Dissertation submitted in partial compliance with the requirements for the Master's Degree in Technology, Homoeopathy, Technikon Natal, 1996. / The aim acupuncture of this study was to compare the treatment and homoeopathic treatment smoking cessation. The study was a clinical trial, in which an acupuncture treatment group group. Thirty was compared with a homoeopathic treatment volunteers who were anxious to stop smoking participated in the trial and were randomly divided into two groups. One group received acupuncture treatment (n=l5), while the other group received homoeopathic treatment (n=l5) in the form of isotherapy. The study took place over a period of 9 months and each participant completed a 3-month trial period. Prior to the trial period each sUbject completed a set of questionnaires. These ~ncluded the Fagerstrom Tolerance Test which determined their dependence on nicotine; a questionnaire to determine if the subject smoked predominantly for reduction of negative affect, for positive affect or as an habitualaddiction; and a questionnaire to determine the subject's estimation of the health risks of smoking. / M

M.Tech. / There are an estimated 1.2 billion smokers globally (WHO, 2004) and according to Groenewald et al. (2007) approximately 24% of South African adults smoke. The use of tobacco is the second highest cause of death and disability in the world (WHO, 2004), the primary cause of death in the United States (Abrams et al., 2003) and the third leading risk factor in South Africa (Norman et al., 2007). This malady is preventable and as such, the use of tobacco must be regarded as an important public health and treatment priority. In dealing with smoking cessation Lebargy (2000), concluded that nicotine replacement therapy has a success rate of between 20% and 25%. What is significant though is that currently used and recommended conventional smoking cessation techniques have many side-effects and contra-indications. They further stress the importance of new more effective techniques in order to fight the pan-epidemic of smoking (Henningfield et al., 2005; Mitrouska et al., 2007) The remedy being investigated is a homoeopathic preparation, Anti Smoking complex, consisting of Avena sativa D3, Daphne indica D6, Nux vomica D6, Caladium seguinum D60, Nicotinum D60 and Nicotiana tabacum D60. The aim of the research was to evaluate the efficacy of the Anti Smoking complex in the treatment of smoking cessation and nicotine withdrawal symptoms of smokers between the ages of eighteen and sixty years. The efficacy of the Anti Smoking Complex was evaluated in terms of the Fagerström Test of Nicotine Dependence (FTND), the Wisconsin Inventory of Smoking Dependence Motives (WISDM-68), weekly smoking logs, and withdrawal symptoms for the purpose of identifying a safer alternative in the treatment of smoking cessation and nicotine withdrawal symptoms. A sample group of thirty participants was recruited at the University of Johannesburg Health Centre and various local pharmacies. Participants attended an initial interview, where they were screened by means of questionnaires and physical examinations. Inclusion criteria comprised of: adults between the ages of 18 and 60 years, who were smoking more than 10 cigarettes a day for at least a year with a score of five to seven on the FTND. Reliability and validity of clinical investigations was ensured by adherence to procedural documentation. 3 The study was conducted over a nine week period and was a random double-blind placebo-controlled clinical trial. Participation in the study was voluntary and participants were free to refuse treatment or withdraw from the study at any time. Participants were placed into two groups of fifteen – the experimental group had to take 10 drops of the Anti Smoking complex four times daily for six weeks and the control group had to take placebo on the same basis. Follow up appointments to monitor results took place on week 1, 4, 7 and 9 respectively. Collected data was analysed using descriptive statistics (frequencies and percentages). The data gathered from the FTND, the WISDM-68 and questionnaires was statistically analysed. The results of the experimental and controlled groups were compared using independent samples t-tests. Disparities of clear-cut variables was analysed using Chi-squared tests. Over time differences was analysed using repeated measures ANOVA (Eiselen, 2007). The homoeopathic complex, Anti Smoking Complex is effective in the treatment of smoking cessation. Both the results of the Fagerström Test for Nicotine Dependence and Wisconsin Inventory for Smoking Dependence supported the above. An overall smoking cessation rate of 20.0% was obtained after the nine week trial period. Of particular importance, there was no significant effect on any of the parameters of the withdrawal symptoms questionnaire. As withdrawal symptoms are a key component of smoking cessation, the action of the complex is incomplete.

