THE USE OF ALCOHOL BY W ORKERS OF THE GARBAGE COLLECTI ON SERVI CE
Alessandr a dos Sant os Mabuchi1 Daniel Fr ancis de Oliv eir a1 Mar lúcia Per eir a de Lim a1 Mir iã Bar bosa da Conceição1
Hugo Fer nandes2
Mabuchi AS, Oliveira DF, Lim a MP, Conceição MB, Fernandes H. The use of alcohol by workers of t he garbage collect ion service. Rev Lat ino- am Enferm agem 2007 m aio- j unho; 15( 3) : 446- 52.
The pr esent st udy aim ed t o descr ibe t he alcohol consum pt ion of a hundr ed w or k er s of t he gar bage collect ion service in t he peripheral Sout h region of São Paulo, SP, Brazil. The Transversal St udy was adopt ed as t he t heor et ical- m et hodological r efer ent ial. Dat a w er e collect ed t hr ough t he quest ionnair e QRCAP, based on t he quest ionnaire AUDI T. The result s showed t hat 94% of t he int erviewees ingest som e kind of alcoholic beverage, w hile 15% w er e consider ed dependent s. Peer pr essur e w as point ed as t he m ain r eason t o init iat e t he habit ( 46% ) . A t ot al of 67% of t he int er v iew ees had alr eady felt som e sy m pt om as t he r esult of t he ingest ion of alcohol and 80% r epor t ed t o be afr aid of get t ing m ent ally ill due t o t he v ice. Ex t er nal and int er nal sit uat ions were report ed as t he precursors of alcohol consum pt ion. However, it was evidenced t hat t he lack of orient at ion and infor m at ion cont r ibut es for t he pr ev alence of t his illness.
DESCRI PTORS: alcoholism ; housek eeping; occupat ional healt h; nur sing
USO DE BEBI DA ALCOHÓLI CA EN TRABAJADORES QUE TRABAJAN RECOLECTANDO BASURA
El est u d io t u v o com o ob j et iv o d escr ib ir el con su m o d e alcoh ol en 1 0 0 t r ab aj ad or es q u e t r ab aj an recolect ando basura en los alrededores de la región sur del m unicipio de São Paulo. Se ut ilizó com o m et odología el est udio t ransversal. La recolección de dat os fue realizada a t ravés del cuest ionario QRCAP, el cual sea basa en el cuest ionario AUDI T. Los result ados m uest ran que 94% de los suj et os ingieren algún t ipo de bebida alcohólica, de los cuales 15% fuer on consider ados com o dependient es. La influencia de los am igos fue señalada com o el m ay or m ot iv o par a iniciar con el v icio ( 46% ) . Sesent a y siet e por cient o de los suj et os había sent ido algún sínt om a com o consecuencia del consum o de bebida alcohólica, 80% m encionaron t ener m iedo adquirir enferm edad m ent al debido al v icio. Condiciones ex t er nas e int er nas fuer on cit adas com o r esult ado del uso del alcohol. No obst ant e, se evidenció que la falt a de orient ación e inform ación sobre el alcohol cont ribuye con su prevalencia.
DESCRI PTORES: alcoholism o; ser v icio de lim pieza; salud labor al; enfer m er ía
USO DE BEBI DAS ALCOÓLI CAS POR TRABALHADORES DO SERVI ÇO DE COLETA DE LI XO
O p r esen t e est u d o t ev e com o ob j et iv o d escr ev er o con su m o d e álcool em 1 0 0 t r ab alh ad or es d o ser v iço de colet a de lix o na per ifer ia da r egião sul do m unicípio de São Paulo. Foi ut ilizado com o r efer encial m et odológico o est udo t ransversal. A colet a de dados foi realizada at ravés do quest ionário QRCAP, baseado no quest ionár io AUDI T. Os r esult ados m ost r ar am que 94% dos suj eit os inger em algum t ipo de bebida alcoólica, sen do qu e 1 5 % f or am con sider ados depen den t es. A in f lu ên cia de am igos f oi apon t ada com o m aior m ot iv o para a iniciação do vício ( 46% ) . Sessent a e set e por cent o dos suj eit os j á sent iram algum sint om a conseqüent e da in gest a de bebida alcoólica e 8 0 % disser am t er m edo de adoecer em m en t alm en t e em v ir t u de do v ício. Sit uações ext ernas e int ernas foram por eles cit adas com o precursoras do uso de álcool. Cont udo, foi evidenciado que a falt a de or ient ação e de infor m ação acer ca do álcool cont r ibuem par a a pr ev alência dessa doença.
