When I began the Compulsion and Recovery Research Project in 1992, I did so in response to the schism between professionals who were leaders in the addiction recovery field. Known as the D and A Debate, this schism resulted in changes in government policy, funding and service provision, causing great confusion to people suffering with addictions. It was described by the media as 'addiction treatment now a battleground'.As a family therapist specialising in addictions recovery, I became concerned about this battle between leaders in the recovery field and its impact on the community. I had experience in running halfway houses for people recovering from addictions and knew that abstinence with AA worked. I embarked on a research project which used a dialectic/narrative method inquiry method, interviewing leaders in the conflict and others who contributed progressive ideas to recovery. This process aimed at ensuring there was validity, rigour and ethics in the research process. Importantly as a result of this inquiry, I came to believe that the Drug and Alcohol Debate (D and A Debate) protagonists need not dogmatically defend their own model to the point of being in conflict, as all their treatments work, and it was valid to concede that different models work for different people in different stages of their recovery - 'whatever works works, and not to be judged by others'. (Nicotine Anonymous The Book, 1992:113) / Doctor of Philosophy (PhD)

Narratives of 'being Maori in addiction' have developed in a context in which Maori have been constituted as both 'drunken savages' and 'traditionally' abstinent. Discourses of colonialism and ongoing marginalisation, not to mention resistance, have been most salient in Maori narratives, while those focused on 'cultural deficit' have been more prominent within hegemonic narratives. The goal of the current thesis was to increase understanding of the construction of being Maori in addiction' by: i) identifying key discursive resources used to constitute related subject positions; and ii) identifying the ways in which such resources were deployed to accomplish particular tasks. A review of influential texts identified several core discourses, which located Maori within 'traditions' of collectivity, spirituality and connection with the land. However, the ongoing impact of colonisation, including contemporary alienation from 'tradition', and construction of Maori as the inferior 'other' within hegemonic narratives were prominent. Discourses of addiction have characteristically been based on biological notions of 'disease' and 'disorder', however, psychosocial discourse has become prominent more recently. The '12 Steps' of Alcoholic Anonymous, which provided the primary resource for participants with regard to 'addiction', also includes explicit discourses of spirituality. The current thesis was implemented within a methodological framework, kaupapa Maori. In this context deconstructive discourse analysis was identied as the most appropriate means of analysing interview data gathered from 11 men attending a 'addiction treatment' programme. The results indicated that while 'tradition' was central to narratives of 'being Maori', dicources of alienation and loss were equally salient. In terms of 'addiction', discourses of genetic inheritance were most prominent, although psychosocially constituted 'underlying issues' were also clearly located as being important. Such 'issues' were linked to both general life experiences and 'being Maori'. 'Treatment' narratives revolved around transformative narratives of 'self'. As participants disconnected themselves from 'addiction' and 'underlying issues', they reconnected with their positive ;essential self', previously compromised by 'addiction'. Two main discourses were utilised in terms of the relationship between 'being Maori' and 'addiction'. The first, deployed in aetiological narratives, constituted an inevitable link between 'being Maori' and substance use. The second, more prominent in 'treatment' narratives, located substance use as antithetical to 'Maori culture'. While both Maori and 12 Step 'traditions' were highlighted in participants' narratives, the latter tended to be privileged. 'Being Maori' was identified as important, or at least relevant, however, the opportunity to engage with integrated indigenised narratives of 'addiction' appeared to be limited by several factors. Essentialist 'tradition', for example, tended to be uncritically privileged within discourses that failed to account for contemporary 'diverse Maori realities', ignoring the complexities of relations between and within Te Ao Maori and Te Ao Pakeha. Additionally, '12 Step' discourses of 'treatment' limited construction of more broadly focused narratives of 'recovery'. Overall, the results indicated a clear need for Maori 'addiction treatments' to avoid essentialist notions of 'tradition' and support integrated narratives of 'being Maori in addication', which reflect the varied needs, capacity and experiences of individuals and whanau.