The ambition of the study Nyanser av beroende is to analyze and problematize the concept of addiction. A broader aim is to investigate if it in the Swedish population exists different patterns of addiction and how these patterns then look like. The empirical material constitutes of Negativa konsekvenser av ANDT-bruk i den svenska vuxna befolkningen 2014. The selection consists of 26 257 individuals with a response rate of 59, 3 percent (N=15 576). The individuals that at some time during the last year used any narcotic substance and fulfilled at least one of the addiction criterias in the diagnose manual DSM-IV are subjects to the analysis (N=560). By the analyze method of Latent klassanalys (LCA), patterns of addiction have been investigated. The theoretical framework consists of medical and social addiction theory. This to see how different patterns of addiction comply with the medical and social perspectives that can be found in DSM-IV. In the latent class analysis, four different groups with different patterns of addiction are identified: Kontrollförlust, Försökt minska intag, Hard core gruppen och Tolerans. The group’s patterns have further on been connected with sociodemographic factors and substance use. The result of this study indicate that addiction is not a homogeneous concept but that there are differences concerning patterns of use and sociodemographic factors.

Codependency is a highly contested construct featuring in the popular, clinical and research literature. Within the academic literature, the voices and lived experience of individuals who consider themselves codependents are mostly unavailable. This Interpretative Phenomenological Analysis (IPA) study explored the lived experiences of 8 individuals self-identified as codependents, who chose 12-Step recovery groups to frame their recovery process. This research addressed the following research question: What is the lived experience of codependency among people who have sought support from a 12-step recovery group for codependents? The idiographic, phenomenological and hermeneutic aspects of the study captured how participants made sense of their experiences of codependency and the meanings of the support group. The information was collected over 3-6 months by means of three in-depth semi-structured interviews and a visual method in which participants selected and analysed objects or photographs which, for them, expressed the meaning of codependency. Four main themes emerged from the analysis of the interviews: (1) Codependency experienced as real and tangible: ‘Codependency explains everything’. (2) Experiencing an undefined sense of self: ‘Codependency helps me to discover my sense of self.’ (3) Seesawing through extremes in life: ‘Like a seesaw, I feel out of control’. (4) Finding meaning in codependency through exploring family experiences: ‘Down to childhood’. The findings revealed that the experience of codependency frames these individuals’ sense of identity, their lifeworlds and the way they view and experience life difficulties. It also provided a highly nuanced and fine-grained analysis of the lived experience of codependency. The study brings a new perspective on the lived experiences of this client group. Although the findings are not straightforwardly generalizable, they may inform clinical practice. It is hoped that this study will raise awareness about this controversial topic, bring a better understanding of codependency and inspire further research.

<p>Problem gambling, a fairly recent addition to the Diagnostic and Statistical Manual of Mental Disorders, is estimated to affect between two and five percent of the US adult population (Volberg 2001). While present in all racial groups, this disorder is not evenly distributed, as Blacks are more likely than any other group to become problem gamblers (Welte et al. 2006). And while this pattern is consistent with those found with other disorders (Black 1984; Ford and Widiger 1989; Strakowski et al. 1993), it is important to note that thirty years ago, when the first study of problem gambling prevalence was conducted and the disease had only recently been institutionalized, there was no difference in rate of illness by race (Kallick et al. 1979). This dissertation aims to explore this phenomenon: the role of race in the making of problem of gambling. </p><p>Through a multi-site and multi-method approach, this study examines the assumed race neutrality of gambling addiction. By tracing the history of gambling policy and North Carolina's adoption of a lottery program, this study explores how the state further defined problem gambling as a mental illness. Following this, participant observation of state-sponsored problem gambling counselor training workshops provides insight into the ways racialized understandings of behavior are constructed and maintained through counselor education. To gain a sense of how gambling is lived, this study involves participant observation of lottery gambling in convenience stores to interrogate racialized conceptions of behavior and reveal how financial gain motivates gambling across groups.</p> / Dissertation