DESCRI TORES: alcoolism o; ser v iço de lim peza; saúde do t r abalhador ; enfer m agem
1 Nursing undergraduat e st udent , e- m ail: ale.m .s@uol.com .br;2 M.Sc.in Nursing, e- m ail: hugoenf@yahoo.com .br. Professor Faculdade Í t alo Brasileira
I NTRODUCTI ON
A
l co h o l i s t h e e l d e st l e g a l a n d so ci a l psychoactive drug. I ts consum ption form as individual, fam ily or cult ur al conduct is influenced by beliefs, habit s and m eanings at t r ibut ed t o it s euphor izing, aphr odisiac, r elax ing, sleep inducing and anx ioly t ic effect s( 1).The consum pt ion of alcoholic beverages is a problem of huge interest in Public Health, as it affects not only consum ers’ health, but also causes econom ic, social an d psy ch ological pr oblem s, w it h en or m ou s repercussions on fam ilies and societ y( 2- 5).
According to the Ministry of Health, in the State of São Paulo, at least 1 m illion people suffer from this p r o b l e m . Al co h o l i sm i s t h e t h i r d m o t i v e o f absent eeism fr om w or k and t he eight cause of t he concession of disease aid by t he Minist r y of Social Security( 6- 7). The work situations that represent greater
risks for alcohol consum ption are socially unprivileged activities, with the constant creation of tensions. This is t he case of urban cleaning workers( 2).
Th ese p r of ession als ar e g en er ically called gar bage collect or s or sw eeper s. The social v iew on t h i s g r o u p o f w o r k e r s a n d t h e i r se l f - i m a g e a r e problem at ic from t he perspect ive of our societ y. The contem pt of this profession originates in the collectors t h em selv es, in t h eir ad v er se econ om ic an d w or k condit ions, which dynam ically I nt eract wit h t he social im age of t he profession it self. The garbage collect ors find them selves obliged, on a daily basis, to deal with such a univ er sally abj ect r ealit y, w it hout r eceiv ing d i g n i f i e d a n d so ci a l l y b a l a n ce d w a g e s, e v e n i n com parison wit h t hose from ot her cat egories in t he t hird sect or, which t hey are part of. Thus, t here are n o con d it ion s in w h ich an y social n eg ot iat ion of professional prestige could overcom e both the sources of t he collect ors’ m ent al discom fort relat ed t o t heir professional life and ident it y( 8).
As a way of fleeing from the m ental suffering and em ot ional overload, connect ed w it h or deriving f r o m t h e w o r k co n d i t i o n s, so m e u r b a n cl ea n i n g professionals find an exit in alcohol, which induces to severe sit uat ions of alcohol dependence( 9).
St udies car r ied out at gener al hospit als in differ ent Br azilian r egions r epor t ed t hat bet w een 9 and 32% of patients’ deaths are related to the abuse and consum pt ion of alcoholic beverages. I n Brazil, it sh ou ld also b e con sid er ed t h at alcoh olism is n ot d i a g n o se d co r r e ct l y d u r i n g a p p o i n t m e n t s a n d
h o sp i t a l i za t i o n s, t h u s i m p a i r i n g m o r e p r e ci se interpretations of this kind of disease. I n fact, we can t al k ab o u t t h e p r o f essi o n al s, l ack o f t r ai n i n g as som et h in g t o b e con sid er ed an d r econ sid er ed in polit ical and Public Healt h pr oposals. Thus, st udies about alcoholism cont ribut e t o t he developm ent and i m p r o v em en t o f p r o f essi o n al s w h o f i g h t ag ai n st chem ical addiction, to provide new elem ents to analyze t he subj ect , t ak ing int o account t he obj ect iv e and subj ect ive aspect s of illness caused by alcohol in t he w or k place( 7).