The purpose of this project was to design and evaluate a sport-based life skills intervention designed for indigenous New Zealand (Maori) youth who may be exposed to drug or alcohol abuse. An indigenous research approach known as Kaupapa Maori research was utilised. As an indigenous approach, Kaupapa Maori signifies the importance of research with Maori being initiated, determined, and validated by Maori and in particular, by those directly involved with the research initiative (Bishop, 1996; Tuhiwai-Smith, 1999). As a result of adhering to a Kaupapa Maori approach the participants determined additional areas of interest including academic self-esteem, intrinsic motivation for schoolwork and career awareness. Therefore, the initial project grew to include several other life skills areas identified by the participants. The life skills basis of the 'Hokowhitu' intervention was adapted from the Going for the Goal (GOAL) and Sports United to Promote Education and Recreation (SUPER) programmes developed by Professor Steve Danish (Danish, 1997; Danish & Nellen, 1997; Danish, Meyer, Mash, Howard, Curl, Brunelle & Owens, 1998). The GOAL and SUPER programmes taught life skills to adolescents including informed decision-making, health-enhancing activities (e.g., goal setting) and health-compromising activities (e.g., drug & alcohol abuse). A New Zealand (NZ) version of the GOAL programme was successfully pilot-tested in 1997-1998 in NZ schools with non-Maori adolescents (Hodge & Danish, 1999; Hodge, Cresswell, Sherburn, & Dugdale, 1999). The evaluation of the Hokowhitu programme used both quantitative and qualitative analyses. The qualitative investigation received an enthusiastic response and supportive results for the Hokowhitu programme. Many of the research participants preferred the qualitative investigative approach because of the culturally recognised components (e.g., Te kanohi ki kanohi or face-to-face method used to ask questions). The quantitative investigation used; Mann-Whitney U, Wilcoxon, Chi Square and McNemar statistical tests (Harraway, 1995). The outcome of the overall programme evaluation showed that the Hokowhitu programme provided improvements in; (a) academic self-esteem, (b) increased intrinsic motivation for schoolwork, (c) increased career awareness, and (d) increased drug and alcohol awareness in adolescent Maori. Also, there was some statistical support for the Hokowhitu programme and evidence that life skills and Kaupapa Maori ideologies were able to be successfully integrated into a sport-based programme.

<p>Anabolic Androgenic Steroids (AAS) have been associated with adverse psychiatric effects, aggression and violent behaviour. The use of them has spread to a larger subpopulation, and the use has been connected to different risk behaviours, such as use of other illicit substances and carrying a gun. Case reports tell about a connection between AAS use and violent crimes, including homicide. The aim of this thesis is to investigate the proposed connection between AAS and crime, focusing on violent crimes, and to inquire into whether this proposed connection between AAS and criminality is affected by other risk factors for criminal behaviour.</p><p>The first two studies of this thesis investigated the registered criminality of individuals testing positively for AAS, with individuals testing negatively serving as control groups. In the two last studies individuals at a clinic for substance abuse treatment (Paper III) and in a prison (Paper IV) were asked about their use of AAS, and their history was assessed using the Addiction Severity Index.</p><p>The main finding of Paper I was the development of criminal patterns over time, with a clear increase of the proportion of violent crimes and weapons offences seen only among the pure AAS users. In Paper II an increased risk for weapons offences among AAS users was reported. In Paper III an increased risk of having been prosecuted for violent crimes and of having been physically abused was seen among the AAS users. In Paper IV, the main finding was the close resemblance of users and non users.</p><p>In summary, this thesis have concluded that the violence previously reported as connected to use of AAS can, to a large extent, be accounted for by other risk factors. There seems, however, to be a connection between use of AAS and a heavy, more planned form of criminality.</p>

The prevalence of addiction in society has called researchers, educators, policy makers, and clinicians to examine and research causes and treatment approaches to address the manifold problems addictions present individuals and society alike. There are many theoretical approaches to understanding addiction and the behavior change processes that lead from addiction to recovery. Religiosity and spirituality have been identified as important factors in addiction, though the exact nature of the relationship is yet to be determined. This dissertation explores the relationship between religiosity and the known treatment outcome mediator. The purpose of this dissertation is to inform theory, training, and practice in the area of addictions counseling. This exploratory study investigated the relationship of religiosity to readiness to change in addictive behaviors. The database from Project MATCH was used which included participant scores from the aftercare arm of the clinical trial. A total of 772 scores were used from responses to the RBB and URICA. Stepwise multiple regression revealed that there were no significant differences detected across variables regarding the relationship of religiosity to readiness to change. / Graduation date: 2003