L’objet de la thèse vise à étudier l’impact du type d’attachement et de la maltraitance sur les troubles de la personnalité d’une population de patients toxicomanes et recevant un traitement de substitution. Notre échantillon est constitué de 140 patients dépendants de drogues toxiques et placés sous traitement de substitution : dans cet échantillon, 70 femmes représentent le groupe expérimental et 70 hommes représentent le groupe témoin.Nous avons utilisé le CASRS (Child Abuse Self Report Scale) pour évaluer les événements traumatiques subis au cours de l’enfance, le MCMI (Millon Clinical Multiaxial Inventory) pour l’évaluation des troubles de la personnalité et l’ASQ (Attachement Scale Questionnaire) pour mesurer le type d’attachement. Nos résultats révèlent qu’il existe des spécificités en fonction des genres. Plus de maltraitance dans l’enfance, davantage d’attachement insécure, plus de troubles de la personnalité ainsi qu’un contexte social-familial particulier chez les femmes ont une importance étiologique. Ces différences épidémiologiques ont un impact sur la gravité de la toxicomanie (surtout en matière de violence psychologique et physique).Ces résultats devraient sans doute nous inciter à revoir nos stratégies de soins pour tenir davan-tage compte d’approches plus spécifiques. / The subject of our work was to study the influence of type of attachment and maltreatment on personality disorders in a population of patients addicted to drugs who receive replacement therapy. Our sample consisted of 140 patients with a diagnosis of toxic drug addiction substitu-tion treatment, including 70 women who represent the experimental group and 70 men who represent the control group. To evaluate the traumatic events in childhood, we used the CASRS (Child Abuse Self Report Scale), for assessing personality disorder we used MCMI (Millon Clinical Multiaxial Inventory) and finally the ASQ (Attachment Scale questionnaire) to meas-ure the type of attachment. Our results show that there are significant differences between males and females. A higher occurrence of abuse during childhood, demonstrates insecure at-tachment, more comorbid personality disorder and a socio-familial especially among women, which may have etiological significance. These epidemiological differences have an impact on the severity of substance abuse (more importantly the emotional and physical abuse). There-fore, these results encourage us to rethink our strategies of care for more specific approaches while handling such patients.

Pour appréhender l'ensemble du problème addictif et proposer une prise en charge appropriée, une évaluation multifactorielle est nécessaire. Les données récentes soulignent que le champ des addictions aux substances doit être étendu au champ des addictions comportementales. Une des lacunes dans la compréhension des troubles addictifs et de leur prise en charge pourrait être due à un manque d'outils d'évaluation standardisés qui évaluent l'ensemble des composantes de l'addiction et leurs répercussions dans différents domaines de la vie du sujet. Dans le champ des addictions aux substances, l'Addiction Severity Index (ASI) est l'outil le plus utilisé mondialement. L'ASI est un instrument qui évaluent les sujets pour la clinique ou la recherche. En France, notre groupe de recherche utilise l'ASI depuis 1992 pour la clinique et la recherche. Nous avons décidé de modifier l'ASI en y ajoutant de nouvelles sections. Depuis 2006, la version française modifiée de l'ASI présente donc des items évaluant l'usage de tabac (Section Tabac) et également des items permettant l'évaluation des comportements addictifs sans substance comme le jeu, le jeu d'argent et de hasard et les troubles du comportement alimentaire. L'objectif général de cette thèse était d'étudier la validité de la version française modifiée de l'Addiction Severity Index (ASI) chez des sujets pris en charge pour au moins une addiction dans des centres de soins spécialisés en addictologie. Les résultats montraient une très bonne validité des données de consommations de substances rapportées par les sujets. Les sections Tabac et Jeu / Jeu d'argent et de hasard avaient été montrées comme valides. La version modifiée de l'ASI semble être un bon outil permettant l'évaluation de la sévérité de l'ensemble des comportements addictifs. Cette adaptation fait de l'ASI modifié le premier outil qui permet d'évaluer l'ensemble des troubles addictifs et qui ne mesure pas uniquement la quantité, la durée et l'intensité de ces troubles. Elle va permettre d'aider le clinicien à mettre en place une prise en charge la plus adaptée et aux chercheurs de caractériser et de comparer les différentes addictions afin de dégager des différences et des similitudes. / A multidimensional assessment is key to understand the addiction problem and to develop an appropriate treatment plan. Recent findings support the scope that addictive disorders should include non-substance use disorders. A significant problem in understanding and managing the addictive disorders may be related to the lack of standardized instruments for assessing problems or other aspects of life that are affected by these pathologies. For the assessment of substance users exists a widely used instrument, the Addiction Severity Index (ASI). The ASI is an instrument that assesses subjects for both clinical and research purposes. In France, our research group used the ASI since 1992 for both clinical and research purposes. We decided to modify the French translation of the ASI and added some new items. Since 2006, the French modified ASI includes items to assess tobacco use but also non-substance addictive behaviors including gaming, gambling and eating disorders. The overall objective of this dissertation was to assess the validity of the French modified ASI in several samples of clients who sought treatment in outpatient addiction clinics. The findings showed a good validity of the self-reported substance use. The validity of the Tobacco section as well as the Gaming/Gambling section have been shown. The French modified ASI is a suitable instrument for assessing any type of addiction-related disorders. This adaptation makes the modified ASI the first instrument that assesses all possible addictive behaviors regardless of the type of the addiction and that measures more than just the quantity, duration, and intensity of addictive behaviors. ASI may be helpful for clinicians in helping them to design the best treatment plans for a patient, for policy makers to objectively understand the need in treatment, care centers or other institutions but also for researchers to measure contemporary issues in addiction treatment and to find similarities and differences between type of addiction.