Th i s st u d y a i m e d t o d e scr i b e a l co h o l consum ption in garbage collection workers, appointing t he fact ors responsible for t he st art of t he addict ion and the im pact of this reality on these workers’ social and professional life, thus providing support for m ore specific car e deliv er y.
METHODOLOGY
This cross- sectional and descriptive study was ca r r i e d o u t t o d e scr i b e t o t h e u se o f a l co h o l i c beverages, the m otives and the consequences of this habit am ong 100 workers from the garbage collection service in São Paulo Cit y.
Data were collected at a com pany responsible for public cleaning in t hree neighborhoods from t he per ipher y in t he Sout h of São Paulo Cit y. Subj ect s were included through “ snowball” sam pling. This type of sam pling was chosen because t he st udy get s int o a sp h er e su r r ou n d ed w it h st ig m as, w h ose t ar g et p o p u l at i o n i s d i f f i cu l t t o access. I n t h i s t y p e o f sam pling, t he subj ect s inv it ed t o par t icipat e in t he study indicate other possible participants, substantially increasing t he possibilit y of locat ing charact erist ics of int erest in t he research.
I t is k now t hat t he t y pe of sam pling used h e r e c r e a t e s s o m e i m p o r t a n t l i m i t a t i o n s , a s im port ant biases in t he ext ernal validit y of t his kind of st udies, besides t he im possibilit y of gener alizing result s, due t o t he sam ple size( 10). Nevert heless, t he
aut hor s consider t hat t he or iginalit y of t he findings go beyond t he st udy lim it at ions, due t o t he lack of n u r s i n g r e s e a r c h w i t h a p p r o a c h e s t h a t si m u l t a n eo u sl y l o o k a t a l co h o l u se a n d so ci a l l y unpr iv ileged act iv it ies.
im por t ance of t heir collabor at ion. The aut hor s also requested authorization to carry out the study on the pr em ises of t he com pany, under t he super v ision of t he social worker act ive t here.
I n com p l i an ce w i t h et h i cal st an d ar d s f or r e se a r ch i n v o l v i n g h u m a n b e i n g s, a cco r d i n g t o resolution 196/ 96 by the National Health Council, the subj ects were asked to participate voluntarily through t he Free and I nform ed Consent Term .
I n order to identify and stratify alcoholism , a q u est ion n air e called QRCAP w as d ev elop ed . Th is quest ionnaire was elaborat ed by Mabuchi, one of t he aut hors of t his st udy, and based on The Alcohol Use Disorder I dent ificat ion Test ( AUDI T) , which t he World Healt h Or ganizat ion elabor at ed in 1992, as a self-reporting instrum ent to identify various alcohol usage pat t er ns, w hich is easily applied and cor r ect ed and has been cross- culturally validated( 11). Besides scoring
t h e fr equ en cy, qu an t it y, depen den ce, dam age an d co n se q u e n ce s o f t h i s co n su m p t i o n , t h e QRCAP ( Quest ionnair e: Relat ion of Alcohol Consum pt ion t o t he Profession) aim s t o assess t he relat ion bet ween
e t h y l i c co n su m p t i o n a n d t h e w o r k o f t h e se professionals, ident ifying t he m ot ives for st art ing t he addiction, the use of alcohol or not while at work, the sym pt om s relat ed t o alcohol int ake and t he subj ect s’ fears relat ed t o t he addict ion.
The answers given to the questionnaire were analyzed and the obtained inform ation was subm itted t o t hem at ic cont ent analy sis. The r esult s descr ibed here are presented as tables and then discussed with a view t o a bet t er underst anding.
RESULTS
The results showed that 91% of the subj ects were m en and 9% wom en. I n t his group, 6 wom en, ch ar act er izin g 6 6 . 7 % of t h e f em ale sam ple, u sed so m e k i n d o f a l co h o l i c b e v e r a g e , b u t w e r e n o t co n si d e r e d d e p e n d e n t . Fi f t y - t w o p e r ce n t o f t h e subj ect s had not finished basic educat ion and only 9% finished secondary educat ion. The subj ect s’ ages ranges from 20 t o 59 years.
