5.6-7.6, [B])., Conclusions: Prevalence of alcohol dependence may vary as much as 4.3 times, analyzing the same dataset in different ways. Brazilian research on alcohol is funded by governmental research and policy-making agencies, providing subsidies for alcohol policy in the country. It is crucial that sufficient methodological information is provided in order to guarantee reproducibility and consistency over time., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Background: Concurrent psychosocial problems may synergistically increase the risk of HIV infection (syndemics), representing a challenge for prevention. We aimed to evaluate the prevalence and associated factors of syndemics among men who have sex with men (MSM) and transgender women (TGW) enrolled in the Brazilian pre-exposure prophylaxis demonstration study (PrEP Brasil Study)., Methods: Secondary cross-sectional analysis of the PrEP Brasil Study was performed. Of 450 HIV-seronegative MSM/TGW enrolled in the PrEP Brasil Study- conducted at Rio de Janeiro and São Paulo, Brazil- 421 participants with complete data were included in the present analysis. Syndemics was defined as occurrence of ≥2 of the following conditions: polysubstance (≥2) use, binge drinking, positive depression screen, compulsive sexual behavior, and intimate partner violence (IPV)., Results: The prevalence of recent polysubstance use was 22.8%, binge drinking 51.1%, positive depression screening 5.2%, compulsive sexual behavior 7.1%, and IPV 7.3%. Syndemics prevalence was 24.2%, and associated factors were younger age (adjusted Odds Ratio (aOR) 0.95, 95% Confidence Interval (95% CI) 0.92-0.98 per year increase), TGW vs. MSM (aOR 3.09, 95% CI: 1.2-8.0), some college education or more vs. less than college (aOR 2.49, 95% CI: 1.31-4.75), and multiple male sexual partners in prior 3 months (aOR 1.69, 95% CI: 0.92-3.14)., Conclusion: Given the high prevalence of syndemics, particularly of polysubstance use and binge drinking, PrEP delivery offers an opportunity to diagnose and intervene in mental and social well-being., (Copyright © 2018 Elsevier B.V. All rights reserved.)