De nombreux individus consomment une, ou plusieurs, substances psychoactives au cours de leur vie. Alors que la majorité des consommateurs maintient une utilisation épisodique et contrôlée, certains perdent le contrôle sur l’usage de la substance ; symptôme majeur d’une addiction. Comprendre les mécanismes psychobiologiques, qui sous-tendent cette vulnérabilité à passer d’un usage contrôlé à un usage compulsif, constituerait une étape décisive dans la compréhension de la pathologie et l’identification de cibles thérapeutiques pertinentes. En effet, malgré un intense effort de recherche au cours des 40 dernières années, les thérapies disponibles se révèlent d’une efficacité limitée. Il faut probablement en chercher la cause dans la complexité de la pathologie, mais aussi dans l’inadéquation des préparations expérimentales à la définition clinique de l'addiction. Dans ce contexte, une étape décisive a été franchie il y a 5 ans lorsque des chercheurs de notre équipe ont développé le premier modèle pluri-symptomatique d’addiction à la cocaïne chez le rat. Grâce à ce modèle, il est possible d’identifier des animaux qui développent un comportement similaire à l’addiction, alors que d’autres maintiennent un usage contrôlé, et ce, malgré une consommation préalable de drogue équivalente. S'appuyant sur ce modèle d'addiction chez le rat, le but de nos travaux de thèse était d’identifier des différences neurobiologiques entre usagers addicts et non-addicts et d’aborder les mécanismes neurobiologiques qui sous-tendent la transition vers l’addiction. Pour ce second point, nous avons considéré les différences majeures identifiées et étudié leur évolution de l’usage précoce de cocaïne (avant l'addiction) à l'usage tardif (après développement de l’addiction) en fonction des sujets (addicts versus non-addicts). Nous avons utilisé une approche multidisciplinaire associant les principales méthodes des neurosciences comportementales, moléculaires et des systèmes. Nous avons comparé addicts et non-addicts au moyen d’une stratégie ciblée et d’une stratégie non ciblée. La stratégie non ciblée a consisté à évaluer l'expression des gènes à grande échelle, dans des structures cérébrales clés, au moyen d’une technique de gene profiling (environ 28 000 gènes testés simultanément). L'approche ciblée a consisté à analyser des facteurs connus pour être modifiés par l'usage ou l’administration chronique de cocaïne. Nous nous sommes concentrés sur une structure majeure, le noyau accumbens, et avons étudié : i. l'expression de gènes cibles au moyen de la qPCR, ii. plusieurs formes de plasticité synaptique à l'aide de l’électrophysiologie in vitro, iii. l'activité des neurones dopaminergiques de l’aire tegmentale ventrale (VTA) (projetant vers le noyau accumbens) au moyen de l’électrophysiologie in vivo, iv. la libération de dopamine dans le noyau accumbens au moyen de la microdialyse in vivo. Nous avons montré que les rats addicts et non-addicts s'adaptent très différemment à la cocaïne. Les usagers non-addicts paraissent en mesure de contrecarrer les changements neurobiologiques précoces provoqués par la cocaïne, tandis que les addicts ne le sont pas. Ils présentent des réponses neurobiologiques similaires à celles d'animaux naïfs vis-à-vis de la cocaïne ou d'animaux ayant été exposés à la drogue sur une très courte période. En résumé, les données obtenues au cours de ce travail de thèse modifient drastiquement la perception commune de la psychopathologie de l’addiction. L'addiction résulterait moins de modifications produites par la drogue (comme on le pense depuis 40 ans) que de l'incapacité à lutter contre ces modifications. / Numerous individuals consume one, or several, psychoactive substances during their lifetime. Although most consumers make only occasional and controlled use of a substance, some lose control of their use, which constitutes a major symptom of addiction. Understanding the psychobiological mechanisms which underlie this vulnerability to the transition from controlled drug use to addiction would constitute a decisive step forward in our understanding of the pathology and in our identification of the relevant therapeutic targets. Indeed despite intense research efforts during the last 40 years, the therapies available are of limited efficacy. This is probably related to the complexity of the pathology, as well as to the unsuitability of experimental preparations to the clinical definition of addiction. In such a context, there was a significant breakthrough 5 years ago when our research team developed the first pluri-symptomatic model of cocaine addiction in the rat. Thanks to this model it is possible to single out animals that develop an addiction-like behavior from others that, despite equivalent prior drug consumption, keep their use under control. The aim of our doctoral research, based on this rat addiction model, was to identify the neurobiological differences between addicted and non-addicted users, and then to start investigating neurobiological mechanisms that could underly transition to addiction. For this latter point we considered the major differences identified between addicts and non-addicts, and we studied their evolution from early (before addiction) to late cocaine use (after addiction development). We used a multidisciplinary approach associating behavioral, molecular and systems neuroscience. We compared addicts and non-addicts by means of a targeted strategy and a non-targeted strategy. The non-targeted strategy consisted in evaluating large-scale gene expression by means of a gene–profiling technique (approximately 28,000 genes tested simultaneously). The targeted approach consisted in analysing factors known to be modified by the use or chronic administration of cocaine. Concentrating on one main structure, the nucleus accumbens, we studied: (i) the expression of targeted genes by means of qPCR; (ii) several forms of synaptic plasticity using in vitro electrophysiology; (iii) the activity of the dopaminergic neurons of the ventral tegmental area (VTA) (projecting towards the nucleus accumbens) using in vivo electrophysiology; (iv) the liberation of dopamine in the nucleus accumbens by means of in vivo microdialysis. We showed that addict and non-addict rats adapt to cocaine in very different ways. Non-addict users seem able to counteract the early neurobiological changes triggered by cocaine, while addict users are not. Addict users present neurobiological responses to cocaine that are similar to those of naive animals or of animals having been exposed to the drug for a very short period. In conclusion, the data obtained during this PhD work radically modify the general perception of the psychopathology of addiction. Addiction would be less due to modifications produced by the drug (as thought for the last 40 years) than to the inability to fight against those modifications.