Table 1 – Alcohol usage t im e and consum pt ion frequency am ong garbage collect ion workers, São Paulo, Brazil ( n= 100)
Source: QRCAP
I t w as obser v ed t hat t he subj ect s’ alcohol consum pt ion frequency was very high, as illust rat ed i n Ta b l e 1 . Ni n e t y - f o u r p e r ce n t o f t h e su b j e ct s con su m e som e k in d of et h y lic su b st an ce, ev en if occasionally. I n t he research group of 91 m en, 96.7% consum e alcoholic beverage, m ost of w hom st art ed t his use during adolescence. Only six subj ect s ( 6% ) answ er ed t hat t hey had nev er consum ed alcoholic
b e v e r a g e s , a l l o f t h e m w i t h u n f i n i s h e d b a s i c edu cat ion .
As t o con su m pt ion f r equ en cy, 3 4 % of t h e subj ects, m ale, consum ed alcohol four or m ore tim es per week, 15% of whom alleged t he consum pt ion of m ore than 3 glasses per day, which evidences alcohol dependence. Moreover, 18% of the investigated workers said that they drank or had already drunk while at work.
n o i t p m u s n o
C Men Women
) n
( (%) (n) (%)
e m i t e g a s U k
n u r d r e v e n s a
H 3 3.3 3 33.3
r a e y 1 n a h t s s e
L 21 23.1 4 44.5
s r a e y 5 d n a 1 n e e w t e
B 11 12.1 2 22.2
s r a e y 0 1 d n a 5 n e e w t e
B 21 23.1 0 0
s r a e y 0 1 n a h t e r o
M 35 38.4 0 0
l a t o
T 91 100 9 100
y c n e u q e r F r
e v e
N 3 3.3 3 33.3
h t n o m r e p e c n
O 3 3.3 4 44.5
h t n o m r e p s e m it 4 o t
2 22 24.2 2 22.2
h t n o m r e p s e m it 3 o t
2 32 35.2 0 0
h t n o m r e p s e m it e r o m r o
4 31 34 0 0
l a t o
Table 2 – Sym pt om s, fears and m ot ives of alcoholic beverage int ake am ong garbage collect ion w orkers, São Paulo, Brazil ( n= 100)
Table 3 – Motives that led to alcoholic beverage intake and offering of beverage by regional m erchants, from t he per spect iv e of gar bage collect ion w or k er s, São Paulo, Brazil ( n= 100)
Source: QRCAP
Table 2 resum es t he subj ect s’ concern wit h being affect ed by som e alcohol- r elat ed disease and t he sym pt om s t hey exper ience w hen using alcohol. Th ir t y - t h r ee per cen t said t h ey h ad n ev er f elt an y collat er al effect , w h ile 6 7 % said t h ey felt , or h ad alr eady felt som e sy m pt om s. Tw ent y- eight per cent o f t h e su b j e ct s a f f i r m e d t h a t t h e y h a d a l r e a d y ex p e r i e n ced co n v u l si o n s o r h a l l u ci n a t i o n s w h en consum ing lar ge quant it ies of alcohol, w hich w er e frequent sym pt om s in t he group of int erviewees t hat was considered dependent . The subj ect s considered liver cirrhosis as the m ost frightening disease deriving f r om alcoh ol. Som e su b j ect s m ar k ed t h e colu m n “ ot h er s” ( 3 % ) , d escr ib in g in t h is sp ace t h at t h e consequences r elat ed t o alcohol t hat m ost caused panic were t he fear of being m urdered when get t ing involved in fights while being drunk and loss of fam ily st r uct ur e.
I t w as obser v ed t hat 5 4 % of t he subj ect s d i d n o t k n o w a n y o n e w h o h a d a c q u i r e d s o m e m e n t a l o r b e h a v i o r a l d i s o r d e r d u e t o a l c o h o l . H o w e v e r, t h e q u e st i o n n a i r e co n t a i n e d a n o p e n space w her e t he subj ect s could m ak e obser v at ions an d , in t h ese ob ser v at ion s, 8 0 % of t h e su b j ect s m e n t i o n e d t h e y w e r e a f r a i d o f su f f e r i n g so m e m ent al or behav ior al disor der der iv ing fr om alcohol con su m p t ion , su ch as m en t al d elay d u e t o h ead t r a u m a s c a u s e d b y f a l l s w h i l e d r u n k , p a n i c sy n d r om e, ag g r essiv en ess an d loss of con t r ol on d if f er en t occasion s.