This study was designed to assess the relationship of selected factors to the developmental outcome of fundamental motor skill performance in young children ages 3 to 6 years residing in foster or adoptive care, and have a documented history of prenatal exposure to cocaine and other drugs. Using an ecological theory of child development and the person-process-context model, the study focused on the child's development in selected gross motor skills. Through multiple regression analysis, the study considered the contributions of the following on motor skill performance as measured by the Test of Gross Motor Development: child effortful control as measured by the Children's Behavior Questionnaire, the nonbiological mother's parental attitude as measured by the adapted Parent Attitude Survey, the amount of early intervention services as recorded in the child's medical chart. Participants included 28 children (15 males and 13 females) and their foster or adoptive mother. There is suggestive but inconclusive evidence for the hypothesis that fundamental motor skill performance is predicted by the interaction of the child's effortful control, the nonbiological mother's understanding and confidence, and the amount of early intervention service the child received, [F (7, 20)=2.24, p<0.07 ]. Trends in the data suggest gross motor performance increases with high levels of early intervention, given children with low effortful control and low levels of parental confidence and understanding. In addition, early gross motor scores did not predict fundamental motor skills, r=.10. Despite a 38% rate of identified early gross motor delay, no child was delayed in fundamental motor skill at ages 3 to 6 years. Fundamental motor skill performance ranged from average to superior, M=121.54. Motor performance was assessed in a clinical setting and caution is recommended when considering skill performance within group settings. Based on this study, children with prenatal exposure to cocaine/polydrugs are viewed as variable in temperamental control and gross motor performance, but perform at an average to above average level in gross motor skill. Further research is needed to validate trends, specifically regarding the interactive effects of child effortful control, parental attitude, and the amount of early intervention service received. / Graduation date: 1997

Current theoretical models of ADHD (i.e., Disinhibition Model: Barkley, 1997; Working Memory Model: Rapport et al., 2001) conceptualize ADHD as the disorder of executive function (EF) with some variation in their emphases on particular components of the broadly-defined EF (e.g., working memory vs. inhibition) and in their postulated relationships with ADHD symptoms. Although these models provide systematic accounts of the manifestation of ADHD, they have not been extensively tested from an empirical standpoint. Moreover, despite the fact that ADHD is highly comorbid with other additional conditions such as learning and behavioral problems and EF deficits are found in individuals with these conditions as well as in those with ADHD, current EF models have not specified the developmental relationship between ADHD and its comorbid conditions. This study was: (1) to examine the extent to which two current models of ADHD are supported in a sample of 102 adults; (2) to present an ??integrated?? model by combining two current models of ADHD and linking them to recent research findings on two common comorbid conditions with ADHD (i.e., reading difficulty and substance abuse); and (3) to test and revise such an integrated model in the light of data using a latent variable analysis. Major findings provided a strong support for the Working Memory Model with a lesser degree of support for the Disinhibition Model. Preliminary evidence of working memory as the primary deficit in ADHD was also obtained in the present sample. Finally, the integrated EF model and its revised model (final model) demonstrated a very good fit to the data. These findings suggest that the integrated model provides a unified account of how EF deficits contribute to the manifestation of ADHD symptoms and comorbid conditions with ADHD. Given some limitations (e.g., sample size and scope) of the present study, current findings need to be replicated.

Anabolic Androgenic Steroids (AAS) have been associated with adverse psychiatric effects, aggression and violent behaviour. The use of them has spread to a larger subpopulation, and the use has been connected to different risk behaviours, such as use of other illicit substances and carrying a gun. Case reports tell about a connection between AAS use and violent crimes, including homicide. The aim of this thesis is to investigate the proposed connection between AAS and crime, focusing on violent crimes, and to inquire into whether this proposed connection between AAS and criminality is affected by other risk factors for criminal behaviour. The first two studies of this thesis investigated the registered criminality of individuals testing positively for AAS, with individuals testing negatively serving as control groups. In the two last studies individuals at a clinic for substance abuse treatment (Paper III) and in a prison (Paper IV) were asked about their use of AAS, and their history was assessed using the Addiction Severity Index. The main finding of Paper I was the development of criminal patterns over time, with a clear increase of the proportion of violent crimes and weapons offences seen only among the pure AAS users. In Paper II an increased risk for weapons offences among AAS users was reported. In Paper III an increased risk of having been prosecuted for violent crimes and of having been physically abused was seen among the AAS users. In Paper IV, the main finding was the close resemblance of users and non users. In summary, this thesis have concluded that the violence previously reported as connected to use of AAS can, to a large extent, be accounted for by other risk factors. There seems, however, to be a connection between use of AAS and a heavy, more planned form of criminality.