BACKGROUND: It is well known that those taking chronic opioid pain medications often become tolerant to the medications and require escalating doses over time (Drewes, 2017). No objective method to identify tolerance currently exists. OBJECTIVE: The objective of this study is to determine the usability and feasibility of a wearable biosensor technology to determine a transition point between opioid naivety and tolerance. METHODS: Participant’s were recruited in the Emergency Department setting and were being admitted with a treatment plan that includes opioid analgesics. Participants were instructed to wear the sensor at all times and to ‘tag’ the sensor when opioid pain medications were administered. This data was analyzed for trends and changes in sensor data before and after opioid administration. Research staff also conducted formative interviews during and after hospital admission to gather information on the participants’ perception of the wearable biosensor and of opioid tolerance. RESULTS: The sample included 17 participants who received, on average, 21.2 morphine equivalents per day during admission. Over 90% of participants stated that they would wear the sensor again, and 70% would even wear two. Data analysis from the E4 biosensor indicated a difference between baseline physiological signaling and post-opioid administration. CONCLUSIONS: In this study, feasibility of wearable mHealth technology was assured, and the preliminary findings of the biosensor data suggest that the features from activity data at different axes can predict opioid use. Future studies will evaluate the development of tolerance among these participants. / 2021-06-17T00:00:00Z

Jiang, Qiaolei. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2011. / Includes bibliographical references (leaves 293-328). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract also in Chinese.