s e l b a i r a
V n %
e s a e s i d d e r a e f t s o M s i s o h r r i c r e v i
L 51 51%
s s e n ll i l a t n e
M 25 25%
r e c n a
C 9 9%
n o it c r a f n
I 12 12%
s r e h t
O 3 3%
l a t o
T 100 100%
s m o t p m y s d e c n e i r e p x E m o t p m y s y n a tl e f r e v e n s a
H 33 33%
s n o it a n i c u ll a
H 16 16%
s n o i s l u v n o
C 12 12%
a i d r a c y h c a
T 12 12%
s n o it a r e tl a d o o
M 27 27%
l a t o
T 100 100%
r e d r o s i d l a r o i v a h e b r o c i r t a i h c y s P r e d r o s i d e m o s d e r i u q c a s a h o h w e n o e m o s w o n
K 46 46%
r e d r o s i d e m o s d e r i u q c a o h w e n o y n a w o n k t o n o
D 54 54%
n % e k a t n i e g a r e v e b c il o h o c l a o t d e l t a h t s e v i t o M k n ir d t o n o
D 6 6%
s d n e ir f m o r f e c n e u lf n
I 46 46%
d a o l r u o h k r o w e v i s s e c x
E 9 9%
n o it a n i m ir c s i d / e v it n e c n i / t n e m e g d e l w o n k c a f o k c a
L 12 12%
e g a b r a g y b d e ll e p x e ll e m
S 9 9%
s r e h t
O 18 18%
l a t o
T 100 100%
s t c e j b u s e h t o t l o h o c l a r e f f o o h w s t n a h c r e m l a n o i g e r f o r e b m u N s e g a r e v e b g n ir e ff o s t n a h c r e
M 61 61%
s e g a r e v e b g n ir e ff o t o n s t n a h c r e
M 39 39%
l a t o
T 100 100%
Source: QRCAP
Table 3 indicat es t he m ot ives t hat facilit at ed alcohol int ake, at t em pt ing t o assess what t he subj ect s associat e t he fact wit h t hat som e of t hem t urn alcoholic bev er ages int o an addict ion. The st r essor s r elat ed t o t h e p u b lic clean in g ser v ice w er e ap p oin t ed as p r ecu r so r s o f t h e w o r k er s’ i n i t i a t i o n i n a l co h o l , charact er izing 3 0 % of all answ er s. How ev er, m ost of t he subj ect s ( 46% ) , associat ed t he st art of alcohol consum pt ion wit h t he influence of friends. They also m en t ion ed ot h er m ot iv es lik e “ dr in k in g t o r elax a l i t t l e ” , “ m i s e r y ”, “ s e p a r a t i o n ” , “ l e i s u r e ” a n d “ u n em p loy m en t ”, cor r esp on d in g 1 8 % of op in ion s under t he it em nam ed “ ot hers”. The 6% of t he sam ple who affirm ed t hat t hey had never consum ed alcohol alleged t hat t his sit uat ion was due t o t heir belonging t o som e r eligion.
W h e n t h e su b j e ct s w e r e a sk e d w h e t h e r m er chant s fr om t he r egion w her e t hey collect t he garbage offered t hem alcoholic beverages as a kind of p leasu r e, 6 1 % an sw er ed “ y es” an d 3 9 % “ n o”. Am ong t he gr oup t hat said no, 6% of t he subj ect s alleged that, even if they were not offered any drink, t hey asked for it and, in m ost cases, t heir request s w ere at t ended.
DI SCUSSI ON
Like in ot her st udies, it was evidenced t hat the use of ethylic substances is m ore frequent in the productive age( 2,7). Moreover, alcohol consum ption was
h igh er am on g m ale w or k er s ( 9 6 . 7 % ) , in lin e w it h o t h er st u d i es ca r r i ed o u t i n Br a zi l a n d i n o t h er count ries( 2,7,11).