The use of anabolic androgenic steroids (AAS) has been associated with use of illegal or unprescribed prescription drugs, as well as different adverse psychiatric effects, such as ma-nia, psychosis and hostility. Further, there is an association between use of AAS and other different risk behaviours, including carrying guns and reckless driving. Taken together, these data suggest that there is a group of AAS users that are not elite athletes, but rather young men at risk for psychiatric illness and criminality, and who use AAS primarily for their aes-thetic effects and possibly for their psychoactive effects. The aim of this thesis is to investi-gate further the connection between use of AAS and use of other drugs, and to investigate whether the proposed side effects of AAS cause an increase in morbidity and mortality. The first study (Paper I) investigates morbidity and mortality in persons testing positive for AAS compared to persons testing negative for AAS at a doping laboratory. Paper II of this thesis studies the presence of psychoactive drugs in diseased men who tested positive for AAS upon autopsy and whether there is any difference between deceased users of AAS and deceased users of heroin or amphetamine (control group). The third article (Paper III) dis-cusses a surprising finding in paper I of increased seizures NOS in users of AAS. Paper IV and V are interview studies from an out-patient substance abuse clinic. The main findings in Paper I was that the majority of deceased users of AAS were also positive for other drugs and/or alcohol on autopsy, and that users of AAS more often than the control group had died from intentional death (suicide or homicide). The main finding of Paper II was that users of AAS were severely at risk for premature death compared to both the control group and the general population. Paper III concluded that the high prevalence of Convulsion NOS in users of AAS most likely was the result of concomitant substance abuse and withdrawal from such use. Paper IV concluded that twelve percent of the patients at the substance abuse clinic had used AAS for at least one cycle. Users of AAS had a higher risk of having been convicted of a violent offence, and users of AAS more often reported having been physically abused. In Paper V, long-terme users of AAS were found to have an increased risk for developing depression in connection with cessation of AAS use. AAS was also re-ported to be used in preparation for crime. In summary, this thesis concludes that there is a solid association between use of AAS and use of other psychotropic drugs in certain subpopulations, and that users of AAS are at risk for premature death due to unnatural causes that may be secondary to use of AAS.

Alcohol-related expectations have been defined as the anticipated consequences from consuming alcohol (Brown, Goldman, Inn, & Anderson, 1980). Previous research has been conducted to examine the role of alcohol expectations in the co-occurrence of alcohol problems with anxiety and depressive symptoms. In the current study, the relationship between alcohol problems, anxiety and depressive traits, and alcohol expectancies were examined within a male juvenile correction sample. Specifically, statistical analyses were conducted to test the degree to which alcohol expectancies combined with anxiety/depression traits improve the prediction of alcohol-related problems beyond that of anxiety/depression traits alone. Archival data were collected from 205 incarcerated male adolescents who completed both the Alcohol Expectancy Questionnaire -- Adolescent Form (AEQ-A) and the Minnesota Multiphasic Personality Inventory--Adolescent (MMPI-A). Two research hypotheses were tested using correlation and regression analyses. The results demonstrated that depressive traits significantly predicted an increase in alcohol-related problems, and the addition of expectancies related to global positive changes and increased social behavior produced a significant gain in the prediction of alcohol problems. Furthermore, anxiety traits significantly predicted an increase in alcohol-related problems, and the inclusion of tension reduction expectancies yielded a significant gain in prediction. The results suggest that alcohol-related problems may be exacerbated by the presence of reinforcement-based expectancies in male juvenile offenders who are concurrently experiencing elevated levels of anxiety and depressive traits. These findings have implications for prevention and treatment programs that utilize cognitive-behavioral and expectancy challenge techniques to affect change in problematic alcohol consumption behaviors. / "December 2006."