The stressors ( sm ell expelled by the garbage, lack of acknowledgem ent or incentive, excessive hour load, social discrim inat ion) deriving from t he public clean in g ser v ice w er e ap p oin t ed in t h is st u d y as precursors of alcohol int ake ( 30% ) and coincide wit h t h e m o t i v e s f o r st a r t i n g a l co h o l co n su m p t i o n m ent ioned by t he gr oup of subj ect s consider ed as dependent . These dat a are in accordance wit h ot her st udies t hat consider socially unprivileged act ivit ies, t ensions, m onot onous work, lack of opport unit y and d ev elop m en t as p ot en t ial h ig h er r isk s f or alcoh ol consum pt ion( 2,7).
Al coh ol i s con si d er ed as t h e m ost easi l y accessible drug. I t is insert ed in our cult ure, present in leisure, inside people’s hom es, in secular as well as religious rit ual life. Alcohol is offered by friends, fam ily and is seen as a source of “ social insertion”( 12).
I n this context, the results of this study showed that 4 6 % o f t h e su b j e ct s a l l e g e d t h a t t h e y st a r t e d con su m in g alcoh ol d u e t o in f lu en ce f r om f r ien d s. Society directly collaborated to m aintain the addiction, w her e 61% of bar or bak er y ow ner s in t he r egion where t he workers collect t he garbage used t o offer alcoholic beverages as a form of friendship, pleasure or grat it ude.
Chr onic alcoholism gr adually est ablishes in i n d i v i d u al s acr oss, on t h e av er ag e, 1 5 y ear s PF con t in u ou s u se, on a daily or alm ost daily basis, consum ing m ore t han 40 gram s of absolut e alcohol per day, according to the World Health Organization( 13).
One can of beer ( 350 m l) contains 17 gram s of alcohol and one dose of sugar cane liquor ( 50 m l) 25 gram s of alcohol( 14). The result s of t his st udy showed t hat
38.4% of t he subj ect s st art ed t o consum e alcoholic beverages m ore than 10 years ago, when m any were still adolescents. Moreover, 15% of the subj ects, m ale, alleged t h ey con su m ed m or e t h an t h r ee doses of et h y lic su b st an ces p er d ay, w h ich m ean s alcoh ol d e p e n d e n ce a cco r d i n g t o t h e a b o v e m e n t i o n e d r ef er en ces.
Alcoholism const it ut es one of t he four m ost com m on causes am ong m en between 20 and 40 years old: suicide, accident s, hom icide and liver cirrhosis. Mo r e o v e r, i t i n t e r f e r e s i n so m e a sp e ct s o f t h e
individual’s life, whet her healt h, civil st at us, carrier, in t er p er son al r elat ion s or ot h er n ecessar y social ad ap t at ion s( 7 ). I n t h is st u d y, t h ese r elat ion s also
coincided and const it ut ed a great source of concern am ong t he subj ect s. Many of t hem appoint ed fight s, j ob loss, f am ily discu ssion s, div or ce an d v iolen ce against t heir wife and children as com m on problem s secondary t o addict ion.
Pu b l i c cl e a n i n g w o r k e r s a r e su b j e ct t o sit u at ion s t h at can p r ov ok e m en t al su f f er in g an d em otional overload, given som e characteristics related to their work( 9). These were appointed by the subj ects
in this study as precursors of ethylic initiation, causing fear of acquiring som e m ent al or behavioral disorder d er iv in g f r om alcoh olism . Besid es sy m p t om s lik e tachycardia or m ood alterations, 80% of the subj ects m en t ion ed t h e f ear of acqu ir in g m en t al pr oblem s secondary to alcohol. Forty- six percent of the subj ects affirm ed t hat t hey knew som eone who acquired one of t hese disorders as a consequence of alcoholism .
Psychiat ric disorders secondary t o alcoholism in clu de am n esia, dem en t ia, h allu cin at ion , delir iu m sy ndr om es; anx iet y, sex ual, sleep and non- specific disor der s and, finally, d elir iu m t r em en s, w hich can be fat al( 15). Tw ent y- eight per cent of t he ex am ined
w or k er s ex per ien ces or h as ex per ien ce con v u lsion or ( v isual and audit or y ) hallucinat ion cr ises, w hich are sym pt om s present in severe cases of alcoholism , which are frequently terrifying and, depending on their sev er i t y, t h e q u a n t i t y o f a l co h o l co n su m ed a n d i n g est i o n t i m e, en t ai l d eat h r i sk s an d i n cr eased m o r t a l i t y l e v e l s. Mo r e o v er, h o m i ci d e o r su i ci d e responses can result from these hallucinations, which also put the integrity of non- alcoholic people at risk( 16).
Thus, this context deserves special attention, not only by health professionals, but also in public policies that act on this reality, through care program s that include prevent ion, follow- up and rehabilit at ion of t he people in v olv ed.
CONCLUSI ON
an d Dr u g s St u d i es ( GREA) , f r om t h e Psy ch i at r i c I nst it ut e at t he Hospit al das Clín icas, Br azil spends 7.3% of it s Gross Dom est ic Product ( GDP) per year t o t r e a t a l co h o l - r e l a t e d p r o d u ct s, r a n g i n g f r o m t r e a t m e n t o f a d d i ct s t o r e l a t e d d i se a se s a n d product ivit y loss due t o alcoholic drinks( 17).
Most exam ined workers are concerned about t h e f a ct o f a cq u i r i n g b i o p sy ch o so ci a l p r o b l e m s secon d ar y t o alcoh ol. How ev er, as alcoh ol ex er t s ex cit in g ef f ect s, it p r om ot es a t em p or ar y lack of inhibit ion and, m ainly, as it is an easily accessible dr ug, based on cult ur al pr em ises, it ends up being offered by local m erchant s as a social pleasure and starts to be used as a m eans of refuge or pastim e, in a circle of friends.
As a large part of t he invest igat ed workers st art ed t heir alcohol consum pt ion during adolescence and as m ost of these people did not even finish basic e d u ca t i o n , a ct i o n s sh o u l d b e t a k e n t o i m p r o v e ch ildr en ’s an d adolescen t s’ edu cat ion , delay in g or d ecr ea si n g a d d i ct i o n s l i k e a l co h o l i c d r i n k s, a n d providing bet t er access t o professionalizing courses, which m ake it easier t o obt ain less exhaust ive work, which is also loaded with “ prej udices” by a large part of t he populat ion.
As soon as efforts are m ade to attend to the n eed s an d ch an g es t h e ev olu t ion of t h e d isease requires, such as t he lack of inform at ion about t he harm caused by alcohol use, unem ploym ent , lack of op p or t u n it y an d in cen t iv es, lack of p sy ch olog ical
act iv it ies t o im p r ov e t h ese w or k er s’ self - est eem , m isery and lack of respect by t he populat ion, which ends up exposing garbage collect ion workers, even if unconsciously, to sham eful and inferiorizing situations, it is believed t hat alcoholism incidence levels will go dow n.
Kn ow led g e ab ou t t h e d r u g s p h en om en on , i n cl u d i n g et h y l i c su b st an ces, i s f u n d am en t al f o r n u r si n g p r a ct i ce , a s t h e se p r o f e ssi o n a l s a r e responsible for prom ot ing care, not only in curat ive treatm ent, related to the effects of alcohol, but m ainly i n p r e v e n t i o n a ct i o n s a i m e d a t cr e a t i n g so ci a l awareness about t he harm caused by t his addict ion. Therefore, w e believe t hat t he academ ic curriculum should address t hem es about t he use and abuse of licit an d illicit su b st an ces in a b r oad er sen se, as suggest ed in a research am ong nursing st udent s in the South of Brazil( 18).
The r esult of t his st udy indicat ed t hat t he i n v e st i g a t e d g a r b a g e co l l e ct i o n w o r k e r s i n t h e p er i p h er y o f São Pau l o Ci t y co m m o n l y co n su m e alcoholic beverages. Howev er, it cannot be affirm ed that the type of work they perform j ustifies the use of alcohol. This is a com plex issue, in which other cause and effect relations should be analyzed, which induce these workers to this causality. Therefore, we suggest that this study be replicated with a larger sam ple, so a s t o co m p a r e d a t a , w i t h a v i e w t o q u a l i t a t i v e cont ribut ions t o t he developm ent of act ions aim ed at im proving t his realit y.
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